February 2008
Be vigilant about blood sugar
Doctors used to believe that people whose fasting glucose levels were below the threshold for diabetes—126 milligrams per
deciliter—were not at increased risk for serious complications. But the latest studies show that even a level of 100 to 125
mg/dl can raise the risk of developing not only diabetes, but also heart attack, stroke, and possibly cognitive decline and
certain cancers.
A new worry: The metabolic syndrome
The government now refers to minimal elevations of glucose, known as impaired fasting glucose, as “pre-diabetes.” These elevations might harm the body directly by damaging blood vessels and nerves. And they might signal a newly identified disorder called the metabolic syndrome, which sharply increases the risk of cardiovascular disease (and possibly certain types of cancer).
The syndrome, in theory, develops when the body starts to resist the glucose-regulating effects of the pancreatic hormone insulin. This apparently triggers a combination of risk factors—not only marginally elevated glucose levels, but also low HDL cholesterol (the good kind) and high triglycerides (a fat that increases coronary risk), as well as excess abdominal fat and high blood pressure.
Your blood sugar levels, in addition to letting you know whether you’re at risk for diabetes, will inform you about your risk for metabolic syndrome.
So, should you test?
Everyone age 45 or over should have their fasting blood-glucose level measured at least every three years. People at high risk require more frequent and earlier testing. Get tested annually starting at age 35 if you have any of the following risk factors (and even sooner if those risk factors are severe or multiple):
If your blood sugar is high-normal, make some lifestyle changes
Consumers Union’s medical consultants advise everyone with a minimally elevated fasting glucose level, with or without other risk factors, to make the necessary lifestyle changes to reduce that level. If your level is high, you should:
If those steps fail to normalize your fasting glucose level, talk to your doctor about whether the benefits of metformin,
a diabetes drug, would outweigh the risks.
If you already have diabetes, take steps to protect your heart
If you have diabetes—either type 1 or type 2—you are the key to controlling it. Research shows that vigilant care can prevent or reduce the risk diabetes poses to the heart (and other organs).
Unfortunately, experts say, some 80 to 85 percent of people with diabetes don’t engage in optimal self-care. If you’re willing to do so, it can make a huge difference in your outcomes.
Once you’ve been diagnosed with diabetes, your plan should include the following:
A new worry: The metabolic syndrome
The government now refers to minimal elevations of glucose, known as impaired fasting glucose, as “pre-diabetes.” These elevations might harm the body directly by damaging blood vessels and nerves. And they might signal a newly identified disorder called the metabolic syndrome, which sharply increases the risk of cardiovascular disease (and possibly certain types of cancer).
The syndrome, in theory, develops when the body starts to resist the glucose-regulating effects of the pancreatic hormone insulin. This apparently triggers a combination of risk factors—not only marginally elevated glucose levels, but also low HDL cholesterol (the good kind) and high triglycerides (a fat that increases coronary risk), as well as excess abdominal fat and high blood pressure.
Your blood sugar levels, in addition to letting you know whether you’re at risk for diabetes, will inform you about your risk for metabolic syndrome.
So, should you test?
Everyone age 45 or over should have their fasting blood-glucose level measured at least every three years. People at high risk require more frequent and earlier testing. Get tested annually starting at age 35 if you have any of the following risk factors (and even sooner if those risk factors are severe or multiple):
- Excess weight, especially with extra belly fat.
- A sibling or parent with diabetes.
- A family history of heart attack in men before age 50 or in women before age 65.
- Race other than Caucasian.
- Gestational diabetes (diabetes during pregnancy) or delivery of a baby weighing more than 9 pounds.
- An HDL level of less than 40 milligrams per deciliter for men; less than 50 mg/dl for women.
- A triglyceride level of 150 or more.
- Hypertension or use of antihypertensive drugs.
- A minimally elevated glucose level on a previous test.
If your blood sugar is high-normal, make some lifestyle changes
Consumers Union’s medical consultants advise everyone with a minimally elevated fasting glucose level, with or without other risk factors, to make the necessary lifestyle changes to reduce that level. If your level is high, you should:
- Exercise, lose weight, and follow a low-fat, low-calorie diet.
- Cut back on saturated and trans fats, even if your LDL level isn’t high.
- Limit your intake of refined carbohydrates.
- Get up to 30 to 35 percent of your calories from fat, mostly unsaturated—even if you don’t need to lose weight.
If you already have diabetes, take steps to protect your heart
If you have diabetes—either type 1 or type 2—you are the key to controlling it. Research shows that vigilant care can prevent or reduce the risk diabetes poses to the heart (and other organs).
Unfortunately, experts say, some 80 to 85 percent of people with diabetes don’t engage in optimal self-care. If you’re willing to do so, it can make a huge difference in your outcomes.
Once you’ve been diagnosed with diabetes, your plan should include the following:
- Exercise. Physical activity can help lower glucose levels and reduce the need for medication, mainly by burning glucose for energy
and, in type 2, by reducing the body’s resistance to insulin. Aim for an hour of physical activity most days of the week.
For advice, click Stay active and fit. - A heart-healthy diet. High-carbohydrate foods such as whole grains and fruits and vegetables used to be restricted or even off-limits. But experts
now recommend that diabetics follow the same heart-healthy diet that is recommended for all Americans. (Just be sure to eat
at regular times, and limit caloric intake for weight control.)
For advice, click Eat a heart-healthy diet. - A high intake of dietary fiber. The soluble kind found in foods such as oat bran, beans, and most produce, may improve glucose control and insulin sensitivity
(and even lower blood-cholesterol levels) in people with type 2 diabetes.
- Well-chosen diabetes drugs, if necessary. We have evaluated six oral diabetes drugs according to effectiveness, safety, side effects, dosing, and cost—
and have chosen three best buys. Read about them in Consumer Reports Best Buy Drugs, and talk to your doctor about which ones make the most sense for you.
- A diabetes-management program, if your health coverage allows it (about 75 percent of plans do). Such programs provide standardized care and periodic checkups
by various specialists, including an endocrinologist, a diabetes educator (usually a nurse), an ophthalmologist, a podiatrist,
a dietician, and an exercise specialist. (If your plan doesn’t cover a diabetes-management program, make arrangements on your
own to see an endocrinologist initially and then periodically, and to see a diabetes educator at least once.)
- Regular checks (three to four times per year) of a protein called HbA1c—a measure of long-term glucose control. Also, frequent at-home blood-glucose checks (talk to your doctor about how often).
Consumer Reports has evaluated best-selling blood-glucose meters for accuracy, consistency, convenience, and discomfort—here are the results.
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