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Prediabetes: What is it and how can I reverse it?
Being diagnosed with prediabetes is not the end of the world, but it is a wake up call to get in better health. Prediabetes has other names tool-- metabolic syndrome, insulin resistance, syndrome X. If you have any of these terms, it is important to do something about it now.
Before people develop type 2 diabetes, known as diabetes mellitus, they usually have prediabetes or impaired fasting blood glucose. Blood sugar levels > 100 mg/dL (5.5 mmol) but < 126 mg/dL (7 mmol) are considered prediabetes.
Prediabetes means that your blood sugar level is higher than normal, but it's not yet increased enough to be classified as type 2 diabetes. Still, without intervention, prediabetes is likely to become type 2 diabetes in 10 years or less. And, if you have prediabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.
There's good news, however. Prediabetes can be an opportunity for you to improve your health, because progression from prediabetes to type 2 diabetes isn't inevitable. With healthy lifestyle changes — such as eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight — you may be able to bring your blood sugar level back to normal.
Prediabetes/diabetes type 2 has become a worldwide epidemic. 57 million people in the United States have prediabetes and most don't even know it, according to the American Diabetes Association.
Mistakenly, many people who believe they're "borderline diabetic" or have "a touch of diabetes" think that they're safe. But research has shown some long-term damage is being done to the body, especially the heart and circulatory system.
Risk factors for prediabetes and diabetes:
- Being overweight or obese. This keeps your body from making and using insulin correctly. Being overweight can also cause high blood pressure.
- Having a parent, brother or sister with diabetes. Having a relative with type 2 diabetes, more than doubles your risk of getting the disease.
- Being of African-American, American Indian, Asian-American, Pacific Islander or Hispanic/Latino heritage.
- Having gestational diabetes or giving birth to at least one baby who weighed more than 9 pounds (4.1 kilograms).
- High blood pressure.
- HDL or "good" cholesterol is < 35 mg/dL (0.9 mmol/L) or your triglyceride level is > 250 mg/dL (2.83 mmol/L).
- Exercising fewer than three times a week.
You can have prediabetes and not know it. Two tests are commonly used to diagnose prediabetes:
- Fasting blood glucose. Measures blood glucose first thing in the morning before you eat. A normal fasting blood glucose is between 70 to100 mg/dL (3.8 to 5.5 mmol). You have prediabetes if your fasting blood sugar is 101 to 125 mg/dL (5.6 to 6.9 mmol).
- Oral glucose tolerance test. Measures blood glucose after fasting and again 2 hours after drinking a glucose-rich drink. Normal blood glucose is below 140 mg/dL (7.7 mmol) 2 hours after the drink. In prediabetes, the 2-hour blood glucose is 140 to 199 mg/dL (7.8 to 11.0 mmol/L). If the 2-hour blood glucose rises to 200 mg/dL (11.1 mmol) or above, you have diabetes.If you have prediabetes, you should do something about it. Studies have shown that people with prediabetes can prevent or delay the development of type 2 diabetes by up to 58 percent through changes to their lifestyle, including modest weight loss (as little as 5 to 7 percent of your current weight) and increasing physical exercise. This makes a major difference!
Prediabetes often has no signs or symptoms.
Darkened areas of skin, a condition called acanthosis nigricans, is one of the few signs of prediabetes. Common areas that may be affected include the neck, armpits, elbows, knees and knuckles.
Classic red flags of type 2 diabetes to look for include:
- Increased thirst
- Frequent urination
- Blurred vision
Consult your family doctor if you're concerned about diabetes or if you notice any type 2 diabetes signs or symptoms.
The exact cause of prediabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of prediabetes.
What is known is that people who have prediabetes aren't quite processing sugar (glucose) properly anymore. This causes sugar to build up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.
Most of the glucose in your body comes from the foods you eat, specifically foods that contain carbohydrates. Any food that contains carbohydrates can affect your blood sugar levels, not just sweet foods.
During digestion, sugar enters your bloodstream and with the help of insulin is then absorbed into the body's cells to give them energy.
Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key that unlocks microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.
When you have prediabetes, this process begins to work improperly. Instead of fueling your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin or both.
The same factors that increase the risk of developing type 2 diabetes increase the risk of developing prediabetes, including:
- Weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have — especially around your abdomen — the more resistant your cells become to insulin.
