Thirty-seven percent of Americans have prediabetes, fasting blood sugar levels considered higher than desirable. (Photo by Getty Images)
Natalie Bernstein, a svelte nursery school teacher, had taken a routine blood test when her doctor called her during the school day with bad news: She had diabetes.
It wasn’t a complete surprise, because her mother and younger sister both suffered from the condition. Her sister, Sonia, had juvenile diabetes, or Type 1, which is linked to an unfortunate gene. But Natalie’s diagnosis was Type 2 — and she was only 35.
Many people think of Type 2s as overweight folks who messed themselves up after decades on the couch guzzling chips and soda. At 5 feet, 7 inches, Natalie weighed 122 pounds, ate the occasional cookie and spent her days with small children. Keeping her weight up was her challenge: She tended to drop pounds fast when she worked out at gyms, so instead she walked several miles daily. “I felt fine,” she says.
“Diabetics are really a heterogeneous group,” says endocrinologist Ping Wang, who runs a fast-growing Diabetes Center at the University of California, in Irvine. The old division — Type 1 shows up young, Type 2 in middle-aged people with bad habits — is giving way to a much more complex picture, embracing more people.
More than 12 percent of Americans ages 20 and older have some form of diabetes, according to estimates from the Centers for Disease Control and Prevention, although a third of that group has not been diagnosed. Another 37 percent, including me — an experienced journalist who regularly covers health — have prediabetes, fasting blood-sugar levels considered higher than desirable.
Diabetes is not a single biological process; rather, its a name for symptoms related to high blood-sugar levels. When we eat a meal, the starches convert to glucose, aka sugar, and the bloodstream can only handle a small amount of glucose at a time, less than we ordinarily eat in a modern diet. So the pancreas releases insulin, which lowers the blood-glucose level. In Type 1 diabetics, the immune system is attacking the pancreas, and it doesn’t make insulin. Type 2 diabetics do make insulin and the vast majority doesn’t have an autoimmune problem.
In the classic explanation of Type 2, age and a fatty body make us insulin-resistant, and the pancreas has to release more insulin to do the job. Over time, it can’t keep up. About 85 percent of people with a diagnosis of Type 2 are overweight, one among many reasons to keep off those extra fat layers. Many heavy people, however, don’t develop diabetes and some Type 2 diabetics don’t fit the insulin-resistance model.
In short, people can end up with high blood sugar for a variety of reasons. A small number have a known genetic defect and so are called monogenetic diabetics. Researchers think that other genetic abnormalities will emerge. A sugar-heavy diet or yo-yo-dieting may work against you, too, but the research is still evolving. As science progresses, the basic advice to stay fit and reasonably slim remains the same.
What we can do differently is drop the blame game.
When my doctor told me I was prediabetic and diagnosed Metformin, a common medication, I felt a surge of shame. “Am I really that fat?” I asked piteously.
He looked at me kindly. “It’s genetic,” he said, and added, “It would still be a good idea to lose some weight — aim for 10 pounds.”
My case helps dispel the myth that all pre-diabetics or Type 2s are gorging on sugar and starch and are inactive. Gluten makes me ill, fast, so for a decade I had no desire for bread or cake. I also drank no soda and had only the occasional fruit smoothie. Yet in that same decade, I developed high blood sugar. I was also moderately fit, walking home from work two miles every day and biking on most weekends.
Related: Is Gluten Sensitivity for Real?
After my doctor’s edict, I upped my muscle building and adopted Pilates and dance. Although I now have visible ab indentations, my blood-sugar level is still high, despite the Metformin. (I’ll admit I haven’t lost the 10 pounds.)
I plan to work harder to avoid diabetes. Still, we can’t be angry at our genes. My grandmother developed diabetes when she was in her 60s. Just like me, she lived alone in an apartment, wrote daily, and could be pushy at times. I remember watching her eat a dinner of one slice of boiled brisket and a can of “dietetic” peas followed by a single square of sugar-free chocolate, as we talked happily for hours.
If diabetes happens to me, I’ll thank her for the blessing of her genes, the good and the bad.