Undetected Diabetes and Survival: Don’t Risk Itby James Hubbard, MD, MPH

You’re stuck in a bad storm and probably can’t get medical help for several days. You begin feeling really weak—maybe a bit nauseated. The weakness is not going away. Actually, when you think about it, through your currently fuzzy brain, you realize you’ve been feeling dehydrated and constantly thirsty for weeks now, but you’ve been urinating more than ever—even several times a night. Something’s up.

Finally, someone who has diabetes checks your sugar with their machine, and your level is sky high. Now you’re in a pickle because you need to get medical care within a day or two. If you don’t, you’ll keep getting worse and could go into a coma or die. In fact, even with treatment, many people with extremely high sugar die.

But the thing is, your situation could have been prevented. More than likely, the high sugar didn’t pop up overnight—one day it’s normal and the next it has doubled. Rather, it probably gradually came on, getting higher over days, weeks, months, or even years, and doing damage to your heart, eyes, kidneys, blood vessels, and nerves along the way.

As I’ve stated multiple times, prevention of disease is one of the keys to survival. Or, if you have a disease already, recognizing it and getting proper treatment so complications don’t occur is essential.

The U.S. Preventive Services Task Force recently came out with some new guidelines for screening for diabetes. The task force is pretty conservative on testing, so I take notice if they recommend something. The details are reported in the Annals of Internal Medicine.

The Task Force’s New Guidelines

For people without symptoms, the USPSTF previously only recommended screening if those people had high blood pressure. The task force found insufficient evidence of the pros and cons of screening for other people.

Am I Overweight?

If you’re not sure whether you’re overweight, you can find plenty of references for height and weight online. One common measurement is the body mass index, which you can calculate easily here. If you have a lot more muscle than most people, the BMI may inaccurately classify you as overweight, but otherwise it tends to works well.

Really, the old tried and true “look in the mirror” test will be enough for most of us. If neither of these things is definitive for you, though, there are some pretty simple instruments you can buy, such as the fat-pinching skin caliper,* to give you a good approximation of your body fat percentage.

But since those guidelines were published in 2008, new research has come out. The bottom line with the new recommendations is if you’re 40 to 70 years old and overweight or obese, you should have either a screening fasting blood sugar or a Hemaglobin A1C (a measure of your average blood sugar that doesn’t require fasting) at least every three years.

That doesn’t apply if you have a family history of diabetes or have symptoms, such as increased urination or thirst. In either of those cases, you may need to be screened right away, or at least more often. It does apply, however, to about two-thirds of the rest of us in that age range.

Recognizing diabetes is important so treatment can begin early to decrease your risk for all those bad things that can happen to your body that I mentioned. In fact, there’s some pretty good evidence that if the sugar is just a little high, walking briskly or doing similar exercise for 30 minutes five times a week and losing 7 percent or more of your body fat (less, of course, if you’re less than 7 percent over normal) can cut your risk of having full-blown diabetes by half. Hey, why don’t we all just do that anyway?

Of course, even if you exercise regularly and are at normal weight you can get diabetes. If you fall into that category, check with your doctor about how often you should be screened.

And finally.

The task force advises that certain groups may need to talk to their doctor to see if they should start glucose testing for diabetes screening at an earlier age or more often. These include “Persons who have a family history of diabetes, have a history of gestational diabetes or polycystic ovarian syndrome, or are members of certain racial and ethnic groups (that is, African Americans, American Indians or Alaskan Natives, Asian Americans, Hispanics or Latinos, or Native Hawaiians or Pacific Islanders).” People in these groups may have a higher risk for developing diabetes younger or with a lower BMI.

If you read the whole guidelines, the USPSTF goes into their logic on screening and how it can prevent complications. It’s pretty interesting.

What about you? Have you been screened? Have you been surprised with a high result? What about diet and exercise? Did it help lower your sugar?


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