If you have prediabetes or are overweight, you have an opportunity to turn your life around and improve your health. This opportunity won't last long, and the longer you wait, the more difficult it will be to regain your health. If you have already been diagnosed with the more serious diabetes mellitus and obesity, you can still take big steps to reduce your symptoms and the risk of developing serious complications.
The alternative is to continue with your present lifestyle and get sicker. Our sincere hope is that you choose to work with us and follow our advice to get better.
In this chapter we cover the basics about prediabetes and overweight but with an approach and a perspective that may be new to you.
What Do We Mean by Diabetes and Prediabetes?
Diabetes is characterized by two factors: abnormally high blood-sugar (glucose) levels, either before breakfast or after eating, and abnormally high levels of insulin (a hormone that normally helps your body to use blood sugar). In prediabetes, blood-sugar or insulin levels, or both, have begun to creep up.
Normally, blood sugar serves as one of your body's main fuels. Without it, you wouldn't have the energy to walk or think. But when blood-sugar levels are too high or too low, you cannot function at your best.
Insulin is also essential in normal health, but high levels lead to many health problems. In fact, elevated insulin usually precedes increases in blood sugar and can serve as a reliable early warning of diabetes risk. We'll explain more about blood sugar and insulin later in this chapter.
The Journey from Prediabetes to Diabetes
It helps to visualize diabetes as a continuum. Early in the disease process, your blood sugar may rise a little too much after you eat a lot of sugars or carbs, making you feel drowsy. At this stage you don't have any formal disease and blood-sugar tests would likely look normal, but we would describe you as being prediabetic. Your body is offering clues, if you pay attention, that you don't handle sugar and carbs very well.
If you ignore these clues, continue to eat whatever you want, and neglect your health in other ways, your sugar and carbohydrate intolerance will get worse. After a few years, your fasting blood sugar will creep up until you get a formal diagnosis of prediabetes. If you ignore this diagnosis, your symptoms will turn into type 2 diabetes, a far more serious disease. If you fail to properly treat type 2 diabetes, it may evolve into a truly horrible combination of type 2 and insulin-dependent type 1 diabetes.
This progression is inevitable if you continue to eat what you have been eating. The sooner you recognize what is happening and take steps to improve your health, the sooner you can take control of your health and your life.
Doctors use a variety of terms to describe prediabetes, with the differences usually reflecting the way they diagnose it. Sometimes this name game becomes confusing for patients. All of the following terms refer to prediabetes.
Impaired fasting glucose
Impaired glucose tolerance
Hyperinsulinemia
Insulin resistance
Hypoglycemia
Metabolic syndrome
Syndrome X
Metabolic Syndrome X
Insulin resistance syndrome
If your doctor has used any of these terms to describe your health, you have prediabetes.
What Do We Mean by Overweight and Obesity?
Many people aren't always clear about what doctors and health experts mean when they talk about overweight and obesity. Part of the problem is that people frequently have distorted views of their own weight, so they think they weigh less than they do. For example, we've seen plenty of men who are physically strong but also terribly overweight.
Doctors use a variety of height-weight charts and body-fat or body mass indicators to determine whether patients are overweight. While none of these methods is perfectly accurate, they do help people assess their weight.
If you're above your ideal weight, odds are that you're overweight. If you have love handles, you're not cute-you're overweight. As a general rule, if you're roughly thirty or more pounds above your ideal weight, you're obese. If you're a hundred or more pounds over your ideal weight, you're morbidly obese.
How to Measure Your Body Mass Index
Using the body mass index (BMI) is one of the most common ways of calculating whether a person's weight is normal or not. You need to know only your weight (using an accurate bathroom scale) and your height. BMI estimates are generally accurate, except for body builders or serious athletes, in which case muscle, not fat, accounts for the excess weight.
Your Body Proportions and Diabetes Risk
Although the BMI gives you a general idea of whether your weight is normal, we've found that body proportions often serve as a better guide to determining whether you might be prediabetic.
To explain, some people tend to gain weight in the buttocks, while others gain it around the belly. Belly fat is the better indicator of prediabetes and diabetes risk.
