If I can help it, I like patients vertical, not horizontal. I want to make sure that nobody gets a disease that could have been prevented. Sure, accidents happen. And illnesses show up every day in the lives of patients and their families who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses.

The research indicates that newly diagnosed diabetic patients present to the doctor with about ten years worth of damage to their blood vessels. What does that mean? It means that we diagnose diabetes about ten years later than the disease warrants. It means that the symptoms we learn to identify in medical school arrive ten years after the disease begins.

So I can wait until a patient begins to complain of frequent urination, unquenchable thirst, and an infection that won’t heal. I can spend ten years ignoring blood pressure readings that continue to rise; discounting cholesterol profiles that continually reveal a combination of high triglycerides and low HDL; supporting frequent car rides to buy fast food and a lifestyle that includes almost no time for stretching, walking or other exercise; saying nothing about to a patient whose diet consists largely of stripped carbohydrate (sugar, corn starch, and white flour) and highly processed, manufactured oils. But at the end of those ten years, I should not feign surprise when that patient shows up exhausted and with a blood sugar of 350.

Recent news from the Centers for Disease Control (CDC) showed that more than one-third of American adults are prediabetic, that half of Americans age 65 and older are prediabetic and that approximately 25 percent are diabetic. Rates of diabetes continue to soar, particularly (but not only) among racial and ethnic minorities. Ninety percent of this is preventable.

Diabetes is, for the most part, a preventable disease, but the key is to start preventing it ten years before your diagnosis. When would that be? Right NOW. Eat protein for breakfast and skip food-like products made from white flour. Stop drinking soda — the research shows that even people who drink diet soda have an increased risk of diabetes. Why? Not sure, but it makes sense from an evolutionary standpoint: When would we ever have eaten something so sweet, and yet not have sugar arrive in our bloodstreams shortly after?  My guess is that we start releasing insulin and getting ready for the sugar to arrive as soon as we taste the soda. No sugar comes, but it’s already too late, and you’ve already wasted your precious insulin stores. And nothing light, lite, quick, instant, or ultra-processed. Eat real food. What’s real? Food that your great-great-grandparents ate.

We must also find ways to be kind to ourselves, to make peace with our minds, to relax, and better manage the stress that we all feel in our hectic and busy lives. Stress increases body weight, blood pressure, and blood sugar. I learned in Traveling with Pomegranates, by Sue Monk Kidd (author of The Secret Life of Bees) and her daughter, Ann Kidd Taylor, that Sue’s hypertension evaporated once she realized how important it was to balance time she spent writing with time walking to the marshes near her home and sitting quietly as a part of the nature all around her. She called it a personal recognition of the fact that “being” is of equal importance to “doing.” 

This concept may be counterintuitive to the Western mind, but that makes it even more valuable. When Americans decide it’s time to make a change, they DO something, like join a gym, or sign up for Weight Watchers. Nobody says, “I’m going to start sitting on the couch and staring at the walls for five minutes.” But that’s an equally important part of the equation in my book.

The stakes are high; diabetes is dangerous. I don’t want to see patients in a hospital bed, if it can be helped. Or even in a wheelchair. I like my patients to remain vertical.