Do you know a family member or a friend that has been diagnosed with Type 2 diabetes? Are you at risk of diabetes (high fasting blood sugars),diagnosed with pre-diabetes (impaired fasting glucose, impaired glucose tolerance) or have borderline diabetes? Or do you have a family history of diabetes like me?

Both my maternal and paternal grandfathers suffered from diabetes. My maternal grandfather had his left leg amputated after a paper cut that developed into a serious infection, despite getting the best care from my aunt, a registered nurse. My paternal grandfather suffered a stroke and was bedridden throughout the remainder of his life.

What comes to your mind when I mention the word diabetes? Blindness, limb amputations, dialysis (relying on a machine to filter blood due to kidney failure), stroke, heart attacks and cancer?

Diabetes is a condition where there’s too much blood glucose in the body and you are intolerant to carbohydrates.

But here’s the kicker, treatment prevents some of its devastating complications but does not usually eliminate the progression to chronic abnormalities or the adverse consequences. The threshold for diagnosing diabetes is getting lower as scientists discover that the trajectory to diabetes speeds up exponentially in the 3 years before diagnosis.

Early detection of prediabetes means we can prevent progression

If we can ‘catch’ diabetes before permanent damage, then you and I have far less to fear.

On its own, metabolism is the coordinated handling of glucose and fat. When we flood our blood with too much sugar, it’s akin to shards of glass that can damage our vital organs and tissues like the eyes, kidneys and nerve endings.

But wait, there’s more: people with underlying metabolic abnormalities like diabetes and obesity are at higher risk of COVID-19 complications. These conditions are associated with increased inflammation and disturbance of normal energy production pathways, which can significantly reduce the immune response to infection.

In a Korean study, a metabolically unhealthy status was defined as the presence of three or more of the following factors: (i) fasting plasma glucose level ≥ 100 mg/dL (5.55 mmol/L) or current use of glucose-lowering agents (ii) blood pressure ≥ 130/85 mm Hg or use of antihypertensive agents  (iii) serum triglyceride level ≥ 150 mg/dL (1.69 mmol/L) or current use of lipid-lowering agents, (iv) high-density lipoprotein-cholesterol level < 40 mg/dL in men or <50 mg/dL in women or current use of lipid-lowering agents), and (v) waist circumference > 90 cm in men or ≥85 cm in women based on the International Diabetes Federation criteria for Asians.

Here’s the thing, the diagnosis of diabetes is often delayed until complications are present and many are unaware that they are prediabetic until it’s too late.

Let’s start from the beginning as this is not just a tale of too much sugar but also of fat.

All food is broken down to glucose or fat. Once the body has used up essential amounts of food for bodily requirements, carbohydrate is stored in the liver and muscle as glycogen. When we run out of space to store glycogen in the liver and muscles, these are converted to fat and stored under the skin.

As it turns out, surplus carbohydrate and fat share the same fate: they are transformed into fat.

What happens if there’s no more space under our skin? Fat spills over to the main organs (liver, pancreas, heart and muscle tissue). This is termed ‘ectopic fat.’ Earlier, I mentioned that fat is inflammatory and kickstarts a lot of problems in our body, in particular insulin resistance. Insulin resistance is the failure of insulin to lower blood glucose.

Imagine having fat in your liver, pancreas, heart and muscle tissues. If fat accumulates in the pancreas, it can prevent the pancreas from doing it’s routine job to produce insulin.

This fatty baggage occupies prime real estate that impairs the function of vital organs or worse, can result in chronic inflammation, scarring and permanent damage. This is the basis of non-alcoholic fatty liver disease (NAFLD), a condition once only prevalent in alcoholics and now dangerously on the rise. NAFLD is defined as the presence of excessive liver fat in the absence of other causes such as excess alcohol.

Simply stated, accumulation of more sugar and fat than an individual’s body can cope with will manifest as diabetes.

The best thing? Type 2 diabetes is recognised as a potentially reversible condition[i] and with increased awareness, you can start preventing diabetes today.

