# TWO. Can Diabetes Be Prevented?

Does regular exercise help to prevent type 2 diabetes?

Is there a particular type of diet that will reduce my chance of type 2 diabetes?

Are there any natural herbs, minerals, or other remedies that prevent diabetes?

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## How does my weight affect my risk of type 2 diabetes?

Weight and risk of type 2 diabetes are clearly linked. Figure 3 shows the risk of development of type 2 diabetes, as it relates to body weight. For clinical purposes, weight is related to height by a formula known as body mass index or BMI. In our society, a BMI of 18 to almost 25 is considered to be healthy and from 25 to almost 30 is considered overweight. From 30 to 35 is considered to be obese and from 35 to 40 is severely obese. A BMI that is greater than 40 is considered morbidly obese, indicating that a person with this degree of obesity is at very serious risk of both immediate and long-term health problems. To calculate your own BMI, divide your weight in pounds by the square of your height in inches (i.e., your height multiplied by itself) and then multiply the answer by 703. For example, if you are 5 feet 8 inches (68 inches) tall and weigh 148 pounds, your BMI will be 148 divided by 68 × 68, i.e., 148/4624 = 0.032 and then multiplied by 705, i.e., your BMI is 22.6. Congratulate yourself, as your weight is in the healthy range! Figure 3 shows the risk for development of type 2 diabetes according to weight for both men and women. The risk of having type 2 diabetes increases as weight increases, even within the normal range, especially for women. Severe and morbid obesity are associated with an almost 100 times greater chance of diabetes in women and almost 50 times for men. The reason for this is principally because the likelihood of having insulin resistance, a major causative factor for type 2 diabetes (see Question 2), increases as weight rises. Very physically active individuals who are overweight or obese by usual standards may be at little increased risk due to the protective effect of exercise (see Question 12).

Body mass index (BMI)

A clinical means of relating weight to height by a formula. To calculate your own BMI, divide your weight in pounds by the square of your height in inches (i.e., your height multiplied by itself) and then multiply the answer by 703.

A BMI of 18 to almost 25 is considered to be healthy.

Figure 3 Relationship between weight risk of type 2 diabetes.

Source: Data from Chan JM et al. Diabetes Care. 1994; 17:961-969; Colditz G et al. Ann Intern Med. 1995;122:481-486.

## Does regular exercise help to prevent type 2 diabetes?

Yes, regular exercise of at least moderate intensity provides some protection against the onset of type 2 diabetes. Exercise improves insulin resistance and thereby makes insulin more effective at removing glucose from the blood. In patients with prediabetes (see Question 9), exercise can prevent the progression of elevated glucose values toward the frankly diabetic range, or even restore them to normal. Exercise also consumes calories from those stored in the exercising muscle as starch (glycogen) and the need to replenish these stores draws glucose out of the bloodstream and thereby reduces the circulating levels. Exercise also helps to maintain a healthy body weight and avoid the weight gain that can lead to diabetes (see Question 11), although it is not as certain that exercise is as helpful in promoting weight reduction. Weight reduction is much more dependent on restriction of food intake. However, exercise is clearly important in maintaining weight loss. Finally it is worth noting that exercise has beneficial effects on the other risk factors that combine with diabetes to cause vascular disease. For example, exercise increases the good (or HDL) cholesterol and improves levels of other blood fats, while lowering- blood pressure and enhancing cardiovascular (i.e., heart and blood vessel) conditioning.

Regular exercise of at least moderate intensity provides some protection against the onset of type 2 diabetes.

Calorie

A unit used to express heat or energy value of food.

Glycogen

Starch, which comprises sugars linked together in a storage pattern.

HDL

High-density lipoprotein; "good cholesterol."