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Diabetes: A plan for living

Nearly 24 million Americans—roughly one of every 13 people—have diabetes, a disease marked by high levels of sugar in the blood. More than 90% of them have type 2 diabetes, which occurs when the body becomes resistant to the effects of insulin (the hormone that enables cells to draw sugar from the blood for energy) and not enough insulin is produced to overcome the resistance. In fact, the number of adults diagnosed with type 2 diabetes has more than quadrupled since the early 1980s. As a result, many experts consider type 2 diabetes an epidemic—a term once reserved only for infectious diseases. Consequently, this report focuses almost exclusively on type 2 diabetes, and includes only a brief explanation of the related, but far less common, type 1 diabetes, a disease that usually first appears during childhood or adolescence. This report describes the basics of how your body metabolizes sugar, how and when to monitor your blood sugar, and how to cope with both short- and long-term complications of diabetes, which include heart attacks and stroke, blindness, kidney failure, and amputation. It also includes detailed, updated information about weight loss strategies, medications, and alternative treatments for diabetes.

Prepared by the editors of Harvard Health Publications in consultation with David M. Nathan, M.D., Professor of Medicine, Harvard Medical School, and Director, Diabetes Center and Clinical Research Center, Massachusetts General Hospital. 45 pages. (2009)

  • What is diabetes?
    • How the body breaks down sugar
    • How diabetes develops
    • Who’s at risk for type 2 diabetes?
  • Diagnosing diabetes
    • Recognizing the symptoms
    • Tests for diabetes
    • Diagnosis and beyond 
  • Managing your diabetes: An overview
    • Monitoring blood sugar
    • A team approach
  • SPECIAL BONUS SECTION: Weight-loss strategies for diabetes
  • Medications for diabetes 
    • Oral medications
    • Insulin 
    • Additional medication options
    • Combination therapy
  • Alternative treatments for diabetes
  • Short-term complications
    • Hypoglycemia 
    • Other diabetic emergencies
  • Pregnancy and diabetes
    • Gestational diabetes
  • Long-term complications
    • Eye disease
    • Nerve damage 
    • Kidney disease
    • Damage to the feet and legs 
    • Cardiovascular disease
  • Resources
  • Glossary

Weight-loss strategies for diabetes

About eight of every 10 people with diabetes are overweight or obese. To highlight this connection, Shape Up America, an organization devoted to raising awareness of the health issues associated with obesity, coined the term “diabesity” in 2000. But experts have only recently begun to understand why excess weight increases the risk of diabetes. They now believe that fat cells—especially those in the belly, where people tend to carry extra pounds—secrete hormones and other chemical signals. Some of these substances trigger inflammation, which interferes with insulin receptors on cells, leading to insulin resistance and eventually diabetes. Most people think of inflammation as redness, swelling, or pain—all signs of the body’s natural reaction to insult and injury. Subtle, chronic inflammation inside the body doesn’t produce these visible signs, but it may raise the risk of diabetes, heart disease, and other illnesses.

The good news is that losing as little as 5% to 10% of your body weight can help manage diabetes. For example, a woman who is 5 feet 4 inches and weighs 165 pounds would need to lose just 8 to 16 pounds to see noticeable declines in her blood sugar (as well as her blood pressure and cholesterol levels). This section describes ways to reach that goal through both diet and exercise. It also includes information on weight-loss medications and weight-loss surgery.

Lifestyle changes make a difference

Making a real effort to lose weight pays off, as evidenced by the Look AHEAD trial, a federally funded study involving more than 5,000 overweight or obese people with diabetes at 16 centers across the United States. Half the participants were randomly assigned to follow an intensive lifestyle intervention that required them to eat less and move more, which a goal of losing at least 7% of their body weight within the first year. Specifically, they ate portion-controlled diets (including liquid meal replacements and frozen entrées) and were encouraged to walk or do other moderate-intensity exercise aiming for a goal of 175 minutes a week. The other participants, who served as the control group, received standard diabetes support and education. After one year, people in the lifestyle group had lost an average of 8.6% of their body weight, compared with 0.7% in the control group. With the weight loss came improvements in blood sugar, blood pressure, and HDL (good) cholesterol, as well as a reduced need for medications to control those factors, as described in a 2007 article in Diabetes Care.

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