Nearly half a billion people globally now have diabetes

[audreyh1]

This is what's so puzzling to me. Their diets have always been very high in carbs (mainly very fast-acting carbs like white rice), yet diabetes wasn't prevalent until Western-style processed foods became readily available. What kind of western-style processed foods is the cause, do you think? A lot of high fructose corn syrup products?

This is the great mystery. Perhaps the food is more processed. In China there was almost no sucrose in the diet at all until recently. However India which invented cane sugar 2500 years ago has lots of traditional sweets*. Maybe they eat more sweets now. Perhaps it’s the addition of modern things like HFCS and unhealthy oils. Western style fast food is much more common in major urban areas. Perhaps there has been a drop in physical activity (urbanization, industrialization). Perhaps as countries become wealthier they eat more. Probably a combination of many factors and hard to say what dominates, but the outcome is shocking.

Worth noting is that folks from the Far East and India that immigrated to the US in the past also tended to develop typical western chronic diseases. But now it’s happening at in the countries themselves.

* I remember a most disgusting Indian sweet snack called jalebis growing up and I never understood how someone could eat something that sweet.

 

[athena53]

Well in India and China this does seem to be something that happened in recent decades. Many folks believe it has to do with Western-style processed food habits becoming more prevalent. Originally these countries seemed “immune” in spite of traditional high carb diets.

I made a half-dozen business trips to India and most recently was there as a tourist 3 years ago. People in India LOVE their "sweets" and it may be that the more prosperous among them are eating more of them. I remember taking my team to a lunch buffet at a really good hotel that had exquisite desserts in very small portions on individual plates. I'd take one. The guys on the team would each take 3 or 4! Ah, gulab jamon- basically a deep-fried donut hole soaked in honey water. Yum. And Lay's Potato Chips were advertised on billboards all over the place in Delhi.

The tour group arranged for us to have dinner with a local family. One of the women in the family, in hearing that a woman in our group was a doctor, brought in her bloodwork results. The doctor told her she had to stop eating sweets and then they retired to a private room for more talk. She told us later that she got the impression that doctors weren't doing much to counsel patients about results.

 

[tmm99]

* I remember a most disgusting Indian sweet snack called jalebis growing up and I never understood how someone could eat something that sweet.

LOL, yeah, they were so sweet, wet and sticky (and gross!) I had a lot of Indian co-workers (IT dept in Silicon Valley) and they brought a bunch of sweets to work on special occasions - My fave was a diamond-shaped cashew-based fudge with silver flakes.

 

[NW-Bound]

Is this "fasting glucose" thing folks keep mentioning the same test as when DW pokes my finger one morning a week and confirms my reading is still below 100? I think the little meter she uses is called an Accu-Chek and is provided free by the nice folks at Medicare. I also found "fasting glucose" on my latest blood work report from doc where it came in at 95. At home, it usually reads between 85 and 95.

So, in home test about the same as the lab test?

We do this finger-pricking fasting glucose test ourselves at home about once every month. If we indulge ourselves and do not have enough activities, have seen the level go up to higher than 110. When we got scared and did the right thing, it dropped to as low as 85.

Is the home test accurate? When coming in for the annual lab blood test, we made the point of doing the same test ourselves at home that morning for a later comparison. The numbers have been in agreement to within 2-3 points. That's pretty darn good.

 

[NW-Bound]

* I remember a most disgusting Indian sweet snack called jalebis growing up and I never understood how someone could eat something that sweet.

I had to look it up. It's about the same as Red Vines.

 

[mpeirce]

This is what's so puzzling to me. Their diets have always been very high in carbs (mainly very fast-acting carbs like white rice), yet diabetes wasn't prevalent until Western-style processed foods became readily available. What kind of western-style processed foods is the cause, do you think? A lot of high fructose corn syrup products?

Another view is that in India, China - lots of places - famine was the main dietary problem people faced in years past.

The people who survived in those conditions were folks who could put on, if not fat, at least, enough bulk to survive the famines. Starchy foods are excellent for doing this in times when the harvest is good.

This same adaptation for surviving famines is very bad when food is plentiful. People who bulk up quickly when eating freely end up being fat over extended periods of time and this leads to diabetes and other metabolic conditions.

 

[RAE]

This is what's so puzzling to me. Their diets have always been very high in carbs (mainly very fast-acting carbs like white rice), yet diabetes wasn't prevalent until Western-style processed foods became readily available. What kind of western-style processed foods is the cause, do you think? A lot of high fructose corn syrup products?

