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Lifestyles Can Save Lives

Ever since I can remember, my mom and grandmother have helped my grandfather prick

his finger when he woke up, before and after every meal, and again before he went to bed. I can

recall the first time I noticed this pattern; my six-year-old self was sneaking over to my

grandfather so that I could get my daily circus animal cookie fix when I was discourteously

interrupted by my mom, who was carrying a small kit with needles, eye-drops, medicine, and

something that looked like my Tamagotchi game. It was not long after this that I realized he

would go through a process of administering a whole array of eyedrops, pricking a single droplet

of scarlet red blood from his finger, and putting that drop into a tiny machine that would give my

mom a number, every day, at least three times a day. As time went by and I gained more

knowledge of the world, I realized the reason why he pricked his finger. He was testing his blood

sugar levels to monitor his diabetes. Knowing nothing more than that diabetes had the most

miniscule connection to blood sugar levels, I pushed the thought aside and returned to my

eight-year-old life. But when I began learning more and more about diabetes, it seemed that there

were more people popping up in my life that struggled with the same thing my grandfather had. I

had realized how many generations of my family had diabetes and the strong links that type 2

diabetes must have to genetics. Despite this obvious connection, I chose to overlook my lifestyle,

similarly to my grandfather, even after he had been diagnosed. My grandfather was the epitome

of a naive diabetic. The realization of this came when the artificial white lights of the hospital

beamed on my youthful, porcelain skin. Holding my mother’s hand, one that seemed to fit

perfectly with mine, we pushed open door after door until we reached a waiting room where my

family had been for hours. The same artificial lights lit up the stacks of magazines, the tired eyes

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of everyone sitting in the colorfully upholstered seats, and the speckled “stone” floor tiles. The

smell of chemicals filled my nostrils, creating the classic hospital aroma that had become so

familiar. My ears filled. The whirring machines on every floor and the rushed footsteps of

doctors and patient families alike, added to the constant buzz of the lights. To any other

ten-year-old, these sounds, these smells, these sights would be anomalous but they had become

so normalized after years of experience visiting my grandfather. Every time he was hospitalized,

my family was right there beside him, helping him through his diabetes which would lead to his

heart attacks, his kidney failure, and his eye disease. Even after being exposed to all that, I still

do not seem to care much about how I eat, how much exercise I get, or about any of the

unhealthy habits I have. Just from a minimal amount of research, I have found that one’s lifestyle

and how they treat their body can and should change based on a family history of diabetes. This

process led me to ask the question: In what ways a change in lifestyle affect a family history of

diabetes and the time to diagnosis?

Diabetes can be broken down into two types: type 1 and type 2. Type 1 diabetes is caused

by the inability to produce insulin from one’s pancreas. Insulin is the hormone responsible for

managing blood glucose levels by allowing for glucose removal through pores created along the

cell walls of blood vessels. Without insulin there is no way for the glucose that comes from

consuming carbohydrates to become energy. The immune system of a type 1 diabetic attacks the

pancreas’ insulin producing beta cells, leading to high blood glucose levels. But the focus of this

essay will be on type 2 diabetes which is caused by the loss of two hormones: glucose dependent

insulinotropic polypeptide (GIP) and glucagon-like polypeptide type 1 (GLP 1). Type 2 diabetics

have a diminishing amount of both of these caused by genetics, so these hormones cannot

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suppress the amount of glucose input into the body. GIP is the first to run out, followed by GLP

1. These hormones, or lack thereof, lead to poor use of insulin. In turn, that creates poor use and

excessive input of glucose and other forms of glucose made by the body through digestion

(Chuck “Diabetes”). Prediabetes is among the most common causes of type 2 diabetes. It is

defined as “​a condition in which blood glucose or A1C levels—which reflect average blood

glucose levels—are higher than normal but not high enough for a diagnosis of diabetes”

(“Prediabetes”). Prediabetes practically ensures the development of type 2 diabetes because it is

considered a sign that the diagnosed prediabetic’s gene is revealing itself.​ The United State’s

rates of diabetes have been climbing for over a decade, whether it be type 2, type 1, gestational

(developed during pregnancy), or prediabetes. A potential reason for the rising diabetes statistics

is the trend of adolescent sedentary lifestyle and fat/carbohydrate filled diets paired with their

genetic disposition. The Center for Disease Control and Prevention (CDC) and the National

Institute of Health (NIH) paired up to do a ​SEARCH for Diabetes in Youth​ study which showed

that the rate of newly diagnosed cases of adolescent type 2 diabetes increased by 4.8 percent

from 2002 to 2012 (Reiter). What is to say that these numbers are not still rising? The CDC also

estimates that 9.4 percent of the U.S. population, or 30.3 million people had diabetes or

prediabetes in 2015 (“National”). ​The rising statistics are alarming, but there are various ways to

reduce these numbers based on newfound research and knowledge in the diabetic community.

