Ray Smith had what he called a typical lifestyle. He ate what he wanted and had an occasional glass of wine when he and his wife dined out. He’d quit smoking cigarettes about 25 years ago. He tried dieting and would lose some weight, but after a while, the 5-foot-10-inch, 78-year-old would always gain it back, hovering around 285 pounds.

Then, about a year ago, his primary care physician, UCHealth internal medicine Dr. Sarvin Emami at the UCHealth Primary Care Clinic – Cheyenne, told him he was “borderline” for Type 2 diabetes.

“She told me that in three to four years I’d probably be diabetic — but I had choices,” Smith recalled.

Smith spent 20 years in the Navy Medical Corps as a technician, medic and researcher. His experience in health care told him that getting Type 2 diabetes was not the path he wanted for his retirement.

Type 2 diabetes: a chronic disease

Unlike Type 1 diabetes, in which the body does not produce insulin, Type 2 diabetes arises when the body makes less insulin and stops using it properly — often called insulin resistant diabetes. Type 2 is the most common form of diabetes, and most people who have it have metabolic syndrome with elevated blood sugar, high blood pressure, high cholesterol and increased abdominal girth, according to Emami. Type 2 is treated with lifestyle changes and often can require medication and insulin in order to keep blood sugars under control.

“The management of diabetes is intensive,” said Julie Gormley, a registered dietitian and certified diabetes educator with UCHealth Diabetes and Medical Nutrition Therapy in northern Colorado. “Preventing someone from developing full-blown Type 2 diabetes is keeping them from more doctor visits, out-of-pocket costs, and worry about managing the disease.”

With Type 2 diabetes, the pancreas makes extra insulin but over time, it’s not able to manufacture enough to keep the body’s blood glucose levels normal, according to the American Diabetes Association.

“When blood sugar levels get too high it can cause damage to different organ systems,” Gormley said. “It affects the eyes, nerves, kidneys and cardiovascular system. The person is at higher risk for health complications, and they feel worse.”

Type 2 diabetes prevention

To monitor diabetes risk, physicians look at a patient’s A1C result, which is a measurement of the average blood sugar level over three months.

“Ray’s (Smith) initial A1C was 6.3 percent, at the top tier of the prediabetes range, which is 5.7 to 6.4 percent,” Gormley said. “At A1C of 6.5 percent or higher, is diagnostic for Type 2 diabetes. He was getting very close.”

That was too close for Smith, so he decided to take his doctor’s advice and do something about it. He called UCHealth Diabetes and Medical Nutrition Therapy in Fort Collins and was screened to see if he could join the upcoming Diabetes Prevention Program.

Just a 5 to 7 percent weight loss can lower the risk of developing Type 2 diabetes by 58 percent. That risk reduction jumps to 71 percent for those like Smith who are over the age of 60, according to the National Diabetes Prevention Program research. The average weight loss for participants in UCHealth’s DPP is 6.1 percent.

The Diabetes Prevention Program

DPP is a Center for Disease Control and Prevention-recognized lifestyle change program, proven to prevent or delay Type 2 diabetes. An A1C in the prediabetes range is one criteria for enrollment. Other health risk factors are considered as well. The program is covered by some insurance plans, and more recently, by Medicare.

Participants must be able to make the one-year class commitment and be ready to make healthier food and exercise choices, Gormley said.

“That’s the beauty of this class, you have a whole year to work on behavior changes because they do take time,” she said. “You have peers and lifestyle coaches to help with that, and at each class, we set goals and steps towards establishing new habits.”

The class meets 24 times over the course of 12 months. It meets weekly for the first 13 classes, covering nutrition and physical activity, with a strong focus on making lasting behavioral changes. Then classes begin meeting less frequently, every two weeks, then every three weeks, and monthly for the last six months.

“The support and accountability gives them a foundation to practice these new healthy habits so they become routine,” Gormley said. “The goal is to develop confidence and independence that will last throughout their lifetimes. They start to realize, I can make this happen in my life even with less support. But they still have that phone, email and monthly classes to be able to check in.”

Peer and lifestyle support

“It’s down to the basics,” Gormley said about the class. “It’s not a fad diet. We are changing little things about nutrition, looking at portion sizes, eating more whole foods and less processed foods, eating out less — all those good things that help ensure overall healthier eating patterns.”

“There was lots of information and we had lots of discussions,” Smith said. “And after the first three months, my A1C dropped to 5.8 percent.”

For him, portion sizing made a big difference.

“I’d take a half a cup, and I’d look at it, and it made me realize how much less it was compared to what I was getting before, probably two cups,” Smith stressed.

He also followed the 50/25/25 rule: fill half your plate with fruits and vegetables, leaving the rest for equal parts protein and starch.

“That was the thing: I was watching what I was eating, not necessarily calorie counting,” he said.

Smith found other tricks that helped him change his habits, like putting snacks on the third shelf so he’d have to reach for them rather than having them right in front of his face. And though he didn’t drink much soda before, he did increase his water intake.

He was able to reinforce the changes with support from family and his classmates.

In this together

“I truly enjoyed Julie (Gormley) and all the people in our class because they were really helpful in changing my life,” he said. “They helped me realize what I should and shouldn’t be doing and getting away from the things that got me where I was before I did this class.”

One of those changes was physical fitness. Smith now does 45 to 60 minutes of physical activity five days a week.

“I’ve seen a really big difference,” he said. “I’ve got more stamina and I don’t get as tired if I’m walking around with my wife.”

Smith finished the program having lost about 32 pounds — an 11 percent weight loss of his initial weight. He also lowered his A1C levels to 5.5 percent — into the normal range.

“I don’t think I could have done this on my own,” Smith said.