Preventing Type 2 Diabetes

In 2014, a study published in BMJ Open stated that a third of adults in the UK have prediabetes. Prediabetes, also called impaired glucose tolerance is the stage at which you can make some simple changes in your life in order to prevent the onset of Type 2 Diabetes. A person may be told they are pre-diabetic if blood tests show that their blood sugar is above normal, but not quite high enough for a formal diagnosis of diabetes. NICE regards a fasting blood glucose level of 6.1 to 6.9 mmol/l (108 to 125 mg/dl) as prediabetes - or equal to a higher risk of developing type 2 Diabetes.  Many people who are prediabetic show no symptoms and may not even know they have higher than normal blood sugar levels. When left untreated, the majority of these people will develop full blown type 2 diabetes within 5 years. Type 2 Diabetes mellitus is a serious condition that can lead to kidney disease, nerve damage, retinal disease, heart disease and stroke. 

There are an estimated 4.5 million people in the UK with diabetes including 1 million who don't know they have it. 3.8 million people are estimated to have both types of diabetes but approximately 90% of diabetes cases are Type 2, which is largely preventable or manageable by lifestyle changes. Diabetes currently costs the NHS 8.8 billion pounds a year so finding ways to prevent it in the first place is crucial to a sustainable future for our healthcare.  

Symptoms of Type 2 Diabetes include:

  • peeing more than usual, particularly at night
  • feeling thirsty all the time
  • feeling very tired
  • losing weight without trying
  • itching around your penis or vagina, or you keep getting thrush
  • cuts or wounds that take longer to heal
  • blurred vision

If you have any of these symptoms, it's vital that you visit your GP to have your blood sugar checked. 

I always say that prevention is better than cure. Type 2 Diabetes is totally preventable. If you have been diagnosed as being prediabetic, consider it as an opportunity to make some lifestyle changes so that you can take the path to good health. 

Type 2 diabetes is proven to respond better to lifestyle interventions than to pharmaceutical treatments, many of which have their own side effects. The following advice is aimed at helping you control your blood sugar, but also to prevent the progress of the disease processes associated with diabetes. This is vital for anyone diagnosed with prediabetes. It also applies to pregnant women or women who wish to become pregnant, due to the risk of gestational diabetes. If you are overweight, have high blood pressure or a family history of diabetes, this advice is also for you!

Eat well

The best way to effectively manage blood sugar is through diet. I don't mean 'going on a diet' - I mean thinking about what nutrients you are getting from your plate. Eat plenty of fresh fruit and vegetables. Forget eating five portions a day - we need to be eating ten portions of fruits and vegetables every day! Vegetables need to form the main part of our diets - with a little meat, fish, eggs, nuts and seeds. The debate still continues about whether a low carb/high fat diet or indeed a ketogenic diet such as the Atkins diet is an effective way to manage diabetes. There are plenty of good sources of information about this, which I will include below. Fruits and vegetables contain insoluble fibre, which slows down the absorption of glucose in the gut. You might think fruit has too much sugar in it, but it contains lots of water and cellulose and its sugars are metabolised differently from those found in fizzy drinks and sweetened foods.
  
Stop smoking
 
Smokers are 40% more likely to develop diabetes than non-smokers. Smoking also complicates insulin-dosing and makes it more difficult to manage the disease effectively. Smoking has its own associated risks - lung cancer, heart disease and emphysema. Smoking reduces blood flow to the outer limbs increasing neuropathy and the risks of infections and ulcers. A person who has diabetes who smokes also has a higher risk of developing heart and kidney disease. The NHS offer a very good smoking cessation program - including apps and personalised reminders of the benefits of stopping: Stop Smoking.
 
Get lean
 
There's lots of evidence about different diets helping to control diabetes, but what they all have in common is that they reduce body fat mass. A study in 2016 followed 32 patients with Type 2 Diabetes who followed a Paleolithic diet for 12 weeks. This means they didn't eat grains, sugars and dairy products, but instead ate vegetables, fruits and nuts with some meat, fish and eggs. These Paleo dieters became lean and lost weight on their abdomens - which is where we tend to store fat, especially when we have reduced sensitivity to insulin. Their blood sugar improved, as well as their resting heart rate and blood pressure. One participant didn't need their medication anymore, and two patients no longer needed blood pressure medication. Not bad for just 12 weeks.
A vegan diet has also been shown to reduce body fat and improve overall lipid profiles - but this was a vegan diet based on vegetables, fruits and nuts with some supplementation - NOT a high-carb 'vegan' diet consisting of pasta, cereals and potatoes. 
There is no one diet that fits all, but anything, whether it's the Atkins diet, a low carb/high fat diet or a Paleolithic diet which reduces overall body fat will substantially reduce your risk of developing diabetes or will help you manage your diabetes more effectively with long term health benefits. 
 
Move more
 
Physical activity is so important, especially today when we are more sedentary than our ancestors used to be. Regular exercise will help to stabilise blood sugar, improve your BMI and reduce overall weight, lower your blood pressure, decrease LDL cholesterol and improve your cardiovascular health. Exercise improves the metabolism of sugars, fats and proteins in the blood and increases the efficient usage of calories by the body. 
A study published in the International Journal of Environmental Research and Public Health this year followed a group of adults with Type 2 Diabetes on a 9 month supervised exercise program. The researchers concluded that low-cost, community based exercise programmes achieved significant benefits on glycaemic control, lipid profile, blood pressure, anthropometric profile and the 10 year risk of coronary artery disease. 
As well as the costs to one's health, the cost of diabetes for the NHS is over £1.5 million an hour. Finding free and low cost solutions is challenging, which is why exercise is so valuable. Both aerobic and anaerobic as well as weight bearing exercises can provide life-changing benefits. You don't 'need to spend hours on a treadmill every day - the most effective exercise for fat loss is high intensity interval training, or short bursts of high intensity exercise. The key is finding a sport or activity that you enjoy - participating with others will also help you to feel motivated. Healthy living starts at home and the risk of diabetes comes from factors that only you can control.
 
Make food your medicine
 
Obviously, I have to mention herbs here! There is research on over 70 natural substances which have been shown to reduce the risk of diabetes. A polyphenol in turmeric, called curcumin was proven to be 100% effective clinically at preventing the transition from prediabetes to Type 2 Diabetes. Other natural compounds found in cinnamon, ginger, coffee and nettle have also demonstrated blood-sugar balancing effects. 
The dietary guidelines offered by different organisations only focus on managing diabetes - they do not account for disease progression. You might manage your blood sugars well through diet alone but you may still develop heart disease, retinopathy, kidney disease or neuropathy. By taking an integrated approach, you are more likely to be able to reduce your risk factors for developing diabetes and live a healthier and longer life.
 
Resources
 

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