One should become more aware of their habits and lifestyle based on their family history

of diabetes, but genetics play the most significant role in the pathogenesis, or manner of

development of a disease, of diabetes (“Pathogenesis”). A study done by the American Diabetes

Association, involving 92 unrelated type 2 Diabetics with a positive family history of diabetes

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and autoimmune defects, found evidence which suggests that their family history may explain

18% of diabetic development in young type 2 diabetics​ ​(Ng et al). This statistic is a perfect

example of how genetics affects the pathogenesis of diabetes because a family history is not the

only thing to take into account when weighing the probability of getting the disease. The link to

genetics is undeniable, especially based on demographics of the disease. According to Maggie

Ng’s study on the history of diabetes, she found that “​Type 2 diabetes mellitus is the

predominant form of diabetes in Hong Kong Chinese, even amongst those with early onset of

disease. Over 50% of these young patients have a positive family history of diabetes, suggesting

a role of genetic factors in its pathogenesis” (Ng et al). Though these statistics may seem

unsettling, they are not to say that having the gene will ensure that it expresses itself right away.

The development of some form of type 2 diabetes is inevitable because of the hereditary aspect,

but drastic changes to lifestyle may help avoid the early expression of the diabetic gene or even

prevent prediabetes from further developing into type 2 diabetes.

Diet is vital to hindering the expression of diabetes in people with a family history of the

disease.​ Meal planning is one option for individuals with the diabetic gene. The balancing of the

food groups is one of the main steps that needs to be taken in planning meals. But first, it is

important to understand a few things about food. In addition to the food groups, there are three

different types of simple sugars: sucrose/table sugar, made up of glucose and fructose;

lactose/milk, made up of glucose and galactose; and maltose/starch, made up of two glucose

molecules. These three simple sugars are easily absorbed in the body because there are less

components for the body to break down. They are usually immediately stored as glycogen, to be

saved for when the body needs to make more energy. Then there are complex sugars such as

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carbohydrates like lentils, quinoa, whole grains and a group known as the “great whites”: bread,

potatoes, rice, and tortillas (Chuck “Diabetes”). Carbohydrates are broken down into glucose and

are less easily absorbed in the body than simple sugars because they utilize more of the body’s

biochemical mechanisms in order to be broken down. For the most part, carbohydrates are an

at-risk person’s nightmare because they cause glucose levels to skyrocket. However, in some

cases, consuming carbohydrates, like whole grains, have proven effective in reducing the risk of

diagnosis. According to a study done by Harvard’s T.H. Chan School of Public Health, ​“The

bran and fiber in whole grains make it more difficult for digestive enzymes to break down the

starches into glucose. This leads to lower, slower increases in blood sugar and insulin, and a

lower glycemic index” (“Simple”). Focusing on what is consumed is only half of managing a

person at risk’s diet, the other half being food portions.

There are various ways of controlling food portions for prediabetics but the most

common are the plate method and the elimination diet. The National Institute of Diabetes,

Digestive, and Kidney Diseases suggests the plate method. The plate method entails a nine-inch

plate with half of the plate filled with non-starchy vegetables or fruits, a quarter filled with whole

grains or another type of healthy starch, and a quarter filled with some type of lean protein

(“Your”). The plate method reduces the amount of all forms of glucose consumed in that meal

while still maintaining the necessary amount of nutrients. ​The elimination diet takes a different

approach to sugars consumed during a meal by narrowing which forms of glucose affect their

blood sugar levels the most. In an interview with Tom Williamson, a previously diagnosed

prediabetic and currently diagnosed type 2 diabetic, he explains his experience with the

elimination diet as a part of his functional medicine process. His diet began by eliminating all

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processed sugars, dairy, caffeine, soy, and any foods​ containing grains including rice, wheat,

barley, rye, and corn for four weeks and slowly adding those components back into his diet to

see how they affected his glucose levels. Through this process, Williamson found that soy, rice,

wheat, barley, and rye aggravated his prediabetes the most. Just by making these dietary changes

and becoming stricter on the amount of carbohydrates and sugar going into the body lowers the

amount of excess glucose present in the blood. If adopted long enough, diet makes a significant

difference in both diagnosed and undiagnosed diabetics, along with other lifestyle factors.

However controlling glucose intake cannot be the only determinant in avoiding the expression of

the diabetic gene.

