Late onset diabetes usually means that a person has too much insulin because his cells cannot respond to insulin. Too much insulin constricts arteries to cause heart attacks, and stimulates your brain and liver to make you hungry and manufacture fat.

Most people who develop diabetes in later life can be controlled so that they are not at increased risk for the many complications of diabetes such as heart attacks, strokes, blindness, deafness, amputations, kidney failure, burning foot syndrome or varicose veins with skin ulcers.

The Insulin Resistance Syndrome puts you at very high risk for a heart attack and is associated with storing fat in the belly, rather than the hips; having high blood triglyceride levels and low level of the good HDL cholesterol; and high blood pressure.

If you have any of these signs, check with your doctor who will order a blood test called HBA1C. If it is high, you have diabetes and can usually be controlled with diet and/or medication. You should learn how to avoid foods that give the highest rise in blood sugar. When you eat, blood sugar level rises. The higher it rises, the more sugar sticks on cells. Once stuck on a cell membrane, sugar can never detach itself. It is converted to a poison called sorbitol that damages the cell to cause all the side effects of diabetes mentioned above.

The foods that cause your blood sugar to rise quickly include all types of flour products: bread, spaghetti, macaroni, bagels, rolls, crackers, cookies and pretzels; refined corn products and white rice; and all sugar-added foods.

There are two type of drugs that are used to treat diabetes: those that lower blood sugar and raise insulin, and those that lower blood sugar and lower insulin also. The safest drugs are those that lower both insulin and sugar. Most diabetics should be on Glucophage (metformin) before meals, at least while you are learning to change your diet and bring your weight where it belongs. It prevents blood sugar levels from rising too high and sticking to cells and has an excellent safety record. However, eating a bagel will produce such a high rise in blood sugar that Glucophage will not be effective, so Glucophage must be used in addition to avoiding foods that cause a high rise in blood sugar. If HBA1C cannot be controlled with diet and Glucophage, your doctor will usually add Avandia 4mg or Actos 30mg. They are essentially the same and can cause liver damage, so liver tests must be done monthly, at least for the first few months.

You should be seen monthly and get either a HBA1C (which measures blood sugar control over the past two months) or fructosamine (which measures control over two weeks). Each time that your HBA1C is above normal (6.1), you should yell at your doctor to change your drugs and he should yell at you to change your diet.

If your HBA1C is still not under control, you need to take a drug that raises insulin levels. I usually start with Glipizide XL. If that doesn't control your HBA1C, I raise the dose, and if that still doesn't work, you will need to inject yourself with insulin. Check with your doctor.

Who is pre-diabetic?

What should a diabetic or pre-diabetic eat?

Dr. Gabe Mirkin has been a radio talk show host for 25 years and practicing physician for more than 40 years; he is board certified in four specialties. For more information and hundreds of health and fitness reports, visit http://www.DrMirkin.com

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