Preventing diabetes: can it be done?

The challenge in preventing type 1 diabetes is figuring out who will get it before most of the damage is done. The immune system may be attacking the insulin-producing cells (beta cells) up to 5 years before the blood sugar goes up. By then only about 10% of the beta cells are left. Scientists are also discovering how challenging it is to stop the immune sytem from completing the attack. The research goes on...

Prevention of type 2 diabetes is easier to study because it's easier to predict who will likely get it. Studies compare treatment groups to a group of people who are not given any specific treatment to lower their chance of getting diabetes and are given vague directions to exercise and eat healthy. The research results are as follows:
metformin 2000 mg daily reduces frequency of diabetes by 30-40%
specific diet + exercise program reduces diabetes 50-70%
strictly following diet + exercise goals reduces diabetes by 90%
Actos 45 mg daily reduces diabetes ~70%
Avandia 8 mg daily reduces diabetes ~70%

So it's important to know what type of diabetes you might get in order to know how you might prevent it. It's also important to know that even with the most effectve prevention, it doesn't work all the time.

Byetta for weight loss or people on insulin

I recently received questions about using Byetta combined with insulin, and using Byetta for weight control when a person ahs well-controlled diabetes. Here is my response.

I'll start with the Amylin company position that Byetta is not FDA approved for use with insulin.

I have dozens of patients on insulin and Byetta, most commonly for weight loss and improved control. People well-controlled on small doses of insulin sometimes get off the insulin. A patient with an A1c of 7 but gaining weight would benefit from Byetta; I would be inclined to cut the insulin in half, and if on 20 units/d or less stop it when starting Byetta. They need to know that they may need to go back up on the insulin dose or restart it if the Byetta doesn't quiet control things.

I've also added Byetta or switched people to Byetta who are well controlled on oral agents but struggling with weight. As long as the A1c is >6.5 it should be covered by insurance. If they're on a weight-gaining medication such as sulfonylurea, Actos or Avandia I would reduce or stop them while adding Byetta.

Don't change or stop any of your medications based on the above information. Only make medication changes by working with your treating physician.

Dietary definition: MEAT

Many times a day when asking patients about food intake I am told 'I don't eat meat'. When I ask how the person gets protein in their diet, they tell me they eat chicken, fish, turkey, dairy products. Somehow the term 'meat' has come to mean specifically 'beef' or 'red meat'. Well, you can take the following as good news or bad news: beef as a general source of animal protein is no more or less healthy than chicken, turkey, pork or fish. a lean cut of any animal flesh will have about the same fat content and overall nutritional value. You will be no healthier eating a pound of chicken or bluefin tuna than a pound of sirloin steak or pork loin. There are a number of on-line nutritional content tables that can verify this. If you know of any dietary research that shows a health benefit from specifically consuming only one source of animal protein or specifically excluding one source of animal protein I will happily share it on my blog.