Do diet and exercise prevent diabetes or just delay it

Miscellaneous and Personal Stuff I Must Share
1

My impression was diabetes was degenerative (at least it is from the people I’ve known who have it). At first you may be able to control it with one med, then it takes several, then you may need insulin.

I don’t know if this is the stereotypical prognosis for all people with T2D, but it is what I’ve seen in family members.

So having said that, does lifestyle prevent diabetes or just delay it? All the studies say ‘prevent’ but I would assume delay is more realistic since a lot of studies seem to be done in 1-10 year windows. If so, how much does it delay it, any studies on that?

2

Unless you are genetically predisposed, keeping a healthy weight and exercising will likely keep you from getting diabetes, not just delay the onset; it is usually a sign of metabolic syndrome which itself is highly correlated with obesity. There’s a good reason for the current diabetes epidemic and it is mostly due to modern lifestyles (although not exclusively, which is why I mentioned genetics). FWIW, it is also a myth that eating a lot of sugar will give you diabetes; total calories and weight gain are more important (although, some foods, like processed meats are linked to diabetes, and sugar does cause blood sugar and insulin levels to fluctuate wildly; on the other hand, exercise helps your body utilize insulin).

3

There’s no one answer to your question because people vary.

The way my doctor explained it to me, your cells have receptors on them for insulin, which is how your body regulates sugar. Some people happen to have fewer of these receptors, so they are more susceptible to getting type 2 diabetes. If you are overweight, then fat basically clogs the receptors, which also makes you more susceptible to getting type 2 diabetes. For whatever reason then, what ends up happening is that the cells in your pancreas have to work harder to compensate, and this puts more strain on them. The thing about these cells though is that they don’t regenerate. You’ve got a fixed number of them, and if they die, that’s it. They’re gone forever. They aren’t replaced like most other cells in your body.

When the cells in your pancreas can’t regulate your sugar properly any more (because they’ve been strained too much or whatever) then you’ve now got type 2 diabetes. The damage to your pancreas is permanent. However, that doesn’t necessarily mean that you are stuck with diabetes for the rest of your life, and that it’s a slow circling the drain type of thing where you just keep getting worse and worse. If, for example, the main reason you ended up with diabetes is that you’ve just got too much fat clogging up all of your insulin receptors, then losing weight frees up those receptors, and your pancreas doesn’t have to work as hard. This is what happened in my case. I lost weight and no longer needed to go on diabetes meds, and I keep my weight and blood sugar in check by just watching what I eat. Some people would say I am “cured” of diabetes but in reality the damage to my pancreas is still there. It’s more like I’ve managed the disease and will probably not have to worry about it for the rest of my life (as long as I keep my weigh in control) rather than an actual “cure”.

One of the keys to this type of success is catching the disease early and making the lifestyle changes necessary to lose the weight and stop the damage to your pancreas. Also, if I hadn’t let myself get so overweight in the first place then I probably never would have developed diabetes. So diet and exercise can prevent it.

Will diet and exercise prevent it in everyone? No.

A friend of mine doesn’t do anywhere near as well with her diabetes. She’s more like the cases you seem to be familiar with, but she also doesn’t watch what she eats enough. Her disease has progressed far enough that I don’t think it is possible for her pancreas to do its job alone any more, so even if she lost weight and ate healthy she’s stuck on meds for the rest of her life.

4

I’m going to say “no”. A woman who lives locally to me was told years ago that she was on the verge of developing diabetes, so she went on a strict diet/exercise regime, and developed diabetes anyways a few years later. She’s now very angry that she ate a bland diet and walked her legs off every day “for nothing” (didn’t make much difference to her weight either apparently)

I developed diabetes out of the blue despite a healthy diet and reasonable exercise (better than average according to the dietician)

5

I think the best answer is, “We don’t know…yet.”

People tend to overestimate the history of effective diabetes treatment. It’s only been a little over 55 years since we discovered that some diabetics rely on insulin (Type I) and others don’t entirely (Type II). It’s even more recent than that that we figured out it isn’t entirely age-dependent (“Juvenile” vs. “Adult-Onset”), and less than 10 years since we dropped the distinction from the nomenclature!

Routine home glucose monitoring is younger than I am.

