Suffice to say, dramatic changes have occurred in our understanding of the onset and progression of prediabetes over the last decade. Lightening speed changes have also occurred regarding the therapies available to achieve optimal blood glucose control.
However, even with all of this change many old dogmas hang on. It’s time to be aware of the new realities. Here I’ve focused on two common old dogmas and the new realities.
Old Dogma: Losing weight will make blood glucose levels plummet no matter how long you have had type 2 diabetes. The message people hear from their providers, ad nauseam (I might add): “if you’d only lose weight your blood glucose would go down.” And the common reply from people with type 2, “I’ll try harder with my 'diet' over the next few months, but please don't put me on a 'diabetes' medication.”
New Reality: Research shows that the greatest impact of weight loss on blood glucose is in the first few months and years after diagnosis. (Read about the Look AHEAD trial results - study about weight loss effect on heart disease in type 2 diabetes) In fact, the biggest bang for the effort per pound is likely in the prediabetes phase (sad fact is most people don’t know or aren't told they have prediabetes). With loss of 5-7% of body weight (~10 to 20 punds) and 150 minutes of physical activity (30 min 5 times a week) large studies have shown that people can prevent or delay the progression to type 2. Once insulin production is on its dwindling course (particularly after 10 years with type 2), weight loss will have less impact on glucose control. Reality is if blood glucose is out of control – it’s time to progress blood glucose lowering medication(s) along because it's doubtful weight loss alone will get and keep blood glucose under control. Today, most experts (including American Diabetes Association and American Association of Clinical Endocrinologists) agree that people with type 2 should start on a blood glucose lowering medication which focuses on decreasing insulin resistance - the core problem in type 2 - at diagnosis.
Old Dogma: People with type 2 diabetes should follow a low carbohydrate diet.
New Reality: Nutrition recommendations for people with type 2 diabetes from American Diabetes Association and other health authorities echo the recently unveiled U.S. 2010 Dietary Guidelines (1/31/11) for carbohydrate: about 45 to 65% of calories (Americans currently eat about 45- 50% of calories as carbohdyrate - not a "high carb" intake).
Countless research studies do not show long term (greater than six months to a year) benefit of low carb diets on blood glucose, weight control or blood fats. People with type 2 diabetes, like the general public, should lighten up on added sugars and sweets (yes, they’re carbohydrate). They should eat sufficient amounts of fruits, vegetables, whole grains and low fat dairy foods – all healthy sources of carbohydrate.
Bottom line: The most important new reality for prediabetes and type 2 diabetes is: Take action as early as possible after diagnosis. Don’t delay, don’t deny. Get and keep your blood glucose, blood pressure and blood cholesterol in recommended target zones.