Q: "I am 57 years old and have just been diagnosed with type 2 diabetes. I have always tried to eat healthfully and stay in shape, especially because I had gestational diabetes, but I am about 10 or 15 pounds overweight. Did I make myself sick? What should I do now?"
Answer provided by Tracey Hanrahan, M.D., family medicine, Providence Medical Group-Mercantile
In answer to your first question: no, you did not make yourself sick. Several factors have been at work here, and the two that probably influenced your diabetes risk the most – your prior gestational diabetes and your age, which puts you past menopause – were out of your control. Carrying an extra 10 or 15 pounds didn't help, but probably wasn't a major contributor. Let's look at each of these risk factors in a little more detail.
It has been well documented that gestational diabetes – high blood sugar that sometimes occurs during pregnancy – puts women at risk for developing type 2 diabetes later. About 5 to 10 percent of mothers who have gestational diabetes will progress into type 2 diabetes right after their pregnancy. Among women whose blood sugar returns to normal after gestational diabetes, there is a 20 to 50 percent chance of developing type 2 diabetes within the next 10 years. That's a very high risk. Your diabetes was diagnosed even later than that, and although we can't know with certainty, it's possible that your commitment to eating well and staying in shape played a role in holding it off for as long as you did.
Age and menopausal changes
For both men and women, the risk of developing type 2 diabetes increases with age. As a 57-year-old woman, you are in your post-menopause years, a time when hormonal changes increase the risk of both adding a little weight around the belly and developing diabetes. Most people aren't aware of the relationship between menopause, belly fat and diabetes risk, but it's pretty interesting, so I'll walk you through a quick explanation.
Before menopause, your ovaries produce most of your body's estrogen in a form called estradiol. Estradiol does a lot of good things: it lowers insulin levels, lowers blood pressure, increases the good kind of cholesterol and lowers the bad kind, and helps to regulate hunger so you feel more satisfied and less tempted to snack. After menopause, your ovaries stop working and your supply of estradiol is turned off. At this point, estrone, another form of estrogen that you've always had in small amounts, takes over as the primary form in your body. Estrone does things differently. It comes mainly from the adrenal glands, but is also created by fat cells. Estrone shifts fat storage from the hips and buttocks – where estradiol liked to store it – to the belly. When your postmenopausal body starts hanging onto that belly fat, the fat itself then turns around and produces more estrone. Rather than keeping insulin levels low, as estradiol did, rising estrone causes insulin resistance, which increases insulin levels. Higher levels of insulin increase fat storage, which increases the amount of estrone circulating in the body, and so on, creating a vicious cycle that feeds on itself and raises the risk of insulin resistance and diabetes, among other problems.
Excess body weight, especially around the belly, is a known risk factor for type 2 diabetes – the more overweight, the higher the risk. An extra 10 or 15 pounds probably isn't enough to be a major contributor, but it doesn't help, either. Those extra pounds do produce more estrone – that troublesome form of estrogen – and contribute to that insulin-resistance cycle. Losing them would lower your estrogen levels and help to moderate your insulin resistance.
One other comment about excess weight: perception and reality don't always agree when it comes to estimating how far overweight we are. For anyone carrying around a few extra pounds – especially if there are diabetes risk factors involved – I recommend a reality check with a physician to understand exactly where you stand compared to your ideal weight and body mass index.
So, what should you do now?
Get to know your disease.
Finding out that you have diabetes can be overwhelming. Learning how it works, what makes it better or worse, and what you need to do to keep it under control can be extremely complicated – but your health depends on it. My first recommendation is to start learning as much as you possibly can. Read about it, talk to other people who have it, and be proactive about taking control of your disease.
Team up with your physician.
Your primary care doctor can walk you through the myriad details of blood sugar balance, diabetes medication (if you need it), what symptoms to watch out for, and how to prevent complications. You should see your doctor every three months, at a minimum, to check your blood work, to get help with any challenges you're having, and to answer any questions that come up. In addition, your primary care doctor can connect you with a whole team of additional resources – such as certified diabetes educators, group classes and support groups – to help you manage your diabetes. Connect with your doctor and put the team to work for you.
Re-learn how to eat – as a family.
One of the biggest challenges for people diagnosed with diabetes is learning how to eat to keep blood sugar under control. The classes and educators listed above can help you with that. But it's the support of the rest of your household that will largely determine your success. Coming home from work to cook one dinner for yourself, and a different dinner for the rest of the family, is too discouraging. Instead, get buy-in from everyone in your home to make the changes together. The way you need to eat to manage your diabetes can be a delicious and healthful way for everyone to eat, and the support you'll feel when everyone's on board will make it a lot easier to make your lifestyle changes stick.
Exercise is probably the single most important piece in any proactive approach to managing a disease and getting healthier. There's tons of evidence about the benefits of exercise – it not only helps control blood sugar, it also improves knee arthritis, helps reduce heart disease, is the best treatment for fatigue, lowers cholesterol, reduces anxiety, cuts the risk of hip fractures – the list goes on and on. When doctors talk about exercise, we don't necessarily mean that you have to join a gym and work out for three hours a day. Just 30 minutes a day of brisk walking can make a huge difference in your blood sugar control. Couple exercise with your dietary changes, and you may find that you eventually walk off those extra pounds, as well.
Take it step by step.
Diabetes is not a diagnosis that is going to be solved in one doctor's visit. Work closely with your doctor through multiple visits to tackle each piece of the challenge, and check in regularly. I've seen people diagnosed with diabetes at all ages, and I've seen many, many success stories. With your history of eating well and staying in shape, you're well positioned to be one of them.
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