Wouldn’t it be nice if the human body had an “early alert system” that advised us when something was about to go wrong with our health?
Pre-diabetes offers a warning and gives us a chance to change the future and reverse the course.
Pre-diabetes, also called impaired glucose tolerance or impaired fasting glucose, means your blood sugar is higher than normal, but not high enough to diagnose type 2 diabetes.
Pre-diabetes is reversible; consider it a warning sign that it is time to take your health more seriously.
It is important to know if you have pre-diabetes, because research has shown that some long-term complications associated with diabetes – such as heart disease – may begin during pre-diabetes.
Without making lifestyle changes (or taking medication), the “side effect” of pre-diabetes is that it is likely to progress to type 2 diabetes.
If your doctor says you have “pre-diabetes,” be sure to ask what your exact blood sugar test results are. Some physicians are not as familiar as they should be with the new national guidelines for diagnosing diabetes. They may be telling you that you have pre-diabetes, when in fact you have actual diabetes.
You Have Diabetes if …
- Diabetes is defined as having a fasting plasma blood glucose level of 126 mg/dl or greater on two separate occasions.
- If diabetes symptoms exist and a casual (non-fasting) blood glucose equal to or greater than 200 mg/dl, and a second test shows the same, then you have diabetes.
You Have Pre-Diabetes if …
- In general, if you have a fasting plasma blood glucose in the 100-125 mg/dl range, you have impaired fasting glucose, or pre-diabetes.
- If your oral glucose tolerance test shows that your blood glucose level at 2-hours is 140-199 mg/dl, you have impaired glucose tolerance.
What Causes Pre-Diabetes?
The exact cause of prediabetes is unknown, but family history and genetics appear to play an important role. Inactivity and excess fat (especially abdominal fat ) also seem to be important factors.
What we know is that people with prediabetes don’t process sugar (glucose) properly anymore, and as a result, sugar accumulates in the bloodstream instead of doing its normal job of fueling your cells .
Most of the glucose in your body comes from the food you eat. When food is digested, sugar enters your bloodstream, and the pancreas secretes insulin to move sugar from your bloodstream into your body’s cells. As the glucose enters your cells, your blood sugar level drops, which signals the pancreas to stop secreting insulin.
With pre-diabetes, this process is disrupted: either your pancreas doesn’t make enough insulin, or your cells become resistant to insulin’s action. So, instead of fueling your cells, sugar builds up in your bloodstream.
Risk Factors for Pre-Diabetes
The same factors that increase the risk of developing type 2 diabetes increase the risk of developing pre-diabetes. These factors include:
Weight – Being overweight is a primary risk factor for pre-diabetes. The more fatty tissue you have — especially inside and between the muscle and skin around your abdomen — the more resistant your cells become to insulin.
Waist Size – A large waist size can indicate insulin resistance. The risk of insulin resistance goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches.
Dietary Patterns – Eating red meat and processed meat, and drinking sugar-sweetened beverages, is associated with a higher risk of pre-diabetes. A diet high in fruits, vegetables, nuts, whole grains and olive oil is associated with a lower risk of pre-diabetes.
Inactivity – The less active you are, the greater your risk of pre-diabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
Age – Although diabetes can develop at any age, the risk of pre-diabetes increases after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age.
Family History – Your risk of pre-diabetes increases if you have a parent or sibling with type 2 diabetes.
Race – Although it’s unclear why, people of certain races — including African-Americans, Hispanics, Native Americans, Asian-Americans and Pacific Islanders — are more likely to develop pre-diabetes.
Gestational Diabetes – If you developed gestational diabetes while pregnant, you and your child are at higher risk of developing pre-diabetes. If you gave birth to a baby who weighed more than 9 pounds (4.1 kilograms), you’re also at increased risk of pre-diabetes.
Polycystic Ovary Syndrome – This common condition — characterized by irregular menstrual periods, excess hair growth and obesity — increases women’s risk of pre-diabetes.
Sleep – People with a certain sleep disorder (obstructive sleep apnea) have an increased risk of insulin resistance. People who work changing shifts or night shifts, possibly causing sleep problems, also may have an increased risk of pre-diabetes or type 2 diabetes.
Metabolic Syndrome Increases Diabetes Risk
Metabolic Syndrome is a cluster of conditions that occur together, increasing your risk of diabetes (or pre-diabetes), heart disease and stroke.
Based on the guidelines from the National Heart, Lung, and Blood Institute (NHLBI) and the American Heart Association (AHA), a person has Metabolic Syndrome if they have any three of the following traits:
- high blood pressure (hypertension)
- excess body fat around the waist
- excess body fat around the waist
- abnormal cholesterol or triglyceride levels
- high blood sugar
Who Needs Pre-Diabetes Screening?
You should be screened for pre-diabetes if you are an overweight adult 45 or older, or if you are under 45 and overweight, with one or more of these risk factors:
- are habitually physically inactive
- have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
- have a family history of diabetes
- are members of certain ethnic groups (including Asian American, African-American, Hispanic American, and Native American)
- have had gestational diabetes or have given birth to a child weighing more than 9 pounds
- have elevated blood pressure
- have an HDL cholesterol level (the “good” cholesterol) of 35 mg/dl or lower and/or triglyceride level of 250 mg/dl or higher
- have polycystic ovary syndrome
- have a history of vascular disease
Signs and Symptoms of Pre-Diabetes
Pre-diabetes generally has no signs or symptoms.
One possible sign that you may be at risk of type 2 diabetes is darkened skin called acanthosis nigricans, particularly the neck, armpits, elbows, knees and knuckles.
Acanthosis nigricans is seen in both men and women. It’s most common in those who are overweight, have darker skin, and have diabetes or are pre-diabetic. Children who develop acanthosis nigricans are at a higher risk of developing type 2 diabetes later in life.
