Prediabetes is the signal for a drastic change in lifestyle. Diabetologist: “Diet and sports must be adopted forever!”

Due to unhealthy eating and sedentary lifestyle, at this moment, 1 out of 10 Romanians has diabetes and 3 out of 10 suffer from prediabetes. According to studies, approximately 20% of patients are not diagnosed with this disease, although according to the clinical context in their case there are clear indications of the condition. Even more worrying is the fact that by 2030, over 10% of our country's population will suffer from diabetes. Unfortunately, studies show that overall, 50% of people diagnosed with prediabetes will end up with diabetes because they don't take action. Ancuța Frigioi, specialist in diabetes and nutrition in Hyperclinic MedLife Constanța, assures us that diabetes can be prevented if we do a few blood tests and an abdominal ultrasound every year, and if we are at increased risk for this disease, we will change our lifestyle.

How sugar acts on the human body

Type 2 diabetes is the most common form of diabetes, being characterized by insulin resistance after the patient, for many years, has led an unhealthy, sedentary lifestyle. But sugar consumed in excess is not the only one responsible for insulin resistance, says diabetologist Ancuța Frigioi.

“Sugar is dangerous for health. It's just that it's not the only dangerous thing. First of all, it's the frequency with which we consume it that matters. Diabetes doesn't appear when we discover a high blood sugar level, but it was established long before. The disease starts in a place that almost no one checks – at the level of insulin. Imagine an ordinary person who drinks a coffee with sugar in the morning. He also eats something sweet on the side. Sugar quickly reaches the blood and increases blood sugar, and the body reacts. immediately.

The pancreas begins to secrete insulin. Glucose enters the blood and becomes energy, which is perfect for the moment. But if the patient does not exercise, the energy is not consumed and the body stores it as fat. In the liver, in the form of glycogen, which is basically a limited reserve. Unfortunately, this happens every day, not just once. And sugar is in many foods that we consume throughout the day. The pancreas will be forced to secrete more and more insulin, and when the body is overloaded, the cells begin to respond less to insulin and insulin resistance appears”, explained the diabetologist.

Sugar substitutes, a short-term solution

At the same time, in addition to sugary products, every day we will also consume fast food, juices, etc., all of which create, in the long term, the onset of diabetes when they are eaten in excess and we do not exercise to burn these calories.

“I tell my patients who have pre-diabetes or a risk of pre-diabetes that the behavior must be completely changed, for life. If we only fool ourselves with products with the Zero Sugar label or with artificial sugar substitutes, we do not solve the problem. If we analyze sweeteners such as aspartame or sucralose, they do not increase blood sugar, but they keep that sweet taste and basically trick the brain, but the feeling of hunger appears earlier and the desire for sweets increases. Xylitol or erythritol has a lower glycemic impact than sugar, but can cause digestive discomfort.

We also have the natural version – stevia – which is metabolically better than the others. The problem is that the ingredient changes, but not the behavior. Sugar substitutes do not solve the metabolic problem. In addition, we will tend to consume more, thinking that it has no sugar. A balanced diet means reducing both the amount and the frequency of sweet consumption. It is preferable to consume a square of dark chocolate, than a liter of soft drink with the Zero Sugar label. Juices are a metabolic accelerator of diabetes”, said the doctor.

The time of day when we eat something sweet is also very important.

“If we make a morning porridge, for example, with 40 grams of oats with 2% fat yogurt, leaner and richer in protein, to which we add a few berries or a banana, it's fine, but if during the day we drink a juice, eat some chocolate, it's not good. We have a healthy lifestyle in the first part of the day for nothing, if we don't take it into account in the evening,” explains Dr. Ancuța Frigioi.

Medical investigations for the prevention of diabetes

Accumulated fat on the abdomen is an emergency signal, says the doctor. If by then we have not done the usual tests, in order not to end up with diabetes, it would be time to take measures and see what situation we are in.

