Prediabetes

Has your doctor told you that “your sugar is a little high”? Perhaps they’ve said you have “impaired fasting glucose” or maybe they used the term “insulin resistance”. If this is true for you, you have prediabetes. Most people have prediabetes before they are diagnosed with type 2 diabetes. Prediabetes is when your blood sugars are higher than normal, but not high enough to be diagnosed with diabetes. You can see the charts below for fasting blood sugar and HbA1C values and how they determine if you have prediabetes or diabetes.

A fasting blood sugar is a very common test that generally is checked when you have blood work done. If your provider feels that you are at risk for diabetes, or are concerned about an elevated fasting blood sugar in the past, they may order a HbA1C. This helps them determine what your average blood sugar control has been over the past 2-3 months.

So, to clarify, prediabetes is a real thing. I’ve heard people say “I don’t believe in prediabetes” or “you either have diabetes or you don’t”. Even some healthcare professionals still have this thought process when it comes to diabetes. However, we know now that diabetes is more of a continuum rather than something that is black and white. Diabetes progresses slowly, and prediabetes is sign you'r eheading in that direction.

Some people improve their diet and exercise after being told they have prediabetes, and their numbers go back to normal. It’s possible for them to stay in the normal range indefinitely. Other people develop diabetes less than a year after having prediabetes. Meanwhile, others may live with prediabetes for years and years without ever progressing to diabetes. Everyone’s body is different so it’s hard to predict what will happen. The more lifestyle changes you make to improve your health, the more likely you will keep diabetes away and keep it from progressing.

So, if you have prediabetes, what can you do? The number one thing is weight loss. If you can lose 7% of your bodyweight, this should result in some improvements in your numbers. Obviously the more weight loss the better, but the ability to keep it off is what is most important. Extra fat on the body causes insulin resistance, which is most likely the main reason your blood sugars are high. With less fat on the body, the more efficiently you utilize the insulin your pancreas naturally makes.

The other big thing to do to prevent diabetes is exercise. The American Diabetes Association recommends getting a minimum of 150 minutes of exercise per week, which is equivalent to 30 minutes 5 days a week. Even in you don’t lose any weight through exercise, it is still going to improve blood sugars. When you’re exercising, your muscles will use the extra sugar floating around in your bloodstream for energy, lowering your blood sugars right then and there. Exercise also helps improve insulin resistance, just like weight loss does.

There is no drug that is FDA approved for prediabetes, but some providers may prescribe a drug called metformin to help. The American Diabetes Association states this drug could be used for people with prediabetes that have a BMI >35, are <60 years old, have a history of gestational diabetes, and/or people that have rising blood sugars despite making lifestyle changes. Talk to your provider to see if this approach is right for you.

Being told you have prediabetes can be a great opportunity to make your health a priority. I unfortunately have talked to many patients recently diagnosed with diabetes that state they wish they took their prediabetes more seriously. Even making small changes can make a difference.