This blog entry will discuss one of the most prevalent but misunderstood conditions in medicine – prediabetes. A diagnosis of prediabetes means that your blood sugar is elevated but not high enough yet to be diagnosed with type 2 diabetes. It is estimated that one in every 3 adults has prediabetes and that the vast majority of them, 84 percent by one estimate, do not know that they have it. Persons with prediabetes are at significantly increased risk of developing full blown type 2 diabetes, heart disease and stroke.
Over the years I have seen many patients in my practice who have been told that that their blood sugar is a “little high” or “borderline.” What they likely have is prediabetes. Prediabetes is not just diabetes lite, it is a serious health condition in itself. Normally the pancreas produces insulin which causes the cells in the body to take in sugar from the blood to be used as energy. Persons with prediabetes have become insulin resistant. This means that the cells in the body do not respond normally to insulin which causes the body to make more and more insulin trying to get the cells to respond. This chronically high level of insulin that does not work properly is at the core of the problem. While this excess insulin no longer works properly to lower blood sugar it is very efficient at storing body fat. This is why persons with prediabetes tend to hold on to belly fat and have trouble losing weight!
Before the blood glucose is high enough for a diagnosis of diabetes, a person may have prediabetes for years because there are no reliable symptoms. If a treatment plan is not instituted, up to 30 percent of them will progress to type 2 diabetes within 5 years. Complications of diabetes are numerous and include heart disease, kidney damage, nerve damage and impairment of vision. Fortunately, if a diagnosis of prediabetes is made early it can often be completely reversed such that the person might never develop diabetes.
Risk Factors for Prediabetes
It is important to know if you are at risk for prediabetes so that you can discuss being tested for it by your primary care provider. It should be noted that African Americans, Latino Americans and American Indians and Pacific Islanders are at greater risk for developing prediabetes. If you have any of the following risk factors, you should be tested for prediabetes.
1. Being overweight or obese
2. Being age 45 or older
3. Having a parent or sibling with type 2 diabetes
4. Exercising fewer than 3 times a week
5. Having a history of gestational diabetes or of delivering a baby over 9 pounds
6. Having a history of polycystic ovary syndrome
One simple test that does not requite an overnight fast is the hemoglobin A1C. This test tells what the blood glucose level has been averaging over the last 3 months. An A1C level below 5.7% is considered normal. An A1C level between 5.7% and 6.4% is considered prediabetes. An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes. Once a diagnosis of prediabetes is made, it is usually within your power to return your blood sugar and A1C values to normal with a few very simple lifestyle changes.
How to Reverse Prediabetes
1. Eat a healthy diet! Remember that it is the sugars, simple starches and processed “junk” foods that keep the insulin levels high and lead to fat storage. Work with a nutritionist to learn which foods are likely to spike blood glucose and insulin the most so that those foods can be avoided. The optimal carbohydrate intake will vary from person to person but should certainly be significantly lower when trying to reverse prediabetes. The American DiabetesAssociation (ADA) recommends the “diabetes plate method” where one half if a 9 inch plate is filled with non-starchy vegetables, one fourth is protein and one fourth is complex carbohydrates. Complex carbohydrates like whole grains and beans have less impact on blood sugar than simple carbohydrates because digestion is slowed down by the fiber content. Using this simple method for most meals is a good place to start and does not require any tedious counting of calories or carbohydrates.
2. Losing weight. If you are overweight, losing as little as 5-10 percent of your current weight can improve your blood sugar levels. The weight loss should come naturally as you implement the above mentioned diet lower in simple carbs and processed foods.
3. Exercise regularly to reduce insulin resistance, increase your energy level and improve your mental health. The goal is 30 to 60 minutes of moderate activity at least 5 days a week. Regular exercise is also a great stress reliever. Walking, jogging, dancing, biking, swimming, exercise classes or videos are just a few examples of moderate exercise.
4. Quit smoking. Smoking is a risk factor not only for heart disease and lung disease but for insulin resistance, prediabetes and type 2 diabetes. Smoking has no place in a healthy lifestyle.
5. Drink plenty of water as a healthy alternative to sugary sodas, juices and energy drinks. How much you should drink depends on your size, activity level and climate. The color of your urine will tell you if you are drinking enough water. If your urine is dark yellow rather than pale yellow, you are likely not drinking enough.
6. Limit or avoid alcoholic beverages. Not only is alcohol a source of empty calories but it lowers your inhibitions making you less likely to make healthy choices with your meals.
In some cases, prediabetes is so far advanced that the lifestyle changes we have discussed may not be enough. If you have made those changes and continue to have abnormally high blood glucoses, your primary care provider may suggest medications to lower your blood glucose as an adjunct to your lifestyle changes.
On a personal note, my own diagnosis of prediabetes in my early 60’s turned out to be a blessing in disguise for me. I had nearly every risk factor on the list. However, once I made the lifestyle changes I have shared with you, my glucoses and A1C levels returned to and remained normal without medication. It is my prayer that if you you have been diagnosed with prediabetes, you too will be able to make the changes that will reverse the condition.
Yvonne Moore, MD
“Dear friend, I hope all is well with you and that you are as healthy in body as you are strong in spirit.” 3 John 1:2 (NLT)