My guess is that some of the more recent additions to their diet that are causing problems include: 1) high fructose corn syrup (and high amounts of sugar of any kind); 2) industrial seed oils; and 3) lots more "acellular" carbs - basically things made from flour or other ground grains, where the cell wall has been removed during processing. Western-style junk food is very high in acellular carbs (cookies, crackers, donuts, bread, etc, etc). Although white rice is a relatively fast-acting carb and is processed to some extent, I don't think it's nearly as bad as eating things made from refined flour - especially when it is consumed with fish or meat and vegetables. And things made from refined flour are often loaded with sugar as well, making them especially harmful.

Here is a link to a study that discusses acellular carb consumption, and why it may be a leading cause of obesity and poor metabolic health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/

The industrial seed oils are also really bad, in my opinion (jug oils you see in the store...........corn oil, veg oil, canola oil, etc). After I learned how that stuff is made , I stopped consuming it completely (it is not something humans should eat, IMO). I believe it will eventually be shown that these unhealthy oils are a big contributor to not only diabetes, but also heart disease and probably cancer.

 

[youbet]

Is the home test accurate? When coming in for the annual lab blood test, we made the point of doing the same test ourselves at home for a later comparison. The numbers have been in agreement to within 2-3 points. That's pretty darn good.

DW has a family history of diabetes and her readings vary from 90 to 110, so she takes a reading 3 - 4 mornings a week. I tend to almost always be below 100, so I just have her do mine once in a while when she's doing hers (and I haven't eaten anything yet that day).

It's nice that technology has evolved to the point that it's cheap/easy to do some basic testing at home. I do my BP/pulse/heart rhythm and fasting glucose right at the kitchen table. The heart info is sent to my doc (I have AFIB) automatically and I just note the fasting glucose level in a notebook.

 

[Bamaman]

As the article below says, diabetes has "exploded" everywhere, with the number of cases increasing by 4X or more since 1980. And a lot of diabetics don't even know they are diabetic, so they are walking around untreated. A lot of this undoubtedly has to do with poor lifestyle choices.........processed food consumption, obesity, lack of exercise. A couple of the main risk factors for COVID were/are diabetes and obesity, and of course diabetes leads to all sorts of other serious chronic diseases.

Meanwhile, the big food companies keep trying their best to get us all hooked on more processed junk foods, most of which are high profit margin items. So I am not optimistic that this trend is going to reverse anytime soon. https://www.studyfinds.org/half-billion-people-have-diabetes/

It also points to heredity, including my grandmother, father, uncle, cousin and my father's first cousin--all dying from diabetes.

The biggest fear is end stage renal failure--and having to go on hemodialysis. Those in that position only last an average of 4 years.

 

[yhoomajor]

It's easy to blame food, but real problem (imho) is what humans are doing these days. A big chunk of population of China and India used to do REAL phsyical labor just 4-5 decades back. Whether it was farming, herding, moving around in country side and so on for good part of the day. And people needed that fat, sugar and carbohydrate to have a healthy functioning body. And less stress with no TV in those days to compare lifestyle vs KimKanye and other FB/instagram influencers.

Now bigger and bigger chunk of population is becoming keyboard warrior and sits on their behind most of the day and then go home and then.. yup - watch TV to de-stress in the evening!!

As I always say.. human society is moving backwards even though most people think we are making progress.

 

[Bamaman]

Is this "fasting glucose" thing folks keep mentioning the same test as when DW pokes my finger one morning a week and confirms my reading is still below 100? I think the little meter she uses is called an Accu-Chek and is provided free by the nice folks at Medicare. I also found "fasting glucose" on my latest blood work report from doc where it came in at 95. At home, it usually reads between 85 and 95.
So, in home test about the same as the lab test?

Tell your DW to quit wasting your time. If you're running that low, you're good to go.

My natural level is 112 and I start getting a little jumpy at 90 or below. Everyone feels better at a certain level, and for me that's 100 points or above.

What's really dangerous is those with very low levels where you black out, your organs start to shut down and your potassium skyrockets. You can even forget to breathe.

There are many misconceptions about diabetes. I'm a Type II on an insulin pump at my request.

