A woman eats a salad in her kitchen and smiles.
Those approaching menopause should be extra careful about diabetes. (For Spectrum Health Beat)

Diabetes is a far too common disease, and unfortunately, it is on the rise.

The statistics are sobering: Diabetes is the seventh leading cause of death among Americans. Sadly, 1 in 11 (29 million) Americans suffer from diabetes, and 1 in 3 (86 million) have pre-diabetes.

The good news is that some forms of diabetes can be prevented, and the best way to prevent this disease is to become educated about what it is and how you can avoid it.

First, let’s be clear about the definitions.

Type 1 diabetes is typically diagnosed in kids or young adults. In Type 1 diabetes, the body (specifically the pancreas) does not make insulin, and, therefore cannot process sugar. The sugar then stays in the blood and can’t get in the cells to be used as energy. Symptoms of this type of disease include weight loss, fatigue, thirst, frequent urination and extreme hunger, even after eating. Type 1 diabetes does not tend to run in families, and diagnosis is done with a simple blood sugar test.

Type 2 diabetes does tend to be hereditary, by both genetic risk factor for insulin resistance and health habits (physical activity and diet). Type 2 diabetes is preventable and is caused by high blood sugar from insulin resistance. Symptoms of this disease include those listed for Type 1 diabetes, plus blurred vision and headaches.

What exactly does insulin resistance mean? Here’s how it works: Insulin is the key to getting blood sugar into the cells—brain cells, liver cells and muscle cells. If someone has insulin resistance, it takes more insulin to get the door of the cell to open. Therefore, while waiting for the pancreas to make more insulin, the blood sugar rises and not only gets pushed into fat, but also causes the many complications of diabetes. As the belly fat increases, it leads to more insulin resistance.

Here’s a simpler way to think about it: When someone with pre-diabetes says they are “craving carbs,” or they are a “carbaholic,” I like to say that they aren’t actually craving carbs; instead, their fat is craving sugar. Unfortunately, when they eat the sugar, it goes straight to their fat, instead of going to their muscles, brain or liver. When people with pre-diabetes eat sugar, they are starving themselves and feeding their fat. To stop the craving, they must stop the sugar for 10 days and tell the fat to “shut up.”

Not all carbs are bad

Now let’s focus on carbs.

Carbohydrates are necessary fuel for our bodies—especially our muscles and our brain. Our liver needs to store a little bit of carbs as glycogen for when we need a boost, like after walking at a good pace for 40 minutes. However, there is a difference between healthy and unhealthy carbs.

Complex (healthy) carbs raise the blood sugar slowly and allow the pancreas to make insulin slowly and push the sugar into the right cells—not into the fat on your body. We need complex carbs at breakfast, morning snack, lunch and afternoon snack, and then not so much for the rest of the day. Healthy carbs include whole grain whole wheat bread, brown rice, sweet potatoes, quinoa, oatmeal (cooked—not the sugary packets), beans, peas and green vegetables.

Simple (unhealthy) carbs raise your blood sugar quickly, overwhelm the insulin in your body and get pushed into your fat. Think of simple carbs as a treat—white rice, white tortillas, baked goods, candy, many cereals, and anything made with mostly white flour.

Unfortunately, too many people think they are doing the right thing by staying away from all carbs. That is the wrong tactic.

When my patients (all women, of course) tell me they don’t eat any carbs, I let them know that’s the wrong approach to good health. The goal is to achieve an even blood sugar with minimal insulin spikes. High insulin can make us hungry for sugar and then pushes the sugar into fat. A healthy diet only contains one small treat per day—a piece of chocolate, a serving of alcohol, or a white flour tortilla.

Think of these types of carbs like a budget—you can have some carbs, but you can’t have them all at once.

Blood sugars and Type 2 diabetes can cause many complications—kidney disease, hypertension, stroke, skin problems, neuropathy, foot problems, infections resulting in loss of toes, eye issues (glaucoma and blindness), and impotence in women and men.

High blood sugars damage and clog small blood vessels, and if organs, including the eye, heart, kidney and sex organs, do not get blood, the various organs can’t work properly and problems occur.

Risk factors to know

It’s important to know the risk factors associated with this disease. Family history of diabetes, being overweight (especially with belly fat), and inactivity are all serious risk factors. In addition, women have two other factors that can work against them: having diabetes during pregnancy and menopause.

Menopause increases the risk by causing insulin resistance, and menopause can also make things worse by causing poor sleep from night sweats. The cycle continues because poor sleep makes it more difficult to have the energy to exercise and make good food choices. Menopause can definitely wreak havoc for women and diabetes.

I see many menopausal women in my office each year, and so many of them tell me about their struggle with weight. I remember one patient in particular I’ll call Sue.

Sue came to see me for heavy bleeding around the time her menopause had started. We did an ultrasound, which showed a thick uterine lining, so I scheduled a dilation and curettage.

During her exam, I also asked her what was the No. 1 struggle in her life. She started crying and told me her weight was her biggest struggle. Over the years, she had managed to keep her weight at a “tolerable” level, but in the past six months (around the time she started menopause), her weight continued to climb and she was giving up.

I couldn’t let Sue leave my office without trying to see what she could change to help with her weight struggle. We went through her diet, and she mentioned that she was avoiding carbs most of the day. She would eat some protein throughout the day and try to starve herself by eating little else.

By the time she began preparing dinner, she was extremely hungry and tired. As a result, she would eat the same meal she had just made for her family—some type of meat and a potato or pasta.

Even though Sue limited her portions throughout most of the day, she was actually causing herself to put on more weight. Her body was so hungry that whatever food was being consumed was being pushed into belly fat. Sue was surprised to learn she was making it worse, but I helped her develop a simple and easy plan to incorporate complex carbs into her diet.

By the time I saw her for her dilation and curettage several weeks later, she was feeling better, had more energy, and had lost six pounds for the first time in years.

It’s important for all of us to know as much as we can about diabetes in order to avoid falling victim to this disease.

Knowing the risk factors plus ways to avoid diabetes (exercise and diet) are imperative.