Prediabetes – A lot of us Have it and Don’t Know it

Prediabetes is defined as a condition in which blood sugar levels are higher than normal but not high enough to be classified as full-blown diabetes.  According to studies from a number of universities and national surveys, 37% of U.S. adults have prediabetes and 12-14% have diabetes, indicating that about half of adults in this country are affected by high blood sugar.  Most cases of prediabetes are not diagnosed - people don’t know they have it. 

There are two types of diabetes, type 1 and type 2.  Type 1 diabetes, which often comes on in childhood, is an autoimmune disease and is not being discussed in this column. 

In type 2 diabetes, people have a fasting plasma glucose level of 126 mg/dl or higher on two occasions.  If you have a blood glucose level of 200 at random times, not after fasting for 8 hours, you may also have diabetes.  Another test commonly used is hemoglobin A1c, which indicates blood sugar levels in the recent past. Levels of 6.5 or higher are seen in diabetes; 5.7 to 6.4 may indicate prediabetes, and levels below 5.7 are normal. 

 Readers probably already know that diabetes is an unpleasant and dangerous disease, affecting vision, the brain, the heart, the nervous system, kidneys, and feet.  It can be reversed, by medication, exercise and a careful diet, but it is better to prevent it. 

Prevention programs are widespread, and generally consist of emphasizing weight loss (loosing even 5-7% of present body weight is very helpful), and exercise (walking or other activities that raise your heart rate), and a healthy diet.  Walk about 30 minutes almost every day.  There is widespread agreement that a diet to prevent diabetes would decrease or eliminate drinks with added sugar, replacement of red meat with beans, nuts, poultry, fish and yogurt.  Yogurt, rather than other sources of dairy foods, seems to reduce the risk of diabetes.  To facilitate weight loss, cheese should be used sparingly, as a condiment. Foods containing white flour, other refined starch, sugars and white potatoes should be avoided.   In a Harvard study by Walter Willett, coffee and decaf coffee decreased the risk of diabetes. Good news for coffee lovers – but avoid adding sugar!  Stevia seems to be a safe sweetener.   Magnesium containing foods, such as leafy greens, beans, nuts and whole grains also decreased the risk.  Following this diet carefully will naturally lead to weight loss in most people.

Walter Willett, an esteemed professor of nutrition at Harvard and the Harvard School of Public Health, has some encouraging words about lifestyle changes to prevent diabetes.  “If you make a change in your diet or lifestyle today, you’re taking your foot off the accelerator, and this happens almost overnight.  If you exercise today, your insulin resistance goes down within hours. And if you keep up the daily exercise, within a day or two your risk of diabetes drops.  Changing your diet might take longer to make a difference, but it’s a matter of weeks, not years.  Even if you are right at the brink of diabetes, you can still rapidly reduce your risk.”

Our local Coastal Health Alliance is a good place to go to get tested for prediabetes.  They have programs to help you if your blood sugar is too high.  We are lucky to have their services so close by. 

Sadja Greenwood, MD, MPH    back issues on this blog