Throughout my years of practicing medicine, I liked to say that I preferred my patients vertical. As opposed to horizontal.

If and when I could help it, I wanted to make sure that no one got a disease that could have been prevented. Sure, accidents happen. And illnesses, sometimes serious, are diagnosed every day in the lives of people who did nothing to deserve them, and who could have done nothing to prevent them. But not all illnesses.

Physicians know from the published research that newly diagnosed diabetic patients present to their doctor with about 10 years worth of damage to their blood vessels. What does this mean? It means that we are diagnosing diabetes 10 years later than the disease warrants. It means that the symptoms we are taught to identify come about 10 years after the disease begins.

So, I could wait until a patient begins to complain of frequent urination, unquenchable thirst, and an infection that won’t heal. I could spend ten years ignoring a blood pressure that continues to rise; a combination of high triglycerides and low HDL; frequent car rides to buy fast food; a lifestyle that includes almost no time for stretching, walking or other exercise; a diet consisting largely of stripped carbohydrates (e.g., sugar, white flour, white rice, corn starch) and omega-6 oils; and and multiple pairs of pants that can no longer be buttoned. But at the end of those ten years, I should not be surprised when that patient shows up exhausted, and with a blood sugar of 350.

The Centers for Disease Control (CDC) currently estimates that one-third (33%) of American adults are now prediabetic, and ten percent are diabetic (most of these, 90-95%, with type 2 diabetes). Thirty percent of Americans aged 65 and older are diabetic. Rates of diabetes continue to soar, particularly among racial minorities, ethnic minorities, and children.

Diabetes is, for the most part, a preventable disease. The key is to start preventing it ten years before you are diagnosed. When would that be? Right now. Increase your protein intake at breakfast and skip ultra-processed items to the greatest extent possible. Stop drinking soda — even diet soda appears to be associated with an increased risk of diabetes. Nothing labeled light, lite, quick, instant, or processed food. Eat real food. What’s real? Food that your great-great-ancestors would have recognized as food. If someone has to tell you how to use it, or when to eat it, it’s not food.

We must also find ways to make peace, to relax, to manage the stress that we all feel in our hectic and busy lives. Stress increases body weight, blood pressure, and blood sugar. A while ago, I read a book by Sue Monk Kidd and her daughter Ann Kidd Taylor entitled Traveling with Pomegranates. Sue’s hypertension evaporated once she realized how important it was to balance the time she spent writing with relaxing, walking the marshes near her home and sitting quietly as a part of the nature all around her. She called it a personal recognition that “being” is of equal importance to “doing.” We are human beings, not human doings.

The stakes are high; diabetes can be dangerous. I have never wanted to see my patients in a hospital bed or even a wheelchair, if it could be helped. I have always liked my patients vertical.