As a primary care physician, I’m usually the type of doctor to see it all — from coughing and sneezing to aches and pains. Increasingly over the years, I am seeing more patients who have prediabetes, a harbinger of full-blown Type 2 diabetes. This corresponds with a recent report from the Centers for Disease Control and Prevention that reveals more than one-third of American adults now have prediabetes—but most don’t know it.
What Is Prediabetes?
When I tell my patients they have prediabetes, many don’t immediately hear the “pre.” I tell them not to jump to alarm and that prediabetes is considered a wake-up call. With lifestyle changes, there’s a good chance you’ll be able to delay the onset of diabetes for at least a few years, if not prevent it altogether (though that’s rare).
If you’re diagnosed with prediabetes, it means you have higher-than-normal blood sugar levels—though not high enough to indicate you have Type 2 diabetes. These higher numbers result when the cells in your body are resistant to insulin, a hormone that helps you use blood sugar for energy, which means you need a higher level of insulin for the cell to work.
Unfortunately, you probably won’t know if you have prediabetes until it comes up via a routine blood test or test ordered to investigate a problem. There are no clear symptoms, and we still don’t know the true causes of it.
Who Is Most at Risk
Some people are at higher risk of developing prediabetes, such as those with a family history of diabetes, and those who have high blood pressure or are overweight or obese. Women who have given birth to a baby weighing at least 9 pounds or had a history of gestational diabetes or hypertension also fall into this category. In addition, you may be at higher risk if you are Asian, African-American, Hispanic/Latino, Native American, or Pacific Islander.
If you fall within any of these groups, your health care provider may suggest routine screening. Two blood sample tests will be performed: fasting blood sugar, which requires you to abstain from eating for at least eight hours beforehand, or hemoglobin A1c, which measures your average levels of blood sugar over the past three months.
If your blood tests indicate that you do have prediabetes, your blood sugar levels should be checked yearly by your provider to be sure the condition hasn’t progressed to diabetes. Risks from diabetes include heart attack, stroke, blindness, and more, which is why it’s so important to identify prediabetes.
Make Lifestyle Changes
If you are told by your provider that you have prediabetes, don’t panic! There are proven steps you can take to help stave off the transition to diabetes and possibly reverse your diagnosis, though the latter is less common.
Lose weight (and keep it off). Studies show that losing just 5 to 10 percent of body weight can make a big difference.
If you smoke, quit. Smoking causes inflammation, which can put you at higher risk for heart attack and stroke.
Adopt a low-fat diet. I often recommend the Mediterranean diet to my patients. This involves eating more plant-based foods, healthy fats (such as olive oil, rather than butter), and fish and poultry at least twice a week, plus using herbs and spices over salt to give food flavor. Also limit your red meat intake to only a few times per month and use portion control to reduce total caloric intake.
Exercise regularly. Specifically, try to get at least 30 minutes of exercise that elevates your heart rate—brisk walking, swimming, jogging, etc.—each day.
Sometimes, I’ll also prescribe a medication called metformin to patients whose blood sugar continues to rise despite making the above lifestyle changes to help delay the onset of diabetes.
Avoiding Diabetes
Taking action early is important, because once you have diabetes, life gets complicated. Diabetes often necessitates daily insulin injections and/or other medications to keep your blood sugar levels in a healthy range, which can be inconvenient and expensive. You will have to perform finger-stick blood tests frequently at home to check your blood sugar levels, plus see your health provider annually (sometimes up to four times per year) to test your blood sugar levels and make sure there aren’t any other concerns as a result of the condition.
Beyond that, diabetes can be detrimental to your major organs and nervous system and can lead to complications including heart disease, blindness, kidney failure, stroke, and neuropathy (nerve damage that can lead to amputation if an injury or infection can’t be eradicated or isn’t caught early enough), generally in the lower extremities.
Fortunately, once making a few changes, many of my patients have been successful at keeping diabetes at bay. If you do get a diagnosis of prediabetes, you and your provider can make great strides by managing it together.
For more information, visit the Centers for Disease Control and Prevention’s National Diabetes Prevention Program, which offers health tips and local and online classes on prediabetes and diabetes.
Dr. LoAn Nguyen is a board-certified internal medicine physician with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Reston Medical Center.
