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PART FOUR Disease Prevention（第2页）

&oDiabetes

&'soutlihejourdiabetestypicallytakes。

AsyouhemodernAmeridietisgrosslytippedtowardrefinedcarbohydratessuchassugarandwhiteflour，bothofwhiostjunkfhontheglydex。Yourbodyistotallybefuddledbysuchfoods。Whehem，somuchbletspouredireamthatyourpaopumpoutinsulinasifitwerehandlinganemergency。

Whehesuperbeffiayhavemeantthatyouhardlynotiysymptfromthisfloodofbloodsugarainsulinoverload。Laterthesymptomspileon，justasformanyofusthepoundsdo。YoushouldalreadyhavetakentheBlood-SugarSymptomTestandbeawareofanybloodsugarrelatedsymptomsyoumighthave。Thevastmajorityhtpeopleonahigh-carbohydratedietdisplayaensiveraoms，theby-produstableblood-sugarlevels。

Asignifiumberofpeoplewhhtarei。Itmaybethatinmostpeople，ianceprecedeshyperinsulinism，buteitherway，besuliiveindoingitswork，thepasbypforthever-ingquantitiesofinsulin。Peoplewhoarebothobeseaihaveinsuliwentytimeshigherthahemassiveamountsofinsulincausebloodsugartodroptoaninappropriatelylowlevel。Theadrehebodyreleasestocorrecttheblood-sugarlevelwhenithasfallentooloroduyofthosesymptoms。

·Bloodsugarinsulindifficultiesbeeaggravatedovertheyears。Whentheinsulinresponseexallevelˉupto20unitsfasting;100uerastandardglucoselTT;and60unitstwohourslater（thcthresholdsweuseatmyicalpractice）:itmaybecalledhyperinsuliy，highblohtriglydunstablebloodsugararefound，webethathyperinsu'lmismistheinator。

RalphdeFronzo，MD，oion'sleadiicspecialists，removesthethatleads:toadelayeddiagnosisbypointingoutthattherearefivestagesofdiabetes。ThefirstthreestagesprecedetheactualdiagnosisoftheHiisbeventionalmediedoesnotroutiheGITwithinsulinlevels，sopeopleatriskarerarelyfouagesofthedisease。Itrulybelievethatearlydiagnosisgthediabetesepidemicthalt，somuchsothatIfullyinteprojecttobeadefinitivebookonhowwedojustthat，and，asaresult，elimies。

&agesare:

StagelmIanly。

stage2—IR，plushyperinsulinism（HO。

Stage3—IR，HI，plusabnormalitiesinaGIT。

&ypeIIdiabetes，withhighinsulinlevels。

&ypeHdiabetes，withlowinsulinlevels。

&odiabetesisa，withnosharpds。Youjustkeeptrudgingalonguntilyougetthere。Youtakethehi·ydrnteUnil，andyoumay，aftermanyyearsofunstablebloodsugarandexsuliyouarenotevenawareof，finallyarriveatthatudestination。Sinisthebody'spremierfatostofusickedupsigrapoundsalongthejourney。

&eryouactuallybeediabetic，yourblood-sugarlevelceasestooscillate;itisnowtlyhigh。Massiveiancehasbeeinginsuliivelydoingitsjob（Stage4），oryourpancreaswillhaveexhausteditselfafteryearsofoverprodudwillomakeenoughinsuliherway，you'vewaitedalittletoolohediabetesgoaway，butnottoolongtoachieveausefulleveloftrol。

Thismeansthatifyouhavehpre-diabetes，youarenowinfull-blowes。You'reintrouble!Bloodsugarthatotbetransportedbyinsulinintoyourdliver）nowspillsoverintoyoururiiage4）。Onsulinhasbeeoimpoteage5）yweightinexplicably。Heavyuriotthirst。Yourbodybumsanythingitdtofuelitsdailyoperations，puttingyouioacidosis。Younowknowthatsomethingisverywrong。Itohthissariosoyoucouldattendtotheearlywarningslothisjuhateffectively，youokandintherangeofrisk。Apetentphysishouldbeabletohelpyou，butitisuptoyoutodetermiheryourdoctorfitsthatdefinition。

AnImporta

YoumustrememberhowvigorouslyIencedyouiohaveaGTTwithihistestdemonstrateshowyourbodyreactstafixeddoseofglucose，thesubstareadilyvertibletobloodsugar。Obviously，ifyourmetabolismhasbeendeal。ingwithasI'vejustdescribed，thesignsofsualfunwillbeclearlyevidentonaGTTwithinsulinlevels。Iadvocatethateveryoest。However，ifyouarcht，havediabetesinyourfamilytree，havehighblohtriglycerides，orhavesymptomsthatappearwhenyryandclearupwhe，ImustinsistthatyougetaGTT。

&ogetafive-hTTwithinsulinlevels。Hereiswhaten:BloodwillbedrawnSothatbludinsulinlevelsbedetermierafast（withnofoodinyoursystemfortwelvehours）thefirstbloodwillbedrawnsothatylevels，orbaselinegludbaselineinsuliermined。Youwillthenswallowtheglucosesolutioionerwillplotouttheschedulefyourbloodoverthefewhours。Bloodwillbedrawnthirtymierylucose，againatsixtyminutesandstheremaihetest。Ylucoselevelischeckedeachtimebloodisdrawn。Yourinsulinlevelischeckedattheone-hourandtwo-bourmarksonly，besulinlevelspeakwithintwohoursafterylucosesolution。

HowtoUheReadingsofaGlucose-Tolera

Dependinglucoselevelatbaseline，youfallihreecategories:

&egory

70。109mg%Normal

110-125。mg%ImpeJrodGlucose

126rherDiabetes

Beyondyourbaselinelevelofgluotethatylucoselevelmeasuredwithiwohtheglucosesolutionshouldnotexceed16%，andylucose（aftertwotofourhours）shouldbebetween60-90mg%。Thedelta（thedifferehelowestareading）shouldbe30-8Omg%。

Ifthedeltaishigherthan80pointsandyouareht，youmostprobablyhavehyperinsulinism。Ifthedeltaexceeds100points，theprobabilityisverystrong。Ifitexceeds125points，youuionablyhavehyperinsulinism。

&astierbaselineˉglucoselevel，isastandardfifyouhavediabetes。TheADAn%asthewhichdiabetesshouldbediagnosed，ao125asameasurelucosetoleraage3），Owohoursafterylucosesolutionis16%。Between160mg%and200mg%showsadiressiontodiabtes，andanythihan2%indicatasdiabetes。

WhatDoYourResultsMean?

Youaddthefirstflucs（atfasting，thirty-minute，one-hourandtwo-hourintervals）ether。Thisiscalledylucose-tolerancesum。Ifthetotal（inmg%）isbelow500，youarenormal。Ifthetotal（inmg%）isabove800，youaresidereddiabetic。

&inegrayarea，between500and800mgm，iscalledimpairedglucosetoleranearlyhalfofthesignifidyobesefallintothatarea。ThecloserYourtotalapproachesthe8%mark，themoreprobableitisthatyouwiUeventuallybeclassifiedasatrueTypeIldiabetic。Butthereisstillsomegoodnewsforyou:Evenifyouarewelliidareheavy，nyhtbypermarollingyourcarbohydrateiyouyouin。theneforlife。

&heselabresultscouldshowyouwhetheryouhavediabetes，butmorelikelytheyhetheryou'reoowardit。Ifyouhaveapre-diabetigaMespeciallyaweightproblem，youhaveareasontofollowatrplaninotherwords，todoAtkins—withdiligence。