Back from the edge

Barbara Wood, 70, from Mississauga, Ontario, remembers being diagnosed with prediabetes in the fall of 2010. “I was mad when I was diagnosed,” she says. “I thought, if you only had been sensible and not put all this weight on yourself.”

Fortunately, with two changes, diet and exercise, Wood can lose her excess weight and perhaps reverse prediabetes. Unfortunately, those two changes are not easy. Humans need energy to live. The human body gets energy by making glucose from food, but cannot immediately use the glucose. It needs insulin to use glucose. The pancreas produces insulin, a hormone that enables the body to control the level of blood glucose, also known as sugar.

With type 2 diabetes, the body does not properly use the insulin the pancreas produces, or the pancreas does not make enough insulin to regulate levels of glucose. The result: Instead of it being properly used for energy, the glucose builds up to toxic levels in the blood.

Prediabetes is a diagnosis for blood glucose levels that are higher than normal, but not high enough to be diagnosed as type 2 diabetes. It is a diagnosis for the middle ground between having healthy blood sugar levels and having type 2 diabetes. The good news is that it is reversible, says Dr. Catherine Yu, Endocrinologist at St. Michael’s Hospital in Toronto. The most effective way to prevent type 2 diabetes is by losing 5% body weight, she says. Those diagnosed with prediabetes have time to start eating healthy and working towards exercising for 150 minutes a week.

“It is not that we eat the wrong things,” says Wood. “We eat a lot of vegetables and our lifestyle is not over the top—it is portion control. That is something I have not got control over yet. I like food! At times, I do have to have a dessert. I’ve always had a sweet tooth.”

After being diagnosed with prediabetes, Wood did not immediately make lifestyle changes. Physically, she felt fine. She knew she needed to lose weight, but the pressure was not urgent. Then at the start of 2011, her younger brother died from diabetes after having the disease for two years. “He turned black around the extremities,” she says. Other than her late brother, to her knowledge no one else in her family has diabetes.

“It was shocking to hear about him after just being diagnosed with prediabetes,” she says. “I thought, ‘oh I better do something. I better be sensible.’”

The disease is an epidemic in this country, with more than ten million Canadians diagnosed with diabetes or prediabetes. [ED note: This statistic has been updated to reflect the recent research.]

“People need to realize that their lifetime risk for prediabetes is probably one in four. It is very, very high,” says Dr. Michael Riddell, Ph.D., Associate Professor at York University’s School of Kinesiology and Health Science. “Largely, that risk is tied to excess body weight and physical inactivity.”

Muscles are responsible for approximately 80% of the bodily blood sugar disposal, says Dr. Riddell. “What is amazing is that you can exercise and not lose any weight whatsoever, but lower your diabetes rates dramatically.” The more muscle a person has, “the more machinery to clear the blood sugar, as well as the fats, in the body.” This is why exercise is important in preventing and managing diabetes.

The most dangerous place to have excess fat is in the abdomen, since it is close to the vital organs. This fat has been shown to be more metabolically active, he says. This means the fat in this area is releasing chemicals, called adipokines, into the body’s circulation that have damaging effects on other tissues, such as the liver, muscles and the pancreas. If a person stores fat in their abdomen, they may be at a higher risk of developing diabetes. Fat is stored safely in the legs, arms and just under the skin where it does not release adipokines.

“This should be a combination of moderate intensity aerobic activity, where you can still carry a conversation while doing it, and resistance training at least two days a week,” says Dr. Riddell. “Just get that first 15-minute brisk walk in. Once you do that for a few weeks the results can be remarkable.”

To lose stubborn abdominal fat one needs to build up to full-body workouts that expend lots of energy. Dr. Riddell recommends brisk walking, cross-country skiing and swimming; and, in particular, Nordic pole walking, which can lessen your risk of diabetes by 60%.

“The key concept behind nordic pole walking is pretty simple: It is cross-country skiing with-out skis,” says Dr. Klaus Schwanbeck, President of Nordixx, Nordic Pole Walking Canada. “While you walk, you propel yourself a little bit forward. You have all the benefits from this one exercise. You have cardiovascular and resistance training and use 90% of your muscles. Pole walking is the most effective exercise to treat and prevent all of the metabolic syndromes: diabetes, obesity and high blood pressure.”

“We used our poles for 15 years, but not the way Klaus does the walking,” says Wood. that’s where my problem lies,” she says. “His method is far better. You put your poles down right beside you instead of in front of you, which gives you more speed.”

Since being diagnosed with prediabetes, Wood has started to exercise more often and goes pole walking for 45 minutes three days a week. “I just have to quit eating—that’s where my problem lies,” she says.

Wood’s doctor explained to her that if she loses 60 pounds, her prediabetes will probably go away. “It is not easy—at least not for me,” she says.

Indeed, the likelihood that a prediabetic can prevent diabetes is very high, if they put in that 150 minutes of exercise a week. In contrast, the likelihood of reversing type 2 diabetes is low. “You have an opportunity,” says Dr. Riddell. “If you are lucky enough to know that you have prediabetes, you can save your pancreas. It is really rare to reverse diabetes and you may be bound to medication for the rest of your life. Now is the time to do something when you still have the time to do it.”

Dr. Riddell’s mantra resonates with Wood. “Now that I know I have it and it is only prediabetes, I can do something about it,” she says. “And I will.”

Type 1 diabetes: At a glance
Type 1 diabetes develops when the pancreas does not produce insulin. If you have type 1 diabetes, glucose builds up in your blood, and becomes toxic, instead of being properly used for energy. Type 1 diabetes is not preventable.

“A lot of the time people with type 1 are not as sedentary as people with type 2,” says Dr. Michael Riddell of York University. But for people living with type 1 diabetes, exercise is beneficial as well. Studies show that if you are physically active, you can live 10 more years with diabetes.