Diabetes affects 29.1 million Americans, or 9.3% of the U.S. population — and of all people with diabetes, about 95% have Type 2. When you live with Type 2 diabetes, you quickly realize that your immediate family lives with it, too. Family support is essential when it comes to day-to-day management of diabetes and avoiding serious health issues related to the disease.
Diabetes can affect the entire family in several ways. In particular, your blood relatives should be aware that a family history of Type 2 diabetes puts them at higher risk for developing both Type 2 and prediabetes. Prediabetes is diagnosed when blood glucose is higher than normal but not high enough for a diagnosis of diabetes; it’s a risk factor for the development of Type 2 diabetes.
Family ties that bind
It is well documented that Type 2 diabetes runs in families. If you have it, your family members — especially close relatives such as siblings and children — have a strong genetic tendency to develop the disease. Your children’s risk of developing diabetes correlates with the age at which you were diagnosed. If you were diagnosed before age 50, your offspring have a one in seven chance of developing Type 2 diabetes; if you were diagnosed after age 50, the possibility drops to one in 13. Some research suggests that a child’s risk for developing Type 2 diabetes increases if the parent with Type 2 is the mother, and that the risk goes up to about 50% if both parents have it. If you’re an identical twin with Type 2 diabetes, your twin’s risk is almost three in four.
In fact, if you have Type 2 diabetes but can’t think of any relatives who have it, chances are that some do have it but don’t know it yet. Currently, almost 30% of people with Type 2 diabetes are unaware they have it, and 51% of people aged 65 years or older have prediabetes.
The risk for Type 2 diabetes is also higher if your family is of Asian American, African American, Native American, Alaskan native, or Hispanic descent.
Gestational diabetes occurs during pregnancy and usually disappears once the baby is delivered. A family history of Type 2 diabetes raises the risk of developing gestational diabetes, and having gestational diabetes significantly raises a woman’s risk of developing Type 2 diabetes later in life. If you have Type 2 diabetes and have a daughter of childbearing age who is considering pregnancy, be sure she is aware of these risks. In addition, when a woman has a history of gestational diabetes, her child’s risk of developing Type 2 diabetes increases.
You can be an advocate for your family members by discussing and addressing their higher risk for Type 2 diabetes, prediabetes, and gestational diabetes. Genetics and ethnicity cannot be changed, but being aware of these risk factors can encourage your family members to attend to any modifiable risks they may have, and sooner rather than later. (For expert tips from an endocrinologist on how to engage your family members in learning about their own risk, click here.)
Encourage your family members to make changes that may help lower their risk for Type 2 diabetes. For example, being overweight or obese and maintaining a sedentary lifestyle increases the risk for Type 2 diabetes. The degree of risk increases as one’s body-mass index (BMI) increases — in fact, around 85% of those with Type 2 diabetes are heavier than their ideal body weight. Since these risk factors can be modified, you and your family members will benefit from focusing on lifestyle changes that not only help your own diabetes treatment plan but also put your family members on a preventive path.
Data show that people with prediabetes are at high risk for developing Type 2 diabetes, but prediabetes isn’t inevitable. The adoption of healthy eating patterns, a weight reduction of 5% to 10% of total body weight, and regular physical activity can bring blood glucose levels back to normal and possibly prevent or postpone the onset of Type 2 diabetes.
Dietary changes and physical activity are also cornerstones for the treatment of gestational diabetes. After delivery, women who have had gestational diabetes can substantially lower their risk of developing gestational diabetes with future pregnancies and Type 2 diabetes later on by following a program of healthy eating and exercise.
A healthful meal plan is an important part of your treatment plan when you have Type 2 diabetes. A consultation with a registered dietitian (RD) is essential to help you learn things such as interpreting nutrition facts labels, managing portion size, learning the effect and balance of carbohydrate-containing foods, and modifying caloric intake to achieve a healthy body weight. Various meal-planning options are acceptable for diabetes management; an RD will consider your personal preferences and diabetes treatment goals to help customize your meal plan.
Medicare and many health insurance plans cover counseling sessions with an RD for people with diabetes. Take advantage of this resource with periodic return visits to help you stay on top of your healthful eating efforts; also, bring a family member along who can benefit from the experience.
Of course, healthy eating is recommended for everyone, and your family members who don’t have Type 2 diabetes are no exception. In fact, people at high risk for developing Type 2 diabetes can reduce that risk with a moderate weight loss — approximately 7% of body weight — using dietary strategies that include eating fewer calories and reducing their intake of dietary fat. (See the “All in the Family” sidebar for ideas on managing your Type 2 diabetes and reducing your family members’ risk.)