Exercise is another main step that one with a family history of diabetes can take in order

to avoid earlier onset expression of the disease. According to Dr. Leonard Chuck Ph.D., M.D., a

physician at Diablo Clinical Research Facility in Walnut Creek, a common misconception of

type 2 diabetes is that there is a lack of insulin receptors and that insulin supplements are the key

to treating type 2 diabetes, when in fact the receptors are fully intact and adding more insulin into

the body may not help with glucose regulation. This leads to the point that “insulin does not

actively drive glucose into the cells”, but allows sugar to get into the cells by punching holes in

the cell walls (Chuck “Diabetes”). In a diabetic, the blood glucose levels cannot drop due to the

inability of glucose cells to move across the cell membrane through the insulin receptors because

the concentration of glucose is higher in muscles than in the blood vessels. So where else is the

glucose to go? Muscles are humans’ largest glucose stores but can get saturated quickly due to

muscles’ precedence on glucose from the blood. By exercising, the glucose is worked out of the

muscles so that there is a lower glucose concentration in the muscle which precipitates the

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movement of glucose molecules into the muscles from the blood. The movement of glucose

refills the glycogen muscle store once again. The lower blood sugar levels cause the body to

overwork itself less. Along with the blood sugar levels, less exercise increases susceptibility for

excess abdominal fat and a higher cholesterol. With excess abdominal fat and higher cholesterol

comes an increased susceptibility to type 2 diabetes and the inefficient use of insulin (Chuck

“Diabetes”). The Diabetes Prevention Program (DPP), a trial run by the American Diabetes

Association, found evidence that the loss of a minimum of five to seven percent body weight and

a consistent 150 minutes of exercise per week reduced the likelihood of developing type 2

diabetes by 58 percent over three years. The DPP recommends that subjects focus on physical

activity through aerobic activity, resistance training, or moderate intensity brisk walking that

breaks up sedentary time (American). Williamson, a type 2 diabetic claims that he “walks more

than three miles a day” during his lunch hour and that the consistency of that walk is what keeps

him healthy. Even with a stricter diet, exercise, and knowledge of family history, there is still the

ordeal of excess blood glucose that a prediabetic body cannot keep up with and that can still

trigger the gene.

​Diet and exercise have proven the most effective in avoiding diabetes, but consulting a

doctor about getting a prescription of oral diabetes medications may help. However current

medication options only technically apply to Diabetics, medications such as metformin help to

reduce glucose levels by promoting the production of GLP 1(Lu). Chuck even claims that if

metformin is prescribed soon enough for a prediabetic or gestational diabetic, it may prevent the

development of type 2 diabetes. Metformin can be the most effective method of prevention of

diabetes for high risk individuals: individuals with history of gestational diabetes, obesity,

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hyperglycemia or rising blood sugar levels despite a significant change in lifestyle

(“Prevention”). In addition to the oral medication that has already proven effective, there is now

more research being done with the human genome in order to target the development of type 2

diabetes in order to prevent it. The National Institutes of Health (NIH), bio-pharmaceutical

companies, and non-profit organizations launched the development of the Accelerating

Medicines Partnership (AMP) in February of 2014. The AMP is setting out to identify DNA

regions critical to the development of type 2 diabetes, analyze them, then search for “individuals

whose genetic inheritance may provide a model of what targeted drugs may achieve” (“Type 2”).

The medication for prevention, not just the treatment, of diabetes is well underway. As

biological, technological, and immunological knowledge is expanding, so should the minds of

those at risk for diabetes.

According to a type 2 diabetic, Alan Paredes, education was the most effective method in

treating his diabetes aside from medication. The one thing that Paredes would want people who

do not suffer from diabetes to know is that “​Diabetes is a gateway opening to other diseases”.

Diabetes can often times lead to cardiovascular disease, kidney failure, lower limb amputations,

and retinopathy, which can result in blindness (“Type 2”). It is also the leading cause to nervous

system damage, lack of sensation or pain in the hands and feet, impotence, gum disease, comas

due to ketoacidosis, and increased susceptibility to infections and illnesses such as pneumonia

and influenza (Saudek and Woodruff, 16). Prevention of diabetes, for those with any risk at all,

whether it be obesity or family history of type 2 diabetes, should begin earlier because if it does

not the numbers of youths suffering from type 2 diabetes and prediabetes will just continue to

rise and an epidemic may be put into motion. The education that children with a family history of

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diabetes can receive is especially important because the additional glucose producing growth

hormone during adolescence can lead to even more issues and aggravation of diabetes (Chuck

“Diabetes”). With all the new technology and applications of technology, diagnosed diabetics are

becoming more self-sufficient. The world of diabetes treatment is advancing. Knowing the

mechanisms and what to look out for before even getting diagnosed with the disease will help

ensure the deferred expression of the diabetic gene. Taking surveys, getting blood tests, and

checking in with a doctor every few years are all easy steps to take as a precaution to getting

diabetes. Education and knowledge about diabetes is just as important as diet, exercise, or

medication.

