Diabetes is an increasing and amazingly common disease.  Over one-third of Americans will develop diabetes at some time during their lives.  The current obesity epidemic has considerably increased the rates up to the currently incredible levels.  

Good: Prevention is much better than treatment, although treatment is of benefit.  Fortunately, the same dietary habits good at preventing or treating diabetes are also those good for other parts of the body.  Whole grains, nuts, raisins, alcohol (one drink/day starting age 45), and vegetable oil (I recommend canola or olive) all help prevent or improve diabetes.  Magnesium (250 mg once or twice a day) and vitamin D (1000 IU daily) supplements are very worthwhile.  Pregnant mothers and little children benefit from cod liver oil, but vitamin D probably gives the same benefits, since cod liver oil has vitamin D in it.  Coffee may help prevent diabetes.  Breast-feeding infants reduces later diabetes in the children.  Exercise and fish or fish oil consumption are very helpful in preventing diabetes.  If you don't like fish, take two fish oil or flax oil capsules a day. Calcium may be helpful as may modest alcohol consumption (Up to but not exceeding one drink per day. I discourage social drinking, since it often leads to heavier drinking. Alcohol is far too dangerous to be a social beverage.). Hints for Avoiding Obesity.  ACE inhibitors can reduce the risk of obesity in patients with hypertension.

Bad: Deep frying foods, and trans-fats are bad.  Trans fats ("partially hydrogenated") are found in most margarines, baked goods, crackers, cookies, pies, microwave popcorn, and many fast foods.  High milk consumption by children appears to increase their risk of childhood diabetes.  Beef and pork increase diabetes, especially processed meats like hot dogs, bologna, bacon, and ham.  If you don't want to die like Dr. Atkins, young and over-weight, don't eat like him.  He was right in urging followers to avoid refined flour.  However, do eat at least a couple servings of whole grain foods everyday along with the other "good" foods above and on my Recommendations for Healthy Living.

High Blood Sugar Increases Depression: 76 people with diabetes were into 2 groups: those whose HbA1c levels was 9% or less and those above 9%. Researchers then gave everyone a standardized test for depression. In people whose HbA1c was lower, only 21% tested as depressed, compared to 42% of those whose HbA1c was over 9%. ADA conference Chicago ’98

Diabetes is Extremely Common in U.S.: The lifetime risk of developing diabetes for individuals born in 2000 is 32.8% for males and 38.5% for females. Females have higher residual lifetime risks at all ages. The highest estimated lifetime risk for diabetes is among Hispanics (males, 45.4% and females, 52.5%). Individuals diagnosed as having diabetes have large reductions in life expectancy. For example, we estimate that if an individual is diagnosed at age 40 years, men will lose 11.6 life-years and 18.6 quality-adjusted life-years and women will lose 14.3 life-years and 22.0. Lifetime risk for diabetes mellitus in the United States. Narayan KM, Boyle JP, Thompson TJ, Sorensen SW, Williamson DF. JAMA. 2003 Oct 8;290(14):1884-90

Diabetes Out of Control for Two-Thirds: Even those two-thirds of 157,000 diabetes diagnosed and under treatment were found to be inadequately controlled with A1C levels over 6.5%, the highest level considered acceptable.  The normal level for healthy adults is 5.1%. Davidson J, et al. Reuters 5/18/05

Screening Recommended Every Three Years After Age 45: The cost of detecting a case by doing testing at a regular medical visit using random glucose measurements was only $275 per case detected.  University of Michigan researchers determines that this was the ideal frequency. Johnson S, et al. Diabetes Care 2/05. Ed: I would think more frequent screening would be appropriate for those at higher risk, e.g., the depressed, the obese, those with family histories.

