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Prediabetes: Don’t Let the “Pre” Fool You




Have you heard of prediabetes? The CDC defines it as “a serious health condition where the blood sugar levels are higher than normal, but not high enough yet to be diagnosed with type 2 diabetes.” Approximately 98 million Americans (1 in 3) have it, and shockingly, 8 out of 10 don’t know it.(1) Symptoms commonly associated with diabetes include feeling extra thirsty, hungry or tired, blurred vision, numbness or tingling in the hands or feet, and urinating more frequently. Prediabetes is often silent, meaning you will not feel any symptoms, but damage is still being done to the body. With early detection, there are steps you can take to prevent or reverse it.


It is important to take action now if you have prediabetes or are at risk for developing it. Prediabetes can be classified as a toxic state, with increased risk for heart disease, stroke, diabetes, and some cancers. It can even result in eye, kidney, and nerve damage.(2) We’re born with smooth blood vessels that allow for easy passage of blood and circulation of other important cells and nutrients around the body. Imagine if someone ran a tiny rake across those vessels day after day, year after year. This is what excess sugar in the blood does. It creates a jagged and damaged surface that no longer allows for smooth passage and increases risk of vessel collapse and clogs. This is what leads to nerve damage, vision changes, heart disease, stroke and more. 


Before long-term consequences of high blood sugars set in, there are many immediate impacts on the body. In prediabetes, we can see increased insulin resistance and multiorgan dysfunction. Dysfunctions include intestinal dysbiosis, increased appetite, impaired insulin secretion, increased liver output of glucose, decreased muscle uptake of glucose, and decreased GLP-1 and GIP, which help regulate appetite and glucose homeostasis in the body.(3) This means that with prediabetes, we’re going to have a more difficult time managing our appetite and weight, processing food, maintaining normal blood sugars, and cultivating a healthy gut microbiome.


So how do you know if you have prediabetes? The gold standard for diagnosis is the hemoglobin A1C. This is a simple blood test your doctor can order. Prediabetes is defined as a hemoglobin A1C of 5.7% to 6.4%. This measures how much sugar is attached to your red blood cells and circulating around your body. We need sugar in our blood to provide quick energy for the body, but too much sugar damages the lining of blood vessels and organs all over the body. This is a gradual, cumulative process that we often cannot feel, which is what makes prediabetes such a sneaky condition. 6.5% or higher, with repeat results, means a diagnosis of type 2 diabetes. Check with your primary care provider. There is growing awareness of the importance of early detection and intervention to prevent prediabetes from becoming diabetes (or better yet, to prevent prediabetes), but this is not a guarantee that your doctor will let you know. Advocate for yourself and ASK. 


So what’s the upside? It is possible to prevent and even reverse prediabetes. Some research studies have shown promising results of reversal in ~40-50% of participants to normal blood sugars with diet and lifestyle changes.(4,5) The earlier it is detected, the more likely you will be able to make the necessary food and exercise adjustments to prevent diabetes and prediabetes. If you are carrying extra weight, weight loss can help. Even losing 5% of your body weight makes a meaningful impact. Diet quality also matters - try the Mediterranean or DASH eating plan. And get more active (150-300 minutes per week at a moderate to vigorous intensity). And lastly, seek out support. Find your local Diabetes Prevention Program, and meet with a Registered Dietitian (even better if they are a Certified Diabetes Care and Educator Specialist). Getting a customized and adaptable plan is key to making sustainable changes that will stick over time. 


Here are some tips to get you started with lifestyle changes:


  • Skip the crash diet. Make small changes that will add up over time. If you love, French fries (who doesn’t?), talk to your Dietitian about how to make them fit in a balanced meal plan.

  • Don’t rely on will power. Being overly restrictive with your diet is a terrible strategy for changes that need to last a lifetime. Make space for small treats throughout the week. Strike a balance. 

  • It’s not a straight line to success. Lifestyle change is a wobbly road. We all get off track from time to time. It’s about what we do most of the time, not all the time. And when we fall off the wagon, it’s about getting back to those healthier habits a little faster than the last time.

  • Find your motivation. Extrinsic motivation might help you get started (i.e. wanting to fit in those pants) but intrinsic motivation is what makes change stick (i.e. I want to be around to play with my grandkids). 

  • Be kind to yourself. Work to stop negative thoughts in their tracks and replace them with useful thoughts. (Negative: I didn’t exercise today. I’m so lazy. Replacement: I didn’t sleep well last night and didn’t exercise as planned, and that’s ok. I need to rest. Can I make time tomorrow or take a 5 minute walk today?). 

  • Seek out support. Enlist your partner to make changes with you. Find an exercise or cooking class or walking group. Join the Diabetes Prevention Program. Talk to your primary care physician. And get one-on-one support from a dietitian. Social support is an often-overlooked area that is crucial for successful change.

  • Make exercise fun. Find your “thing.” The best form of exercise is one that doesn't feel like a chore. Build it into your lifestyle. For example, take a trail or beach walk on the weekends. 


Risk factors for prediabetes include being overweight, >45 years old, being active <3 times per week, family history, history of gestational diabetes or polycystic ovary syndrome (PCOS), or one of the following racial or ethnic backgrounds: African American, Hispanic/Latino American, American Indian, Pacific Islander, and Asian American.(1) If you have any of these risk factors, ask your doctor to check your A1C. Or review your lab results - it’s possible you have it and were never told.



References

  1. Prediabetes. CDC. https://www.cdc.gov/diabetes/basics/prediabetes.html#:~:text=What%20Is%20Prediabetes%3F,1%20in%203%E2%80%94have%20prediabetes.

  2. Prediabetes A Fundamental Text. ADA; 2021

  3. DeFronzo. Diabetes. 2009; 58(4): 773-795

  4. Dagogo-Jack S. BMJ Open Diabetes Research and Care. 2022.

  5. Diabetologia. 1991 Dec;34(12):891-8.

  6. Diabetes Tests. CDC. https://www.cdc.gov/diabetes/basics/getting-tested.html

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