Most people associate diabetes with being overweight or having a family history, but these lesser-known risk factors can play a role too.
Youprobably know diabetes is a major health problem in America—but you might be underestimating your own chances of getting the disease. One survey found that almost half of adults at risk for diabetes believe they have no risk. But with almost 10 percent of the U.S. population living with diabetes, there's a good chance you have some risk factors for diabetes that you might not even be aware of.
You may know about the more obvious diabetes risk factors—say, family history and obesity—but there are other, less obvious things that can have in impact on your risk of developing diabetes, too. And because diabetes symptoms can be vague and non-specific, it’s important for you and your doctor to be aware of your chances in order to make a plan for whether you should be tested for high blood sugar, the hallmark sign of diabetes.
1. You're apple-shaped
The most well-known risk factor you’ve probably heard about for diabetes is your weight. “Weight gain and development of obesity is the biggest risk factor for diabetes,” says Reshmi Srinath, MD, director of the weight and metabolism management program at The Mount Sinai Hospital in New York City. And while it’s true that having a high BMI (body mass index) is a diabetes risk factor, you may be surprised to know that where your weight is located on your body also plays a role, even if you’re not technically considered obese.
Those who have more weight around their middle—known as being “apple-shaped”—have a greater chance of developing diabetes than those who are “pear-shaped,” with more fat distributed around the thighs and buttocks, research shows. Although doctors aren’t exactly sure why this is, it likely has something to do with how visceral fat, the kind that accumulates around your belly, affects the workings of nearby internal organs. Get out your tape measure: a waist size greater than 35 inches for women or greater than 40 inches for men means a higher diabetes risk. Exercise and a healthy diet can help you lose your “spare tire.”
A waist size greater than 35 inches for women and 40 inches for men means a higher type 2 diabetes risk.
2. You don't come close to hitting your daily step count
If you work in an office glued to your computer all day, that might mean your lifestyle is too sedentary for your own health. According to the American Diabetes Association (ADA), the eight to 13 hours a day we spend sitting at our desk, driving to and from work, using devices like cell phones and tablets, and watching TV are increasingly contributing to our risk of diabetes.
“Engaging in a sedentary lifestyle, where we take in more calories than we burn, can contribute to weight gain,” Dr. Srinath says. The ADA recommends getting up and walking around at at least every 30 minutes throughout the day to avoid being too sedentary. “Moving or standing more during the day can have many benefits, including burning calories and increasing muscle, both which help improve insulin resistance,” says Shannon Weston, RD MPH,a diabetes educator and registered dietitian with Cizik School of Nursing at UTHealth-Houston. The hormone insulin helps your body process blood sugar, so the less resistant to insulin you are, the better.
3. Soda is one of your go-to beverages
Apparently, you can’t kale salad your way out of a bad soda habit. A penchant for soda and other sugar-sweetened drinks can raise your risk of diabetes, even if you otherwise have a healthy lifestyle, according to research. In one study, those who drank more than three 12-ounce sodas a week had a 46 percent increased risk of prediabetes, a precursor to the disease. It all comes down to the sugar content. “One 12 ounce can of soda has 39 grams of sugar, but the American Heart Association recommends that men consume no more than 37.5 grams of added sugar per day and women no more than 25 grams of added sugar per day,” Weston says.
In addition, soda is high on the glycemic index, which means it has a high carb load that you digest quickly, especially because it's a liquid. This causes a spike in blood sugar and a high demand for insulin. Over time, this can wear out the pancreas. Research on the effects of diet soda has been mixed, but the ADA advises it only to replace higher-calorie drinks. Water is still your best choice.
4. You're basically always stressed
If you feel yourself constantly stressed out, or if you have other mental health conditions like depression, you may be at a higher risk of developing diabetes. Stress puts the body on high alert to prepare for fight or flight. “When you’re stressed, cortisol levels increase, which pulls blood sugar out of cells into the blood stream for energy,” Weston says.
But because your stress is often more mental than physical (you don't actually need the extra energy to fight a saber-toothed tiger, like our caveman ancestors did), this has unintended effects on your blood sugar metabolism.
"Chronic stress increases cortisol, which tells the brain to increase appetite and cravings for certain foods, especially carbs and fat," Weston says. People struggling with depression may also lack motivation to exercise or make healthy food choices, which can contribute to diabetes risk as well. Make it a priority to find stress-reduction techniques, such as meditation, that work for you and you can do regularly. Try these alternatives to meditation or this stress-reducing yoga routine.
5. Your bedtime is a little too late
Your nightly Netflix binge could be messing with your metabolism and increasing your risk for diabetes. According to the National Sleep Foundation, not getting enough sleep (less than seven to nine hours) throws off hormone production and may cause less insulin to be released. In addition, “lack of sleep also raises your stress hormones, which can then raise glucose levels,” Dr. Srinath says. “Lack of sleep also impairs your ability to make healthy food choices.” Being tired increases our appetite because we need extra energy, which leads to weight gain, Weston says. In one study, sleeping less than seven to eight hours a night was linked to an increased risk of diabetes.
6. Your race is considered high-risk
Unfortunately you just can't control certain risk factors for diabetes. You probably know that your personal family history affects your risk, but even if no one in your family has been affected, your race and ethnicity may still affect your chances. "African Americans, Mexican Americans, American Indians, Pacific Islanders, and Asian Americans have an elevated risk for these diseases, partly because these populations are more likely to be overweight," Weston says. Doctors are working to understand additional factors that may make certain ethnic groups more likely to develop diabetes.
7. You've been diagnosed with PCOS
If you’re a woman with polycystic ovary syndrome (PCOS), you are also at a higher risk for diabetes. According to one study, women with PCOS were four times more likely to develop diabetes than women without the condition. Women with PCOS are more likely to be overweight or obese, which is a diabetes risk factor; but there are likely other hormonal factors at play. “PCOS is an indicator of insulin resistance, which causes an increase in blood sugar, and over a period of time elevated blood sugar increases diabetes risk,” Weston says. If you have PCOS, talk to your doctor or dietitian to see how your diet and exercise can help you manage your diabetes risk. Medications are also available.
Women with PCOS were four times more likely to develop diabetes than those without the condition.
8. You've had gestational diabetes during pregnancy
You may have been diagnosed in pregnancy with gestational diabetes after taking a glucose tolerance test (you’ll remember this one because you had to guzzle a huge, orange-flavored drink that wasn't so pleasant). Pregnancy hormone levels can affect your body’s production of insulin, making some women who wouldn’t otherwise appear to be at risk of diabetes develop GD. But your diabetes risk didn’t end when your baby was born—unfortunately, simply having GD can raise your risk for getting diabetes later on. This may be in part because risk factors for GD, such as being overweight, having PCOS, being of a non-white race or having prediabetes, are the same as for diabetes itself. If you had gestational diabetes, the ADA recommends being tested for diabetes six to 12 weeks after birth and at least every three years after that. (Here's more info on eating healthy with gestational diabetes.)
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