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NEW YORK: More than one in three adults in the United States has prediabetes, a condition in which blood sugar levels are higher than normal, which can lead to diabetes. And more than 1 in 10 people have diabetes, a condition characterized by even higher blood sugar levels that can ultimately lead to eye problems, heart disease, stroke, nerve damage, and other serious health problems. Possibly.
By controlling blood sugar levels, these complications can be avoided. What you eat, when you eat, your exercise habits, and even your level of stress can all influence how high (or low) your blood sugar levels are.
“You don't want to wait until you're prediabetic or diabetic to start thinking about it,” said Dr. Elizabeth Halprin, chief of adult diabetes at Joslin Diabetes Center in Boston. “I want you to think about how to prevent that from happening.”
What is blood sugar?
Your body breaks down the carbohydrates you eat into glucose, which is absorbed into your bloodstream. This is the body's main energy source.
The pancreas senses the amount of glucose, or sugar, in the blood and produces a corresponding amount of the hormone insulin. Insulin is the key to getting sugar into cells and using it as fuel.
Normally, some sugar remains in the blood and binds to proteins such as hemoglobin. That's fine in itself, but too much can cause problems.
“Think about spilling milk or sweets on the floor. Think about how sticky it gets,” says Dr. Susan Spratt, a professor of medicine in the Department of Endocrinology, Metabolism, and Nutrition at Duke University. . “That's what's happening inside your body. It sticks to all your blood vessels and turns everything into gum.”
When blood sugar levels are consistently high, some people develop insulin resistance. Your body doesn't respond well to insulin, and your cells don't take in enough glucose from your blood. The pancreas produces more insulin, but eventually it can't keep up, leading to high blood sugar levels and eventually prediabetes or diabetes.
Over time, excess sugar in the blood can damage blood vessels and cause long-term complications of diabetes.
How are blood sugar levels measured? How do you know if your levels are healthy?
The hemoglobin A1C test measures what percentage of red blood cells have glucose bound to hemoglobin. This test helps your doctor estimate your average blood sugar levels over the past three months. A blood sugar test directly measures how much sugar is in your blood at any given time.
Doctors usually measure glucose and A1C using blood drawn from a vein. (You can also use a finger stick test.) To get an accurate baseline, you usually test your blood sugar while fasting, meaning you haven't eaten anything for at least 8 hours. Your doctor can diagnose diabetes if your fasting blood sugar and A1C levels are both above certain thresholds, or if one of them is above a threshold in two separate tests.
Doctors are trying to keep diabetic patients' A1C levels below 7% to reduce the risk of complications, which can cause lightheadedness, tremors, irregular heartbeats and, in severe cases, brain damage. The aim is to avoid hypoglycemia. It's working.
Doctors say wearable sensors called continuous glucose monitors that measure blood sugar levels in real time could be especially useful for patients at risk of hypoglycemia.
How often should I get tested?
The answer depends on your health and risk factors.
The American Diabetes Association recommends that doctors begin testing blood sugar in adults who are overweight or obese and have additional risk factors for diabetes. These include people who have a first-degree relative with diabetes or who have heart disease, high blood pressure, or polycystic ovarian syndrome. Due to biological and socio-economic factors, being of African American, Asian American, Latino, Native American, or Pacific Islander descent is also considered a risk factor. This is because diabetes is more prevalent in these groups than in white patients.
If your results show that you have prediabetes, you should have a blood test every year. If the results are normal, you should be tested every three years.
People without risk factors should start testing at age 35.
How do foods affect blood sugar levels?
Foods high in starch and carbohydrates, such as pasta, rice, bread, and potatoes, as well as sweet foods, such as cookies and soda, can raise blood sugar levels.
“In people with diabetes, the relationship between insulin and glucose is messed up,” Halprin says. The spike in sugar causes the pancreas to release large amounts of insulin. When your blood sugar levels plummet, you can experience cravings and feel sick.
Eating proteins and fats along with carbohydrates slows their absorption and makes blood sugar levels more stable. “The rise hasn't been that big, and the fall hasn't been that fast,” Halprin said.
Skipping or delaying meals and consuming alcohol in excess or on an empty stomach can cause hypoglycemia, especially in people with diabetes.
What else can cause blood sugar levels to spike or drop?
Exercise helps lower blood sugar levels by burning glucose for energy, building glucose-receptive muscles, and reducing body fat that makes cells resistant to insulin.
Stress causes an increase in a hormone called cortisol, which signals the liver to release more glucose into the blood, Spratt said.
Lack of sleep can also cause elevated cortisol levels, she said. And not sleeping well can make it harder to eat well, lose weight, exercise and deal with stress, which can indirectly affect blood sugar levels, Halprin said.
How do you keep your blood sugar levels in check?
Doctors recommend that people with diabetes or pre-diabetes eat a plate that's half green vegetables, one-fourth lean protein, such as fish or lentils, and one-fourth starch. Masu. Thinking about your diet this way can help you stay healthy even if you don't have diabetes.
Physicians often work with patients to identify changes that are practical and culturally appropriate.
“For example, you can't just tell a Hispanic person to stop eating rice or plantains and start eating salad,” Halprin says. “That won't work.”
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She might instead recommend eating less rice and more legumes, which are high in protein and fiber, which can help you feel fuller for longer. Whole grains can also be healthier. For example, replacing white rice with brown rice can help reduce blood sugar spikes. It's also helpful to add vegetables that are high in fiber and don't raise blood sugar levels, and avoid sugary drinks like soda and juice.
“Sometimes you can cut it out, and maybe they don't miss it too much,” said Dr. Elizabeth Vaughn, an associate professor at the University of Texas Medical Branch.
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Exercise (even just a 10-minute walk after a meal) can help lower blood sugar levels. It also helps you lose weight, which doctors say is essential in managing diabetes because it reduces insulin resistance.
What drugs lower blood sugar levels?
If these interventions are not sufficient, your doctor may prescribe medications. Metformin is an inexpensive and widely used first-line drug that reduces glucose production in the liver. Sulfonylureas are also an older, cheaper class of drugs that stimulate the pancreas to release more insulin, but they can cause blood sugar levels to drop too low and lead to weight gain.
Diabetes drugs such as Ozempic and Jardiance are expensive but can help with weight loss and lower blood sugar levels. Doctors say insulin is expensive and requires injections, but it is often effective when other drugs are ineffective.
“If you have a blood sugar problem and can't control it with diet, exercise, better sleep, or stress management, don't turn down your medication,” Spratt says.
This article was originally published in The New York Times.