The landmark study, the Diabetes Control and Complications Trial, which showed that glucose control through insulin and diet delays onset, progression and complications? 1993. And in the last couple of years, studies are coming out which show that *very *tight glucose control may actually do more harm than good!

engineer_comp_geek does a good job of explaining, more or less, the two keys in current diabetes theory: insulin resistance worsened by excess fat and lowered insulin production due to pancreas damage. It seems to explain what we see happen, but still…a theory, and one that may change as we learn more. They’re working on it, but doctors do not have all the answers. (They do ask fascinating questions, though!) Modern medicine really is…modern.

But Corcaigh, I do have to add…if your neighbor was *following *a weight loss diet (I don’t know what the “bland” complaint was about: there’s no reason a weight loss diet or a diabetes diet need be bland) and “walking her legs off” and didn’t lose weight…something was wrong, and it wasn’t diabetes.

I do have a couple of slim patients with diabetes. I have no obese patients without diabetes. Observationally, there is a connection, and it’s strong enough that it finally motivated me to lose weight to stave off my own impending diabetes.

6

Whynot answered quite cogently, maybe you should think of it this way. We all have predispositions to certain illnesses due to our genetic make-up. If we minimize the factors that will contribute to increasing the likelihood of a specific illness, we are less likely to get that illness.
For example, if you have a family history of chronic lung problems and breathing difficulties, you probably don’t want to be in a trade that creates a lot of dust or pulmonary irritants. Will you still have asthma? Maybe, but being in conditions that inflame it are going to make it worse.
Eating a healthy diet and doing regular moderate exercise aren’t going to make you live forever, but will make the years you have worth living. I just finished reading two books, Wheat Belly and Nutrition andPhysical Degeneration although I don’t buy into everything, a lot of what’s said makes sense to me.

So will lifestyle eliminate the chance of you getting diabetes? No way to know. Sittting on the couch doing nothing, definitely will enhance your chances of getting it though.

7

My take (and personal experience) is that diet and exercise have a high likelihood of helping manage the disease, if not stave off it developing in the first place.

In my case, I became extremely sedentary once I got out of school and started working full-time; I gained about 45 pounds over the course of a decade or so. My diet was bad, as well, particularly the amount of regular (sugared) soda I drank – on a typical day, I was drinking 6-8 cans of regular Pepsi.

When my type 2 diabetes was developing (it doesn’t run in my family, btw), the uncontrolled disease caused some weight loss. Ironically, I was trying to diet at the time, and I just thought that the diet was working. Eventually, I started feeling lousy, my breath got funny-smelling, and my feet started to hurt (neuropathy). That’s when I finally went to the doctor.

When I was diagnosed, my hemoglobin A1C was at 8.8 (a number at 6.5 or above is a de facto indicator of diabetes, as I understand it). Within 18 months, through changes in diet (no more sugared soda or orange juice, cut back on the white carbs overall), oral meds (metformin and Actos), and some light-to-moderate exercise (lots of walking), I got my A1C down to 5.9 (a “normal” A1C number is 4.0 - 6.0). Then, 2 years ago, I started running, and started making more changes to my diet (more vegetables, more whole grains). My A1C is now at 5.1, and my endocrinologist says, “whatever you’re doing, don’t stop!” (he’s also been able to cut my med dosage in half).

As engineer_comp_geek aptly states, I am under no illusions that I’ve cured my diabetes. I have it well under control, but I’ve worked hard at getting it to that point. I am hopeful that I’ll be able to forestall complications, or the need to go on insulin, for as long as possible (and, who knows, maybe in 10 or 20 years, there’ll be an actual cure).

8

I have lost 85 pounds and have always gotten a good amount of exercise (walking). I take metformin and my blood glucose is now well within the normal range and actually lower since I lost more weight. I even wonder whether I need to continue the metformin, but it also helps with weight so I am reluctant to mess with it.

9

I have a cousin with type 1, which, as I understand it, is an autoimmune disease that damages the pancreas. My father has type 2, and is obese, htough not morbidly so. Compared to folks we see in Doctor’s office waiting rooms, he looks slim. He has had it for over 30 years and, with my mother’s help, has managed it well. He was never able to lose any weight, however, and is now on inulin as well as oral meds. But his numbers are good.

I’m built like him, and my focus is on preventing diabetes though exercise and watching what I eat, monitoring my fasting blood sugar, and reading everything I can find on the subject. So far, so good. I am somewhat insulin resistant, but HIIT exercise really really makes a difference.

