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November 14th is World Diabetes Day. The purpose of this day is to raise awareness of a condition affecting millions of people all over the world. It is estimated that 3 million Canadians are living with diabetes, and almost 6 million have prediabetes. Over 50% of type 2 diabetes is preventable, and early intervention is key to preventing the progression of this chronic disease. In this article I will review how to assess your risk for developing type 2 diabetes, and what to do if you are at an elevated risk.

The following factors increase your chances of developing type 2 diabetes:

  • being overweight (especially if excess weight is carried in your abdomen)
  • age 45 or older
  • family history of diabetes
  • being of African, Arab, Asian, Hispanic, Indigenous, or South Asian descent
  • high blood pressure
  • high cholesterol
  • lack of physical activity
  • poor dietary habits
  • history of gestational diabetes (elevated sugar levels during pregnancy)
  • polycystic ovarian syndrome (PCOS)
  • obstructive sleep apnea

Diabetes and pre-diabetes can be diagnosed by measuring your hemoglobin A1C, a marker of how much sugar has been floating around in your bloodstream for the past three months. The A1C test is reported as a percentage. The higher the percentage, the higher your blood sugar levels have been. Results from this test can be interpreted as follows:*

6.5% or higher = diabetes
6.0 – 6.4% = prediabetes
5.5 – 6.0% = at risk for diabetes/prediabetes
Less than 5.5% = normal

If you do find yourself with suboptimal A1C levels, take this as a call to action. While we can’t change our age or genetic predisposition, we can control other predisposing factors such as our eating habits and sedentary lifestyle to prevent or at least delay the onset of type 2 diabetes. I generally focus on improving the following lifestyle factors:

  • Modest weight loss of 5-7% of body weight. That’s only 10 to 14 pounds for someone who weighs 200 pounds.
  • Reducing carbohydrates in the diet and increasing the amount of protein, fibre and healthy fat.
  • Physical activity (from walking to resistance training), aiming for 150 minutes per week.
  • Stress reduction.
  • Sleep, aiming for 7-8 hours/night and increasing the quality of sleep.
  • Correct nutrient deficiencies, especially vitamin D, which regulates the genes related to blood sugar metabolism.

Supplements such as chromium, berberine, magnesium, gymnema and bitter melon have been shown to support healthy blood sugar metabolism and may be an appropriate addition for some patients. Check with your naturopathic doctor to determine the dosage and duration of use that is best for you.

*It is important to discuss your optimal A1C level with a healthcare practitioner who can interpret it in the context of your age, ethnicity, and medical history.

References:

Houlden R. Diabetes Canada Clinical Practice Guidelines Expert Committee. Canadian Journal of Diabetes. 2018; 42 S1-S5. Retrieved from  https://www.canadianjournalofdiabetes.com/article/S1499-2671(17)30811-0/pdf

Elhayany A, Lustman A, Abel R, Attal-Singer J, Vinker S. A low carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a 1-year prospective randomized intervention study. Diabetes Obes Metab. 2010 Mar;12(3):204-9. https://www.ncbi.nlm.nih.gov/pubmed/20151996

Dyson PA. A review of low and reduced carbohydrate diets and weight loss in type 2 diabetes. J Hum Nutr Diet. 2008 Dec;21(6)530-8. https://www.ncbi.nlm.nih.gov/pubmed/18759958

Leung L, Birtwhistle R, Kotecha J, Hannah S, Cuthbertson S. Anti-diabetic and hypoglycaemic effects of Momordica charantia (bitter melon): a mini review. Br J Nutr. 2009 Dec;102(12):1703-8 https://www.ncbi.nlm.nih.gov/pubmed/19825210

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Ooi CP, Yassin Z, Hamid TA. Momordica charantia for type 2 diabetes mellitus. Cochrane Database Syst Rev.2012 Aug 15;8:CD007845.

Suksomboon N, Poolsup N, Yuwanakorn A. Systematic review and meta-analysis of the efficacy and safety of chromium supplementation in diabetes. J Clin Pharm Ther. 2014 Jun;39(3):292-306

Kumar SN, Mani UV, Mani I. An open label study on the supplementation of Gymnema sylvestre in type 2 diabetics. J Diet Suppl. 2010 Sep;7(3):273-82

Hruby A, Meigs JB, O’Donnell CJ, Jacques PF, McKeown NM. Higher magnesium intake reduces risk of impaired glucose and insulin metabolism and progression from prediabetes to diabetes in middle-aged Americans. Diabetes Care. 2014 Feb;37(2):419-27

Wang J, Persuitte G, Olendzki BC, Wedick NM, Zhang Z, Merriam PA, Fang H, Carmody J, Olendzki GF, Ma Y. Dietary magnesium intake improves insulin resistance among non-diabetic individuals with metabolic syndrome participating in a dietary trial. Nutrients. 2013 Sep 27;5(10):3910-9.

Mooren FC, Krüger K, Völker K, Golf SW, Wadepuhl M, Kraus A. Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects – a double-blind, placebo-controlled, randomized trial. Diabetes Obes Metab. 2011 Mar;13(3):281-4

Zhang H, Wei J, Xue R, Wu JD, Wang ZZ, Wang SK, Zhou ZX, Song DQ, Wang YM, Pan HN, Kong WJ, Jiang JD. Berberine lowers blood glucose in type 2 diabetes mellitus patients through increasing insulin receptor expression. Metabolism. 2010 Feb;59(2):285-92

Yin J, Xing H, Ye J. Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism. 2008 May;57(5):712-7