Being overweight is the number one risk factor for developing type 2 diabetes. Weight is also directly linked to prediabetes. It’s harder to treat diabetes if you’re not at a healthy weight.
Diabetes is a disorder of metabolism – the way your body uses food and converts it to the energy you need to live – to move around, exercise, think or sleep. Type 2 diabetes, which accounts for up to 95 percent of all diabetes diagnosed in adults, usually begins with insulin resistance. Resistance means the cells in your body do not use insulin properly.
Type 2 diabetes is caused by having too much glucose in your blood, also called blood sugar. As your food digests, it is broken down into glucose. Glucose is a form of sugar that is capable of entering your bloodstream. Combined with insulin, your body absorbs glucose and provides energy.
Insulin, a hormone, is made inside your body. It is made in response to the amount of glucose in your blood. Insulin regulates your body’s use of glucose to provide energy.
People with diabetes can have too much glucose in their blood for two reasons: their body does not make enough insulin, or their body does not use insulin properly, called insulin resistance.
Insulin resistance is common among people who are not physically active and are overweight. This is especially true for people who carry extra weight around the belly area, rather than around the hips. Being overweight makes it hard for your body to use insulin. In response to insulin resistance, your body starts producing more insulin to compensate. Blood glucose levels may stay in the normal range for a while. But, eventually your body cannot produce enough insulin and glucose levels rise. Now you have prediabetes and are headed down the road to full blown type 2 diabetes.
How much to lose?
You can determine if your weight is causing health risks by using three key measurements:
- Body mass index (BMI) estimates body fat through a calculation based on height and weight. Normal BMI is 18.5 – 24.0, overweight is 25 – 29.9 and obese is 30 or more. It easiest to use this BMI chart.
- Waist measurement should not be more than 35 inches for women, or more than 40 inches for men. If most of the fat is around your waist, rather than at your hips, you have a higher risk for type 2 diabetes and heart disease.
- Other risk factors are associated with obesity, including high blood pressure, high cholesterol levels, high blood glucose, not being physically active, tobacco use or a family history of any of these risk factors.
Simple, two-step treatment
You can control diabetes, or, if you have prediabetes, you can stop the downward spiral toward type 2 diabetes with a two-pronged approach. Lose just five to seven percent of your body weight and become more active for 150 minutes every week. These two lifestyle changes are the most effective tools to treat diabetes or prediabetes. Even a modest weight loss can have a major benefit for people with diabetes.
“People with prediabetes who take part in a structured lifestyle change program can cut their risk of developing type 2 diabetes by 58 percent (71 percent for people over age 60),” according to the Centers for Disease Control and Prevention.
For a person who weighs 180 pounds, that means losing just 9-13 pounds. But that includes not gaining back the weight.
If your doctor says you have prediabetes, that means you have a much higher chance of developing type 2 diabetes, heart disease and stroke. Losing some weight and getting a moderate amount of physical activity every day can delay or prevent type 2 diabetes. For every two pounds a person with prediabetes loses, he will reduce his risk of progressing to type 2 diabetes by 12 percent. An eight-pound loss can cut your risk in half, as long as you keep it off.
Many people who implement these lifestyle changes and stick with them will see their body return to normal glucose levels, often without taking medications. The sooner you start these lifestyle changes the better health you’ll have.
Getting to an ideal BMI improves the health of people with diabetes and prediabetes. But, is maintaining an ideal weight a realistic goal for all people with diabetes? The answer is “no,” judging from the United States’ growing obesity epidemic.
Weight loss is more difficult for people with diabetes or prediabetes. The body adapts when calories are reduced. Many dieters find they can stay on a weight-loss diet and maintain the weight loss. However, it’s frustrating to not be able to lose additional pounds. Weight loss often plateaus at about six months and most people can keep the weight off for about a year.
One way to accomplish additional weight loss is to continue to reduce portion size. The benefits to your blood glucose control begin to occur almost immediately upon reducing the amount of food and beverages you consume. It occurs even before much weight has been lost. Eating less has long-term beneficial effects independent of weight loss.