Pre-Diabetes Cutoff Revised: The new cutoff for the diagnosis of pre-diabetes is a fasting blood sugar (FPG) of 100 mg/dL, down from 110 mg/dL. Large prospective studies have shown that improved diets and exercise can head off the development of Diabetes Type 2. Overweight adults age 45 or older should be tested every three years for diabetes or more often if there are any other risk factors, such as family history, present. Diabetes Care. 2003;26:3160-3167; World Health Organization criteria for diabetes is FPG of 126 mg/dL or a two-hour plasma glucose (PG) of 200 mg/dL after a 75 g oral glucose challenge. The two-hour PG has been considered the de facto "gold standard" because it is a better predictor of all-cause mortality or cardiovascular mortality than an elevated FPG value. The FPG cutoff value is based on the prediction of retinopathy beginning at approximately 126 mg/dL. Impaired glucose tolerance (pre-diabetes) is defined as FPG of 100-125 mg/dL or when the two-hour PG after a 75 g oral glucose challenge is 140 to 199 mg/dL (six tablespoons of sugar mixed in water is fine and far cheaper than what the hospitals use) . A second confirmatory test is recommended on another day, if the first test proves high.

Dementia Higher in Diabetics: In a study of 2600 adults ages 40-65 in the Israeli Ischemic Heart Disease followed for almost 40 years, the mental status of 1892 participants was determined, and 652 were identified as possibly demented. This was confirmed in 309 subjects (16.3 percent). Those with diabetes during the study were 2.83-times more likely to develop dementia than those without diabetes. MS Beeri, et al. Mount Sinai, New York. Neurology, November 23, 2004.

Depression Higher in Diabetes and Increases Risk of Death: In a 10-year follow-up study of 558 diabetic and 7063 nondiabetic in a nationally representative group, the prevalence of depression was higher in the diabetic than in the non-diabetic group (26 percent vs 16 percent). After taking account of social, demographic, lifestyle, and health-status factors, diabetics with depression had a 54 percent greater mortality rate than those without depression. There was no significant association between depression and mortality among the people without diabetes. Depression may decrease the capacity for self-management, and for complying with diabetes care regimens. Zhang et al. CDC, American Journal of Epidemiology, April 1, 2005.

Iron Deficiency Anemia Can Make A1c Blood Sugar Test Look Elevated: The major form of glycohemoglobin is hemoglobin A1c (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycemic diabetic patients and correlates with glycemic control. However, iron deficiency anemia (IDA) affects the levels of HbA1c. In 50 patients with iron deficiency anemia, before iron treatment (100 mg/day for 3 months), the mean HbA1c (7.4%) level in patients was higher than in healthy controls (5.9%) (p < 0.001). The HbA1c decreased significantly after iron treatment from 7.4% to 6.2% (p < 0.001). Iron deficiency must be corrected before any diagnostic or therapeutic decision is made based on HbA1c. Effect of iron deficiency anemia on the levels of hemoglobin A1c in nondiabetic patients. Coban E, Ozdogan M, Timuragaoglu A. Akdeniz University,  Antalya, Turkey. Acta Haematol. 2004;112(3):126-8

High Blood Sugar Harmful Even in the "Normal" Range: Increased fasting blood glucose (FPG) and 2-hour postprandial plasma glucose (PCPG) levels with normal hemoglobin A1c (HbA1c) levels are recognized as risk factors for cardiovascular disease. Of 404 individuals with normal HbA1c levels (<6.0%), only 60% had normal glucose tolerance, 33% had impaired glucose tolerance, 1% had isolated impaired fasting blood glucose (FPG), and 6% had type 2 diabetes mellitus. Of those without normal glucose tolerance, 80% had normal fasting blood glucose levels. The upper limit of normal for blood glucose at 110 mg/dL is too high and that attempts to lower HbA1c in these individuals will require treatment preferentially directed at lowering postprandial glucose levels. Diagnostic and therapeutic implications of relationships between fasting, 2-hour postchallenge plasma glucose and hemoglobin a1c values. Woerle HJ, Pimenta WP, et al. University of Rochester  Arch Intern Med. 2004 Aug 9-23;164(15):1627-32.  

