Let's outline the journey that diabetes typically takes.
As you now understand, the modern American diet is grossly tipped toward refined carbohydrates such as sugar and white flour, both of which comprise most junk foods and rank high on the glycemic index. Your caveman body is totally befuddled by such foods. When you eat them, so much blood sugar gets poured into the bloodstream that your pancreas has to pump out insulin as if it were handling an emergency.
When you were 18, the superb efficiency of your body may have meant that you hardly noticed any symptoms resulting from this flood of blood sugar and resultant insulin overload. Later the symptoms pile on, just as for many of us the pounds do. You should already have taken the Blood-Sugar Symptom Test and be aware of any blood sugar-related symptoms you might have. The vast majority of overweight people on a high-carbohydrate diet display an extensive range of symptoms, the by-products of unstable blood-sugar levels.
A significant number of people who are overweight are insulin resistant. It may be that in most people, insulin resistance precedes hyperinsulinism, but either way, because insulin in not effective in doing its work, the pancreas reacts by pouring forth ever-increasing quantities of insulin. People who are both obese and pre-diabetic often have insulin levels some twenty times higher than the norm. The massive amounts of insulin cause blood sugar to drop to an inappropriately low level. The adrenaline the body releases to correct the blood-sugar level when it has fallen too low also produces many of those symptoms.
Blood sugar/insulin difficulties become aggravated over the years. When the insulin response exceeds normal levels-up to 20 units fasting; 100 units one hour after a standard glucose load for a GTT; and 60 units two hours later (the thresholds we use at my clinical practice)-it may be called hyperinsulinism. When obesity, high blood pressure, high triglycerides and unstable blood sugar are found, we can be certain that hyperinsulinism is the common denominator.
Ralph deFronzo, MD, one of the nation's leading diabetic specialists, removes the confusion that leads to a delayed diagnosis by pointing out that there are five stages of diabetes. 10 The first three stages precede the actual diagnosis of the illness. That is because conventional medicine does not routinely recommend the GTT with insulin levels, so people at risk are rarely found in the early stages of the disease. I truly believe that early diagnosis could bring the diabetes epidemic to a screeching halt, so much so that I fully intend my next project to be a definitive book on how we can do just that, and, as a result, eliminate diabetes.
The stages are:
Stage 1-Insulin Resistance (IR) only.
Stage 2-IR, plus hyperinsulinism (HI).
Stage 3-IR, HI, plus abnormalities in a GTT.
Stage 4-Type II diabetes, with high insulin levels.
Stage 5-Type II diabetes, with low insulin levels.
The road to diabetes is a continuum, with no sharp curves and no steep ascents. You just keep trudging along until you get there. You take the high-carbohydrate trail, and you may, after many years of unstable blood sugar and excessive insulin release that you are not even aware of, finally arrive at that unpleasant destination. Since insulin is the body's premier fat creator, most of us will have picked up significant extra pounds along the journey.
Then, after you actually become diabetic, your blood sugar level ceases to oscillate; it is now consistently high. Massive insulin resistance has been preventing insulin from effectively doing its job (Stage 4), or your pancreas will have exhausted itself after years of overproduction and will not be able to make enough insulin (Stage 5). Either way, you've waited a little too long to make the diabetes go away, but not too long to achieve a useful level of control.
This means that if you have not dealt with pre-diabetes, you are now in full-blown diabetes. You're in trouble! Blood sugar that cannot be transported by insulin into your cells (and liver) now spills over into your urine, wasting vital energy (Stage 4). Once your insulin has been reduced to impotence (Stage 5) you start losing weight inexplicably. Heavy urination leads to constant thirst. Your body burns anything it can find to fuel its daily operations, putting you in a state of ketoacidosis. You now know that something is very wrong.
I took you through this scenario so you could attend to the early warnings long before you hit this juncture. To do that effectively, you need to know where you stand in the range of risk. A competent physician should be able to help you, but it is up to you to determine whether your doctor fits that definition.
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