Ajay Rai
Status: 39, single, no children
Profession: Software engineer
Issue: Managing type 2 diabetes In the time he had free from his work as a software engineer, Ajay Rai kept active—skiing, hiking, and inline skating. So he got worried when, one day on a stationary bike at the gym, he felt totally exhausted after just three minutes. Traveling back home in southern India soon afterward, Rai noticed an unquenchable thirst and frequent urination. Upon his return to the States, an emergency-room doctor discovered high blood sugar levels—and diagnosed Rai as one of the 16 million Americans now estimated to have type 2 diabetes.

Slim and just 36 years old at the time, Rai didn't fit the traditional profile: overweight, inactive, and older than 40. But his heritage put him at increased risk. Like Native Americans, blacks, and Hispanics, Asian Americans are susceptible to developing an inability to properly regulate insulin, the key blood-sugar-regulating hormone. (Some doctors surmise that this happens because these groups have recently adopted the more sedentary Western lifestyle and richer diet.)

With type 1 diabetes, which affects about 5 percent of the world's population, patients sicken suddenly when the pancreas stops making insulin, perhaps due to a virus or an autoimmune response. In contrast, type 2 tends to develop over several years, with blood sugar levels—and often body weight, especially in the midsection—increasing. People with type 1 diabetes need insulin injections to live, but people with type 2 can generally control blood sugar levels with oral medication, diet, and exercise.

That's the good news. More sobering is the fact that experts expect the incidence of type 2 diabetes to double during this decade. And its symptoms can be so subtle that, according to the Centers for Disease Control (CDC), more than one-third of Americans who now have type 2 diabetes don't know it. "Diabetes can be associated with serious long-term complications, including nerve damage, kidney damage, vision loss, and heart disease," says Mary Sheehan, MD, an endocrinologist at the University of Maryland's Joslin Diabetes Center. "Most complications to secondary diabetes develop five years or more after diagnosis. However, there is a group of people who develop complications earlier, which suggests they may have had diabetes prior to being diagnosed."

Lifestyle Changes
Since Rai's diagnosis, he says, "I have cut way down on sugars, especially refined sugar, and I eat small, frequent meals." These are critical first steps, says Jeannette Jordan, RD, a Charleston, South Carolina­based spokesperson for the American Dietetic Association. But she points out that "because we now know that more than 70 percent of diabetics end up dying of heart disease, it's important to focus on not only lowering blood sugar, but also lowering blood fats and controlling blood pressure."

It's important to focus on not only lowering blood sugar, but also lowering blood fats and controlling blood pressure. A person with diabetes must work with a dietitian on an individual meal plan based on basic guidelines. First, advises Jordan, track the carbohydrates in your diet. Starches, fruit, and dairy products are all high in carbs, which convert into glucose when digested. "It's not the source of the carbs," she says. "It's the amount." Granted, refined sugars are concentrated, so limit intake, and cut out other carbs to compensate when you do eat sugars.

Next, learn about portion sizes. Many people eat too much of the right things, says Jordan—for example, 16 ounces of juice, when a serving is 4 ounces. Also, avoid saturated fats. Bake, broil, or grill foods, methods in which fat comes out of the food instead of being added. And don't skip meals, or your blood sugar might drop too low. "This is the way everybody should eat," Jordan points out. "It's preventive."

Eating well is especially important for the 16 million Americans estimated to suffer from prediabetes, which occurs when blood sugar levels are above normal but not yet critical. "This has not always been addressed in the past," Jordan says. "But talking to people early about diet and exercise can delay or even prevent the onset of diabetes."

Regular exercise is equally important—something Rai has reemphasized by walking or going to the gym most days. "Exercise works almost like medicine; it actually helps the body use insulin better," says Jordan. A new study suggests that regular exercise alone cuts prediabetes risk (Diabetes Care, 2003, vol. 26, no. 3).

Supplement Strategy
Rai takes a daily multivitamin, but that may not be enough, according to Julian Whitaker, MD, author of Reversing Diabetes (Warner Books, 2001) and director of the Newport Beach, California­based Whitaker Wellness Institute Medical Clinic. "I look at diabetes as a nutritional wasting disease," he says. "It's the excessive loss of water-soluble nutrients, such as B-complex vitamins, zinc, chromium, calcium, and magnesium." Elevated blood sugar, he explains, essentially acts as a debilitating diuretic.

For people newly diagnosed with diabetes, Whitaker advises taking copious amounts of vitamins and minerals—often ten times the RDA, with the exception of some minerals. "Excess water-soluble vitamins simply flush out, so you can't hurt yourself by taking too much," he says, "only by taking too little." To prevent or reverse diabetes complications over the long term, he recommends a high-potency multivitamin-mineral supplement that contains megadoses of the nutrients that can reduce type 2 risk: vitamins C, E, B6, and B12; biotin; magnesium balanced with calcium; and chromium. Chromium, he explains, seems to facilitate insulin's uptake of glucose into the cells, critical for people with prediabetes and type 2 diabetes, whose bodies still produce insulin but no longer use it effectively. Even more promising, he says, is vanadyl sulfate, a trace mineral that seems to mimic insulin and improve cells' insulin sensitivity.

A few herbs also may help. An extract of Gymnema sylvestre has lowered blood sugar in people with diabetes and may even help repair or regenerate insulin-producing beta cells. Banaba leaf (Lagerstroemia speciosa), recently introduced from Asia, seems to have a similar effect. Finally, to protect against damage to nerves and blood vessels, Whitaker suggests a natural therapy: alpha-lipoic acid, a potent antioxidant.

Medication Pros And Cons
Rai takes an oral medication that stimulates his beta cells to produce more insulin, which helps depress his blood glucose level. "By keeping his blood sugar within normal limits," says Sheehan, "he can substantially minimize his risk of developing long-term complications." To track how well he controls that level, she suggests getting his hemoglobin checked (A1c test) every three months and monitoring his blood sugar at home.

Blood-glucose-lowering drugs are sometimes necessary, says Whitaker. But he emphasizes that drugs don't address the underlying condition and warns that side effects can include weight gain, gastrointestinal upset, and sometimes serious liver problems. "With a healthy diet, exercise, and careful nutrient supplementation," he says, "I find that many patients can keep their blood sugar within normal levels and wean themselves off prescribed medications." If a patient's blood sugar level remains unacceptably high after introducing lifestyle changes, Whitaker prescribes a lower-than-average dose of medication and he increases it gradually, if necessary.

All drugs have side effects, agrees Sheehan. "But by far the greatest risks," she says, "come from not managing or not recognizing the diabetes itself."

Susan Enfield has written for Outside, Men's Journal, and Sports Illustrated for Women. While researching the growing prevalence of diabetes, she was inspired to cut down on carbohydrates.