 

[jollystomper]

It's easy to blame food, but real problem (imho) is what humans are doing these days. A big chunk of population of China and India used to do REAL phsyical labor just 4-5 decades back. Whether it was farming, herding, moving around in country side and so on for good part of the day. And people needed that fat, sugar and carbohydrate to have a healthy functioning body. And less stress with no TV in those days to compare lifestyle vs KimKanye and other FB/instagram influencers.

Now bigger and bigger chunk of population is becoming keyboard warrior and sits on their behind most of the day and then go home and then.. yup - watch TV to de-stress in the evening!!

As I always say.. human society is moving backwards even though most people think we are making progress.

+1000

There is much focus on diet, but little consideration for exercise and just staying active. It seems that as standards of living increases, one sad impact of advancing technology is less exercise. I do not mean "gym workout" when taking about exercise - just regular moving around and not sitting in front of computer/phone/tablet/TV for hours on end. It is a great preventative action to increase the odds of not getting, or impact of, diabetes. but unfortunately many health care systems do not focus on preventative actions. We have also made exercise into an "expensive" expenditure and that adds to the problem.

 

[audreyh1]

We do this finger-pricking fasting glucose test ourselves at home about once every month. If we indulge ourselves and do not have enough activities, have seen the level go up to higher than 110. When we got scared and did the right thing, it dropped to as low as 85.

Is the home test accurate? When coming in for the annual lab blood test, we made the point of doing the same test ourselves at home that morning for a later comparison. The numbers have been in agreement to within 2-3 points. That's pretty darn good.

Yeah, that really is very good. Certainly good enough!

Interesting that you use fasting glucose to monitor your diet and activities.

Do you ever do any post-prandial testing?

I have a ketone meter that can do glucose. I tried it a couple of times last year out of curiousity when I had a bit of a groggy feeling after a meal. It was about 1 hour after the meal, not the more typical 2 hours, but both times the reading was under 100 which really surprised me. So must have been something else causing the groggy feeling - perhaps just redirection of blood flow.

 

[audreyh1]

I had to look it up. It's about the same as Red Vines.

Doesn't seem like it because the jalebis are dripping with a thick sugar syrup. Kind of like a small funnel cake, but then soaked in orange colored and flavored sugar syrup for a long while. They are super sticky.

 

[NW-Bound]

Yeah, that really is very good. Certainly good enough!

Interesting that you use fasting glucose to monitor your diet and activities.

Do you ever do any post-prandial testing?

No. Should I?

If fasting glucose is low, doctors don't care further, and that's why I don't do more.


PS. In one year, my fasting blood glucose was 105, due to a period where I slacked off. My doctor got me back in 3 months for an A1C test, which I then aced because I got back to my regime. So, everybody was happy and that was that.

 

[Jenna]

Three ideas to look at. All three have made a huge impact on our health:
1. Hormone Replacement, low Testoterone affects A1C
2. Dr Stasha Gominak-Neurologist, Vitamin D, Vitamin B and Sleep-affect on Blood Sugar
3. Intermittent Fasting, Gin Stephens, Dr Fung/18 hours fasting every day

 

[audreyh1]

No. Should I?

If fasting glucose is low, doctors don't care further, and that's why I don't do more.


PS. In one year, my fasting blood glucose was 105, due to a period where I slacked off. My doctor got me back in 3 months for an A1C test, which I then aced because I got back to my regime. So, everybody was happy and that was that.

No. I was just asking.

HbA1C is a better measure than fasting glucose as it shows what your blood sugar is doing on average over 3 months.

One of my docs does HbA1C for all patients, not just those diagnosed with pre-diabetes or worse. He also does fasting insulin which can detect hyperinsulinemia way earlier in advance of blood sugar problems showing up.

The problem with using blood sugar as a measure of metabolic problems is that your body will fight hard over many many years, to keep blood sugar levels in check by pumping out as much insulin as needed. Elevated blood sugar is only detected once the pancreas is damaged enough that it can no longer keep up with the demand for insulin. Insulin resistance occurred years before, creating this vicious cycle leading to type 2 diabetes, but it is undetected unless you can detect that blood insulin levels are too high.

 

[ExFlyBoy5]

More processed foods. You can't feed the enormous population of the world without it. Folks are quick to dismiss this with statements like, "stop eating that!" but the fact remains that because of food cost/food deserts/etc. that a LOT of people have to deal with, it just isn't that simple.

Also, I think most of the Wal Marts offer on-demand A1C testing and I think it's pretty cheap...probably a lot cheaper than asking a physician to order it.

