Prediabetes? Is it for real? The Center for Disease Control and Prevention, Department of Health and Human Services, U.S. Govt., says “prediabetes means your blood glucose (sugar) levels are higher than normal—but not high enough to be diagnosed as diabetes.” Blood glucose (sugar) levels are one the symptoms of prediabetes that people ignore.
The American Diabetes Association classifies anyone with fasting blood sugar between 100-126 mg/DL or the equivalent of HbA1c between 5.7-6.4% as having prediabetes. Those with fasting blood sugar above 126 mg/DL or HbA1c 6.5% are said to have diabetes.
Most of us think – we’re fine, going about our business, like normal. Then we visit the doc; either just for a regular physical or because we feel we’re using the washroom a lot more than before, so let’s figure out what’s happening. He/she orders some tests, the results arrive with a red mark against the blood sugar number and boom – we now have diabetes!
That’s not quite how it all happens.
Elevated levels of insulin and blood sugar cause diabetes damage to you body for years before you’re actually labelled “diabetic”. That period, often lasting years, is called prediabetes. It is like you are “on the fence.” Many experts refer to this condition as “borderline diabetes.”
The mechanism through which elevated sugar and insulin levels harm your body is being better understood each day. The sooner we are able to catch the symptoms, the sooner we can prevent full blown diabetes from harming us.
While the exact causes of prediabetes is yet unknown, family history and genetics seem to play a role in its development. A sedentary, stressful lifestyle and poor food choices and obesity seem to be the triggers that then ‘manifest’ or make the genetics play out.
Temporarily elevated blood sugars are a normal phenomenon in our bodies. Blood sugar usually rises after we’ve eaten a meal. But normal glucose metabolism assures that this excess glucose is taken care. Insulin is released from the pancreas in response to high levels of blood glucose. It assists the movement of this glucose from the blood to the inside of cells where glucose is used as fuel for the various cellular activity. Glucose beyond this is stored in the liver first, and after the liver is full, it is stored in the fat cells around the body.
Problems arise when glucose levels stay elevated for a long time. This usually happens when the pancreas is unable to produce enough insulin or cells become resistant to the action of insulin and do not respond to it the way they normally should.
Prediabetes begins with impairment of glucose metabolism. This leads to elevated blood glucose levels. These levels are high enough to start causing damage to the body but we can’t yet tell, because many of us may not have symptoms. It is often only when the condition progresses to full-blown diabetes that the person gets to know that he or she has diabetes.
Prediabetes is a condition that precedes type 2 diabetes. The same risk factors that increase the risk of developing full-blown type 2 diabetes are also the ones that increase the risk of prediabetes.
Other conditions that increase the risk of prediabetes are elevated blood pressure, low levels of HDL or “good” cholesterol and high levels of triglycerides in the blood.
A CDC report in 2014 found that 86 million Americans had prediabetes and if they did not make diet and lifestyle changes, 15-20% of them would end up diabetic within the next 5 years.
Alarmingly, diabetes is not the only danger awaiting those with prediabetes. Ongoing research shows that several other serious health problems come in tow, and these are called complications of diabetes.
One study found that the elevated insulin and sugar damage during the prediabetes period can increase your risk of various cancers by almost 15%!
In another study of 2000 men, conducted over a long 22-year period, it was found that having a fasting blood sugar in excess of just 85mg/DL increased the risk of dying from cardiac diseases by a whopping 40%!
This is because when there is too much insulin in the body, it is accompanied by an increase in IGF (Insulin-like Growth Factor), a hormone that is critical for proper growth and death of all cells. Too much IGF can lead to tumors and cancer.
That’s why we need to take prediabetes seriously.
So how can you tell if you already have prediabetes? The skin on the back of your neck, armpits, knuckles and groin may present the first symptom of prediabetes. If it has darkened more than other parts of your body (a symptom called acanthosis nigricans), it could be a sign of insulin resistance and prediabetes. Other areas to be examined include armpits, knees, elbows and knuckles. These should be considered as warning signs of prediabetes.
These symptoms could mean that your prediabetes has progressed and that you are closer to being diagnosed with diabetes:
While “fasting blood glucose” was used as the diagnostic criteria for a long time, it is now viewed as being less reliable than the HbA1c test for the first diagnosis of diabetes and prediabetes.
The HbA1c test measures how much sugar is “coating” your red blood cells and is believed to give a more accurate picture, since it represents a 6-week average of your blood sugar.
The American Diabetes Association classifies anyone with HbA1c between 5.7-6.4% as having prediabetes (equivalent of 100-126 mg/DL) and anyone with HbA1c above 6.5% as having diabetes.
However, there are several practitioners who believe that given all the damage that high blood sugar can do, the HbA1c target for anyone wanting to avoid prediabetes should be even lower (closer to 5%).
These practitioners recommend using a more elaborate version of the post-meal blood glucose blood test as the screening test for prediabetes. If you have tested high risk on the “Prediabetes: Am I at risk?” questionnaire, you may want to consider this method of testing, right at home.
Prediabetes reversal begins with proper knowledge. While many of us are aware of type 2 diabetes, very few of us know about prediabetes. Even many conventional physicians do not consider pre-diabetes as a real condition.
If you have any of the risk factors mentioned above, you should keep a close watch on your blood sugar levels. Statistics reveal that if left untreated, 37% of prediabetes cases progress to full-blown diabetes within 4 years or less. Lifestyle interventions decrease this risk substantially.
Positive lifestyle modifications begin with diet. All foods that promote inflammation should be eliminated or reduced substantially. Simple, refined carbs and sugary foods should be cut down. Eat whole grains, fruits and vegetables and lean meats as well as fatty fish. Cut down on red meats and processed meats. Increase your intake of healthy fats to make up for the reduced carbs; good fats help curb sugar pangs and help you stay fuller for longer. They are also a great source of the fat soluble vitamins K, E, D and A, which play crucial roles in insulin signaling and resistance.
Reduce alcohol consumption. Stop smoking and recreational drug use abuse. Create a physical activity regimen. Burn fats and keep your body fit.
We’ve talked about what kind of diet you need to follow, the principles behind creating your own prediabetic diet and lifestlyle changes that you can adopt to help you get back to health. Explore the information and talk to your physician and nutritionist, who will help you create a systematic plan to reverse pre diabetes.
3. Bjornholt JV, Erikssen G, Aaser E, et al. Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men. Diabetes Care. 1999 Jan;22(1):45-9.