03/26/2011 11:52 am ET Updated May 26, 2011

The Key to Preventing Type 2 Diabetes

It is estimated that approximately 57 million people have prediabetes. To me, one million sounds like a lot, I can't even begin to fathom a number as big as 57 million. This enormously, huge number is twice the number of people that already have diabetes, estimated to be 26 million.

A little over one-quarter of these people, approximately seven million don't even know that they already have the disease. In fact, it is estimated that one out of every two people that are newly diagnosed with diabetes already have at least one diabetes related complication at the time of their diagnosis. These complications do not occur overnight, which means the diabetes did not just recently develop. The real tragedy, is that in most diabetes complications are not reversible. Can you imagine, "Well your lab results came back and it looks like you have type 2 diabetes. And that numbness and sporadic burning you have been experiencing in your feet is what we call neuropathy. It is caused from having diabetes. You are going to have it from now on because it doesn't go away once you get it?" Think of the frustration; imagine the anger.

If you put aside for a moment the mental anguish and physical discomfort associated with diabetes, consider the following. In 2007, the total direct and indirect health care costs of diabetes were 174 billion. Medical costs are over twice as high for people with diabetes than those without the disease. Diabetes is undoubtedly one of the most expensive illnesses of our time.

For as long as I have been an adult, I can remember the cost of health care being an issue. The selection of our presidents has been decided in large part based upon their position on health care reform; how they were going to improve it or fix it.

Type 2 diabetes is highly treatable and equally important, highly preventable, particularly if insulin resistance, or "rusty hinges" as I refer to it is diagnosed early. It should be well known by now, but apparently is not, that a lifestyle that includes overeating and little physical activity is the major reason why about 80 percent of the people that have type 2 diabetes develop it.

It is obviously unknown just how many people understand the cause and effect relationship of a sedentary lifestyle, overeating and weight gain, and the development of type 2 diabetes.

Ideally, it would be great if all people knew this and made the necessary lifestyle changes to ensure they were eating right and getting enough physical activity to avoid developing this unfortunate yet seriously expensive disease. In reality though we all know that this is not the case and will never happen.

If a serious dent is to be made in the growing number of people that are annually diagnosed with type 2 diabetes, then meaningful interventions years before the actual diagnosis need to take place.

Imagine planting a seed in the ground and then waiting 10 years for the young tree to grow and mature enough to produce fruit. If on the fifth year you change the tree's environment or the care of the young tree then it may postpone the day in which it produces fruit. Change the environment enough and it may never produce fruit.

The same is true of type 2 diabetes. Type 2 diabetes takes about 10 years to develop from the time insulin resistance first begins until the day the blood sugar levels actually climb above normal for the first time. If in the fifth year, or earlier, it is identified that the person has become insulin resistant

(The amount of insulin being produced by the pancreas can be measured and if elevated above normal levels indicates insulin resistance) then steps can be taken to reduce or eliminate the insulin resistance. By doing so this may stop the progression that ultimately leads to diabetes.

I would like to suggest that when a doctor has a patient that is at risk for type 2 diabetes perhaps by meeting certain criteria (family history, being overweight, sedentary, metabolic syndrome, etc.) that blood work be done, such as a C-peptide test, that would inform the doctor as to how much insulin the patient's pancreas is producing. An over production of insulin is called hyperinsulinemia and is a good indication that there is insulin resistance. If there is an overproduction of insulin then it would obviously be appropriate for the doctor to discuss the findings with the patient and explain the extreme need to make some lifestyle changes in hopes of averting the development of type 2 diabetes.

A key point here that needs to be emphasized is that to avoid developing type 2 diabetes, insulin resistance needs to be identified and reduced, or eliminated before a sufficient number of the insulin producing cells in the pancreas stop working. By doing this, type 2 diabetes can often times be prevented, however, once type 2 diabetes has been diagnosed it is not thought to be curable.

As I mentioned previously, there are an estimated 57 million people with prediabetes, most of which do not fully grasp the severity of their situation, that they are likely to go on to develop type 2 diabetes, if they do not make some swift and sometimes drastic changes in their lifestyle behaviors. The remainder of the 57 million people do not even realize that they are prediabetic.

Granted, there are also those that know they are prediabetic and that they risk developing type 2 diabetes in the near future but choose to do nothing to prevent it. These people are beyond the scope of this article.

In summary, with the numbers of people being diagnosed with type 2 diabetes rising faster than ever before, I recommend looking into the feasibility of periodically checking insulin levels in patients at risk for prediabetes and type 2 diabetes that meet certain criteria, such as a family history, being overweight and/or sedentary, been diagnosed as having the metabolic syndrome, or having an elevated lipid profile.

With the high costs of treating patients with type 2 diabetes, it would be cost effective, at the least, in my estimation, to routinely check insulin levels in these at-risk individuals with the goal in mind of identifying people with clinically documented hyperinsulinemia and then providing them with the information necessary to help them positively change their lifestyle, thereby preventing type 2 diabetes in the future.