Hip Fractures Increased 120% by Diabetes and Also by Insulin: 109,983 nurses ages 34-59 were followed for 22 years: 1,398 had a hip fracture. Compared with women without diabetes, the age-adjusted relative risk (RRs) of hip fracture was 7.1 for women with type 1 diabetes and 1.7 for those with type 2 diabetes. After further adjustment for BMI, smoking, physical activity, menopausal status, daily intake of calcium, vitamin D, protein, and postmenopausal hormone use, the multivariate RR of incident hip fracture in individuals with type 1 diabetes compared with individuals without diabetes was 6.4 and with type 2 diabetes was 2.2. The RRs increased with longer duration of type 2 diabetes (3.1 [2.3-4.0] for >/=12 years compared with no diabetes, P for trend < 0.001) and ever use of insulin. Prospective study of diabetes and risk of hip fracture: the nurses' health study. Jamghorbani M, et al. Isfahan University of Medical Sciences, Iran. . Diabetes Care 2006 Jul;29(7):1573-8.

Testing Blood Sugar: A study by Consumer Reports (8/05) of 13 blood glucose monitors found that OneTouch Ultra had the highest score with excellent ease of use and accuracy and very good consistency. BD Logic and FreeStyle Flash did next best with very good ease of use. Accu-Chek came next.  Walmart's ReliOn New Tek had poor ease of use and only fair consistency although it saved $640 per year. OneTouch and FreeStyle can be used on the arm except in the first 2 hours after a meal, insulin dose, or exercising, or to rule out hypoglycemia, since arm testing may not pick up rapid changes in blood glucose levels.

Prevention

ACE Inhibitors and ARBs Help Prevent Diabetes: In two meta-analyses of clinical trials investigating the effect of the inhibition of the renin-angiotensin system either with an angiotensin converting enzyme inhibitor (ACEI) or with a selective angiotensin receptor blocker (ARB) on the incidence of new cases of type 2 diabetes mellitus in adults with arterial hypertension or with congestive heart failure, the protection appears similar with ACEIs in six trials in a total of 24.623 patients (hazard ratio: 0.77; p < 0.00001) and with ARBs in five trials in a total of 14.344 patients (hazard ratio: 0.79; p < 0.00001). It is consistent whatever the comparator, a thiazide diuretic agent, a beta-blocker, a dihydropyridine calcium channel blocker or a placebo. Similar reduction in new cases of type 2 diabetes with angiotensin receptor blocker and ACE inhibitor: comparison of meta-analyses of prospective randomised trials. Scheen AJ. Universite de Liege. Rev Med Liege. 2005 May-Jun;60(5-6):424-8

Alcohol: Light Drinking Decreases DM-2 Risk: Women who consumed ½ to two drinks a day were 58% less likely to develop type 2 diabetes. The association between light and moderate drinking was most apparent with wine or beer. Drinking more than two drinks a day of hard liquor doubled a woman's risk. The study covered 100,000 25-44 year old women with 10 year follow-up in the Nurses Health Study-II. Archives of Internal Medicine 2003;163:1329-1336

Alcohol: In a meta-analysis of 14 studies, conducted in the United States, Japan, Finland, Korea, the Netherlands, Germany and the UK, and involving a total of 11,959 cases of type 2 diabetes among 369,862 men and women who were followed for 4 to 20 years, or an average 12 years, the lowest risk of diabetes, a 30% decrease, was found among moderate drinkers (1/2 drink per day to 4 drinks per day) and the highest risk occurred among nondrinkers and heavy drinkers. Body mass index, a measure of height versus weight, did not seem to affect the results. Koppes LL, el a. VU University, Amsterda. Diabetes Care, March 2005. Ed: Since alcohol is a dangerous and addictive drug, it should be treated very carefully.  Individuals with past histories of alcohol abuse should not risk going back to drinking.  Those with family histories of alcoholism should be very careful. Social drinking is a bad idea, since it leads to heavier drinking and driving after drinking.  Heart research suggests that between 1/2 and 1 drink per day achieves the maximum benefit.  This study is agrees with that finding.  Set a strict rule of never drinking over one drink on any given day, drink it at home, and don't drive for at least two hours afterward.

