November is National Diabetes Month, and with over 100 million Americans diagnosed with diabetes and prediabetes, it’s time we all understood a little bit more about what's going on here and how we can start preventing - instead of just treating - this chronic, life threatening disease.

When you ask most people what diabetes is, they’ll usually say some version of, “It’s when people eat too much sugar!” Which is kind of like saying traffic jams happen because there are too many cars – technically true, but the whole picture includes many other factors, like highway design, careless drivers causing accidents, the jerks who block the box, malfunctioning signals, road work…you get the idea! What I want to do here is give you the full scoop, in a brief and painless way, so that the next time someone at a dinner party makes a joke about that dessert giving them diabetes, you’ll be able to bring some nuance to the conversation.

Fuel Up

Let’s keep going with the car analogy here. If molecules of sugar in the blood are cars, then the cells are the garages the cars are trying to get to. You have to have some sugar, in the form of glucose, driving around at all times so that cells that need energy can grab some to use. But glucose doesn’t just drive straight into the garage of the cell – it needs to open the door. So, think of insulin as a one-time use garage door opener. Our garage door opener factory making all these single-use gadgets is the pancreas.

As long as there are a normal number of cars on the road, the factory can keep up with making the door openers pretty easily. When glucose shoots up in response to a meal high in sugar OR a simple carbohydrate (let’s say white bread), the factory goes into overtime and pushes out a ton of openers. Lots of garage doors fly open, and the cars are pulling in left and right! In fact, there are so many garage doors open that there aren’t enough glucose cars driving around to provide energy where it’s needed most – the brain. You might start to feel fuzzy or woozy, hungry again or sluggish. So your brain tells you to reach for another high carbohydrate snack, sending the body on this roller coaster of over production of insulin all over again.

Now, over time, the workers in the pancreas are sort of sick of this working environment. They’re putting in extra hours, working the night shift, and their union isn’t super great so a bunch of them quit. There are cars flooding the roads, but they can’t get into the garages because not enough of those single use openers are being made. And on top of that, the garages themselves are on the blink! The doors are worn out from overuse so some of them don’t open at all. The highways (your blood vessels) are suffering wear and tear from the high volume of traffic, and the construction crew is doing a slapdash job of filling potholes – and in this scenario, the substance they’re filling them with is cholesterol plaque (there’s your direct connection to heart disease!) So the problem isn’t just too many cars, it’s how those cars are handled once they’re on the road, too.

Red light, green light

Still with me? The horrifying truth about diabetes is that by the time someone has blood glucose levels that are high enough to diagnose with the disease, over half of the function of the pancreas may already be lost – those workers that quit are very wary to return to jobs making garage door openers!

That’s Type 2 Diabetes in a nutshell – it’s not just a problem of there being too much glucose, it’s how resilient the systems that handle it are. Genetics that predispose someone to diabetes could include poor insulin production, reduced insulin sensitivity, or increased carbohydrate absorption, which is why some people get it sooner than others, even with the same food and environmental conditions.

Genetics also determines whether someone will have Type 1 diabetes, which occurs when the pancreas is unable to produce insulin. It can also sometimes be a result of infections later in life. Those pancreases are just an empty building. The workers never showed up, the machinery was never installed! People with this expression of the disease rely on insulin shots and infusions to manage blood glucose.

Traffic control

Here are the three biggest factors to be aware of if diabetes runs in your family or you want to be proactive in preventing that internal pile up!

1. Get your blood glucose checked annually. “Fasting” glucose is part of the complete standard blood panel you can do with an annual physical, and shows how much sugar is circulating even if you haven’t eaten recently. That number should be under 100 mg/dL, but it’s also important to note what it has been in the past. Are you at 98, but you were at 89 last year and 79 the year before? That’s a red flag! There are other tests your doctor can do, too, but that is the simplest, easiest, and cheapest.

2. Ensure each time you eat (a meal OR snack), you have something that contains protein, fiber, and fat. Those factors slow the absorption of glucose from carbohydrates, making it easier for your pancreas to keep up with insulin output. I recommend the protein + produce combination – a small apple with 2 Tbsp of peanut butter, for example, or veggies and hummus. Avoid having a snack of just carbohydrates, especially refined grains (I’m looking at you, pretzels!)

3. Talk a walk after meals. Exercise activates secondary insulin receptors so that your pancreas doesn’t have to work as hard, and insulin sensitivity stays higher. Think of it like opening a second garage door for the car to go in, even if the first one is still broken. Blood glucose is your body’s first and primary source of energy, so getting blood pumping and muscles working will burn some up right away.

Even people with hereditary risk of developing diabetes will NOT necessarily get the disease. And the good news is that the lifestyle that treats and prevents it is the same one that will make you feel better, sleep better, and be able to do better in the world!

Sarah Waybright MS, RD is the owner and founder of WhyFoodWorks and the team dietitian for Vegetable and Butcher. WhyFoodWorks does nutrition education through food in Washington, DC in corporate seminars. Vegetable and Butcher is a subscription-based service that delivers chef designed, dietitian approved, thoughtful prepared meals to health-conscious people in Washington, DC. You can find Sarah on Twitter, Facebook, Pinterest or Instagram to get food and nutrition tips - and of course, healthy recipes.