The frequency of acanthosis nigricans varies between ethnic groups. According to the American Academy of Dermatology, people of African, Caribbean, or Hispanic descent are at an increased risk. All ethnic groups are equally at risk of acanthosis nigricans when body mass index (BMI) is well above normal.
Classic signs and symptoms that suggest you’ve moved from prediabetes to type 2 diabetes include:
- Increased thirst
- Frequent urination
- Blurred vision
Pre-diabetes is best treated with a proactive, renewed commitment to making healthier choices every day. It can, and usually is, treated with diet and exercise alone. However, some people with pre-diabetes are treated with a medication called metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet).
Research published in the New England Journal of Medicine showed that lifestyle changes reduced diabetes incidence by 58% compared to metformin, which reduced the incidence by only 31%.
Scientifically-Proven Lifestyle Interventions for Pre-Diabetes
A 2014 study published in the International Journal of Medical Sciences summarized that the following lifestyle factors are important and effective:
Physical activity may contribute to 30-50% reduction in the development of T2DM (Type 2 Diabetes Mellitus).
Any type of exercise will help. For example, walking, the most popular choice of physical activity, has been shown to reduce the relative risk of T2DM by 60% when walk for 150 min/week, compared to walking for <60 min/week.
If you have difficulty in walking because of joint problems, other forms of physical activity, for example, cycling, swimming or gym-based activities are all good choices, as well.
Do something you enjoy, which doesn’t depend on the weather.
For example, I have a treadmill at home, which allows me to walk indoors when it’s miserable outside (no excuses!). I’ve had my treadmill for about 10 years now, so for me, it has been an excellent lifestyle investment.
I also recommend a wearable activity tracker to help with motivation and provide you with a feedback loop. I’ve written a post on the best fitness trackers for the budget-minded to give you some ideas.
Diabetes prevention studies have demonstrated that diet composition is another important factor to prevent the development of T2DM.
Epidemiological studies suggest that the risk of diabetes can be increased or decreased owing to dietary factors.
The dietary factors which may increase the diabetes risk are consuming excessive amounts of:
- refined grains
- sugar-sweetened beverages
- red and processed meat
Those foods which decrease diabetic risk are:
- whole-grain cereal
Note that these dietary findings are independent of body weight change; soeven without weight loss, dietary changes make a big difference.
A large number of prevention studies concerning dietary factors have been conducted in many countries during the past several years.
A Mediterranean diet characterized by a high intake of vegetables, fruit, legumes, extra virgin olive oil, nuts, fish, whole grains and red wine also showed a remarkable decrease in the incidence of diabetes.
Behaviors and Habits
Obesity is one of the most important risk factors for pre-diabetes. Adipose (fat) tissue, particularly of the tissue surrounding internal organs (e.g. visceral fat) can create inflammation by secreting various proinflammatory adipokines.
“For every kilogram of weight loss, there was a 16% reduction in risk [of diabetes], adjusted for changes in diet and activity. Lower percent of calories from fat and increased physical activity predicted weight loss”.
As far as the importance lifestyle factors, I think the 2007 study published in the British Medical Journal said it best:
“Lifestyle and pharmacological interventions reduce the rate of progression to type 2 diabetes in people with impaired glucose tolerance. Lifestyle interventions seem to be at least as effective as drug treatment”.
If you are overweight, you may be interested in trying non-prescription alli (orlistat), which binds with lipase to block the absorption of dietary fat. It is the only FDA approved over-the-counter weight loss supplement available in the U.S. There are numerous clinical studies on its safety and efficacy.
It is only for individuals over 18 with a BMI of 25 or above.
Monitoring Your Progress
When you are working to reverse pre-diabetes, your health-care professional will advise you on how often you should have your blood tests checked – usually every 3 months.
Having your own personal home glucose monitor (finger stick test) is important. It allows you to be involved in managing your pre-diabetes, and tracking your progress.
Write down the numbers and what was consumed to learn how you respond to different meals. This is the only way to test different pre-diabetes meal plans to find out how various food choices affect your blood sugar.
Do the following to track your meals and foods:
- Check your blood sugar and write it down.
- Enjoy your meal and write down what you ate and the portion sizes.
- In two hours, check your blood sugar and write it down. Did that meal treat your body well? How much did your blood sugar go up? How did you feel?
- Keep a log of these readings to discuss them with your health-care professional or nutritionist to problem-solve ways to make better diet choices. This will help you find foods to eat and foods to avoid for your personal situation.
I like the Freestyle Lite blood glucose monitoring system. It’s small and discreet, and takes the smallest blood sample size of all the glucose monitors (so there’s less pain). It also has a convenient backlight, and a a test strip port light.
It doesn’t require any coding, and it’s testing time averages only 5 seconds.
The Freestyle Lite stores up to 400 results with date and time, and provides results in 7, 14 and 30-day averages, so you can track trends.
The box comes with the FreeStyle Lite Blood Glucose Meter, 1 lancing device, 10 lancets, and a carrying case.
It’s very reasonably priced, and extra test strips for this unit are easy to find.
It looks like pre-diabetes is reaching epidemic proportions; according to the 2017 National Diabetes Statistics Report from the Centers for Disease Control (CDC):
- A total of 84.1 million adults aged 18 years or older have pre-diabetes (33.9% of the adult US population)
- 23.1 million adults aged 65 years or older have pre-diabetes
Most of those cases of pre-diabetes will progress into full-blown type 2 diabetes.
Don’t be one of those people.
Think of pre-diabetes as a fork in the road:
- Ignore it, and your risk for type 2 diabetes goes up.
- Lose a modest amount of weight and get regular physical activity, and your risk goes down.
You know what to do.
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