Understanding Pre-Diabetes

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Type 2 diabetes can be controlled, but at present it can’t be cured. That isn’t quite true of pre-diabetes. Although pre-diabetes isn’t an acute condition, it can, like many acute conditions, be handled with proper treatment.

Although pre-diabetes can’t be treated with an antibiotic or some aspirin and a few days of rest, it can be beaten with a program of exercise and good nutrition. This is a good thing because 79 million Americans have pre-diabetes. In fact, a multi-center clinical trial called the Diabetes Prevention Program -Joslin researcher Edward Horton, MD, headed the Joslin team- proved that diet and exercise were the best medicine to prevent pre-diabetes from turning into type 2 diabetes. Lifestyle measures beat out the pill metformin as the most powerful preventive treatment.

People in the study reduced their risk for developing type 2 diabetes by 58 percent. Dr. Horton explained that “volunteers in the Diabetes Prevention Program, all of whom had prediabetes at the beginning of the study, were divided into three treatment groups. Compared to the group who received an educational program only, those who participated in a program of lifestyle modification consisting of a healthy diet, modest restriction of caloric intake and increased physical activity such as brisk walking for half an hour most days of the week were able to lose 5 percent to 10 percent of their body weight and reduce their risk of developing type 2 diabetes by more than half”. Pretty impressive, right?

Pre-diabetes describes a condition where blood glucose levels are less elevated than in type 2 diabetes, but they are not in the normal range. Changes in blood glucose metabolism that precede diabetes build over time, so it is likely things haven’t been normal for a while. Unlike type 2 diabetes, pre-diabetes doesn’t generally come with any outward symptoms. Most people don’t know they have it. Don’t be fooled by its name, however, pre-diabetes is a serious condition. Many of the metabolic changes that happen with diabetes have already happened in your body. By the time you are diagnosed, the pancreas is unable to produce enough insulin to meet all of your body’s needs. Often people with pre-diabetes have cholesterol and blood pressure problems in addition. (Diet and exercise can work to help control those issues also.)

For pre-diabetes, pre-meal fasting blood glucose levels will read between 100 mg/dl and 125 mg/dl, and 2-hour glucose levels during an oral glucose tolerance test will read 140 to 199 mg/dl. More recently an A1C test that is between 5.7 and 6.4 percent is also considered diagnostic of prediabetes. (Normal blood glucose levels in someone without prediabetes or diabetes are less than 100mg/dl fasting and less than 140mg/dl two hours after a meal or a glucose tolerance test.)If you have been diagnosed with pre-diabetes there are some things you can do to get your A1C back into the normal range. If you don’t get much exercise, now is the time to start. Forget all the excuses. Exercise for many of us isn’t fun, but you do feel better afterward and the rewards are legion. You don’t have to take up jogging or diving; walking for ten minutes three times a day will start you on the way to better blood glucose control and better health.

If you are eating yourself into obesity, take stock of your habits. You don’t have to buy doll sized tableware or stop eating the foods you love. Often, just cutting back by a couple hundred calories by limiting snacking or calorie-laden beverages, along with increasing your activity level will move you out of the danger zone. 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.

Do you need help managing your diabetes? Learn more about the Adult Clinic at Joslin Diabetes Center.

3 Responses to Understanding Pre-Diabetes

  1. Matt C says:

    Strikes close to home. With a family history of diabetes, and having lost my grandfather to complications thereof at age 53… I can’t warn people enough, to watch for the warning signs, and if they appear – ACT! Refusing to change your lifestyle is like signing your own death sentence.

  2. Johnson says:

    Thanks, Joslin. I really get a lot of information about diabetes from your article. But is it mainly related to what we eat? If we chage our eating habbits, for example, to eat healthy food against diabetes based on the doctors’ advice or experts’, can idabetes be released or cured finally? Thank you.

  3. Franz says:

    Having “pre-diabetes” does not mean that you can’t eat certain foods. The solution isn’t “avoid foods with sugar in them.” Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or pie.

    If you do have prediabetes, research shows that doing just two things can help you prevent or delay type 2 diabetes: Lose 5% to 7% of your body weight, which would be 10 to 14 pounds for a 200-pound person; and get at least 150 minutes each week of physical activity, such as brisk walking.

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