Most Americans, including people with Type 2 diabetes, fall far short of recommended daily allowances for fiber and whole grains. To improve both your and your family’s intake of fiber and whole grains, eat five or more servings of fruits and vegetables each day. Beans — kidney beans, black beans, and red beans — contain lots of soluble fiber that lowers total blood cholesterol, which is often elevated in individuals with diabetes. A good rule of thumb is to “stick close to Mother Nature,” because less processed foods typically have more fiber. Start by trying to make at least half of your grains whole by choosing 100% whole wheat bread for sandwiches, popcorn (hold the butter) for a healthy snack, and whole grain breakfast cereals.
Even healthy foods can contain carbohydrate, so it’s important to use nutrition facts labels to help you balance the carbohydrate in your meal plan. Help your family members learn to read labels; it can be eye-opening.
If you’re not already doing so, get the family together for meals. Did you know that some research suggests that eating together as a family reduces the risk of being overweight and having eating disorders? In addition, the family that eats together appears to consume more healthful foods.
Adults with Type 2 diabetes should work toward increasing physical activity to at least 150 minutes on a weekly basis. The ideal is moderate aerobic activity such as walking (2 miles in 30 minutes) spread over at least three days each week, with no more than two days in a row without exercising. Some other examples of moderate physical activity include bicycling (4 miles in 15 minutes), water aerobics (30 minutes), stair walking (15 minutes), gardening (30 to 45 minutes), and raking leaves (30 minutes).
During physical activity, try to maintain a heart rate between 50% and 70% of your maximum heart rate. To calculate your maximum heart rate, subtract your age from 220. If you’re 60 years old your maximum heart rate is 220 minus 60, or 160 beats per minute, so 50% to 70% of your maximum heart rate would be 80 to 112 beats per minute. During the first few weeks, aim for the lowest part of your target rate, then gradually build up to the higher number.
Unless your health-care provider advises you not to, add resistance or strength training to your regimen at least twice a week to build and maintain muscle. Regular physical activity and exercise can help improve hemoglobin A1C (an estimate of your average blood glucose level over the past two or three months), overall fitness, heart health, muscle strength, and sensitivity to insulin, the hormone that helps control blood glucose levels.
If physical activity hasn’t been a regular part of your diabetes treatment plan, start slowly and build up. And it’s always a good idea to discuss any plans with your health-care provider, just to make sure that you’re in shape to handle added physical activity.
Let your family members know about your regular physical activity — joining in and exercising with you may help them avoid developing Type 2 diabetes. Regular moderate activity of 150 minutes per week has been shown to reduce blood glucose in those at risk and decrease the rate of onset of Type 2 diabetes over time. Even young children in your family who are risk for Type 2 diabetes can benefit by engaging in at least 60 minutes of daily physical activity. Equally important, the American Academy of Pediatrics recommends limiting a child’s total entertainment screen time — that is to say, sedentary time — to less than two hours per day. To increase the whole family’s activity levels, try to include more “NEAT” (non-exercise activity thermogenesis) activities like walking up and down stairs and walking in place during TV commercials in everyday life. Lead by example where physical activity and exercise is concerned; it will help with your own day-to-day diabetes management and, if they follow you, could lower your family’s risk for Type 2 diabetes.
For holidays and birthdays, consider fitness-oriented gifts with each family member’s interests in mind, and think “family activity” during every season. Winter workouts may include building a snowman or, when the weather is too cold to be outside, walking in the mall. In the spring, plan a family vacation or weekend outing that includes exercise. As the weather warms up, skip the drive-through car wash and tackle the job as a family. During the summer months, make going for a walk, run, or bike ride together a scheduled event. Take up a new family hobby such as inline skating, tennis, or hiking. And in the autumn, sign up as a family and train together for a charity run, walk, or bike ride, or take weekend walks in different places around town.
Your blood relatives should tell their health-care providers about their family history of Type 2 diabetes and be tested for it. Adults of any age who are overweight and have any other risk factors should be tested for diabetes; adults with no risk factors should be tested initially at age 45 and, if those test results are normal, at least every three years afterward.
When an adult has risk factors for Type 2 diabetes but normal blood glucose levels upon testing, a health-care provider may choose to test more frequently than every three years. Children who are overweight and match two of the following factors should be monitored for Type 2 diabetes at age 10 or at the onset of puberty, whichever comes first:
• a family history of Type 2 in first- or second-degree relative;
• Native American, African American, Latino, Asian American, or Pacific Islander ethnic heritage;
• signs of insulin resistance or conditions associated with insulin resistance; or
• a mother with a history of diabetes or gestational diabetes while carrying the child.
Encourage your family members to be proactive in their efforts to minimize their risks for Type 2 diabetes. Increased physical activity, healthy food choices, and sustained weight reduction all improve insulin sensitivity and therefore decrease insulin resistance. These positive lifestyle behaviors also lower blood pressure and blood fat levels, which also can help lower the risk of heart disease.
With awareness, information, and proactive conversation, make sure that your legacy is not Type 2 diabetes, but a habit of healthy family living.