People with big rear ends tend to have a pear or pyramid shape, whereas those with a big belly have an apple or diamond shape. The diamond-apple shape points to prediabetes, diabetes, and what is sometimes called metabolic syndrome and Syndrome X. Belly fat results from two particular types of fat deposits. Subcutaneous fat is stored under the skin of the belly, and visceral fat is intertwined around organs in the midsection. Both subcutaneous and visceral fat secrete inflammation-causing substances that further harm the body.
Measuring Your Body Proportions and Belly Fat
How do you measure your belly fat? The simplest method is to stand naked in front of a mirror without sucking in your gut. If your belly sticks out from your chest (not counting your breasts, if you're a woman), you have too much belly fat.
Another way is to measure your waist, but don't use your belt size. Men tend to wear their belts below their waists, leading them to think they're thinner than they really are.
To accurately measure your waist, use a cloth tape measure. Place one end of the tape measure on top of your belly button, wrap it around your back, and match up the other end at your belly button. Don't suck in your belly as you take this measurement. If you're a man with a waist larger than forty inches or a woman with a waist larger than thirty-five inches, you have a high risk of developing prediabetes and diabetes, as well as heart disease.
For a more precise calculation, you can measure your waist-hip ratio. The bigger your waist, relative to your hips, the greater your risk of developing prediabetes, diabetes, and heart disease. Follow the previous instructions to measure your waist. Next, measure your hip circumference toward the top of your buttocks.
Now use a calculator to divide your waist measurement by your hip measurement. For example, if your waist is fifty-four inches and your hips are forty inches, your waist-hip ratio is 1.35. Here is what the different ratios mean:
If your ratio is 0.95 (men) or 0.80 (women) or less, you have a low risk of developing prediabetes and diabetes and are not overweight.
If your ratio is 0.96 to 1.0 (men) or 0.81 to 0.85 (women), you have a moderate risk.
If your ratio is 1.1 (men) or 0.86 (women) or higher, you have a high risk.
Are You Prediabetic or Overweight? Take the Quiz
We would like you to take a few minutes to answer the questions on the following quizzes, which assess your risk of being prediabetic or overweight. The first two quizzes are for women, and the second two are for men. (Some questions are identical, but others differ.) Be honest in your answers. No one except you has to see them.
The Prediabetes Quiz for Women
My doctor has told me that either my blood sugar (glucose) Y/N or my insulin is high.
I've been diagnosed with either carpal tunnel syndrome Y/N or Bell's palsy.
I think my belly is too big. Y/N
My waist is more than thirty-five inches (eighty-nine cm) Y/N around.
I often skip breakfast, except for coffee. Y/N
I often skip breakfast or just eat something starchy, like Y/N a bagel or a muffin.
I often skip breakfast to lose weight. Y/N
I get tired and sleepy after eating, especially after lunch. Y/N
I often feel like taking a nap during the day or the Y/N early evening.
I have trouble falling asleep at night. Y/N
I have trouble getting up in the morning and must have Y/N some coffee or a soft drink to fully wake up.
I often have food cravings, especially for something sweet, Y/N and have trouble resisting these foods.
I snack a lot late at night. Y/N
I often crave starchy foods, such as pasta, pizza, or bread. Y/N
I have to add sugar to my coffee or tea, or it tastes too bitter. Y/N
I drink one or two cans or bottles of some type of nondiet Y/N soft drink each day.
I usually have some sort of dessert or other sweet food Y/N at least once a day.
I often feel stressed out. Y/N
I seem to have a lot less energy than other people my age. Y/N
I'm usually too tired to exercise, or I don't have enough time. Y/N
I am usually very thirsty. Y/N
I urinate a lot. Y/N
I have mood swings one or more times each week, going Y/N from calm to irritable or from upbeat to depressed.
I've been told that my blood pressure, cholesterol, or Y/N triglycerides are higher than they should be (without taking medications).
Between the ages of forty-five and fifty-five, I was diagnosed Y/N with low thyroid and also went through perimenopause.
A brother, a sister, or a parent was diagnosed with diabetes. Y/N
Interpretation: If you answered "yes" to any of these questions, there's a good chance that you have, or are at risk of developing, prediabetes. If you answered "yes" to more than five of the questions, you have a very high risk of being prediabetic.