Vit D/Cod Liver Oil Helps Prevent Juvenile Diabetes: Elina Hypponen, PhD, of London's Institute of Child Health did Finnish study of 12,000 children born 1966 and found 80% decrease in diabetes among children getting adequate vitamin D usually in form of cod liver oil. Finland gets very little winter sunlight. However, breastfeeding and sunscreen usage may also reduce vitamin D intake in US. Lancet 11/5/01

Cod Liver Oil by Mom Cuts DM-1: When mothers took cod liver oil during pregnancy their offspring had a lower risk of diabetes. The unadjusted OR was 0.30, p = 0.01. This association changed very little and was still significant after adjusting for age, sex, breastfeeding and maternal education. Mothers taking multivitamin supplements during pregnancy [adjusted OR= 1.11, infants taking cod liver oil in the first year of life [adjusted OR = 0.82 and the use of other vitamin D supplements in the first year of life OR = 1.27. Study of over 1000 women in Norway. Case control study using 85 diabetics and 1023 controls. Diabetologia 2000 Sep;43(9):1093-8

Lifestyle Change, Metformin, Troglitazone Prevent Diabetes:  In the Diabetes Prevention Program 1-2 year DB PC study of 2340 high-risk pre-diabetic adults, (DPP) was a randomized clinical trial of prevention of type 2 diabetes in high-risk people, metformin redued the risk of developing diabetes by 43% (6.7 cases per 100 person-years vs. 12 with placebo). An intensive lifestyle intervention program did even better with a 65% decreased risk (5.1 cases per year). Troglitazone, an insulin-sensitizing agent, did best with a 75% decrease, but it had to be stopped after nine months because of liver toxicity. After the troglitazone was stopped, there was no long-term benefit with those patients developing just as much diabetes as the placebo group. Prevention of Type 2 Diabetes With Troglitazone in the Diabetes Prevention Program. Diabetes. 2005 Apr;54(4):1150-1156.

Magnesium Rich Foods Lower Diabetes Risk: The Harvard Nurses and Medical Professionals Studies examined data on 85,060 women and 42,872 men with no history of diabetes, cardiovascular disease, or cancer at baseline. Using a validated food frequency questionnaire every two to four years during follow-up of 18 years in women and 12 years in men, researchers found the fifth with the highest dietary magnesium intake had a relative risk of type 2 diabetes was only 0.66 when compared to the fifth with the lowest intake after controlling for many possible confounding factors. Major food sources of magnesium include nuts, whole grains, and green leafy vegetables. Ruy Lopez-Ridaura, Harvard. Diabetes Care. 2003;27:134-140,59-65,270-271. Ed: Both magnesium rich food and magnesium supplements have a lot of favorable studies to support their use. See Magnesium for many more studies.

Peanuts Protect Against Type II: JAMA 12/9/02, Harvard 83,818 female nurse study found those eating nuts of any kind five or more times a week were 27% less likely to develop diabetes.

Peanut-Raisin Snack Better: Study of 10 healthy subjects found chocolate-coated candy bar or coke & chips caused higher sugar and insulinemia and lower sugar on rebound than a banana-peanut or especially raisin-peanut snack. Am J Clin Nutr 1987 Jan;45(1):86-91

Vegetable Fats Protect Against Type II: The diabetes incidence was negatively associated with dietary polyunsaturated fatty acids, vegetable fat, and trans fatty acids and positively associated with omega-3 fatty acids, cholesterol, and the Keys score. After simultaneous adjustment for other dietary fat, only vegetable fat remained clearly related to diabetes risk. Relative risks across quintiles of vegetable fat intake were 1.00, 0.90, 0.87, 0.84, and 0.82 (P = 0.02). Diabetes Care 2001 Sep;24(9):1528-35

Vitamin D: Diabetes in Children Reduced by Supplement: A Finnish study following over 12,000 babies born in 1966 found those who were given the recommended amounts of vitamin D supplement had an 80% reduced risk of developing diabetes. Authors recommend children under six months have 8.5 micrograms a day (mcg), and 7 mcg a day from seven months to three years. Those who had rickets, a disease linked to vitamin D deficiency, in the first year of life had a three-fold risk of developing diabetes. Finland has the highest reported incidence of type 1 diabetes in the world. In north Finland, there are only two hours of sunlight, a key source of vitamin D, each day in December. BBC News 11/2/01 and Lancet 11/5/01; Vitamin D status increases the expression of Type 1 diabetes in non-obese diabetic mice. Data in the mice, as well as human epidemiological data, point to the importance of preventing vitamin D deficiency in early childhood. Controlling this dietary factor could be an easy and safe way to reduce the incidence of Type 1 diabetes in subjects who are genetically at risk. Belgium. Diabetologia. 2004 Jan 31

