In our last article, we discussed the importance of diet in diabetes. This week we continue with diet and go on to diagnosing diabetes.

Elliot Joslin MD (Joslin Clinic, associated with Harvard University in Boston, Massachusetts) stated over 75 years ago that a person who has had diabetes education lives longer. With the internet now available to most of us, a wealth of diabetes education is there for our reading and understanding. If one is to GOOGLE "diabetes," various websites will pop up. An excellent one is diabetes.org which is the American Diabetes Association (ADA) website for laypeople and health professionals. Frank Sacks, MD and collaborators had an article published in the New England Journal of Medicine in February of 2009, related to multiple diets. They had large groups of individuals on meals with different percentages of protein, carbohydrates and fats in them. This actually mimicked all the different types of diets that Americans have been using (South Beach diet, Zone diet, Atkin's diet, etc.). This study has been considered the "mother of all diet studies." The conclusion was that weight loss was all secondary to the total number of calories eaten. As long as you eat fewer calories every day (portion control), you will lose weight. There is no magical action when you eat any of the macronutrients (fat, protein, carbohydrates) in particular percentages. Within the last week, there were announcements made suggesting that low-carb diets are more beneficial than low fat diets.

The idea behind this is to place less stress on the pancreas with a low-carb diet. However, a higher fat diet can also tax the cardiovascular system with more atherosclerosis (hardening of the arteries). Mechanistically, the important point is that to lose weight we need to eat fewer calories and increase exercise to burn more calories. It has come to light that it is critically important to understand the importance of tight diabetes control early in the beginning of the disease process. If one has a family member that is suspected of having diabetes, it is critical to get annual diabetes screening.

Diagnosing

Historically, diabetes was diagnosed after an eight-hour fast overnight.

-If the reading was over 126 mg/dL on two different occasions, a diagnosis of diabetes was made.

-Another way was to do a 75 Gm (liquid) carbohydrate challenge. The patient was asked to drink 75 Gm of a liquid carbohydrate after being in a fasting condition, and then blood was drawn from the arm. If the blood sugar was over 200 mg/dL 2 hours after taking the drink, the patient was diagnosed with diabetes.

- Finally, if a patient was complaining of continual thirst, noticing increased urination, increasing weight loss, tiredness, blurry vision, and a random blood sugar was obtained over 200 mg/dL, the patient was diagnosed with diabetes.

At the beginning of 2010, the ADA approved using an HgbA1c (glycosylated haemoglobin) lab test to meet diagnostic criteria. A1c (for short) is a non-fasting lab test that can be done by either a pin-prick on the finger or by drawing blood from the arm (more accurate). A1c also shows how well-controlled your diabetes is. A person is diagnosed with diabetes if the reading is above 6.5%. You also use A1c as the golden standard for chronic diabetes control. Ideally a person with diabetes should have a reading of 6.5%-7.0%. A1c actually measures the average blood sugars (both fasting and after meal [2 hour post prandial] blood sugar readings) over the last 60-90 days prior to doing the test. This lab test is recognized around the world. People with diabetes should know what their last reading was, as this indicates the importance of their reaching better control and possibly needing better lifestyle modification measures, and/or additional medications. In simple terms, A1c is the measurement of how much blood sugar binds (attaches) to a protein (haemoglobin) in the red blood cells. Of course, we all have sugar floating around in our bloodstream, BUT people with diabetes have higher readings of blood sugar, and therefore more binding of sugar to the haemoglobin occurs resulting in higher A1c readings. A person without diabetes has an A1c of 4-5.7%. A pre-diabetes individual is diagnosed with a reading of 5.7-6.4%.They still have an opportunity to avoid diabetes by making some lifestyle modification (exercising and less caloric intake) to lose weight.

This article is courtesy of Diabetes Foundation of St. Maarten in collaboration with Dr. Frank Lavernia, a distinguished diabetologist expert. Learn more about his research on http://www.franklaverniamd.com

In the coming weeks, there will be more information pertaining to diagnosis, lifestyle modifications (diet and exercise) and treatment with medications. If you have any questions, don't hesitate to write to

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