On a regular basis, I have to tell a new patient that their blood sugars are too high. But please don’t shoot the messenger: It’s nothing personal. Not when the latest statistics reveal that fully one-half of the population over age 65 is now diabetic or prediabetic. And certainly not when the stats show that the majority don’t even know. Unbelievable, right? But it’s true. It’s either you or your spouse. You or your next-door neighbor. You or your best friend. Fifty percent. It doesn’t have to be this way.
Here’s the better news: Ninety percent of this is reversible. Approximately 9 out of 10 don’t have to take this news lying down. Approximately 90 percent of the population can make this go away. That’s my job. I prevent diabetes and I do it with words. Words are my tool.
So let’s talk about the words that doctors use to make the diagnosis. “Diabetes.” “Pre-diabetes.” The term “diabetes” describes fasting blood sugars higher than 124, or a hemoglobin A1C higher than 6.4. “Pre-diabetes” indicates a fasting blood sugar between 100 and 124, or a hemoglobin A1c between 5.7 and 6.4. These numbers are helpful to medical professionals and insurance companies, especially for purposes of reimbursement, availability of services, and risk analyses for dreaded consequences (like heart attacks, blindness, amputations, dementia, strokes, kidney failure, and so on). They also give us a way to assess whether things are going in the right or the wrong direction. And I’m happy to share them with patients. But they don’t only mean what you think they mean. There’s more here than meets the eye.
Here’s what “diabetes” and “prediabetes” mean to me:
Don’t think of these terms as reflections of how abnormally elevated your blood sugars are. Rather, think of them as the degree to which you need to pay attention in order to get them back in the normal range. “Prediabetes” might mean that it’s time to start taking that daily walk you’ve been thinking about, to get more sleep, or to eat more nourishing fat (YES, I said that) such as avocados, olive oil, nuts, deep-sea fish and dark chocolate. Or maybe all three. “Diabetes” might mean that you’re likely to benefit from medication to sensitize your insulin and help it work more efficiently. Plus the walking, plus more vegetables, plus better sleep.
Diabetes does not mean the problem is more serious. It means the problem demands more attention. But if you do pay attention, if you do clear out the white flour, sugar, corn syrup and so forth from your cabinets, and switch your snack from a package of peanut butter crackers to a spoonful of real peanut butter, the chances are excellent that your blood sugars will benefit. And so will you.
What we call it has more to do with how much work it takes to keep blood sugars normal than the actual severity of the disease. The problem isn’t “diabetes.” The problem is elevated blood sugars. As long as you can keep your blood sugars in the normal range (most of the time), you win. It doesn’t matter what you call it.