“When this abdominal obesity appears, we can think about insulin resistance. The pancreas produces more and more insulin when we eat unhealthy. And a paradox appears. The patient has normal blood sugar and is not worried. But insulin is increased and here, in fact, is the invisible phase of diabetes. In order to understand how we are doing, we should do several blood tests such as: fasting blood sugar, taken in the morning on uneaten, glycosylated hemoglobin, the HOMA index which shows us insulin resistance, the glucose tolerance test, which is underused, the complete lipid profile, transaminases, creatinine, urine summary, abdominal ultrasound – let's see if the liver is fatty – that is, it suffers from hepatic steatosis, non-alcoholic steatohepatitis which can lead to fibrosis, later to cirrhosis and even to hepatocarcinoma uric, C-reactive protein, because it is a marker of inflammation. In selected cases, we can take Peptide C, which shows us how much insulin the pancreas produces, insulin and pancreatic antibodies to differentiate the types of diabetes,” the diabetologist emphasized.

Prediabetes is treated by changing lifestyle

If the analyzes indicate prediabetes, in the first phase, the doctor recommends a diet accompanied by regular physical exercise, measures that must become a long-term lifestyle.

“That belly is not only unsightly, it's metabolic. The body has transformed the triglycerides into fat. The fat is not only on the belly, but also on the inside. In the prediabetes phase, I recommend to patients a low-calorie diet, which should later become a lifestyle, because that's the only way they will stay healthy. Our body has a metabolic memory. And it will always want to return to the weight at which it felt best, even if it was medically wrong Depending on the individual patient, the metabolic memory reset is different in time.

Movement and protein consumption are absolutely necessary in the weight loss process in order not to lose muscle mass. The liver produces glucose and the muscle consumes it. In addition, with age, muscle mass decreases. I recommend cardio exercises, but also weight lifting,” explains Dr. Ancuța Frigioi.

Losing weight is not an easy process, says the diabetologist. The patient must be aware of the danger posed by diabetes, be conscientious and persevere with the recommended measures.

“Diabetes is a very insidious disease that affects all the organs, from the eyes to the nerves. The worst thing is that it settles unconsciously, that is, the patient feels fine, nothing hurts most of the time, and this is where the resistance to the diet appears. Prediabetes is the moment when he must understand that he is given another chance for health by changing his lifestyle. If he is lucky, we will not need to recommend drugs for resistance severe insulin resistance, we go on a diet and sports that must be adopted forever, if he wants to stay healthy.

I always explain to my patients that these measures must be maintained in the long term. When they lose weight, a decrease in glycosylated hemoglobin is also observed, the HOMA index also decreases. Likewise, it will be seen on ultrasound that a grade 3 steatotic liver becomes a grade 2 steatotic liver. But all these changes are maintained only if they adopt this lifestyle forever.

It is not at all easy for a person who is used to eating fat, a lot, sweet, etc. to lose 10-15 kg. Often the help of a psychologist is also needed. I empathize with my patients and I don't completely eliminate their preferences, but I reduce them. If before, the patient drank 2 liters of carbonated drinks a day, we reduce it to one glass that he can share as he wishes throughout the day. A state of depression also appears in the diet, the patient becomes apathetic because he got his mental well-being from those foods. If it is too difficult, he will give up”, explains the diabetologist.

As for sports, the doctor says that here too there is a trap because many patients are tempted to eat a lot after burning calories through sustained movement. It is advisable to consume high-quality protein, after sustained physical effort, to restore the muscle fiber and hydrate as best as possible.

Prevention of diabetes through genetic tests

Not to be neglected in nutritional diseases is the genetic component. Dr. Ancuţa Frigioi specifies that the risk of diabetes is much higher in a person who has cases of diabetes and obesity in the family.

“Prevention for patients who have cases of obesity and diabetes in the family must be taken even more seriously. Likewise in heart diseases that often derive from weight gain. Including the lipid profile can be genetically inherited. Because that is what we are made of, from a genetic DNA. Beta thalassemia is also an inherited disease. Genetic tests such as the one launched by MedLife, Longevity 100+, are very good because they help you prevent, and prevention is the most important”, concluded the diabetologist.

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