By Arthur Agatston, MD, Everyday Health heart expert
If you are age 25 to 50, the odds are about 40 percent that you've been diagnosed with prediabetes, diabetes, or metabolic syndrome. Shocked by this statistic? You should be! Not long ago, diabetes and prediabetes were rare. In fact, diabetes is such a strong risk factor for heart disease that medical professionals define it as a "coronary heart disease risk equivalent." This means that a person with diabetes has the same high risk of a heart attack as someone who has already had one. Up to 70 percent of people in coronary care units have prediabetes or diabetes. Women, take note: If you have diabetes and have suffered a heart attack, you have an even greater risk of having another heart attack or heart failure than a man who has diabetes and has suffered a heart attack.
Diabetes is well known as a disease characterized by the body's inability to process sugars and starches. Less well known are the problems that people with diabetes have processing fats in their diet. There are two common types of diabetes: juvenile-onset, or what's now known as type 1 diabetes (which usually appears abruptly before age 30), and adult-onset, or type 2, diabetes. Prediabetes, sometimes called metabolic syndrome, insulin resistance, or Syndrome X, will lead to full-blown type 2 diabetes if it goes unchecked. The difficulty with processing fats and the risk of heart attack and stroke begin in the prediabetes phase, which is defined as a blood sugar level of 100 to 125 mg/dL.
The problem with type 2 diabetes and prediabetes is that people who have these conditions process fats abnormally, leading to low levels of good HDL and elevated levels of triglycerides. They also have more small HDL and more small, dense LDL. In addition, they often have high blood pressure and more inflammation in their arteries.
To help reduce these risks, national guidelines recommend that people with diabetes keep their blood pressure below 130/80. Giving up cigarettes is even more important for people with diabetes than it is for others, because smoking and diabetes are a deadly combination. Type 2 diabetes is also closely linked with obesity, which explains why, as the population gets fatter, the rate of type 2 diabetes is soaring. What is even more alarming is that there are millions more "diabetics in training" in our country today. I am speaking of our children, who, as they grow fatter and less fit, are rapidly becoming prediabetic or even diabetic. Type 2 diabetes can no longer be called an "adult-onset" disease.
Luckily, type 2 diabetes is largely a "man-made" disease that we can unmake if we set our minds to it. Exercise, weight loss, and strategic dietary changes  particularly eliminating the highly processed "bad carbs" found in baked goods, breads, snack foods, and other starchy and sugary favorites  are all very effective in reversing insulin resistance.
