Preventing Type 2 Diabetes (S2-03)

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hello nation today we're going to talk about preventing type 2 diabetes what used to be called adult-onset diabetes the rates are increasing dramatically not only in the United States but around the world the number of people in the United States with diabetes approximate 30 million the number of people with pre-diabetes it's approximately 80 million and every year five to ten percent of those folks convert over to type 2 now what is pre-diabetes it's pretty simple we have our categories and ranges on blood sugar levels if you get above a certain level you have diabetes we have the certain range for normal so it's that grey zone your numbers aren't quite normal but they're not quite in the diabetic range how do we define diabetes as caregivers fasting blood sugar below 100 is normal 126 is greater is diabetes between 100 and 126 first thing in the morning without eating anything all night that's called pre-diabetes now if we do a fancy test called the glucose tolerance test you swallow 75 grams of a really sweet syrup you check your blood sugar exactly at two hours people who are normal are less than 140 people who are diabetic are 200 or greater and if you're in that gray zone the pre diabetes you're between 140 and 200 the last way and I think one of the most easiest ways to get the diagnosis is to do a hemoglobin a1c so blood tests we use in diabetes clinic that gives us an average of the blood sugar over the prior three months for people with diabetes we're trying to get them less than seven but if your a1c is between 5.7 and 6.5 that's called pre-diabetes if you're below 5.7 then you're not at risk now who is at risk I think the highest risk are folks that have a family history of type 2 mother-father siblings remember it's always our parents fault it's passed along so strongly from generation to generation because it's in the genes not Jordache jeans but these are the genetic makeup of our body now if you're a member of a certain ethnic group like native american indian pacific islander Hawaiians same group African Americans Latinos you're going to be at a higher risk because it runs strongly in those ethnic groups if you have a certain body habitus if you have a beer belly or that most you carry most of your weight down here if you have high blood pressure abnormal cholesterol level this is these are other metabolic factors that are associated with pre-diabetes and lastly if you are a female and you had a baby over nine pounds that puts you at risk because it turns out that if your blood sugars are a little high during pregnancy makes the make baby very big and lead 2 c-sections all kinds of other problems well what can we do if you have pre-diabetes and you are at risk and once again your biggest risk factor is having someone in your family with type 2 you let your father or your mother and if both your parents have time to there's virtually a hundred percent chance you're going to get it during a lifetime but we can prevent it what can we do let's go to nonpharmacologic first what does that mean it means lifestyle trying to get down to a good ideal body weight even if you don't get skinny minny any little bit of weight reduction helps and physical exercise I was an investigator in a large government funded study called the diabetes prevention program and it turns out that exercising 30 minutes a day mostly aerobic five days a week trying to lose five to six percent of your body weight it's not that much can reduce the conversion from pre-diabetes to type Q diabetes by almost sixty percent easier said than done but you got to get some support system and you know that goes along with people with type 2 diabetes as well that's very powerful now one thing people don't do enough that I think they should is consider medications it turns out that the medications we use to treat Type 2 diabetes once you once your blood Sugar's cross that line into the critical area we just use them earlier and they've been studied they're called prevention studies they're all listed in this excellent text book written by this very famous author oh yeah me and there's a chapter on preventing type 2 diabetes so for example metformin it's also called glucophage insulin sensitizer drug called pioglitazone known as actos fat blockers that is sold over the counter called allure what we call carbohydrate absorption inhibitors precose and a very recent study called origin that looked at the incidence of diabetes in people who had pre diabetes and were given low-dose long-acting insulin glargine every single one of those studies it statistically prevented the conversion of people with pre-diabetes to type 2 so my theory is why not use them a little bit earlier they're not strange drugs or not different drugs they're just used a little earlier in the natural history so think about this if you can do something like lifestyle plus or minus a medication you gotta talk to your doctor of course that it's quite powerful now the last thing I want to say is that only one out of eight people who are identified as having pre-diabetes as I defined earlier go on to develop type 2 diabetes so some people are more at risk than others improving your lifestyle is always a good thing it helps your blood pressure cholesterol even if your risk for type 2 diabetes isn't as strong as others there is another test it's called the pre dicks test p re D X and it's a blood test that looks at other biologic markers that are associated with the development of type 2 diabetes and that test may also help you know how much of a risk you are at getting type 2 diabetes so at set nation prevent diabetes

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