Posted by - J. Rand Baggesen, M.D.

As the holiday season approaches, our monthly column will focus on one of the best gifts you could give to yourself, understanding your personal risk for developing diabetes. Everyone knows the holiday theme, “Eat, Drink and be Merry”. For those interested in maximizing their personal wellness, I propose a slight variation, “Eat, Drink in moderation, Exercise and be Merry!”. Now before you label me Dr.Ebenezer Scrooge, let’s talk about the impact of diabetes mellitus on our society and what you can do to lower your risk.

Adult onset or type II diabetes has been on a fast and steady rise along with the increase in bodyweight of our population. The ramifications to patients and society cannot be overstated. According to the American Diabetes Association, 21 million people suffer from outright diabetes, 54 million people have pre-diabetes. Pre-diabetes or insulin resistance is when your body has a hard time processing sugar but there are no outright signs of diabetes. This can go on for years before the actual diagnosis becomes apparent. Of the 21 million people with diabetes, one third are undiagnosed. Diabetes spending equates to greater than 11% of health-care expenditures in 2002 with direct spending of $132 billion. With almost 7% of the population suffering from diabetes and untold numbers a clinical risk, it is important to understand how you can detect risk factors years before you blood sugar is out of control.

With the steady rise in weight of our population caused by sedentary lifestyles coupled with the “baggy size” mentality, diabetes is at epidemic proportions. Only within the past 100-200 years has our developed world enjoyed such an overabundance of processed foods, often high in fat and carbohydrates. There appears to be a genetic predisposition associated with the development of diabetes. The diagnosis, management and complications caused by diabetes are a perfect example of how American medicine is organized to treat disease but often does a poor job at prevention.

So, how do you know if you are at risk for diabetes, do you have pre-diabetes? Okay, here’s where you can call me Dr. Ebenezer Scrooge-you don’t need to look like Santa Claus to have prediabetes. Prediabetes is a condition where the cells of your body become resistant to the actions of your own body’s natural insulin. Insulin is a hormone that is released from your pancreas after you eat. It attaches to receptors on cells and acts as a key to open a door allowing sugar into the cell for energy. The effects of a sedentary lifestyle, increased consumption of foods high in fat and sugar over a long period of time decrease the effectiveness of insulin and its ability for your body to metabolize sugar.

Most people are diagnosed with diabetes after years of being in this prediabetic state. A fasting blood sugar of greater than 126mg/dl is the definition of diabetes. A fasting blood sugar of between 100-125mg/dl is the definition of prediabetes. Another way of diagnosing prediabetes the something called an oral glucose tolerance test. You are given a sugary drink and a blood sample is taken 2 hours later. A blood sugar of below 140 is normal, between 140-199 pre-diabetes and over 200 outright diabetes. Other blood tests that can help find those at risk include advanced cholesterol testing, GGT, insulin, pro-insulin, adeponectin, hs-CRP, fibrinogen, Lp-PLA2 and Apo-E. These complex laboratory indicators often fall into patterns that show a susceptibility to diabetes and problems with cholesterol accumulation within your arteries. These advanced tests are available through commercial laboratories today.

This is where the high-tech medicine approach to diabetes comes in to play. Advanced cholesterol testing in combination with the other factors listed above give insight years before your body is damaged by the pre-diabetic and diabetic state. With this knowledge you can modify the way you eat, increase your exercise and if needed take medicine and greatly reduce the likelihood of becoming diabetic. Using these advanced blood tests in combination with today’s noninvasive vascular imaging gives patients and their doctors information years before the complications of diabetes affect your health. 65% of people with diabetes die of heart attacks or stroke. By using a high-tech laboratory and imaging approach you can better define your risk and adjust your personal lifestyle to minimize this growing health threat.

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