The Overweight and Obesity Quiz for Women
I know that I am overweight. Y/N
I was told by my doctor that I should lose some weight. Y/N
I carry my extra weight around my belly. Y/N
I weigh more than I would like to. Y/N
I've found that most diets don't work for very long. Y/N
I wear larger clothing sizes than I'd like to. Y/N
I think a lot of other people are way too thin. Y/N
I think it's normal to gain weight as we get older. Y/N
I have trouble getting in and out of my car. Y/N
I like big cars because I have more room in them. Y/N
I feel as though airline seats are not wide enough for me. Y/N
I spend a lot of time thinking about what I'm going to eat Y/N later.
I often continue to eat even after I feel full-it's hard to Y/N stop eating.
I sometimes "pig out" at meals. Y/N
I have regular food cravings, or I sometimes binge on Y/N individual foods.
If I have to walk any kind of distance, I feel my heart Y/N beating and feel out of breath.
Interpretation: If you answered "yes" to any of the first six questions, you have a weight problem and you know it. If you answered "no" to the first six questions but did answer "yes" to two or more of the remaining questions, there's a good chance that you're overweight but may be in denial of it.
The Prediabetes Quiz for Men
My doctor has told me that either my blood sugar (glucose) Y/N or my insulin is high.
I've been diagnosed with either carpal tunnel syndrome or Y/N Bell's palsy.
I'm heavier than I should be around my belly. Y/N
My waist is more than forty inches (101 cm) around. Y/N
I often skip breakfast, except for coffee. Y/N
I often skip breakfast or just eat something starchy, like a Y/N bagel or a muffin.
I get tired and sleepy after eating, especially after lunch. Y/N
I often need to take a nap during the day or the early evening. Y/N
I have trouble falling asleep at night. Y/N
I have trouble getting up in the morning and must have Y/N some coffee or a soft drink to fully wake up.
I often have food cravings, especially for something sweet, Y/N and have trouble resisting these foods.
I snack a lot late at night. Y/N
I often crave starchy foods, such as pasta, pizza, or bread. Y/N
I have to add sugar to my coffee or tea, or it tastes too bitter. Y/N
I drink one or two cans or bottles of some type of nondiet Y/N soft drink each day.
I usually have some sort of dessert or other sweet food at Y/N least once a day.
I often feel stressed out. Y/N
I seem to have a lot less energy than other people my age. Y/N
I'm usually too tired to exercise, or I don't have enough time. Y/N
My interest in sex is not as great as it used to be, or I have Y/N trouble getting and maintaining an erection unless I take medication.
I have mood swings one or more times each week, going Y/N from calm to irritable or from upbeat to depressed.
I get angry a lot at family members, coworkers, and Y/N other drivers.
I am usually very thirsty. Y/N
I urinate a lot. Y/N
I've been told that my blood pressure, cholesterol, or Y/N triglycerides are higher than they should be (without taking medications).
A brother, a sister, or a parent was diagnosed with diabetes. Y/N
Interpretation: If you answered "yes" to any of these questions, there's a good chance that you have, or are at risk of developing, prediabetes. If you answered "yes" to more than five of the questions, you have a very high risk of having prediabetes.
The Overweight and Obesity Quiz for Men
I know that I am overweight. Y/N
I was told by my doctor that I should lose some weight. Y/N
I have a little paunch, but it's not all that bad. Y/N
People have told me that my love handles are cute. Y/N
I have to admit that I've got a pretty good size beer belly. Y/N
I weigh more than I did in my early twenties. Y/N
I think it's normal to gain weight as we get older. Y/N
I wear a larger belt size than I did ten years ago. Y/N
I wear larger clothes (e.g., shirt size or pants waist size) than Y/N I did ten years ago.
I have trouble finding shirts that fit or comfortably closing Y/N the top button on business shirts.
I think thin guys tend to look weak or effeminate. Y/N
I prefer driving large cars, such as an SUV or a full-size Y/N pickup truck because I have more room in them.
I have trouble getting in and out of my car. Y/N
I feel as though airline seats are not wide enough for me. Y/N
If I have to walk any kind of distance, I feel my heart Y/N beating and feel out of breath.
I often continue to eat even after I feel full-it's hard to Y/N stop eating.
I sometimes "pig out" at meals. Y/N
(Continues...)
Excerpted from Stop Prediabetes Now by Jack Challem Copyright © 2008 by Jack Challem. Excerpted by permission.
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