 

[NW-Bound]

No. I was just asking.

HbA1C is a better measure than fasting glucose as it shows what your blood sugar is doing on average over 3 months.

One of my docs does HbA1C for all patients, not just those diagnosed with pre-diabetes or worse. He also does fasting insulin which can detect hyperinsulinemia way earlier in advance of blood sugar problems showing up.

The problem with using blood sugar as a measure of metabolic problems is that your body will fight hard over many many years, to keep blood sugar levels in check by pumping out as much insulin as needed. Elevated blood sugar is only detected once the pancreas is damaged enough that it can no longer keep up with the demand for insulin. Insulin resistance occurred years before, creating this vicious cycle leading to type 2 diabetes, but it is undetected unless you can detect that blood insulin levels are too high.

Next time I see my doctor, will ask about the insulin test.

I have the impression that because the test for A1C costs a bit more, insurance companies may bark at doctors ordering it for people with low fasting glucose.

 

[Scratchy]

Interesting thread, certainly seems that public health efforts to manage diabetes get at best a C- around the globe.

Wanted to share my personal experience in this-about four years ago, I wore for two weeks a continuous glucose monitor (CGM). This amazing device, which one self-implants onto their shoulder, in addition to showing an instant reading at any time, provides a continuous record of glucose measurements for two weeks. The data is collected on a reader or on a cell phone app and is processed and summarized in a number of ways, and can be transmitted electronically to your medical provider. Unfortunately, the reimbursable indications for it are rather narrow, and do not include borderline diabetes as in my case. I paid for it out of pocket (was able to get one for about $100).

Seeing the effects of diet and exercise in real time was amazing and a powerful incentive to control my glucose more effectively. I found out what foods I can tolerate and which I can't. (Example: If I have my favorite dessert of thai sticky rice with mango I get a sugar spike to 210. But if I exercise moderate level on an elliptical for 4 minutes beginning about 30 minutes after I eat that sticky rice my sugar spikes no higher than 140. Worth it!!) I found out how eating different foods at different times of the day and in different combinations affected me. I am fortunate in that exercise has a very powerful and immediate effect on my glucose levels. My pre-diabetes seems to be more related to beta cell deficiency (insulin production) rather than insulin resistance. This device helped my physician and me understand this. This understanding in turn led to my physician discontinuing glucophage for me, which has limited effect in patients like me.

Four years after the first time I wore one, I am on no diabetes medicines and my HgA1C levels are lower than they used to be.

I am not suggesting CGM is the solution to the public health crisis in metabolic disease-much more basic interventions are called for. Also not suggesting everyone should be asking or expecting their physician to prescribe or even be familiar with CGM. However, I do think CGM currently is underutilized-with respect to educating and motivating the patient, and with respect to identifying patients with relatively normal fasting glucose and HgA1C who are having diabetic level glucose spikes (which some believe are the cause of significant morbidity). I'm hoping that future data will better show the benefits of these devices and their indications and use will expand in the future.

 

[tmm99]

More processed foods. You can't feed the enormous population of the world without it. Folks are quick to dismiss this with statements like, "stop eating that!" but the fact remains that because of food cost/food deserts/etc. that a LOT of people have to deal with, it just isn't that simple.

Also, I think most of the Wal Marts offer on-demand A1C testing and I think it's pretty cheap...probably a lot cheaper than asking a physician to order it.

On-demand testing would be good. Some easy but accurate home kit would be even better.

 

[audreyh1]

It’s amazing how diabetes in a population can increase so quickly:

Over the past three decades, the prevalence of diabetes in China has sharply increased. The prevalence of diabetes was reported to be less than 1% in 1980 (2), 5.5% in 2001 (3), 9.7% in 2008 (4), and 10.9% in 2013, according to the latest published nationwide survey (5) (Fig. 1).

https://diabetes.diabetesjournals.org/content/67/1/3

I think by 2017 it had increased to 12.8%.
https://www.bmj.com/content/369/bmj.m997

China surpassed the US during the 2010s.

The US rate in 2018 was 10.5%.

 

[Bamaman]

Interesting thread, certainly seems that public health efforts to manage diabetes get at best a C- around the globe.

Wanted to share my personal experience in this-about four years ago, I wore for two weeks a continuous glucose monitor (CGM). This amazing device, which one self-implants onto their shoulder, in addition to showing an instant reading at any time, provides a continuous record of glucose measurements for two weeks. The data is collected on a reader or on a cell phone app and is processed and summarized in a number of ways, and can be transmitted electronically to your medical provider. Unfortunately, the reimbursable indications for it are rather narrow, and do not include borderline diabetes as in my case. I paid for it out of pocket (was able to get one for about $100).

