Diabetes is a disease that is in part inherited, and in part the result of unhealthy personal diet and lifestyle.  It is significantly linked to increased body weight and in particular increased abdominal weight.  The disease frequently is preceded by a condition called “insulin resistance.” This pre-diabetic state does not result in significant increased blood sugar (glucose) levels in it’s earlier stages; rather it is diagnosed by a group of findings that would be identified by a knowledgeable physician familiar with this condition.  As a forerunner to the majority of cases of diabetes, this condition can be identified years in advance of the overt development of traditional diabetes that has as its hallmark increased blood sugar levels.  

So, as a patient, how does one determine if they have “insulin resistance?”  Also, why is it so important to identify this condition very early in its course?  As a patient, you can suspect this condition if you are overweight and specifically if you have a “belly.”  Abdominal fat functions differently in the body and produces and processes fatty substances differently than other areas of the body.  If this describes your body  then request that your physician evaluate the possibility of “insulin resistance.”  If you have hypertension, increased blood levels of triglycerides (one of the body’s fat substances), low HDL (the protective/healthy form of cholesterol), or a high normal or borderline elevated blood sugar, you are more likely to have the insulin resistance syndrome (IRS).  If you combine increased abdominal weight with any two of the above findings, you almost certainly have this condition.  A low HDL (also known as the “good” cholesterol) is the most disturbing finding and is frequently associated with future diabetes and serious heart disease.  There are several other more sophisticated blood tests that can add to the assessment of this condition.

It is estimated that 24% of the population has this condition and a much higher percentage in people over 55.  There are at least 17 million overt diabetics and millions more under the radar screen with IRS.  The reason that IRS is so very important to identify at an early stage is that the complications of diabetes often begin with this condition and may be present for 5-10 years before full-blown diabetes is diagnosed.  The complications of diabetes can be devastating and include disease of the blood vessels and nerves. Heart disease is developing in most diabetics for years before they are diagnosed.  Diabetes is the leading cause for people needing dialysis (kidney failure).

So, pay attention!  With a national epidemic of obesity and a disease that is seriously entrenched in the genetic fiber of this country, we are diagnosing diabetes years too late.   If your belly is prominent, if you have high blood pressure and/or a low good cholesterol (HDL), lose weight, walk 45 minutes per day, don’t smoke, make sure your blood pressure is low (less than 130/80) and see a knowledgeable physician.  The social, personal and financial cost of this condition will significantly impact the economics of health care going forward, unless there is a huge effort by patients to control their life style and be diagnosed and treated very early.