Question: Can a person with "borderline diabetes" reverse the problem with diet changes, weight loss, and exercise?
Dr. Hibberd's Answer:
Yes. Borderline diabetes is a difficult term to generalize about. What needs to be made clear is that you have diabetes. End of question.
Now, can diabetes be diet controlled with a calorie-restricted diet and exercise? Definitely. Remember, diabetes is a lifetime diagnosis, and is not cured, simply controlled by various measures which work best when tailored to the individual.
The damage diabetes does to our microcirculation, especially to the small vessels of our kidneys, heart, eyes, and brain, can't be underestimated.
All diabetics should be aware that their glucose management will determine onset and extent of premature vascular changes seen with uncontrolled glucose management, whether you want to call it diabetes or not.
Elevated blood glucose values often correlate with premature circulatory disease, and we have aggressive preventive regimens to add an element of protection to premature failure of our microcirculation.
As an example, the LDL cholesterol targets are 80 as opposed to usual nondiabetic targets of 100 to 130 depending upon associated risks. This lower target is very rarely achieved without pharmaceutical help, often a statin medication.
We now consider the use of an ACE inhibitor medication to prevent the progression of proteinuria and renal dysfunction that is so often the reason many diabetics need dialysis.
In the same way, we recommend yearly professional eye (opthalmoscopic and slit lamp) evaluation for all diabetics to treat (often by laser) and manage the almost inevitable premature retinal changes (called retinopathy) that will lead to early loss of vision if left unaddressed.
In addition, be especially careful to have a yearly foot evaluation to inspect for neuropathic changes often associated with diabetes. Do not delay care if ulcers or inflammation develops, especially in the feet.
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