Seeing the effects of diet and exercise in real time was amazing and a powerful incentive to control my glucose more effectively. I found out what foods I can tolerate and which I can't. (Example: If I have my favorite dessert of thai sticky rice with mango I get a sugar spike to 210. But if I exercise moderate level on an elliptical for 4 minutes beginning about 30 minutes after I eat that sticky rice my sugar spikes no higher than 140. Worth it!!) I found out how eating different foods at different times of the day and in different combinations affected me. I am fortunate in that exercise has a very powerful and immediate effect on my glucose levels. My pre-diabetes seems to be more related to beta cell deficiency (insulin production) rather than insulin resistance. This device helped my physician and me understand this. This understanding in turn led to my physician discontinuing glucophage for me, which has limited effect in patients like me.

Four years after the first time I wore one, I am on no diabetes medicines and my HgA1C levels are lower than they used to be.

I am not suggesting CGM is the solution to the public health crisis in metabolic disease-much more basic interventions are called for. Also not suggesting everyone should be asking or expecting their physician to prescribe or even be familiar with CGM. However, I do think CGM currently is underutilized-with respect to educating and motivating the patient, and with respect to identifying patients with relatively normal fasting glucose and HgA1C who are having diabetic level glucose spikes (which some believe are the cause of significant morbidity). I'm hoping that future data will better show the benefits of these devices and their indications and use will expand in the future.

The new relatively inexpensive CGM's are hitting the retail market very fast, especially since Medicare will now pay for them. I've found the CGM to be very helpful to teach me what different kinds of foods do to my blood sugar.

And what most people don't realize is that every time we eat, everyone's blood sugar levels jump dramatically. My levels on a normal meal might go up 100 points into the low 200's. The problem with Type II's is that our levels are very slow to drop back to normal levels. That's why I chose to go on an insulin pump.

A bag of microwave popcorn increases 100 points to me. An ice cream cone is also good for another 100 points.

What's strange is a fast change in blood levels in the middle of the night. Sometimes it's high and sometimes I'll hit a low--with no reason. The CDG monitor will beep and wake me up--sending me to the kitchen to eat something when I'm at a low level.

And it's true that hard labor can make one drop 50 or 100 points in a few minutes. If I'm at 110 on my GCM and I cut grass manually on my steep hillside, I can easily drop to a dangerous 50-60 and just about pass out. I keep sweets to eat to avoid such drops.

The whole truth is that the American diet is full of carbohydrates. We all need to eat more green and less white. White includes breads, rice and other carbs that turn into sugar. We need to eat more veggies, including broccoli, carrots, mushrooms, spinach and green beans. Drinking alcohol and sugared drinks are also a no-no for diabetics.

And there's no such thing as pre-diabetic. Either you are or you're not diabetic. Weight control and eating habits go a long way to making improvements in your position.

 

[RAE]

And there's no such thing as pre-diabetic. Either you are or you're not diabetic. Weight control and eating habits go a long way to making improvements in your position.

Yeah, and the problem is that current medical guidelines often call for doing very little for someone diagnosed as "pre-diabetic" - other than "watching" their fasting blood glucose number over time. It's a mistake, because if changes in diet/lifestyle are not made as soon as there is a hint of a problem, full-blown diabetes (and the damage it causes to the body) can develop rather quickly. The other issue here is that a lot of doctors are reluctant to advise patients about diet/lifestyle changes that could help greatly, and instead focus on drugs used to treat diabetes, once there is a diagnosis. That's an issue with our whole system of medical care, IMO.......the focus is on drugs and procedures to treat disease after it develops - not on other (non-drug) measures that could be taken to prevent the disease from developing in the first place.

 

[Chuckanut]

It is as incorrect to say you you are or you're not diabetic as it is to say there is no prediabetes.

I am not a medical person. I depend on a variety of knowledgable people for my information. If you listen to the interview with Dr. Lustig (who among other things is an endocrinologist) that I mentioned above, his position is that if one is 'pre-diabetic' damage to one's body is already happening, it's just not very noticeable.

Medical definitions of what is good and bad change. His discussion about how the acceptable ALT score changed from 25 to 40 is interesting.