- Illustration by Annie Internicola
Bill Pfleging arrived somewhat suddenly—and altogether accidentally—upon his diagnosis for type 2 diabetes. In a haze of pain, the 56-year-old Woodstock resident was admitted to Kingston Hospital in the spring of 2008. After running some tests, an emergency room doctor identified the source of the agony: a kidney stone. Pfleging was told it would pass in about 48 hours. “And by the way,” the doctor added on his way out the door. “You’re also diabetic.” His tone was lackadaisical—but his words hit Pfleging with machete-like force. Both Pfleging’s mother and grandmother had died from complications of type 2 diabetes. For Pfleging, “It felt like a death sentence.” He left in shock—but ready to make some radical changes that would turn his life around and set him squarely on the path to health.
Many type 2 diabetes diagnoses come in just this way—inadvertently exposed by blood work from a separate medical event. Diabetes can enter a life silently, lurking for years before an onset of symptoms such as excessive thirst, increased hunger, and frequent urination. By the time symptoms appear, it’s likely that high blood-glucose levels have wreaked some havoc on the body’s delicate latticework of cells and tissues. But whenever the diagnosis arrives, it’s always a wake-up call. The message is firm and clear: You must change your diet and your lifestyle. If you don’t you’ll face an uncertain future, and increased odds for complications ranging from kidney failure and heart disease to amputations and blindness.
A dazzlingly large number of people are receiving this message nowadays. An estimated 27 million Americans have diabetes, and another 65 to 70 million are prediabetic. One out of three people born today will develop diabetes. And according to a University of Chicago study, the incidence of type 2 diabetes in the U.S. will double in the next 25 years. Around the globe the statistics are not much better, but it is the American way of life—an exported culture of Big Gulp sodas, supersized meals, and sedentary habits—that’s largely to blame.
Yet there’s good news, too. The complications of diabetes are largely preventable, and the conscientious patient can live a healthy life for many years through careful adjustments to diet and lifestyle. If type 2 diabetes is caught early enough, as it was with Pfleging, its status can even be reversed, with blood sugar levels returning to normal after a few months of dedicated, boot-camp-like change.
Goodbye, White Bread
When Pfleging arrived at Kingston Hospital, his blood sugar was hovering at 250—well above the normal range of under 120. A hemoglobin A1C test, which reveals blood-sugar levels from the previous three months, confirmed a diabetes diagnosis, and Pfleging’s family doctor wanted to start him right away on oral medications to control the problem. But Pfleging resisted. “I knew that if I went on meds, I wouldn’t change my eating habits,” he said. Since Pfleging wasn’t having any symptoms yet, his doctor agreed to a little experiment: He would let his patient give diet-modification a try.
Pfleging is a big guy—the kind of guy who can handle a carton of Ben & Jerry’s or a family-size bag of chips in one sitting. And in his previous life, he did. But after the diagnosis he changed his habits completely. One of the first things to go was steak and potatoes; instead, he added more vegan and vegetarian foods to his repertoire—good, clean organic food that was not highly glycemic. He also banished the Four Whites: white flour, white sugar, white rice, and white potatoes. He and his wife dusted off their old rice cooker and started using it to cook up a week’s worth of brown rice to keep in the fridge as a handy accompaniment to nonstarchy vegetables and lean proteins. Pfleging ate multigrain breads—and green salads with almost every meal. He became a label reader, and was shocked to find sugar in everything, although it was often veiled under ambiguous markers like cane crystals and corn syrup. Agave became his low-glycemic sweetener of choice.
After four months of Pfleging’s revolutionized diet, new blood work showed absolutely no sign of his diabetic former self. His doctor was pleased—and the patient beamed with pride and relief. “I didn’t stop eating; I just changed the content of what I was eating,” says Pfleging. And he kept going, ultimately losing between 35 and 40 pounds in one year. To this day Pfleging has to wear his wedding ring on his thumb because it slips right off his slimmer ring finger. “I kind of like it there now,” he says. Like a trophy on the mantelpiece, it reminds him of victory.
A Shape-Shifting Disease
This is not your mother’s diabetes: The disease today looks nothing like it did just two decades ago. One of the most shocking recent changes is the rise in type 2 diabetes among children; it is now one of the most common new diagnoses in pediatric practices. The change is so complete that you’ll no longer hear a doctor refer to type 2 as “adult-onset diabetes” and type 1 as “juvenile diabetes,” as they were formerly known. While type 1 diabetes is an autoimmune disease, in which the body stops producing the insulin that regulates blood sugar, type 2 diabetes is a lifestyle disease, in which the body develops a resistance to insulin in response to the way we live. Suddenly, the repercussions of our Western lifestyle are surfacing even in kids 10 to 15 years old—kids who are overweight and less active than ever before.