[i] Taylor, Roy, et al. “Remission of human type 2 diabetes requires decrease in liver and pancreas fat content but is dependent upon capacity for β cell recovery.” Cell metabolism 28.4 (2018): 547-556.

In fact, there is a lot we can do and my biggest tip; TIME is of the essence (hint the best time to start managing your health is now). It is about fine-tuning the amount of food you need and taking action to lose excess weight.

How much weight do you need to lose? There is a dose-dependent effect, meaning the more you lose, the more you gain. Even better, I have categorised the evidence into light, moderate and high intensity.

The biggest gain comes from the most intensive intervention however you know what is more realistic and sustainable in your life. So choose your own adventure (Tip: If you copy and paste the ‘tiny url link in the flowchart below, you will be redirected to more information).

Light intensity

The Norfolk Diabetes Prevention Study[i] found losing 2-3kg and increased physical activity over two years, reduced the risk of Type 2 diabetes by 40 to 47 per cent for those categorised as having prediabetes.

Moderate intensity

Weight loss has shown to be more effective than medicines in reducing the incidence of diabetes in people with pre-diabetes. The Diabetes Prevention Study[ii] found a 7% reduction in body weight reduced the incidence of diabetes by 58% compared to 31% with metformin (metformin is the first line prescription medicine to reduce diabetes).

Severe intensity

According to Professor Roy Taylor[iii] who led the Counterpoint study, if people within six years of diagnosis lose 15kg or more, they have a 9/10 chance of returning to normal glucose control. The trick is to start the process early before it’s too late.

Interestingly, it doesn’t really matter what diet you select[iv], as long as it delivers the results and is sustainable. The choices to lose weight can include liquid shakes, low carbohydrate diet, low fat diet, Mediterranean diet or intermittent fasting strategies. For more information about fasting, go here.

For myself, I found the fasting mimicking diet (a low protein and low carbohydrate diet of 800 calories) for 3-5 days per interval of my choice ‘perfect’ to maintain my ideal weight.

Here’s the interesting thing, the fasting mimicking diet changed my thinking of how much food I actually required. I discovered that I was overeating and that my portion size could be much smaller. I lost 8kg the first time around and re-do the fasting mimicking diet whenever I put on an additional 2-3kg.

You can DIY (Do It Yourself) by incorporating 2 avocados and spoonfuls of superfood powder per day. For more information on the DIY option, read the Wellness Outpost article here or you can purchase Prolon, a specially formulated meal package that provides all the nutrition you need per day to complete this diet. It is a 5 days pack and food includes soups, health bars, crackers and herbal teas.

Most telling was Prof Taylor’s comment that, the key to sustain long-term weight gain is continued regular follow up and support.

As a service to my loyal readers and in honour of my grandfathers, I am offering a complimentary consultation (valued at $125) on how I can assist you to prevent diabetes for a LIMITED TIME (for the first 50 registrants). I think if my grandfathers received the same information you will be receiving from me, their lives could be quite different.

To book the LIMITED complimentary consultation for the first 50 registrants, go here.

I have also organised a ‘Control Diabetes and Reduce Your Risk of Severe Illness’ workshop that you can register here.

References:

[i] Sampson M, Clark A, Bachmann M, et al. Lifestyle Intervention With or Without Lay Volunteers to Prevent Type 2 Diabetes in People With Impaired Fasting Glucose and/or Nondiabetic Hyperglycemia: A Randomized Clinical Trial. JAMA Intern Med. 2021;181(2):168–178. doi:10.1001/jamainternmed.2020.5938

[ii] Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. doi:10.1056/NEJMoa012512

[iii] Taylor, R. (2020), Type 2 diabetes remission: latest evidence for health care professionals. Pract Diab, 37: 177-182. https://doi.org/10.1002/pdi.2297

[iv] Taylor R, Ramachandran A, Yancy W S, Forouhi N G. Nutritional basis of type 2 diabetes remission BMJ 2021; 374 :n1449 doi:10.1136/bmj.n1449