Prediabetes in Depth

While not as serious as frank diabetes, prediabetes is, nevertheless, dangerous and common: 1 in 3 adults in the US has prediabetes and most of these people are not aware of it (unless their blood sugar or A1c has been checked by their doctor). They also have no symptoms. The risk for developing frank type 2 diabetes, heart disease, and stroke is significantly increased in people with prediabetes, so we need to take prediabetes very seriously. Go and get tested for prediabetes if you fall into any one of the following categories:

·     have belly fat

·     are over 45 years old

·     have a family history (parent or sibling) of type 2 diabetes

·     have high blood pressure (higher than 130/80 mm Hg)

·     are a woman with previously diagnosed gestational diabetes, polycystic ovaries or have given birth to a child weighing over 9 pounds

Make an appointment to see your primary care provider and make a point to exclusively focus on prevention of diabetes, heart disease, and stroke. Your provider may order blood tests beyond merely your blood sugar and A1c (cholesterol, LDL, HDL and triglycerides and your TSH to evaluate thyroid function).

Be a true partner to your provider: know your weight, waist circumference (ideally no more than 37 inches in men and 32 in women; for Asians the numbers are about 5 inches lower). Know your family history and what your average blood pressure (home measurements) is. Mention any prior history of heart or artery disease or procedures (stress tests, echos, ultrasounds of your carotid arteries, angiograms). If you have an old ECG, bring it to your appointment.

A blood pressure log with at least 10-15 measurements is especially helpful. You need to have a good blood pressure monitor and follow your provider’s instructions on how to accurately measure your blood pressure at home.  

If you smoke, you need to give up smoking. The combination of smoking and either diabetes or prediabetes is too dangerous for your arteries. It can lead to heart attacks and stroke even if your doctor prescribes adequate medications to control blood sugar, blood pressure, and cholesterol.

You have to increase the level of your physical activities, achieving at least 15,000 steps a day, grabbing any opportunity you have (at home, work or school) to move, lift light or medium weights on a daily or every other day basis and perform balance and stretching exercises like tai chi or yoga.

You also need to understand what a healthy diet is: what a portion of fruits and vegetables is and what are the healthful fats. You have to severely restrict added sugars (sugary beverages, cookies, desserts, candies, cakes, donuts), refined grains (white bread, white past, white rice, white potatoes) and fried foods. Depending on other factors, you may be more liberal with good sources of protein like fish, nuts, eggs, dairy (avoid full fat) and lean meat.

Investing in a personal trainer and/or a dietician/nutritionist is a great idea.

Getting your metabolism back on course requires motivation, willingness to invest about two hours of your personal time, and working closely with your primary care provider. Insulin resistance, prediabetes and type 2 diabetes are all serious conditions. Treat them as such.