What can be done? “Good dietary habits need to be instilled at a very young age,” says Rehan Ahmad, DO, of Orange County Diabetes & Endocrinology in Newburgh. “And daily exercise must be incorporated as a total necessity.” The birth of industrialization, and now computer culture, have made our lives easier yet rendered us sedentary. Our genes, unfortunately, haven’t caught up to the change. Type 2 diabetes is in fact an epigenetic disease; that is, the genes causing it can either lie dormant or get turned on like a light switch by our self-created environment.
Some are more prone than others; risk factors can include family history and ethnicity. Yet one factor increases the chances of developing diabetes exponentially: obesity. Bariatric surgery—in which the size of the stomach is reduced via gastric banding—has surfaced as a highly effective treatment for obesity-related diabetes in recent years. “Weight loss, surgical or nonsurgical, helps reverse insulin resistance and can therefore reverse type 2 diabetes,” says Dr. Ahmad. Yet he cautions that it’s not a cure. “If individuals regain weight after bariatric surgery, they redevelop insulin resistance and hence type 2 diabetes.”
No Silver Bullets
For various reasons, many people will not be able to reverse their diabetes through diet or surgery; instead, they’ll need to manage it with a deft juggling act of diet, oral medications, and possibly an insulin pump or injections. Every body is different, and every case is different. That’s why Gretchen Scalpi, author of The Everything Guide to Managing and Reversing Pre-Diabetes and The Everything Diabetes Cookbook, cautions against a one-size-fits-all approach. Scalpi—a registered dietician and certified diabetes educator who sees clients in Fishkill and New Windsor—looks at the whole person, taking into account their lifestyle, work situation, habits, and other health issues. “I’ll suggest something different for a retired person living at home than for someone who’s commuting to the city and has little time to prepare his own meals,” she says.
Scalpi also assesses each client’s learning style. Counting carbohydrates to manage blood sugar might work for a tech-savvy person. But for visual learners, she uses what she calls the “plate method.” She’ll draw a plate and divide it into three parts. Half the plate is for vegetables (nonstarchy), a quarter is for protein, and the final quarter is for carbohydrates (whole grains). “This is an easy way to maintain carbohydrate control throughout the day,” says Scalpi. And her clients find it a relief. “They say, ‘Gee, this isn’t that bad. I can still eat regular foods; I just need to balance this.’”
Whether we’re diabetic or not, “We need to pay better attention to portion size,” says Scalpi, who keeps food models in her office to show what a real portion looks like. A serving of meat or tofu, for example, is no bigger than a deck of cards. “People are shocked,” she says. “They have no idea what a portion looks like.”
It Takes a Village
Teamwork is key to managing diabetes, involving everyone from doctors and nutritionists to educators and supportive family members. In this spirit, a new wave of hospital-based diabetes programs is one of the health-care system’s wisest responses to the diabetes epidemic in America. The Center for Diabetes Management—at Saint Francis Hospital and Health Centers in Poughkeepsie—is Dutchess County’s first and only center to receive recognition from the American Diabetes Association. Its program director, Mary Anne Kesting, has been working with diabetes patients for more than two decades. Her team offers group and individual classes on topics like carbohydrate counting, and support groups for insulin pump users and others. The ultimate goal is to keep patients’ blood-sugar levels as close to normal as possible to avoid problems with the kidneys, eyes, and heart. “Patients do better when they’re a partner in setting goals,” says Kesting. “This isn’t a one-time fix; it takes time to change a behavior. But as they follow through and start to feel better, they realize that it really does make a difference. Then they want to keep going.”
Kesting believes that most of us have a lot to learn when it comes to adjusting our diets and ignoring the messaging that we get from our culture of mega-consumption. “At the mall or the movies you see these kids going around with 32-ounce jumbo sizes of sweetened juice or soda. There are a lot of empty calories and empty sugars in there that they really don’t need. We’ve gotten ourselves into some pretty bad habits. We have to do something as a group to fix this.”
For starters, it’s easy to get screened for diabetes with a simple blood test. Not everyone has a “lucky kidney stone,” as Pfleging calls his, to signal that things have gone awry. In the meantime, Kesting echoes other experts when she points to the diabetes diet as a model: vegetables, whole grains, fresh fruits, lean proteins. “This is the way we all should eat.”
Dr. Rehan Ahmad, D.O. (845) 561-5972
Gretchen Scalpi, RD, CDE (845) 831-7258
The Center for Diabetes Management, Saint Francis Hospital and Health Centers, Poughkeepsie (845) 483-5188