How to delay or even prevent the onset of diabetes (and other pathologies).

It is one of the most common chronic diseases. To date, more than 3.5 million people in France are being treated for diabetes, of which more than 90% suffer from type 2 diabetes, which mainly affects adults. But the disease does not develop overnight; it is preceded by a more or less long and silent phase of blood sugar dysregulation, which is called prediabetes.

A crucial moment to postpone or even avoid the transition to diabetes. This condition of prediabetes – or moderate hyperglycemia – is reversible, provided you adopt an appropriate lifestyle. Balanced diet and physical activity are the recipe. On the occasion of World Diabetes Day next Tuesday, 20 minutes gives you the details.

An intermediate and silent stage

But prediabetes, kézako? “Glycemia [taux de sucre dans le sang] Normal is less than 1.06 grams of glucose per liter of blood (g/l) on an empty stomach. Diabetes occurs when a blood sugar level is above 1.26 g/l, checked twice. The area in between consists of prediabetes, explains Dr. Pascal Goncalves, also known as Dr. Food, general practitioner and author of Better prevention (ed. Thierry Souccar). The problem with prediabetes is that it is silent: it can be asymptomatic for years, but if we do nothing it is a risk factor for the development of type 2 diabetes and pathologies of cardiovascular disease, heart attacks and strokes. Hence the importance of prevention.”

In his office, nutritionist Raphaël Gruman sees “many patients with prediabetes, but who don’t necessarily know it because there are no suggestive signs. Usually it is men aged 40 and over with poor dietary habits and women approaching menopause who consult me ​​because they want to lose weight but cannot. If prediabetes is suspected, I prescribe two tests, the Quicki index and the Homa index.

Once the diagnosis has been made, “it is time to ‘take advantage’ of this moderate hyperglycemia to raise patients’ awareness of the two essential pillars for delaying or even avoiding diabetes: eating a healthy diet and practicing regular physical activity,” explains Dr. Goncalves. In general, the message is well received. “Diabetes scares patients: they all say: ‘I don’t want to get diabetes’, because they all have someone around them who gets or even has to get insulin injections every day. The announcement of prediabetes has the effect of an electric shock.”

Not a diet, but a rebalancing of the diet

Therefore, the first step: reconsider the diet. “When I was 50, my glucose levels went up,” says Guillaume, 54 years old. But after three yo-yo diets I said: stop! And now I have treatment. I’m a little careful, but not too much.” The problem “is that he talks about restrictive diets, which never work in the long term,” Dr. Goncalves. On the other hand, the Mediterranean diet, as a nutritional model, is effective. It prefers plants, whole grains, legumes and nuts and olive oil, and limited consumption of animal products (fish, poultry, eggs, dairy products). And avoid red meat and processed meats, he explains. The modernized version, the 3R diet, for ‘eating real, plant-based and varied foods’, with the least amount of ultra-processed products – full of sugar, salt, fats and chemical additives – is what’s good. .

In practice, “I initially prescribe total abstinence from sugar,” Raphaël Gruman explains. I eliminate all intakes: simple sugars, added to the diet (chocolate, jam, desserts, pastries, etc.), as well as complex sugars found in starchy foods, pasta, rice and bread. This protocol lasts a few weeks, then we gradually reintroduce complex sugars: starches and whole grains, with the lowest glycemic index, and no more than one serving per day. Patients generally observe this phase carefully because they do not want to develop diabetes with lifelong treatment. Especially because they initially consult me ​​mainly to lose weight, and the very fast results are motivating.”

Simple sugars “are reintroduced much later and under certain conditions: they should not be eaten in isolation,” Raphaël Gruman emphasizes. If you eat a pastry in the middle of the day, because it is not mixed with the food, the sugar will rise very quickly in the blood and cause hyperglycemia. On the other hand, the passage of sugar into the blood, when combined with other non-sweet foods, is much more gradual. This is common sense, valid for everyone, (pre)diabetic or not.” “Many associate pleasure with junk food, as if we cannot enjoy ourselves by eating healthy,” adds Dr. Goncalves. “I changed my diet by removing what was harmful without any sense of deprivation,” confirms one reader. In one year, I lost 20 pounds without difficulty or frustration and regained impeccable blood sugar levels.”

“Don’t sit”

Second component: physical activity. “The starting point is not to sit,” says Dr. Goncalves. It is not a matter of jogging three times a week or cycling for two hours at night, but of fighting a sedentary lifestyle. This could be walking, gardening, doing crafts or walking to school with the children, anything as long as you don’t sit and enjoy doing it for a long time. Because the goal of changing your lifestyle is to maintain it for a lifetime. And to be regular: it is better to walk for 10 minutes every day than for an hour on Sunday. That’s why I’m writing about the recipe for walking the dog for 10 minutes three times a day. At first it makes them laugh, but they do it and get well-being from it every day.”

If they lead a sedentary lifestyle, “brisk walking is a good start, as are flexibility exercises, yoga and core strength: simple and quick activities to incorporate into everyday life,” explains Raphaël Gruman. And for those who are athletic, I offer HIIT-type exercises, shorter and with high intensity, to combat insulin resistance.” Measures that work. “More than 90% of my prediabetes patients escape diabetes with a balanced diet and regular exercise,” reassures the nutritionist. Especially because “this lifestyle modification prevents the worsening of diabetes and its therapeutic escalation in the long term, and also limits the risks of stroke, heart attack, depression, certain cancers or osteoporosis,” adds Dr. Goncalves. And if you develop diabetes, you should not stop your efforts, the doctor warns. Otherwise you will need two, instead of one medicine per day. And instead of two, you’ll have to get insulin injections! »

Anissa Boumediene