What is pre-diabetes and should you be worried?
What is Pre-Diabetes?
Having a blood sugar level that is higher than normal, but still below the threshold for having full blown type 2 diabetes puts you in the category of pre-diabetes. When someone is diagnosed with pre-diabetes, it is important to take action because otherwise it will develop into type 2 diabetes. In one study 10% of people with this condition went on to develop type 2 diabetes every year. Development of full diabetes usually happens within ten years or less.
Moreover, pre-diabetes carries risks in its own right, even if you feel perfectly healthy. Pre-diabetes alone boosts your risk for heart disease and stroke by 50 percent, and raises your risk for kidney problems by 70 percent compared with people without pre-diabetes. You can also start to develop ‘microvascular complications’ of diabetes – damage to your kidneys, eyes and nervous system – in the pre-diabetes period.
What are the signs?
There are usually no signs or symptoms with pre-diabetes. Signs of diabetes can be increased thirst, frequent urination, fatigue and blurred vision, and sometimes people may notice certain areas of their skin have developed dark velvety patches known as acanthosis nigricans.
Who should get checked?
- everyone over age 45
- younger people who are overweight or have a waist size greater than 40 inches for men or 35 inches for women
- little or no physical activity
- family history of diabetes
- high blood pressure
- high cholesterol
- previous diagnosis of heart disease
- previous diagnosis of polycystic ovarian syndrome
- diabetes during pregnancy (gestational diabetes) or have delivered a baby weighing more than nine pounds
What should you do if you have pre-diabetes?
Lose weight – every bit helps! Losing 5 to 10% of your body weight will often be enough to return your glucose levels to a normal range and to prevent or delay any progression towards developing diabetes.
Whilst the general advice is to avoid refined carbs and focus on vegetables, beans, nuts, fish, good fats such as avocados, olives, almonds, and to restrict meat to perhaps twice per week, the fact is that everybody responds differently to the same foods! I have patients with pre-diabetes or type 2 diabetes who have found it very useful to buy home glucose testing kits and test their own blood sugars 2 hours after eating to see how different foods affect their blood sugars, which makes a lot of sense because there is high interpersonal variability in post-meal glucose levels.
2) Consider a form of regular fasting, such as intermittent fasting or time-restricted feeding which means eating your calories during a specific window of the day. For example, if you have dinner at 6 pm and then don’t eat breakfast until 12 pm the next day, this is time-restricted fasting. This may also help blood sugars.
3) Don’t underplay your diagnosis:
Many people may be walking around unaware that their blood sugars are higher than they should be. Even slim people can be at risk of blood sugar problems (see my blog on skinny fat). Of those who are told they have pre-diabetes, it is estimated that only 42% of patients make any lifestyle changes! Why wait? There’s a window of only three to six years in which you can turn around elevated glucose levels.
4) The good news is that studies on people with pre-diabetes such as the Diabetes Prevention Project have shown that diet and exercise put off the development of diabetes by about 10 years! Moreover, the surprising results were that lifestyle change was dramatically better than the medication metformin. The diabetes incidence was reduced by 34% with lifestyle and 18% with metformin as compared to placebo.
Be proactive. Get tested. Make the lifestyle changes – they really do work.