Making lifestyle changes now can help stop or reverse the disorder
It was a few weeks before Christmas 2019, and I was nervous.
I had just been to the doctor, who told me I was 50 pounds overweight for my height. I was not looking forward to getting my lab results. My fear: a diabetes diagnosis.
During both my pregnancies, despite being a healthy weight, I developed gestational diabetes, which put me at risk of type 2 diabetes. And as my kids grew, so did the numbers on the scale, adding to that risk.
The lab results validated some of my fears. My fasting glucose level indicated prediabetes. That meant my blood sugar levels were higher than standard but not high enough to qualify as type 2 diabetes. More than one in three Americans has prediabetes, yet 84% don’t know they have it, according to the Centers for Disease Control and Prevention.
At 42 years old, learning I was prediabetic hit me hard. I was only a few years younger than my dad was when he received a type 2 diabetes diagnosis, and I remember the toll it took on his health.
For the 23 years my dad lived with type 2 diabetes, I watched him endure complications, including retinopathy, neuropathy, kidney failure, a foot amputation, and ultimately death at 68 years old.
As I reflected on his health journey and my diagnosis, I considered how genetics, family history, medical history, and lifestyle choices all play a part in the risk of developing type 2 diabetes.
Genetics and type 2 diabetes
The American Diabetes Association (ADA) explains that having type 2 diabetes means your body doesn’t use insulin properly. Insulin enables cells in the muscles, fat, and liver to absorb glucose from the blood. When the body creates insufficient amounts of the hormone insulin, glucose doesn’t go into the body’s cells and instead stays in the blood, making blood sugar levels rise and causing damage throughout the body. Some people can control their blood sugar levels with healthy eating and exercise; however, other people may need medication or supplemental insulin to manage it.
Over the past decade, researchers have identified hundreds of variations in genes related to type 2 diabetes, says Liana K. Billings, MD, vice chair of research and education in the department of medicine and director of clinical and genetics research in diabetes and cardiometabolic disease at NorthShore University HealthSystem.
By looking at an individual’s gene variations, researchers can create a score “that can potentially help determine a patient’s predisposition to developing type 2 diabetes or diabetes-related complications or dictate which therapy they will respond to if they have the condition,” Billings says.
The next step, she adds, is figuring out how to “leverage those exciting findings and be able to use them clinically in order to better predict and treat diabetes.”
But if you share a family history of type 2 diabetes, you share more than genetics. You also share certain lifestyle behaviors that may put you at increased risk, Billings says.
“Families tend to eat together and do activities together. So certain environmental exposures that are common among family members can increase risk of developing diabetes,” Billings says.
While some people inherit a predisposition for type 2 diabetes, environmental factors trigger its onset, according to the ADA. That’s where factors like weight, activity, and even air pollution come into play.
Measuring risk for type 2 diabetes
Marriam Ali, MD, assistant professor in the division of endocrinology at Loyola University Medical Center, says the following put you at higher risk of type 2 diabetes:
- Family history of type 2 diabetes, such as a parent or sibling with the condition.
- Underlying conditions like high blood pressure and high cholesterol.
- Low levels of physical activity.
- High body mass index (BMI).
Race and ethnicity. American Indians, Alaskan Natives, Hispanics, non-Hispanic Black people, and Asian Americans are at greater risk than white people, according to the ADA.
While the reasons for increased risk among some racial and ethnic groups are complex, the Food and Drug Administration reports that socioeconomic status, cultural attitudes and behaviors, and lack of access to healthcare all contribute.
Additionally, women of any race or ethnicity who develop gestational diabetes during pregnancy are more likely to develop type 2 diabetes later in life.
During pregnancy, the placenta produces hormones. Some of those hormones can block insulin, leading to insulin resistance. “Pregnancy is a window into the future of your health,” Ali says. “If you develop diabetes during gestation due to the short-term period of insulin resistance in pregnancy, this may indicate a future role of increased insulin resistance that leads to the development of type 2 diabetes later in life.”
People with type 2 diabetes tend to have chronic illnesses associated with metabolic syndrome, Ali says. Metabolic syndrome — marked by conditions such as increased BMI, high triglyceride levels, abnormal cholesterol levels, elevated blood pressure, and elevated fasting glucose — increases your risk for diseases including stroke and heart disease.
Preventing and reversing type 2 diabetes
Whether you’re at risk for type 2 diabetes or diagnosed with prediabetes, Ali says there are ways to prevent or delay its onset.
“Diet and exercise are crucial in the success of preventing diabetes,” she says. “Even small changes like adjusting your food choices to include nonstarchy vegetables, high-fiber carbs, and more lean protein; or modest weight loss, such as 5%; can be very effective in preventing diabetes.”
In people who already have type 2 diabetes, diet, exercise, medication, and insulin can help their glucose levels return to a prediabetic or nondiabetic range.
Some diabetes medications lower glucose production in the liver and improve the body’s sensitivity to insulin so it uses insulin more effectively. Other drugs help the body secrete more insulin, and still others reduce blood sugar.
The good news: Even though keeping diabetes under control is a lifelong effort, “It is very achievable with a commitment to diet and exercise, effective medications, and assistance from your diabetes care team to guide you along that journey,” Ali says.
Lifestyle modifications worked for me. After my prediabetes diagnosis, I began walking an hour per day and joined a weight-loss program. Within six months, I lost 30 pounds, and I am no longer prediabetic. Accepting my family history and my own medical history helped motivate me to make healthy changes. While making changes isn’t always easy, for me, the effort was well worth it.