Vitamin D Helped Diabetic Rat Model: Clin Chim Acta. 2005 May 5

Whole Grains, Cereal Fibers, Dietary Magnesium Protect Against Type II: Refined grains, glycemic index, fruits and vegetables had no impact. Prospective 6 yr Iowa study of 36,000 women . Am J Clin Nutr 2000 Apr;71(4):921-30

Whole Grains & Polyunsaturate Fats Good: A higher intake of polyunsaturated fat and possibly long-chain n-3 fatty acids could be beneficial, whereas a higher intake of saturated fat and trans-fat could adversely affect glucose metabolism and insulin resistance. In dietary practice, exchanging non-hydrogenated polyunsaturated fat for saturated and trans-fatty acids could appreciably reduce risk of Type II diabetes. In addition, a low-glycaemic index diet with a higher amount of fiber and minimally processed whole grain products reduces glycemic and insulinemic responses and lowers the risk of Type II diabetes. Diabetologia 2001 Jul;44(7):805-17

Whole Grains Increase Insulin Sensitivity: After 6 weeks in diabetes II patients, 9 of 11 preferred whole grain diet. Insulin resistance is a risk factor for diabetes II and coronary heart disease. Am J Clin Nutr 5/02

Whole Grains: Yet Another Study Shows Whole Grains Protect Against Diabetes: The Insulin Resistance Atherosclerosis Study of 956 adults found that consumption of whole grain foods, primarily dark breads (whole wheat and whole rye) increased insulin sensitivity.  A decrease in insulin sensitivity is one of the best predictors of diabetes. Angela Liese, Univ South Carolina. Am J Clin Nutr. 2003;78:985-971.

Harvard Says Diabetes Type 2 Could be Nearly Eliminated by Healthy Living: "Recent studies have also suggested a potential role for coffee, dairy, nuts, magnesium, and calcium in preventing diabetes. Overall, a healthy diet, together with regular physical activity, maintenance of a healthy weight, moderate alcohol consumption, and avoidance of sedentary behaviors and smoking, could nearly eliminate type 2 diabetes." PRIMARY PREVENTION OF DIABETES: What Can Be Done and How Much Can Be Prevented? Schulze MB, Hu FB. Harvard. Annu Rev Public Health. 2005 Apr 21;26:445-467.

Biochemistry

Ceramide Role in Saturated Fats & DM: Journal of Biological Chemistry saturated fat metabolite ceramide contributes to the development of insulin resistance in cultured cell experiments. The excess accumulation of ceramide in the body is a necessary link connecting saturated fats to insulin resistance. 4/03

AGEs Damage in DM: AGE (advanced glycosylation endproducts) are the damaged remains of enzymes, DNA and collagen that accumulate in the body and contribute to the accelerated aging found in diabetes. AGEs contribute to collagen damage in joints, skin and artery walls, causing a doubling of arthritis complaints in people with diabetes as well as acceleration of atherosclerosis, heart disease and cataracts. AGEs begin to form when glucose attaches to the amino acids lysine and arginine within protein structures (AKA, glycosylation). Then zinc can form a crosslink between two nearby glycosylated proteins. When someone has a HbA1c test, the results reveal a lot more than just the average blood sugar level over the last 6 weeks. This test measures glycosylation of proteins in hemoglobin, and in turn tells how likely it is that AGEs are being formed in the body. The higher the HBA1c, the greater the rate of AGE formation. ADA Chicago Conf ‘98

MSH Hormone Increases Diabetes in Mice: U. Denver research has found that a hormone called MSH, present in humans and mice, is necessary in obese mice for them to develop diabetes.  Mice without the POMC gene that makes MSH don't get diabetes. Obese humans with high MSH are more likely to become diabetic.  J Endocrinology 12/03.