There's Nothing "Pre" About Prediabetes (Continued)

Even though the train is already heading down the tracks, you're not helpless. You can control the speed of the engine. Prediabetes, like diabetes — they're really the same thing — is a disease of insulin resistance. Your body makes insulin but doesn't use it wisely. To combat this insulin resistance, your body over-produces insulin until it wears itself out, which is the point at which the train goes out of control and goes screaming down the tracks. So the trick here is to find a way to put on the brakes before that point, and there are two ways to do that: Either you need to medicate the insulin resistance into submission, or you need to change the driving forces behind it. Both have been shown to work. You can delay the onset of full-blown diabetes for decades, maybe more.

Medicating insulin resistance into submission is sort of like being the tiger tamer with the whip. Only instead of using a whip, you use a pill bottle. The most studied medication option is a family of anti-insulin resistance drugs called thiazolidinediones, or TZDs for short. A number of clinical trials have shown that even very small doses of these meds are highly effective in slowing down the train. But there's a problem. In larger doses, this class of meds has been implicated in train wrecks. They may cause heart complications and are suspected of being cancer accelerators. It does you no good to keep the diabetes at bay if you're going to drop dead of a heart attack or cancer.

A safer, but less effective drug option, is the diabetes "starter" drug metformin. It's been in clinical use for over five decades and has been proven to be quite safe. Starting metformin earlier in the course of the disease could be a good option for many people. Tiger cubs are easier to control than full-grown monsters.

The other option, instead of drugs, is to slow the circus train down by depriving the engine of fuel. It's possible to remove the driving forces of insulin resistance, giving your body a chance to rest, thus slowing the progression of the disease from prediabetes to diabetes. How do you do that? You cheat and change the rules of the game. It's simple to say but difficult to do: Lose weight. No, seriously, it works. Weight is the biggest driver of insulin resistance. Lose some weight, reduce your insulin resistance. You don't even have to get yourself skinny. Any reduction in weight can help slow the diabetes train.

Now, losing weight is difficult. It takes hard work and discipline. And time. And patience. But the payoff is worth the effort. Of course, if you can't quite pull off a meaningful weight loss, you could try a combination: take  a little medication and lose a little weight.

But never forget, there's nothing pre about prediabetes. It is diabetes. The disease process has begun. You've got to take it seriously and do something about it, now.

Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.

Read Wil's bio here.

Read more of Wil Dubois' columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

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Last Modified Date: June 19, 2013

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by Brenda Bell
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...
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