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I Have Prediabetes: Now What?

If you are reading this, you or a loved one have probably been told by your doctor that you have abnormally high sugar levels. The doctor may have called it Impaired Fasting Glucose or Impaired Glucose Tolerance, but both of those are just fancy medical words for prediabetes. This means your blood test results for sugars (glucose) were above normal but below actual diabetes range. For the most common test, the fasting glucose test, prediabetes results are 5.6-6.9 mmol/L (100-124 mg/dL). Prediabetes is extremely common; 35% of people in the USA are diagnosed with prediabetes.

What Is Diabetes?prediabetes overweight obesity exercise diet copyright US CDC

Diabetes is a disease caused by your body losing the ability to properly digest and use sugars and starches in your foods, thus leading to high levels in your blood. Too much glucose floating around your bloodstream for many years can cause many toxic problems to your organs if not treated — especially with your eyes, kidneys and lower legs. For example, diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputation and new cases of blindness among adults in the United States and much of the world. Diabetes also raises your risk of heart disease and some cancers.

It may help to think of diabetes as a modern lifestyle disease, mostly caused by all developing countries’ gains in weight, less physical activity, and changes in diet. Diabetes is a global epidemic. Tens of millions of people have diabetes, and many people are undiagnosed because they’ve never been tested. There are two types of diabetes, and type 2 diabetes accounts for 90 to 95 percent of diagnosed diabetes in adults.

Why Is Prediabetes So Concerning?

Prediabetes concerns us doctors because it means you are at extremely high risk of developing diabetes in the next few years — but you still have great control over preventing any more progression! This is crucial for you to understand, so let’s say it again: you have great control over whether or not you develop full diabetes. You should think of prediabetes as an early warning sign from your body, a major wake up call that whatever you’ve been doing to your body isn’t too healthy. Most likely, you fit one or more of these three major risk factors:

  • Body mass index (BMI) over 25
  • Lack of enough exercise (not sure how much is enough? Read this)
  • Food choices and portions not ideal (for food tips, read here)

How Great Is My Risk of Progressing to Type 2 Diabetes?

Studies show that a prediabetic person has a 25% risk of developing diabetes within three years, and a majority within ten years. The greatest risk factor by far is overweight and obesity. Having a BMI under 23 is ideal, and a BMI of 25 increases your lifetime risk of diabetes by 600%. A BMI 0f 30 increases your risk by 4,000% — that’s 40 times the risk! You can find out more of your risk of diabetes and heart disease by filling out this online risk calculator.

How Can I Prevent Diabetes?

If you follow the three lifestyle steps below, you can lower your risk more than half! One of the most important public health research studies ever, the Diabetes Prevention Program, proved that lifestyle changes worked better than pills. Lifestyle changes lowered a prediabetic person’s risk by 58% over three years — much better than the 31% improvement with a daily pill. The three most important lifestyle tips are:

  • 1. Lose weight. Weight gain and obesity are the #1 causes of type 2 diabetes — and weight loss is the #1 way to reverse and control it.  The great majority of Americans are at major risk of diabetes, as 69% of Americans are overweight or obese. In this DPP study, the goal was to lose at least 7% of your body weight. Your goal should be to lose 5-10% of your body weight.
  • 2. Exercise. Exercise may not directly cause much weight loss, but exercising muscles absorb sugars much more effectively. This is why exercising is crucial to help control sugars, both in a prediabetic as well as in diabetics. How much exercise is enough? We usually recommend 150 minutes a week of moderate exercise, but any amount is better than nothing. Also, recent research shows that shorter, more intense workouts also can help (click here to read more about this high intensity interval training).
  • 3. Proper diet. Healthy food choices also are crucial to control your sugars. Diabetes and prediabetes isn’t so much a sugar problem, it’s a starch and carbs problem, as well as total calories. In other words, you shouldn’t just be thinking, “I need to cut down on my sweets and sugars.” No, the bigger culprit are total starches — pastas, breads, rice and potatoes are the main culprits. In all these cases, processed versions are never as healthy as the originals. A few quick tips:
    • Brown is always better than white: White bread and flour has lost all the nutritious fiber which helps regulate your bowels as well as your sugar spikes after a meal. If you love your carbs, at least try to switch to whole wheat pastas, breads and rice.
    • Portion control: Total calories are also important, as most likely you are taking in a bit more than you realize. These extra calories will get deposited as fat, which leads to more risk of diabetes.
    • Cut back on sodas, beer and juices: All these are empty calories, full of processed sugars which stress out your liver and pancreas. These unhealthy carbs, especially in sodas, are a major cause of obesity and diabetes in both children and adults.

Type 2 diabetes is partly genetic, so no matter how healthy you are, it still may be inevitable. But these above steps are always good advice for all of us. Another great thing about these healthy life changes is that they also dramatically reduce your risk of heart disease, many cancers, and early deaths from all causes.

diabetes exercise overweight obesityCan Medications Help Me?

One prescription medicine in particular, called metformin, can help prevent a prediabetic from developing full diabetes. In the DPP study above, metformin reduced the prediabetic patients’ risks by 31%. That’s pretty good — but not nearly as good as lifestyle changes! Metformin may be especially helpful if you are very overweight (BMI over 35), if you are under 45 years old, or if you are a woman with a history of high sugars during pregnancy.

If metformin is a good choice for you, don’t ever forget that lifestyle changes, at any time in your life, are far more important than any medicine. Even if you have diabetes, it will always be important to reach for those health goals.

What About Natural Medications or Herbs?

Some foods and supplements may benefit you, but some popular ones may not be as effective as you’ve heard — especially selenium. For the most evidence-based advice, read this excellent medical review here.

When Should I Get Retested?

A prediabetic patient should get their glucose tested once a year. One other test, the HbA1c, measures your glucose levels over the previous three months and often is helpful as a second test. People with diabetes usually get this HbA1c tested every three months.

In Summary

Don’t get discouraged with this prediabetes diagnosis — you have control over the next steps! Even if you already have diabetes, you could maybe avoid that second or third medicine, especially insulin injections, if you followed those above lifestyle steps and especially lost 5-10% of your weight.

What Resources Can Help Me?

There is a wealth of information from the American Diabetes Association.

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