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home : education : schools November 25, 2015

4/29/2014 1:10:00 PM
Are you on the Diabetes Train?
By Richard Aguilar, MD Medical Director Diabetes Care Foundation

Almost every day we hear about new diets, medications or exercise programs that can slow down, stop, and even "cure" Type 2 Diabetes Mellitus. With so much information and misinformation regarding diabetes, it seems the best place to start would be to discuss this disease state in a way we can all understand: The Diabetes Train.

Type 2 diabetes (T2D) is the development of abnormally elevated sugar in the blood called hyperglycemia. The fasting sugar in the blood should normally be <100mg/dl, and 2 hours after a meal challenge it should remain <140mg/dl. As the defects driving this disease progress, the normal glucose levels begin to slowly rise over time, often taking years to eventually pass these normal values. "pre-diabetes" is the usual first phase, and eventually in most cases it can proceed to T2D. If the development of T2D was like a train-ride starting in one location as normal and arriving at the destination with T2D, how long does it take to get from point A to point B, and when can we detect pre-diabetes?

Let's say we knew that Michael was going to develop T2D, we could say he has a genetic train ticket or predisposition to get on the Diabetes Train, but having a ticket doesn't mean he will arrive to his diabetes destination in his lifetime. The genetic predisposition, declining insulin production from the pancreas and the resistance to his insulin signals, are just some of the factors that constantly move the train along. His train starts in Los Angeles, CA at birth and eventually arrives at the New York state line where T2D is diagnosed. We now know that after the train starts moving the trip can take 10-15 years to fully develop. We also know that by the time he develops pre-diabetes, he has already traveled as far as Harrisburg, PA. In the 1980s, the average age of T2D was 67, it then dropped to 54 and now it is 46 years of age. This suggests that the Diabetes Train is now arriving at the New York state line much earlier in life than before.

So what's moving the train faster along its tracks?

Excessive calories, excessive weight, and lack of exercise cause the train to move faster, like adding coal to a locomotive engine. The U.S. population is now consuming more calories, is more obese and has decreased the time spent in daily exercise activities. More coal in the locomotive.

There are a number of medications available for the treatment of T2D, but those who are at risk for developing T2D, a predisposition for having a Diabetes Train ticket, should consider slowing down their train. Reducing the coal in their locomotive can be accomplished by reducing their intake of calories, their weight, and increasing their physical activities. This can easily be done by leaving a small portion of food at each meal on the plate (don't finish everything), a brisk walk for 10 minutes 2-3 times a day may be easier to carve out than a 30-minute program, and the loss of a couple pounds per month could go a long way.

Risk factors for T2D: Being overweight (a body mass index (BMI) greater than 25), a family history of diabetes, sedentary lifestyle, certain races (including Hispanic, Asian, American Indian), age over 45, hypertension, abnormal lipid levels (low HDL good cholesterol ) are some of the major risk factors.

Take the Diabetes Risk Test, available from the American Diabetes Association, to see your risk for developing diabetes and if you are at risk, try taking steps to slow down your train: www.

Sisters Country residents are invited to attend the free symposium, Healthy By Choice, on Thursday and Friday, May 1 and 2 at Sisters High School Auditorium. Doors open at

6 p.m.

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