Type 2 diabetes affects every aspect of life once diagnosed. Eating what tastes good is

no longer an option because a diabetic’s dietary restrictions are necessary. Watching that extra

episode of ​The Office​ instead of going for a brisk walk or run can be fatal.​ ​Diabetes is a chronic

disease which gets worse with time so anything one can do to either prevent or avoid getting

diabetes will extend their life span by leaps and bounds. A healthy lifestyle is indispensable in

the lives of people with a family history of diabetes, but it can also help to prevent further health

complications for people with the condition. That is why if one adopts the lifestyle, diet, exercise

habits, management of stress of a diabetic, in addition to being knowledgeable about diabetes

sooner, the diabetic gene is less likely to express itself early-on. Maintaining a healthy lifestyle

of an at-risk of diabetes individual is good for more than just preventing diabetes, it is something

that I believe everyone should adopt.

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Works Cited

American Diabetes Association. “Prevention or Delay of Type 2 Diabetes.” ​Standards of

Medical Care in Diabetes 2017, ​Jan. 2017,

http://care.diabetesjournals.org/content/40/Supplement_1/S44, Accessed 3 Mar. 2018.

Chuck, Leonard. “Diabetes Basics.” Diablo Clinical Research, Hawaii Discussions, 6 July 2007,

Diablo Clinical Research, Walnut Creek, CA. Keynote Speech.

Chuck, Leonard. Personal Interview. 26 February 2018.

Lu, Stacy. “How to Prevent and Treat Prediabetes.” ​Diabetes Forecast​, Mar. 2018,

www.diabetesforecast.org/2018/02-mar-apr/how-to-prevent-and-treat.html?loc=morefro

m. Accessed 16 Feb. 2018.

“National Diabetes Statistics Report, 2017.” Centers for Disease Control and Prevention,

https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf,

Centers for Disease Control and Prevention, Accessed 18 Feb. 2018.

Ng, Maggie C.Y., et al. "Genetic Factors and Autoimmunity in Chinese Patients with Early

Onset Type 2 Diabetes Mellitus." ​Diabetes​, May 1999, p. SA403. ​Student Resources in

Context​,

http://link.galegroup.com/apps/doc/A54771853/SUIC?u=wal55317&xid=4079ba17​.

Accessed 14 Feb. 2018.

Paredes, Alan. Email Interview. 8 March 2018.

“Pathogenesis.” ​MedicineNet​, 13 May 2015,

www.medicinenet.com/script/main/art.asp?articlekey=6385. Accessed 13 Apr. 2018.

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“Prediabetes & Insulin Resistance.” ​National Institute of Diabetes and Digestive and Kidney

Diseases​, U.S. Department of Health and Human Services, 1 Aug. 2009,

www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-i

nsulin-resistance.

Reiter, Amy. “Rates of New Diagnosed Cases of Type 1 and Type 2 Diabetes on the Rise among

Children, Teens.” ​National Institutes of Health​, U.S. Department of Health and Human

Services, 17 Apr. 2017,

www.nih.gov/news-events/news-releases/rates-new-diagnosed-cases-type-1-type-2-diabet

es-rise-among-children-teens. Accessed 3 Mar. 2018.

Saudek, Christopher and Sandra Woodruff. ​The Complete Diabetes Prevention Pan: A Guide to

Understanding the Emerging Epidemic of Prediabetes and Halting Its Progression to

Diabetes. ​Penguin Group, 2004.

“Simple Steps of Preventing Diabetes.” ​The Nutrition Source, ​Harvard T.H. Chan School of

Public Health,

https://www.hsph.harvard.edu/nutritionsource/diabetes-prevention/preventing-diabetes-fu

ll-story/. Accessed 18 Feb. 2018.

“Type 2 Diabetes.” ​National Institutes of Health​, U.S. Department of Health and Human

Services, 22 Feb. 2018,

www.nih.gov/research-training/accelerating-medicines-partnership-amp/type-2-diabetes.

Accessed 17 Feb. 2018.

Williamson, Tom. Email Interview. 6 March 2018.

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“Your Game Plan to Prevent Type 2 Diabetes.” ​National Institute of Diabetes and Digestive and

Kidney Diseases​, U.S. Department of Health and Human Services, 1 Feb. 2017,

www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes/ga

me-plan. Accessed 3 March 2018.

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