Why should I care about prediabetes?

 Prediabetes should be taken seriously because if it is not addressed, it can become diabetes in 10 years or much sooner. Almost everyone who develops type 2 diabetes will first have prediabetes. But, the good news about learning you have prediabetes is that you can make changes to prevent diabetes and bring your blood sugar levels back down to normal.

What is prediabetes?

Prediabetes means that your blood sugar is higher than the normal level, but it is not yet high enough to qualify as diabetes. Prediabetes can catch you by surprise, because most people have no symptoms, so they may only learn they have prediabetes when they get blood tests done.

Other people may feel more tired than usual, feel thirsty, are urinating more often, or may notice darkened skin on the neck, armpits, elbows, and knees. Other names for prediabetes you might hear from doctors or nurses are “impaired glucose tolerance” or “impaired fasting glucose tolerance.” These conditions are based on blood test results, and they put you at a higher risk for developing type 2 diabetes and heart disease.

What causes prediabetes?

Many factors contribute to prediabetes — there is no single cause. Certain genes may increase your risk for prediabetes, but there are many other risks for developing prediabetes. Having extra body fat (especially abdominal fat) and being inactive are two of the highest risk factors.

In a healthy body, the sugars that you eat go into your bloodstream, and the sugars are delivered to cells in your muscles and tissues that need energy, with the help of the hormone insulin. In someone with prediabetes, this process does not work as well, and the sugar begins to build up in your bloodstream instead of getting delivered to the tissues that need it.

This can happen because your body does not produce enough insulin or because your cells do not respond to the insulin as well. When there is more sugar in your blood than normal, this can damage your blood vessels and organs.

How is prediabetes diagnosed?

It is recommended that you see your doctor to have blood tests done if you have risk factors for prediabetes, which include: being overweight, not active, having family members with type 2 diabetes, having had diabetes during pregnancy, having polycystic ovarian syndrome, high blood pressure or high cholesterol. Certain races also have a higher risk for prediabetes, including African Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders.

Prediabetes is diagnosed by blood tests that measure your blood sugar (glucose) levels. There are several different tests your doctor may use. One is the glycated hemoglobin test (you may hear this called hemoglobin A1C), which measures your average blood sugar over the past three months. An A1C level between 6-6.5 percent is considered prediabetes. Levels higher than 6.5 percent (on two different testing times) mean you have type 2 diabetes.

Another test that could be done is the fasting blood sugar test, where you fast overnight and have your blood taken the next morning before eating. A blood sugar of 100-125 mg/dL is considered prediabetes, or “impaired fasting glucose.”

The other test you may have done is the oral glucose tolerance test, where you fast overnight and then the nurse or doctor will give you a sugary drink and test your blood sugar two hours later. A blood sugar level from 140-199 mg/dL is considered prediabetes, or “impaired glucose tolerance.”

Can prediabetes be prevented?

Prediabetes can be prevented with the same steps that are taken to treat it: eating healthy foods, being physically active, and losing extra weight. Even losing 10-20 pounds can help reverse prediabetes and prevent development of type 2 diabetes. If possible, getting good sleep can also help prevent prediabetes — it is shown that people who sleep less than six hours a night are at higher risk of having prediabetes.

How is prediabetes treated?

Fortunately, if you have prediabetes, there are lifestyle changes you can make to get your blood sugar back to normal and prevent the development of type 2 diabetes. One of the most important changes you can make is to eat healthy foods, especially vegetables, fruits, and whole grains. Try to cut down on fast food, meats, white breads and white rice, and juice, pop, and alcohol. Use artificial sweeteners in coffee instead of sugar and avoid extra desserts.

Another very important lifestyle change you can make to treat prediabetes is to be more active. This can mean small changes, like walking when possible instead of driving or taking the stairs at work. You don’t have to go to the gym or “work out” to be active — things like dancing, gardening, or taking kids to the park are great activities.

Another thing you can do to improve prediabetes is to get at least six hours of sleep every night. It is also important to quit smoking, which can increase your risk of developing type 2 diabetes.

In addition to these lifestyle changes, your doctor might recommend medications if you are at high risk for type 2 diabetes or if your prediabetes is getting worse. These could include metformin (Glucophage) or acarbose (Precose).

Action steps for anyone with prediabetes

Changing such big parts of your life like diet and exercise can be extremely tough, but this is the key to reversing or improving pre-diabetes. In addition to helping lower your blood sugar, these changes can also make your heart healthier, cut down your risk of strokes, and improve your overall wellbeing and mental health.

Tell your doctor you want to develop an action plan to get healthier. This includes establishing plans for exercise, healthy eating, smoking cessation, moderate alcohol intake, and weight management. This may include meeting with a nurse educator and having a consultation with a dietician and personal trainer. Also talk to your doctor and find out how often you should have a general medical examination and how often to follow up on your pre-diabetes.

Remember, your current state of health did not happen overnight, so bringing things back into balance won’t happen overnight either. Just a few, well planned, strategic, consistent changes can make a big difference.

The focus is not on a crash diet, “lose 20 pounds in 20 days” or any such nonsense. It is starting a new, healthy way of life that you can live with every day. It is also important to get “buy-in” from your family.  You can’t do it alone, and if the people around you are not participating in a healthy lifestyle, it will be very hard for you to do so.

So go ahead, make the call to your doctor, and start planning for a healthier life. Remember, every great journey begins with a single step.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

Brooke Rosen is a third-year medical student at Mayo Medical School in Rochester, Minnesota. She has been involved in the medical student section of the Minnesota Medical Association for two years and is dedicated to improving healthcare delivery and access and reducing health disparities.