Diabetes prevention measures

Maintaining a balanced lifestyle, conducting glucose tolerance screening at least once a year for high-risk groups, and initiating intervention as early as possible when signs of blood sugar damage appear—these three have been confirmed by long-term follow-up data from China, the United States, Europe and other countries and regions, and can reduce the risk of type 2 diabetes by more than 50%.

To be honest, I have been at a community endocrinology free clinic for almost three years, and I have seen too many people make mistakes in preventing diabetes. Last year I met a 47-year-old Aunt Zhang. Her mother and brother are both diabetic. Her fasting blood sugar was 6.3mmol/L, which is just on the border of impaired glucose tolerance. She was so panicked that she heard her neighbor say that "glucose rise is all caused by staple foods." She cut off all rice and noodles and only ate boiled vegetables and boiled eggs every day. After two months, she was so hungry that she felt dizzy and broke out in cold sweats from time to time. When she checked again, her blood sugar rose to 6.7mmol/L, and even her blood lipids were high.

In fact, regarding dietary prevention and control, there are currently two parallel mainstream directions in the nutrition field. There is no absolute right or wrong, only suitability. One is a low-GI balanced diet generally recommended by domestic guidelines. You do not need to completely cut out staple foods. You only need to replace 1/3 of the polished rice and white flour with whole grains such as oats, brown rice, and miscellaneous beans. Eat enough dark vegetables every day and control the intake of added sugar and fried foods. The advantage of this model is that it has a strong feeling of satiety. It is easy for ordinary people to adhere to it for a long time. There are almost no side effects. It is suitable for most pre-diabetes or high-risk groups. The other is the low-carb or even ketogenic diet that has become very popular in recent years, which reduces the energy supply ratio of carbohydrates to 20% or even lower, and mainly relies on fat and protein for energy. Many studies have confirmed that this model can quickly reduce weight and improve insulin resistance, but the mainstream attitude in the domestic endocrinology community is still relatively Caution: After all, most people cannot stop eating staple food for a long time. Once they return to a normal diet, it is easy to rebound. Moreover, long-term low-carb may also increase low-density lipoprotein and increase cardiovascular risks. Unless you can implement it under the full guidance of a professional nutritionist, it is really not recommended to try it on your own.

After talking about eating, let’s talk about the exercise that everyone is most likely to go to extremes. Don't believe the rumor that "you have to walk 10,000 steps a day to prevent diabetes." I just met an uncle two months ago. He walked more than 20,000 steps a day in order to make up for the steps. In the end, I developed synovitis in my knees. I lay at home for half a month, but my blood sugar rose a lot. The current consensus in the sports medicine community is actually very practical: as long as you move, it will work. If you are an office worker who sits in an office every day and cannot spare a whole time for fitness, you can break your exercise into pieces: get off the bus two stops ahead of your commute and walk for 15 minutes, stand up and do squats or raise your legs for 5 minutes every hour of work. Don’t slump on the sofa to check your phone immediately after eating. Stand and clean up the housework and take a walk. A total of 30 minutes of moderate-intensity activity every day can improve insulin sensitivity, which is not much different from running for 30 minutes continuously. Of course, if you have exercise habits and add strength training twice a week to build some muscles, it will be even more profitable - muscles are the "big consumers" of blood sugar. People with high muscle mass have much smaller blood sugar fluctuations than people with less muscle.

Another point that is most easily overlooked is screening. Many people think that if their fasting blood sugar is normal during the annual physical examination at work, they will be fine. This is really a big misunderstanding. I just treated a 32-year-old programmer last month, who is 175cm tall and weighs 180kg. His father has diabetes. The fasting blood sugar during the physical examination at the workplace was 5.4mmol/L, which seemed to be completely within the normal range. However, he always said that he was too sleepy to keep his eyes open after lunch and sometimes felt flustered. I asked him to do a glucose tolerance test. Two hours after the meal, his blood sugar reached 11.3mmol/L, which has reached the diagnostic standard for diabetes. Especially for high-risk groups with a family history of diabetes, a BMI over 24, high blood pressure and high blood lipids, and women who have had gestational diabetes, do not wait for the symptoms of "three more and one less" to appear before checking. It is best to do an oral glucose tolerance test once a year, including fasting and two-hour post-meal blood sugar measurements, so as to truly identify early blood sugar abnormalities.

As for the question that many people ask about "should you take medicine to prevent diabetes in the early stage?", the current guidelines in different countries do give different recommendations. The American Diabetes Association's guidelines recommend that if lifestyle adjustments have no effect after 3 months, you can take metformin or acarbose intervention, which can further reduce the risk of disease. However, our Chinese guidelines still recommend giving priority to lifestyle adjustments. Unless you have several high-risk factors, drug intervention is recommended under the guidance of a doctor. After all, taking medicine is always a supplement, and there is no "miracle medicine" that can replace a healthy lifestyle.

To be honest, among the hundreds of pre-diabetes people I have come into contact with, those who did not eventually develop diabetes are not the kind of people who are particularly harsh on themselves and dare not touch anything sweet. Instead, they are all able to stick to small changes: for example, changing the full-sugar milk tea they drink every day to three-thirds of sugar or sugar-free, taking an extra two or three days a week for a walk, occasionally eating hot pot and barbecue without anxiety, and just eating and exercising normally the next day. After all, preventing diabetes is a lifelong matter. A slow flow of water over a long period of time is much more effective than a fast-paced diet in the short term. There is no need to pursue 100% perfection. Habits that can be adhered to for a long time are truly useful habits.