As far as fat goes, here’s an article from today’s New York Times, reporting studies that call many of our current assumptions into question.

Fitness over weight

10

Would you mind linking to those studies please? I’m curious as to what is meant by very tight glucose control, and what the complications (bar the hypoglycemic unawareness and thus increased potential for complications related to that) are.

11

I don’t know the woman personally, I know of her, and know that for years, come rain, hail, wind or shine she went for a 5 mile walk every day, she was chubby when she started and is still chubby now. From what I hear her husband is a bit of a dick and he made sure she ate low sugar foods even though he was still eating away merrily. She became quite the conversation piece for a while that she’d gone to all that trouble and still got diabetes anyways.

12

Why would you “bar” that? That’s exactly the most worrisome problem - increased (slightly increased, but increased) death from hypoglycemia and cardiac events.

Also, weight gain, increased cost in supplies and insulin, an increase in the time spent managing your diabetes daily, greater demands in terms of diet and exercise compliance. You’ve got to commit to blood glucose testing at least 4 times a day and either an insulin pump or (generally) 4-6 insulin injections a day. That’s a lot to ask of people, especially if it the risk of injury or death outweigh the benefits of less peripheral vascular damage.

Intensive insulin therapy, tight glycemic control, etc. are generally described as keeping your blood glucose between 70 and 130 fasting, and under 180 by 2 hours past a meal, with an A1c under 7.0. Some studies have gone even tighter, looking at what happens if the A1c is kept under 6.0.

Currently, it is contraindicated in people who have frequent hypoglycemic episodes, have mental or physical conditions which would make them incapable of recognizing or safely managing hypoglycemia, children, elderly, cardiac patients and those who already have vascular disease or complications of diabetes. It appears to be less helpful than we once hoped in an acute care/postsurgical/ICU setting.

It’s definitely an “ask your doctor” therapy. Only she and you can decide if your particular situation and commitment make it a good choice for you.

http://www.hindawi.com/journals/arp/2012/690362/
http://laboratory-manager.advanceweb.com/Magazine/References/References-for-A-Review-of-Tight-Glycemic-Control.aspx

13

I meant “bar” only in the sense that I was already aware of those, nothing else. :wink:

That’s a way of life for most T1 diabetics (most of the ones I know anyway), to be honest; we have to test blood sugar whenever we want to eat, inject whenever we want to eat etc, and count every carb…

Thank you for the links – I will take a proper look at those later – I notice from a cursory glance that many of the conclusions are applied to T2 diabetics, and I wonder if the conclusions carry over to T1.

14

Ultimately though it makes sense that if she failed to achieve any weight loss, it’s not surprising she didn’t see any benefit with respect to diabetes. It doesn’t matter if she scarfed snickers all day hiding under her desk at work or if pixies injected her with butter while she slept.

Now if she lost and kept off 55 pounds and still got diabetes it might be surprising. Of course there’s always other issues too. But I wouldn’t expect to fend off diabetes with lifestyle changes if none of my lifestyle changes improved my weight or fat levels.

15

Well, obviously, there may well be more to her story than you (or any of us) know.

Walking every day is great, and 5 miles is quite a distance, but it may or may not be burning a whole lot of calories (it’ll depend on her weight, and how quickly she walks). That said, walking (or any exercise) also has the benefit of helping your body burn calories more efficiently (as I understand it, when you’re exercising, you’re less dependent on insulin to help you convert blood sugar to energy).

While avoiding sugary foods is a good idea for someone worrying about diabetes, there are a lot of other foods which are pretty much just as bad, from that standpoint, including white bread, potatoes, etc. You indicated that she switched to a “bland diet”, but it’s not clear if she avoided those other types of foods. And, there’s also the question of how much she was eating, even if she was eating the right sorts of foods.

But, ultimately, it may well be that, even if she was “doing everything right”, she was just destined to develop diabetes. Just as someone who exercises, eats right, doesn’t smoke, etc., can develop heart disease, and die of a heart attack, while taking all of those steps can reduce your odds of developing diabetes, it’s not an ironclad guarantee.

16

Type II is entirely preventable. An estimated 90% of type II cases are already completely attributed to lifestyle problems, and while there isn’t completely conclusive evidence yet, I’d bet that a big chunk of the remaining 10% can be laid at the feet of inappropriate diet and lack of effective exercise in the future. The evidence is so overwhelming that you really don’t even need to argue about this one.

