Lurching Toward Diabetes: What To Do Before The Sugar Hits

This Friday, the story and legacy of sweetness comes to the stage.

The new one-woman show Sugar, starring Robbie McCauley, breathes life into the sugar trade, slavery, racism and McCauley’s own struggle with diabetes.

Diabetes 101

In fact, a colloquial name for diabetes is “sugar”—appropriate, as the disease is characterized by having high levels of sugar in your blood.  Nowadays, diabetes often goes hand-in-hand with the word epidemic: 25.8 million Americans are diabetics — about 1 in 8 people (1 in 4 for those 65 or older).

McCauley suffers from the less common form, Type 1 diabetes, which accounts for about 5% of all cases. Her body produces little or no insulin (the hormone that enables sugar in the blood to enter the cells which, in turn, use it for energy). The majority of diabetics in America suffer from Type 2 diabetes, which is when your body doesn’t respond correctly to insulin (called insulin resistance) or doesn’t produce enough insulin. Type 2 diabetes disproportionately affects African-Americans, Hispanics, and American Indians. Regardless of the type, diabetes can lead to heart disease, stroke, high blood pressure, eye problems, kidney disease, nervous system damage, and amputations.

Catching It Early

McCauley told the Boston Globe, “My official diagnosis didn’t happen until I was in my early 20s, but I realized all my life that something was off in my body.”

She brings up a good point about being keyed into hallmark diabetes symptoms. For Type 1, there’s not much you can do to avoid the onset of the disease, but there’s a little more wiggle room for Type 2. This is hopeful, since the CDC estimates that 79 million Americans have prediabetes (when blood sugar levels are higher than normal, but not yet high enough to be classified as Type 2 diabetes). With these current estimates, roughly 1 in 4 Americans is at risk of developing full-blown Type 2 diabetes in 10 years or less. If you’re 45 or older, have a family history of diabetes, are overweight, don’t engage in much physical activity, or have other risk factors, you’re more likely to be diabetic. But if you know you’re prediabetic, there are several things you can do to delay—and even prevent—the onset of disease.

(If you’re curious if you’re at risk for diabetes, the American Diabetes Association offers an online Type 2 Diabetes Risk Test. You can also ask your doctor about testing your blood sugar.)

A Chance to Take Control

The Diabetes Prevention Program (DPP), a large clinical study of people with prediabetes, showed that lifestyle changes reduced the development of type 2 diabetes by 58%. (It’s even more encouraging for those 60 or older; their risk was reduced by 71%.) Study participants ate a diet lower in calories and in fat content and aimed to exercise 150 minutes a week so they could lose 7% of their body weight (which is about 12 pounds for a person that weighs 170 pounds).

A more recent study, done in the predominantly Latino and lower-income city of Lawrence, didn’t show such dramatic success as the DPP. But researchers did find that through culturally-tailored messaging and support — like using telenovelas, or Spanish-language soap operas, to talk about healthier food choices — minor weight-loss led to clinically significant blood sugar and insulin improvement among prediabetics.

I know, it’s the same ol’ advice: eat healthier and exercise more. But with over a quarter of the American population estimated to have prediabetes, it’s worth a try.

The power of encouragement shouldn’t be underestimated here. You probably know someone who has prediabetes so be sure to throw some emotional support their way. The DPP used intensive one-on-one counseling and group support during the study. It’s not just about the actual lifestyle changes; it’s also about a nurturing social environment that supports those lifestyle changes and helps maintain them.

Simple Advice, Complicated Solution

A nurturing social environment is one thing, an equitable physical environment is another.

If you live in a food desert, having access to healthy foods to “eat healthier” is about getting on a bus, trekking through the city, and finding someone to take care of the kids while you travel miles to buy healthy food options that might even be out of your budget. If you live in an unsafe neighborhood, the idea of going for a brisk walk at night in order to “exercise more” could be putting you in danger, whether real or imagined. Or maybe working two jobs gives you little time to go to the gym, which may not even be remotely close to where you live.