- Inactivity. The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.Age. The risk of prediabetes increases as you get older, especially after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age. However, older people aren't the only ones at risk of prediabetes and type 2 diabetes. The incidence of these disorders is also rising in younger age groups.
- Family history. The risk of prediabetes increases if a parent or sibling has type 2 diabetes.
- Race. Although it's unclear why, people of certain races — including African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders — are more likely to develop prediabetes.
- Gestational diabetes. If you developed gestational diabetes when you were pregnant, your risk of later developing diabetes increases. If you gave birth to a baby who weighed more than 9 pounds (4.1 kilograms), you're also at increased risk of diabetes.
- Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes.
- Inadequate sleep. Several recent studies have linked a lack of sleep to an increased risk of insulin resistance. Research suggests that regularly sleeping fewer than 5.5 hours a night might up your risk of prediabetes or type 2 diabetes.
Other conditions associated with diabetes include:
- High blood pressure
- Low levels of HDL, or "good," cholesterol
- High levels of triglycerides — a type of fat in your blood
When these conditions — high blood pressure, high blood sugar, and abnormal blood fats and cholesterol — occur together along with obesity, they are associated with resistance to insulin. This is often referred to as metabolic syndrome.
Here's some information to help you get ready for your appointment, and what to expect from your family doctor.
What you can do
For prediabetes, some question to ask your family doctor are:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something. And, be sure that you understand your doctor's recommendations before you leave.
What to expect from your doctor
Your family doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
Who should be tested
The American Diabetes Association recommends blood glucose screening if you have any risk factors for prediabetes. This includes if:
If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes. Guidelines from the American College of Endocrinology suggest the following to treat prediabetes:
In other cases, medications to control cholesterol — statins, in particular — and high blood pressure medications are needed. Healthy lifestyle choices remain essential, however.
Because the findings from several recent studies suggest that regularly getting a good night of sleep may reduce insulin resistance, try to get at least six hours or more of sleep each night.
Many alternative therapies — including cassia cinnamon, chromium, ginseng, glucomannan, guar gum, gymnema, magnesium, milk thistle, prickly pear cactus, soy and stevia — have been touted as possible ways to treat or prevent type 2 diabetes. Although some of these substances have shown promise in early trials, there's no definitive evidence that any of these alternative therapies are effective.
If you're considering dietary supplements or other alternative therapies to treat or prevent prediabetes, consult your family doctor. They can help you weigh the pros and cons of specific alternative therapies.
Healthy lifestyle choices can help you prevent prediabetes and its progression to type 2 diabetes — even if diabetes runs in your family.
If the list looks familiar, you're onto something. The same lifestyle changes that can treat or even reverse prediabetes help prevent the condition, too.
You're likely to start by first seeing your family doctor.
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. You'll probably need to fast for at least eight hours prior to your appointment so that your doctor can measure your fasting blood sugar level.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.Make a list of all medications, as well as any vitamins or supplements, that you're taking.
- Write down questions to ask your family doctor.Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together.
- How can I prevent prediabetes from turning into type 2 diabetes?
- Is there a medication I can take?
- What types of side effects can I expect from medication?
- I have other health conditions. How can I best manage them together?
- How much exercise do I need?
- Are there foods I need to avoid? Can I still eat sugar?
- Do I need to see a dietitian?
- Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?
- Has your weight changed recently?
- Do you exercise regularly? If so, how long and how often?
- Do you have a family history of diabetes?
- You're overweight, with a body mass index above 25
- You're inactive
- You're age 45 or older
- You have a family history of type 2 diabetes
- You're African-American, Hispanic, American Indian, Asian-American or Pacific Islander
- You have a history of gestational diabetes or have given birth to a baby who weighed more than 9 pounds (4.1 kilograms)
- You have a history of polycystic ovary syndrome
- You have high blood pressure
- You have abnormal cholesterol levels, including an HDL cholesterol below 35 mg/dL (0.9 mmol/L) or triglyceride level above 250 mg/dL (2.83 mmol/L)
- Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.
- Get more physical activity. Aim for 30 to 60 minutes of moderate physical activity at least five days a week. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day
- Lose excess pounds. If you're overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.
- Take medications as needed. Sometimes medications — such as the oral diabetes drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes. This includes if your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome.
At Leavitt Family Medicine, we are here for you, for all your medical needs. We welcome your questions and comments; Please let us know how we can help you.