Type I is possibly preventable, but the case is much less clear.

Your risk of type I is higher if you have relatives with it, but even identical twins do not always develop the disease, strongly suggesting an environmental or autoimmune trigger. Cow’s milk has been suggested as one strong candidate, as infants who were breast-fed have a much lower incidence of diabetes than infants who drank formula or milk.

You may not buy into all of the paleo diet claims, but there is some clinical and research evidence that some foods are especially problematic for susceptible individuals and can result in the development of autoimmune disorders like vitiligo, alopecia, Crohn’s and celiac, arthritis, and multiple sclerosis, among others. MS may be the most spectacular of these types of diseases since it results in neurological problems. There are two video presentations Cordain on the etiology of MS, TED Talk by Dr. Wahls) about how dietary interventions can help with MS.

In addition to cutting out grains, legumes, and dairy per the standard paleo recommendations, the autoimmune protocol of the diet contraindicates nightshades (potatoes, tomatoes, eggplants), peppers (bell peppers, hot peppers, etc. and spices containing peppers like curry powder, paprika, and chili powder) and eggs. Since there is already an established association in the mainstream medical community with dairy and type I, I don’t think it’s too much of a stretch to suggest that some or all of these other foods might be contributing factors as well. There’s no conclusive evidence at this time, however.

For type I diabetics, a study on a low carbohydrate diet showed that it significantly decreases insulin dependence and prevents large swings in blood glucose levels. A recent study — one of the few so far that specifically looked at a paleo-style diet — shows that a paleo diet is apparently also good for insulin control. This is not a big surprise considering that the food restrictions and recommendations often add up to paleo being a de-facto low glycemic index and/or low carb diet, depending on your food choices day to day.

So, changing your diet might help prevent the development of even type I diabetes, and if you eventually develop it anyway, will help with control of blood sugar swings, reduce your use of insulin, and probably decrease your chances of complications from the disease.

As for the exercise angle, it’s well known that glucose sensitivity changes in response to exercise. This change apparently takes place at the cellular level involving glucose transport molecules. This is quite apart from any body composition changes as an adaptation to exercise, like decreased adiposity and increased lean body mass. Anything you can do to reduce your body fat to appropriate levels will change both insulin signaling and your hormone profile in various ways, and exercise is positively associated with long-term maintenance of a healthy weight.

17

Apparently diabetes rates have increased a lot over the last 20 or 30 years, both inside and outside the United States. So it’s reasonable to think that something has changed in peoples’ environments which increases the chances of getting diabetes. The obvious suspect is Western Junk Food, like McDonalds food, Kentucky Fried Chicken, etc.

Anyway, consider the contrapositive: If increased amounts of junk food (or some other environmental factor) caused millions of people to get diabetes over the last 20 or 30 years, then in the time before that, there were millions of people who did NOT get diabetes because they did NOT consume the junk food which has become so cheap and available.

It follows that avoiding junk food can indeed completely prevent diabetes for a lot of people.

18

The concept that diabetes rates are skyrocketing is not that cut and dried. A good deal of the increased rate can be traced to 3 things.

  1. The median age is going up, and diabetes is a disease that increases with age (an older grayer society has a higher % who are Type II).

  2. There is more public awareness of diabetes, so more people who have it know it. I think that there are about 2-3 diagnosed diabetics for every 1 non-diagnosed. The ratio was probably different in the past when people didn’t know they had it.

  3. The definition of diabetes is more lax now. It used to be a fasting blood glucose to 140, now it is 126. That alone added million(s) to the rank and file of diabetics.

I’ve also read that average fasting glucose levels haven’t changed much since the 80s.

Having said that, a healthy diet and exercise can delay diabetes. I don’t know if they can prevent it for everyone though, or just for some people. I get the impression with some people their glucose control gets worse and worse with time, if lifestyle alone controls it in their 40s, by the time they hit 60 they may need drugs too.

19

I agree that these are issues which need to be addressed before anyone can reasonably conclude that diabetes rates have increased a lot.

I did not research the issue exhaustively, I just did a quick Google search and found this study which used a consistent definition of diabetes and concluded that total rates of diabetes (both diagnosed and undiagnosed) had increased substantially over the last 20 years within each age group.

Yes, the question is how much a difference it can make.