Prediabetes: The Shock of Diagnosis
Turning It Into an Opportunity to Improve Your Health
Because I write about nutrition and health, I often receive emails from people who have just been diagnosed with prediabetes — what is often the prelude to type 2 diabetes (T2D). Their initial reaction is shock. They're feeling stunned and frustrated and their minds race ahead to the complications of poorly controlled type 2 diabetes. They all wonder; does prediabetes always lead to diabetes; what they can do to stop the possible shift from prediabetes to diabetes.
I know the feeling. Some years back, when I was an overweight couch potato, and dealing with plenty of work and home stress, I had a comprehensive workup done by a physician. When I saw that my fasting glucose was 110 mg/dl (6.1 mmol/l) — smack in the middle of the prediabetes range — I knew exactly what it meant. I too was shocked. And embarrassed. If I was dispensing advice, I should have known how to take better care of myself.
The physician, a colleague, didn't seem all that concerned, but I later learned that my fasting glucose paled compared to his, which was over 400 mg/dl (22 mmol/l). It took me two years before I found a helpful nutritionist. With dietary changes, I lost 20 pounds and my blood glucose dropped to normal.
Steve wrote to me with a similar feeling of shock. "After struggling with my weight and nutrition, including going on and off low-carb diets at least three times over the past three years, I was just diagnosed with prediabetes," he wrote. "Needless to say it was a shock and disheartening to hear." Steve, however, turned one of life's more serious lemons into lemonade. "It was also a great motivator to beat this and move off the dangerous path I was on."
So does prediabetes always lead to diabetes? The truth is, prediabetes does not have to be a steppingstone to more serious illness. In fact, I often describe the diagnosis as an opportunity — to improve one's health and overall quality of life. And that's how you should see it too. I believe that many and perhaps most people can reverse prediabetes through better eating habits, a little bit of exercise, and stress management.
What The Numbers Really Mean
Prediabetes affects upward of 100 million Americans, and it doesn't strike out of the blue. Many people develop early signs or symptoms suggestive of prediabetes. Belly fat, high blood triglycerides, and a "normal" blood glucose level in the 90s mg/dl (5-5.5 mmol/l) are red flags. Feeling perpetually stressed, skipping breakfast, and feeling drowsy after lunch or dinner also point to prediabetes and T2D risk. But a closer look at the numbers is the best way assess your risk.
- Fasting blood sugar is the most common way of measuring glucose tolerance. However, a normal blood glucose of 65-99 mg/dl (3.6-5.5 mmol/l) sometimes is a "false normal," which can create a sense of complacency. A false normal occurs when the pancreas works overtime to secrete excess insulin to force down glucose levels.
- Measuring fasting insulin in conjunction with glucose may be the best indicator of prediabetes and T2D risk. Unfortunately, a lot of physicians don't measure fasting insulin, and if they do, they aren't sure how to interpret the results. An ideal fasting insulin level is less than 7 mcIU/ml. A level above 13 mcIU/ml is worrisome.
- Measuring HbA1c is important too. An HbA1c is a several-week snapshot of your blood glucose. The ideal number is 5% or less, but achieving 5.5% is far better than 6.7%.
Armed with knowledge, you can improve your numbers and maybe even reverse prediabetes. But even if you can't achieve completely perfect numbers, you can definitely improve your current ones.
The prediabetes diagnosis can be one real wakeup call, one that begs us to change our habits. Many of us live in a sea of junk food — fast food, soft drinks, pizzas, microwave meals, too much alcohol. When we're stressed, our eating habits slide, we skip meals, and when we're famished (i.e., our blood sugar is crashing), we turn to the quickest fix: junk food. But the quick fix is also the unhealthiest one. Fresh foods, such as a salad with cubes of baked chicken, or even an apple with slices of low-fat cheese, are healthier options for a midday meal or snack.
Reversing direction on the steppingstones toward diabetes does take effort and making changes – and sticking with them most of the time. (The dietary advice for T2D also works for prediabetes, but we'll offer much more specific advice in the coming months.) When people say it's all too hard, my response is that life will be much tougher when they lose their health.
So if you've gotten a diagnosis of prediabetes, consider it a motivator, not a setback. Dean summed it up perfectly: "I wanted to make sure I am not among the people headed for diabetes."
- Kraft JR. Detection of diabetes mellitus in situ (occult diabetes). Laboratory Medicine, 1976;6(2):10-22.
- Zavaroni I, Bonini L, Gasparini P, et al. Hyperinsulinemia in a normal population as a predictor of non-insulin-dependent diabetes mellitus, hypertension, and coronary heart disease: the Barilla factory revisited. Metabolism, 1999;48:989-994.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...