We’re bombarded by advice about healthy eating and exercise, but we also need to lend an ear to the social inequalities that make following that advice far more complicated. To pick up on this side of the conversation, I highly recommend you listen to Radio Boston today. Robbie McCauley from Sugar will be joining them, as will Yvette Cozier from the Boston University School of Public Health.


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  • Valerie S

    We need to do much more than “lend an ear to the social inequalities” that make following health guidelines for diabetes almost impossible for low income and minority people. It should be front and center in the debate since, as mentioned earlier in the article, T2 disproportionately affects African-Americans, Hispanics and Native Americans. The consequences of their poor health affects everyone, not only because they are our neighbors, but lost wages, productivity and the enormous monetary costs to our already precarious health care system. As far as food deserts, there is no city planning that I know of that prevents their development, or prevents fast food places from proliferating in poorer neighborhoods. Our cities need that kind of long-range planning- plans with health and wellness in mind. As a person who’s lived with T1 diabetes for over 20 years (the term “diabetic” is an unnecessary and unhelpful label) I know the time and effort involved in maintaining health. I do not have complications but I did not get to this point by myself, or on insulin alone. Emotional support is key- we need to do more than “throw some emotional support their way.” Pills, nagging, blaming and hand-wringing will not bring about the significant changes needed for all Americans to be healthy- not just those of us with diabetes. Ongoing support groups, mindfulness-based meditation techniques, art-based therapies, like storytelling groups (Robbie McCauley runs these) and diet and nutrition counseling should be integral to diabetes care (all health care!) alongside clinical care. Pills, and even insulin, are not magic bullets. If T2 diabetes is a lifestyle disease then let’s give Americans, especially low income and poor Americans, access to healthy environments and reject the “let’s make as much money as we can now” philosophy that drives our economy, while in the process, creates unhealthy environments.

  • Concord

    Parents are highly responsible for potential full-blown diabetics .  It’s essential that this writer’s recommendation to look up online for American Diabetes Association, be heeded.  No one ever regrets at the start, uncontrolled Diabetes brings multiple problems, to the individual and to the society.  No one wants to get blind, develop depression, suffer a stroke or a heart attack , ends up on dialysis, or die in coma,  only because of uncontrolled Diabetes.   

  • Daniel Haszard

    Be aware of drugs that potentiate diabetes.
    The use of powerful antipsychotic drugs has increased in children as young as three years old. Weight gain, increases in triglyceride levels and associated risks for diabetes and cardiovascular disease. The average weight gain (adults) over the 12 week study period was the highest for Zyprexa—17 pounds. You’d be hard pressed to gain that kind of weight sport-eating your way through the holidays.One in 145 adults died in clinical trials of those taking the antipsychotic drug Zyprexa. This was Lilly’s #1 product $5 billion per year sales,moreover Lilly also make billions more on drugs that treat diabetes.
    — Daniel Haszard Zyprexa activist and patient.

  • Reasonable?

    If you have a diagnosis of pre-diabetes or diabetes please consider a low carbohydrate diet: Paleo, Primal, Atkins, South Beach, even Eat to Live (which if followed strictly is low in effective carbs).

    Fat consumption is NOT a driver of diabetes or cardiovascular disease IF consumed with a low amount of carbohydrates.

    Consuming 20 to 50 g of carbohydrates per day will improve diabetic symptoms for most Type 2 diabetics.  Type 1 diabetes see Dr Bernsteins Type 1 Diabetes book.

    Popular medicine has not yet caught up with the evidence because of perpetuation of beliefs based on bad science.

    Unfortunately, many are suffering when solutions are freely available.

  • BustedPancreas

    Wow, one of the few good news stories out there regarding “diabetes.”  The authors at least got it right!! To reiterate – there is NOTHING that can be done, at this time, to prevent type 1 diabetes.  Type 1 diabetes is generally an autoimmune condition that results in the immune system attacking the insulin-producing beta cells of the pancreas.  People with Type 1 diabetes MUST take insulin to survive; there is no other treatment at this time.  People used to refer to type 1 diabetes as “juvenile diabetes,” but that term is no longer used because about 50% of type 1 diabetics are diagnosed as adults.