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Diabetes, Am I At Risk?

Last month I reviewed the definition and disease process of Diabetes. This month I would like to personalize this subject a bit more and explore whether you are at risk. I would also like to share some tests that are important when assessing Diabetes. My focus this month will be Type II Diabetes, since it is more common as we age and has a greater chance of prevention. Being informed is one of the best ways to reduce you risk and control this disease…so use this information wisely.

Although I have classified this as an American disease it affects all races and genders. American ethnic minorities seem to be hardest hit, especially African Americans, Native Americans, Asians and Hispanics who have a risk two to six times greater than the average Canadian or Caucasian American. Other risks include increasing age, obesity, sedentary lifestyles, history of gestational diabetes and family history of diabetes. Studies also show that those who are not breast fed and given cow’s milk (or milk based formula) instead have a greater risk. Body types that are Apple shaped (carry their weight in their abdomen/above the hips) and those who have a Buffalo hump (fatty accumulation at the top of the spine/base of the neck) are at greater risk. BMI’s of 30 or greater, or a high waist hip ratio are numerical guidelines to assess risk. Skin tags, those fleshy growths of skin commonly found on the neck and armpits are a sign of trouble with blood sugar control, not necessarily a tell-tale sign of Diabetes, but a clue that it is time to pay attention to your blood sugars. Those individuals who are already having trouble tolerating glucose in that their insulin response is not appropriate or their blood sugar levels do not return to fasting levels quickly enough; or those that have a history of hypoglycemia (low blood sugars) may all be at risk of moving towards a Diabetic state as well.

So maybe you have a few of the above risk factors, how do you know if you have Diabetes? Certainly if you are overweight and fit some of the numerical criteria a screening should be done. As we discussed last month, when the blood sugar levels remain high they begin to affect the blood vessels and organs they supply. Poor/blurry vision, recurrent vaginal yeast infections, or fungal infections causing itchy skin may be some early signs. The classic presentation is frequent urination with increased thirst, hunger as well as weight loss and fatigue; but at this stage the disease is well underway. Diabetes may diagnosed on a routine visit for other reasons. Diabetics frequently suffer from high blood pressure or high cholesterol and triglyceride levels, so if you have either of these very common conditions it may be a good idea to request some routine testing.

The most standard test for Diabetes is a fasting blood glucose level. The diagnosis of Diabetes may be made if there are one or more fasting blood glucose readings greater than or equal to 126mg/dL. Or if there are any of the classic symptoms along with a blood glucose over 200mg/dL. A second standard test is the Oral Glucose Insulin Tolerance Test. This test screens the body’s reaction to glucose and insulin over a two hour period, thus getting a thorough picture of this relationship, diagnostic criteria for this test is blood glucose over 200mg/dL two hours after a glucose challenge. Finally, a test which is useful in assessing blood sugar management over a longer time frame is the glycosylated hemoglobin test (HgA1c). If glycosylated hemoglobin is over 6.5% it is considered diagnostic of diabetes. HgA1c levels are also an effective way of monitoring whether blood sugar management has been good. Since this disease is at such epidemic proportions, most recent guidelines are encouraging practitioners to screen for borderline diabetes. Here lab values are fasting blood sugars between 100-125, or HgA1c of 5.7-6.4%, or glucose tolerance of 140-199mg/dL…enough numbers!?!

Naturopathically we are seeking to look at the body as a whole. With that in mind, and also considering the pancreas as part of the endocrine system, it is of great value to assess overall endocrine function by concurrently screening the thyroid and adrenals. These glands have a profound effect on how and why the pancreas is functioning as well. For example when we are experiencing stress cortisol is released from the adrenals which delivers a message to the pancreas to release insulin. When an overworked overweight individual’s pancreas is getting this message over and over again outside of meals you can see where the body is tempted to stop listening. Sadly this whole-body type of view is not often embraced in conventional practice, so I encourage you to ask!

Hopefully this has been some useful information in regards to the risks and diagnosis of Diabetes. Next month I will explore some preventative lifestyle suggestions and treatment options outside the norm…so stay tuned. Best wishes for a healthy 2012!

DO something you love, BE with someone you love, EAT your vegetables, DRINK clean water, BREATHE deeply and MOVE your body EVERYDAY!

By Tracy Erfling

Dr. Tracy Erfling is a naturopath physician in the Lower Columbia Region. Questions? erflingnd@hotmail.com