Self-control your food
In the October 2016 article of AFMC’s, diabetes series we showed how important it is to develop a personal meal plan. There is no “diabetic diet.” But, a personal meal plan will show what foods and how much of them you can eat.
Eat a variety of healthy foods that are low in fat, salt and sugar. Look for high-fiber foods such as beans, veggies and whole grains. Use this guide when filling your plate:
- ¼ lean protein such as fish or chicken
- ¼ whole grains
- ½ vegetables and fruits
- Low-fat dairy or water as your beverage
Get in the habit of reading food package labels so you know exactly what you’re eating. Remember, you’ll need to reduce your calories by 3,500 calories to lose one pound of body fat. If your goal is to lose a pound a week, that means you’ll need to cut out 500 calories a day, every day.
Try using Lose It, My Fitness Pal, or SuperTracker Home. These free internet or smartphone apps make it easy to track your food and calorie intake and activity levels. But you have to use them. Try starting with just tracking your food and beverages on weekdays. Take the weekend off but try to keep eating healthy. Like any lifestyle change, it will take several weeks to establish before it becomes part of your daily routine.
Becoming more active
In addition to controlling your weight, effective diabetes treatment should include increased physical activity. Doing moderate to vigorous aerobic exercise for 30 to 60 minutes a day, most days of the week, provides many benefits.
Any activity helps you meet the goal of getting 150 to 300 minutes of moderate activity each week. That means about 30-45 minutes a day, on most days of the week. By choosing activities you enjoy, you’ll be more likely to remain physically active for the rest of your life.
You don’t have to be active for 30-45 continuous minutes. If your schedule is hectic, mix it up by getting 10-15 minutes of activity at three different times of the day. For people with diabetes, the best time to exercise is about 30 minutes after a meal. This gives your food time to digest, and is about the time when glucose starts flooding your body. The health benefits are the same as long as you’re active most days of the week. Try to get at least 10 minutes of activity at a time.
If you’ve been a couch potato for a while, start slow with exercise. Start with just 10 minutes a day of moderate activity. Adding five minutes each week will get you to the minimum of 30 minutes a day in five weeks. At the end of five weeks, this lifestyle change will have become a habit – just part of your daily routine.
Moderate physical activity means you are breathing quickly, yet you’re not out of breath; after about 10 minutes you will be lightly sweating; and while you can talk normally, you are breathing fast enough that you cannot sing.
Vigorous physical activity means you are breathing deeply and quickly; working up a sweat after a few minutes and cannot talk normally without stopping for a breath.
There are different types of exercise and it’s best to engage in a variety of them each week:
Aerobic exercise uses large muscles, makes you breathe harder and your heart beat faster. Examples of aerobic exercise include walking, jogging, climbing stairs, hiking, dancing, bicycling or using a stationary cycle, an exercise class, or playing a sport such as tennis or basketball.
- Strength training builds muscle and keeps your bones healthy. You can use hand weights, elastic bands or weight machines in a gym. Work up to every other day but at least two times a week. Start with a light weight and slowly increase the weight as your muscles become stronger. A rule of thumb is, if you can do 8 to 12 repetitions using a hand weight, it’s time to increase the weight by one to two pounds.
- Stretching activities increase the flexibility of your joints. Stretching also lowers stress and helps prevent sore muscles. Yoga, tai chi and some floor exercises, if done slowly, are examples.
- Add variety and increase activities. Add extra activities throughout your day. For example, walk around while on the phone, lift hand weights while watching television, take stairs instead of the elevator, take a 10-minute walk at work instead of a coffee break, park far away from the store entrance, or get active with your children or grandchildren at a park. Add variety to your daily routine by, for example, walking 20 minutes, lifting hand weights for 10 minutes and then climbing stairs for 5 minutes.
Always discuss new physical activity plans with your doctor before starting to find out what’s safe for you. This is especially important if you have been inactive for a long time or you are over age 50. Also ask him or her if you need to adjust the amount of medicine or food you eat before/after physical activity.
For more information on setting exercise goals, see the Nov. 2016 post “Set Exercise Goals to Manage Diabetes.”