Prediabetes: cause for concern?
Prediabetes means that your blood sugar levels are not quite high enough for a diagnosis of Type 2 Diabetes. More than 1 in 3 Americans— about 88 million people-- have prediabetes, and of those, more than 84% don't know it. Even more alarming is that 1 in 5 adolescents and 1 in 4 young adults are now prediabetic. Almost all cases of Type 2 Diabetes are preceded by prediabetes. Despite these alarming numbers, the good news is that the progression from prediabetes to diabetes is not inevitable: you can take steps to reverse it.
What is prediabetes and what causes it?
Prediabetes is an indication that your body is having problems with insulin management. Insulin is a hormone made by your pancreas that lets blood sugar into the cells that is used as energy. If you have prediabetes, your cells don’t respond normally to insulin, a state called “insulin resistance”. So the pancreas makes more insulin to try to get the cells to respond. Eventually your pancreas can’t keep up and your blood sugar rises, setting the stage for prediabetes—and Type 2 Diabetes later on.
Prediabetes typically results from being significantly overweight (especially if there is also excess belly-fat), an inactive lifestyle and a diet high in carbohydrates.
Symptoms and risk factors for prediabetes
Despite its extremely high prevalence, those with prediabetes typically have no symptoms. This is why it’s so important to be watchful for risk factors.
You are at risk of developing prediabetes if any of the following apply to you[i]:
Being overweight
Being 45 years or older
Having a parent, brother, or sister with type 2 diabetes
Being physically active less than 3 times a week
Having previously had gestational diabetes (diabetes during pregnancy) or giving birth to a baby weighing more than 9 pounds
Having polycystic ovarian syndrome (PCOS)
Diagnosing Prediabetes
As mentioned previously, the vast majority of people with prediabetes don’t know they have it, so it’s often caught through routine testing or at a doctor’s office.
A diagnosis of pre-diabetes is determined if fasting blood sugar measures 100-125 mg/dL. (Higher than 125 mg/dL means that you have crossed the line into Type 2 Diabetes).
Another path to diagnosis is A1C, which measures your average blood sugar for the past two to three months. An A1C of between 5.7-6.4 will likely result in an assessment of prediabetes. (6.5 or higher? You’ve got Type 2 Diabetes).
Conventional medical treatment
Prediabetes is now treated “conservatively” (i.e. without drugs) with a combination of dietary recommendations, exercise and the recommendation to lose weight. At this stage, daily self-monitoring might also be recommended (measuring blood sugar using the dreaded “prick” test).
However, occasional brief visits to the doctor are typically not the best context for conversations about these steps. This is because many people face challenges making lifestyle changes in their eating and exercise habits, let alone accommodating self-testing for blood sugar.
What to do with this information? Prevention, prevention, prevention
Many people think that unless and until they have a formal diagnosis of Type 2 Diabetes, there is no need for action. And a condition like prediabetes, where no symptoms can be seen for many years, might seem difficult to prevent. But this is far from the truth. Here is what you can do:
1) Know your risk factors. The presence of even a single risk can make you much more likely to develop prediabetes, especially being overweight.
2) Monitor your blood sugar or get screened regularly. This helps you identify prediabetes early, and also enables you to determine if the lifestyle changes you have made are sufficient to reverse rising blood sugar.
3) Here’s the most important takeaway: It’s possible to actively modify many of the risk factors long before they become problematic, especially weight gain. This can be achieved through lifestyle choices such as eating only (or largely) whole foods, exercising regularly and managing stress levels. Even with several risk factors present, it’s possible to reverse prediabetes and keep Type 2 Diabetes away.
The same things that cause prediabetes in adults cause it for children and teens: obesity, lack of exercise, and a diet high in carbohydrates. Frequently, these lifestyle trends run in families. This is why it’s important that parents take any actions necessary to establish healthy eating and exercise habits for their children. When parents make these changes, they can help turn the tide for the whole family.
Reversing Prediabetes with nutrition and weight loss
The first element of a prevention strategy is to have a long-term rather than a quick-fix approach to dietary changes and weight loss. Many with pre-diabetes have tried every “diet” known to (hu)man, having lost and then regained the excess weight over and over again. (For more on this, check out the blogpost: “4 Reasons Why You Can’t Keep the Weight Off”). Going on a diet for a limited time, and then returning to what you were doing before is precisely what does not work. The key is willingness to make permanent changes.
It’s also important to recognize that any weight loss has a positive impact on blood-sugar levels. You don’t have to reach your ideal body weight to see health benefits, losing just 10 to 15 pounds can make a big difference[ii].
A second element is that unless insulin resistance is halted, the weight just creeps back because the underlying metabolic process driving weight gain has not been addressed. Without balancing the metabolism, weight loss is usually not sustained. (See separate blog on the importance for weight loss of establishing and maintaining a “Balanced metabolism”).
The third important element is a personalized approach to nutritional therapy that takes into account eating patterns, preferences, metabolic goals and comorbidities (or other conditions).[iii] (For more on this, see blog on “A personalized approach to weight management”). One-size-fits-all programs (such as Mediterranean, paleo, keto, etc.) work for many of those who wish to lose weight, but not for everyone.
A fourth element can also make a big difference. Michael Dansinger, MD Director of the Diabetes Reversal Program at Tufts Medical Center, emphasizes the benefit of coaching assistance: “I suspect that having a good coach can quadruple the odds of long-term success compared to going it alone. It is just too hard to police yourself without help.”[iv] (See “Why coaching can be critical to weight loss”).
All of this makes prevention, prevention, prevention the overall strategy for addressing prediabetes.
Metabolic balance®, the nutrition program I am certified to coach, can help you achieve sustained weight loss and increase your chances of reversing prediabetes. This program, based on more than 20 years of clinical experience, begins with an analysis of your unique blood labs and health profile. These data are the basis of a personalized food plan incorporating only whole foods that directly addresses prediabetes and insulin resistance. The program also includes regular coaching sessions with me.
Call me for a free 15-minute consultation or schedule one on the online scheduler to learn more about how I can help you lose weight, modify your risk for developing prediabetes and even reverse it.
[i] https://www.cdc.gov/diabetes/basics/prediabetes.html
[ii] Wilding, J (2014) “The importance of weight management in type 2 diabetes mellitus” International Journal of Clinical Practice 68 (6): 682–69: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238418/pdf/ijcp0068-0682.pdf
[iii] https://www.thelancet.com/action/showPdf?pii=S2213-8587%2819%2930149-4
[iv] https://www.bostonmagazine.com/sponsor-content/80-of-diabetics-can-reverse-their-disease-heres-how/