Discussing prevention in the realm of diabetes really involves three things: 1) The first is preventing diabetes altogether. 2) The second is the prevention of the progression of pre-diabetes to full-blown diabetes. And 3) is preventing the progression of diabetes once it is diagnosed and avoiding the development of organ damage caused by diabetes. So let’s take them one at a time.
First, the prevention of diabetes. I often say to my patients that diabetes stems primarily from three factors: your genes, your weight and your age. We can do precious little about our genes and no one has yet figured out how to stop the march of father time. So that leaves us with controlling our weight. By far, the most effective way to prevent diabetes is to control your weight, keep it down to as healthy a weight as possible, preferably below a body mass index of 25. As the table below demonstrates, the risk of diabetes rises very sharply with an increase in weight or body mass index (BMI).
Controlling one’s weight is easier said than done, as we all know. But as we age past our twenties and thirties, controlling weight becomes more difficult and requires a gradual, slow, but definite reduction in our daily calorie intake. This means we simply must reduce our portions, reduce our alcohol intake and reduce the carbohydrate calories we take in on a daily basis. Why is this necessary? In a nutshell, it is because our metabolism slows as we age year by year. Our calorie intake, the food and drink we take in, must therefore match that reduction of calorie expenditure by our bodies year by year.
Pay close attention to your weight. Step on the scale several times a week, if not every day. Examine your body mass index and work to keep it below 25 where the risk of diabetes is more tolerable. (You should know that the middle of the “normal” body mass index 21 is where the risk of diabetes is considered very low, but even though 25 is the upper end of “normal” body mass index, there is a significantly higher risk of diabetes.)
Additional research tells us additional, more subtle diabetes risk factors play a role, but I spend most of the emphasis here on body weight because it is far and away the most important predictor of diabetes year over year. There is a second and independent thing you can do to prevent diabetes – and that is exercise. Numerous research studies have shown the benefits of exercise in preventing and controlling diabetes, apart from its effects on weight. The most helpful form of exercise according to most experts is regular sustained walking of thirty to sixty minutes per day. More than sixty minutes is even better. But even short bursts of exercise are good for us and may have some preventive effect for diabetes. Intensive short bursts of exercise even several times a week probably helps.