Diabetes and Lipid Clinic of Alaska



Can diabetes be prevented?

Diabetes can be a serious, costly and devastating disease. We know that the diagnosis of diabetes is preceded by a decade or more of increasing resistance to the effect of insulin and ultimately to the progressive failure of the pancreas which is the body organ that produces insulin. Glucose is the fuel that powers the body and the body functions best when glucose is maintained in a very narrow range of about 80-95.

As the pancreas progressively fails, the ability to produce insulin drops below the level needed to maintain normal glucose levels. As this happens, blood glucose values start to rise. When fasting glucose levels rise to greater than 126 or when glucose values taken after a meal rise to greater than 200 then we say that the person has developed diabetes. The reason that these glucose levels define diabetes is that above these levels, damage occurs to the small blood vessels of the body, particularly those in the eye and the kidney.

Generally, we consider glucose to be normal if it is less than 100 fasting, and less than 140 measured 2 hours after a meal or glucose challenge.

“Pre-Diabetes” falls in between the normal and the diabetic range. That is to say, a fasting glucose that is higher than 100 but less than 126, or a glucose value a standard glucose challenge that is greater than 140 but less than 200.
About 15% of people who have glucose values in the pre-diabetic range will become diabetic each year. If we could prevent some or most of these people from becoming diabetic then we could make enormous savings in cost and human suffering.

Should “Pre-Diabetes" be treated?

There has been considerable discussion about whether it is worthwhile to treat Pre-diabetes, or simply treat the diabetes once it develops and try to prevent complications at that time.

This is like not treating a pre-cancerous lesion because by itself it is not going to limit lifespan. However, as we know, that is obviously bad medicine since if it turns cancerous it would certainly limit lifespan. Waiting for the lesion to progress before taking it seriously obviously makes no sense.

Many studies have shown that increased risk for heart attack or stroke (what we call macrovascular or large blood vessel disease) starts with glucose values that are in the “impaired” range that we see in pre-diabetes. Potentially treatment of pre-diabetes and prevention of diabetes may reduce these risks of heart attack & stroke


Two large studies looked at the impact of changes in lifestyle on the change from pre-diabetes to diabetes. In both studies, intensive lifestyle changes resulted in a 58% reduction in diabetes.

That is the good news; the bad news is that it takes intensive and costly lifestyle changes to accomplish this and many people would not be able to make these changes.

In essence, as per the trial called Diabetes Prevention Program (DPP), success depended on:

  • Weight loss of 7% of total body weight
  • Exercise for at least 30 minutes per day
  • Consume a diet, low in fat, high in fiber

While we always recommend lifestyle changes, many people are unable to maintain the intensity of change that would lead to a meaningful reduction in the conversion to diabetes.

Diabetes prevention: 5 tips for taking control


Tweaking your lifestyle could be a big step toward diabetes prevention—and it's never too late to start. Diabetes prevention is as basic as losing extra weight and eating more healthfully. Consider the latest diabetes prevention tips from the American Diabetes Association.

Tip 1: Get more physical activity

There are many benefits to regular physical activity. It can help you lose weight but even if it doesn't, it's still important to get off the couch. Whether you lose weight or not, physical activity lowers blood sugar and boosts your sensitivity to insulin—which helps keep your blood sugar within a normal range.

Research shows that both aerobic exercise and resistance training can help control diabetes, but the greatest benefits come from a fitness program that includes both.

Tip 2: Get plenty of fiber

It's rough, it's tough—and it may reduce the risk of diabetes by improving your blood sugar control. Fiber intake is also associated with a lower risk of heart disease. It may even promote weight loss by helping you feel full. Foods high in fiber include fruits, vegetables, beans, whole grains, nuts and seeds.

Tip 3: Go for whole grains


Tip 4: Lose extra weight

If you're overweight, diabetes prevention may hinge on weight loss. Every pound you lose can improve your health. And you may be surprised by how much. In one study, overweight adults who lost a modest amount of weight—5 percent to 10 percent of initial body weight—and exercised regularly reduced the risk of developing diabetes by 58 percent over three years.

Tip 5: Skip fad diets and make healthier choices

Low-carb, low-glycemic load or other fad diets may help you lose weight at first, but their effectiveness at preventing diabetes isn't known; nor are their long-term effects. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients. Instead, think variety and portion control as part of an overall healthy-eating plan.

The American Diabetes Association recommends blood glucose screening for everyone age 45 and older who's overweight. If you're older than age 45 and at a normal weight, ask your doctor about earlier testing. Also ask your doctor about testing if you're younger than age 45 and overweight with one or more additional risk factors for type 2 diabetes—such as a sedentary lifestyle or a family history of diabetes.

Also share your concerns about diabetes prevention. Your doctor will applaud your efforts to keep diabetes at bay, and perhaps offer additional suggestions, possibly medications, based on your medical history or other factors.


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