Course of action to stop diabetes

Sept. 02--Toni Pille lives on a 40-acre farm in Espanola, north of Medical Lake, where she and her husband raise sheep, cut hay and eat local: potatoes they grow, meat from the farmer around the corner.

She's a "from-scratch cook" who's never been interested in preparing one meal for herself and another for her husband, she said. And she'd "fought the weight battle" all her life,

"If I was a cow, I would be an easy keeper," said Pille, 65. "I don't need a lot of food to gain."

But diagnosed as prediabetic after some blood tests, she was ready to lose weight.

In the past year, she has dropped 45 pounds -- and reduced her blood sugar to a healthier level -- with help from a coach and a yearlong "lifestyle change" program at WSU Extension.

The Diabetes Prevention Program's classes target overweight people diagnosed with prediabetes or considered at high risk for the disease. Developed by the Centers for Disease Control and Prevention, the national YMCA and UnitedHealth Group, the program is based on research that found that many prediabetics who lost 7 percent of their body weight and exercised at least 150 minutes a week had a good chance of warding off Type 2 diabetes.

The research, led by the National Institutes of Health, found that prediabetics who received intensive, one-on-one coaching on nutrition, exercise and behavior changes cut their risk of diabetes by 58 percent -- significantly more than those who received standard care and an antidiabetic drug or a placebo. "Standard care" meant annual 20- to 30-minute sessions in which participants got written materials about healthy eating and exercise.

In 2012, 29.1 million Americans, or 9.3 percent of the population, had diabetes, according to the American Diabetes Association. Another 86 million Americans 20 and older had prediabetes.

In 2011 in Spokane County, 10 percent of adults reported having diabetes, according to the Spokane Regional Health District. That compared with 8.9 percent in Washington overall.

The NIH's findings changed the way health professionals try to help people prevent diabetes, said Dori Babcock, director of WSU Spokane County Extension and one of its two CDC-trained diabetes prevention coaches.

Rather than a delivering a one-size-fits-all prescription to eat better and exercise more, Babcock said, care providers now know they can get better results by factoring in individuals' unique environments and helping them identify specific weight-loss strategies.

"We recognize that people are the experts on them," Babcock said. "They know what's going to work for them. And we can work together, with them, on what's realistic."

By last week, about 65 percent of participants in the Extension classes that will wrap up this month had lost at least 7 percent of their body weight, with more people close to that goal, Babcock said.

WSU Extension is gearing up to launch another round of classes later in September. The YMCA of the Inland Northwest, which has run 10 sessions since 2011, also will start more classes toward the end of this year, said Aleisha Colvin, the Y's health and wellness director.

As Pille's class approaches its final meeting, she said she intends to keep off the weight she's lost.

Key strategies for her: heeding portion sizes, adding fruits and vegetables, sticking to a fat-gram budget -- and incorporating 150 minutes of "sweaty exercise" into her week by using her recumbent stationary bike, listening to audio books and playing solitaire on her iPod to pass the time.

The program "fit in my lifestyle," she said. "It was something I could do within the structure of feeding my husband. I was ready."

Reversible, for a while

Prediabetics and diabetics share a common problem: insulin resistance. But while prediabetes can be reversed through weight loss and exercise, diabetes is generally forever.

The pancreas, a gland behind and below the stomach, secretes insulin into the bloodstream, where it circulates. Insulin normally enables sugar, or glucose, to enter the body's cells -- where it's needed for energy -- and reduces the amount of sugar in the blood.

In prediabetes and Type 2 diabetes, the cells become resistant to insulin, and the pancreas secretes more to try to overcome the resistance. Instead of moving into cells, sugar builds up in the blood.

At diabetic levels, the extra glucose can wreak "all kinds of damage," Babcock said. Diabetes raises the risk of cardiovascular, kidney and gum disease; blindness; and foot and nervous system problems.

In addition, the stress on the pancreas to produce insulin essentially burns out insulin-producing cells, leading to a permanent loss of function, said Jen Ropp, diabetes education program coordinator at Rockwood Clinic's Diabetes Education and Nutrition Services.

Genetics and other medical issues may factor in, "but weight has a big part of that picture," Ropp said. "You're going to see more insulin resistance at a higher weight."

Ropp's program at Rockwood isn't associated with the CDC-led program, but she said she "absolutely" recommends the classes.

While Rockwood has a prediabetes group that meets monthly, participants usually only come once, Ropp said, because their insurers balk at covering more visits.

"They get the basics of 'This is what the DPP trial shows. We are suggesting you need to do it. Now you need to go figure out how to do it for yourself,'" she said.

As the number of diabetics continues to rise in the U.S., Ropp added, "we are hoping that insurance will get on board and think more preventively, especially Medicare, Medicaid."

Building skills to last

Each session of the Diabetes Prevention Program lasts 12 months. Participants meet weekly for 16 weeks, then monthly.

Participants gain the skills it takes to lose weight, Babcock said.

The coaches teach participants how to adjust their schedules to make time for exercise, how to track their food along with their weight loss, how to change their home and work environments to ease their efforts.

Group members support one another, developing questions and answers together, Babcock said. As a coach, she encourages members to share their own experiences and make suggestions rather than delivering answers from on high.

They talk about dealing with psychological and social aspects of weight loss: how to handle "emotional eating," how to turn down a dish at a potluck without feeling rude. They talk about how to handle a relapse.

Support provided by fellow participants -- including her husband -- was key to Spokane Valley resident Becky Knapp's success in the program. Knapp, 67, also started the program last September through WSU Extension.

Knapp said she and David Knapp, 68, each have lost roughly 25 pounds. Neither had been diagnosed as prediabetic, but both had family members with diabetes and were overweight. Still, it took some "internal strength" to sign up, Knapp said. As a registered dietitian, she hesitated to ask for help.

The group effort paid off. Her class was made of a dozen or so men and women who varied in age and background, she said, all "working on this issue together."

"The guy that I cook for and eat with was interested, too, and it wasn't like I was doing this diet thing and he wanted no part of it," Knapp said, "which had been sort of our life story prior to this."

She's more energetic. She's more agile. It's been a good year for David, too, she said.

"We just feel so good," Knapp said. "And we both know this is good for our long-term health. And we're at the age where that's the most important thing."

___

(c)2014 The Spokesman-Review (Spokane, Wash.)

Visit The Spokesman-Review (Spokane, Wash.) at www.spokesman.com

Distributed by MCT Information Services