Four Ways to Prevent Diabetes When You Live with a Mental Illness
This next section focuses on four ways a person with a psychiatric disorder can make small changes that can help prevent diabetes.
They say "prevention is the best cure." With that in mind, here are some ways to prevent diabetes.
1. Get Tested for Metabolic Syndrome
There is a standard set of tests healthcare professionals use to measure a person's risk of metabolic syndrome. They include:
- baseline weight
- body mass index rating
- stomach measurement
- glucose test
- blood pressure test
The glucose level test is, of course, the most important test for diabetes. Most who have insurance and are able to get a yearly physical have easy access to these tests. They are not overly expensive and only require a one-time doctor visit for the measurements and a blood draw. In a perfect world, all people with a diagnosed disorder and especially those on the high-risk antipsychotics are tested upon diagnosis and are monitored every six months for changes.
Of course, we are not in a perfect world. The reality is that there are many people without access to adequate mental health care which translates to a lack of physical health care as well. Dr. William Wilson, M.D., Professor of Psychiatry and Director, Inpatient Psychiatric Services Oregon Health and Science University, puts it this way, "The main problem with our system is that there is a lack of care all around when it comes to mental illness. People often need help regarding the labs for metabolic syndrome, but it's hard when they have to see a psychiatrist and a GP to get the care they need. Patients in the hospital get all of the panels from blood tests to weight and cholesterol levels. The problem is when they get out of the hospital. Monitoring is hard, especially if there is no insurance."
So what is the solution? It all comes down to finding someone with the time and for some, finding someone they can actually afford. Dr. Wilson answers, "I believe that this is actually a political question. It's not that health care professionals don't have information about metabolic syndrome and the risk of diabetes. They know what tests are needed and how often people need to be monitored. The delivery system is the problem. People simply don't have access to care."
If you, or the person you care about, don't have easy access to the diabetes tests, are there free clinics in your town that offer metabolic panels? Can you find a pharmacy that offers a one-time blood sugar test? Can you pay out of pocket for these tests? If you only can pay for one test, it's a good idea to try the A1C. It measures your glucose level over a period of two to three months. You may have to get creative, but the tests are essential to your health.
2. Change Your Diet 10%
It's well documented that any amount of weight loss is a positive. In fact, just losing 10% of your body weight can make a big difference in your diabetes risk, especially if you can lose weight around the stomach. Dr. Andrew Ahmann, Director of the Harold Schnitzer Diabetes Health Center at Oregon Health and Science University, notes, "There is such an emphasis on weight loss for cosmetic reasons. So people have these unreachable goals that they think have to happen in order for them to get healthier. But reducing weight by even 5% can make a significant difference in diabetes risk."
Trying to completely change your diet to prevent diabetes is overwhelming, but just changing 10% of your diet can help you lose a small amount of weight that can make a big difference. Then you can lose more from there.
The biggest goal is to lose fat around the stomach. This can be difficult if the weight gain is due to an antipsychotic, but it never hurts to do all you can until you can find a medication with less weight gain. Here are some small but powerful changes you can make immediately:
Gradually change from soda pop and juice to soda water. Pop is a true empty calorie product. All pop causes weight gain simply because the body doesn't know what to do with the empty calorie except slap it onto the body as fat. Juice has more nutrition but is often very high calorie for just a small amount. Soda water may not be as appealing at first, but you can get used to it.
Eat one low-fat meal a day. A low-fat diet is one of the best ways to manage and prevent diabetes. Just make one change a day. A salad at the restaurant with a low-fat dressing. No cheese on the hamburger. Half the fat ice cream. Milk instead of cream. It's a start.
Eat half of whatever you're having. If it means sharing meals when you eat out, asking for small portions in restaurants or cooking a lot less at home, do what you can. There is no need to 'cook for the week' if this causes you to eat a lot more.
- Have zero junk food in the house. Zero! Unless you're willing to get in your car at 2 AM for a cookie run, having zero junk food in the house is an excellent way to end night binging. You may eat a bag of carrots instead, but that is better than a bag of cookies.
Read the book Eat This Not That to learn how to count calories in commonly eaten foods. When you find out the calorie count of a scone for example, (500-700 calories) you will never look at food the same.
Look at labels and avoid all products made with high fructose corn syrup. The less sugar you eat the better- which makes sense if you're trying to manage or prevent diabetes, but if you find this difficult, at least eat natural sugar.
These are a few basic suggestions that can help you eat a healthier diet. (Of course, if you have diabetes, you already have your dietary guidelines.) There is no question that diets, such as those recommended by the American Diabetes Association are the best choice, but if you're having psychiatric symptoms, you do what you can. Cleaning vegetables, chopping them, cooking them, eating and then cleaning up can be extraordinarily difficult when you're not doing well, but moving towards this is always a good goal.
Dr. Ahmann tells HealthyPlace.com, "There is no time in a typical medical visit to make significant or productive dietary and exercise plans. You can go rah-rah and try to go over the issues. So while we tell patients they have to have a healthy diet, you have to keep it limited and set targets and goals for each visit. For a lot of people, it may be just one goal- park your car at one end of every parking lot, try to make a note on the fridge that says eat this many vegetables a day. I try to find other types of support for my patients who do have time to deal with their diet, but it can be hard."
No matter what situation you're in, if you keep one goal in mind- to reduce belly fat- you have a good chance of reducing your risk of diabetes significantly. And all research shows that lowering your weight is the #1 way to manage your health. So keep trying and do all you can and remember, just a 10% change can make all of the difference and believe it or not, can reduce your risk of diabetes by as much as 60%!
3. Exercise More that You're Exercising Now
Joe, the man who spoke of depression and type 1 diabetes tried to find the right exercise for many years. Here is how he describes his quest:
"I eat right and do all that I should to manage diabetes. I exercise as much as I can. I play tennis and do other sports, but I've found that weight training 45 minutes a day is the only exercise that really helps. It has to be weight training and it has to be that amount of time. It's always a challenge to find the time- but it's the only way I've found to keep my blood sugar balanced."
The type and impact of exercise is an individual matter and what works for one person certainly may not work for another. What exercise do you like to do? Have you thought of belly dancing, flag Frisbee, or simply walking with a friend in a beautiful location? Are you a group person or a solitary exerciser? If you have a lot of depression, what do you need to do in order to exercise more than you do now? If you care about someone with schizophrenia who never exercises, is there something you can do together that doesn't seem like exercise? Remember, any amount of exercise helps.
4. Work with a Healthcare Professional to Find the Right Medications with the Lowest Diabetes Risk
This is the most important step if you have gained weight due to a high-risk antipsychotic. Of course, this has to be done with a licensed doctor, preferably a psychiatrist (a specialist in psychiatric medications), and it will take time to find the best medication. It all depends on the level of your symptoms and of course, your access to healthcare. Metformin, the most popular anti-diabetic drug (for type 2 diabetes) in the United States, may be a great help as well. The antipsychotic dilemma is obviously the biggest detriment to healthy insulin production. If you are able to tolerate Abilify or Geodon, it's worth discussing a change with your healthcare professional.
Of the four above, what can you do first? You can just choose one and see great improvement.
The Diabetes Prevention Program (a multicenter clinical study that included the National Institute of Diabetes and Digestive and Kidney Diseases) concluded that people can reduce their risk of diabetes by over 50% with very simple diet and exercise changes. These changes can also normalize blood sugar and lower other health risks associated with metabolic syndrome. The study also showed that Metformin reduced the risk of diabetes by over 25%. This is good news for anyone with a psychiatric disorder.
Last Updated: 25 January 2019
Reviewed by Harry Croft, MD