If it seems like diabetes is everywhere these days…it is. The CDC estimates that nearly 10% of Americans have diabetes (the 7th leading cause of death in the US). But that stat pales in comparison to the 86 million people in the US diagnosed with prediabetes currently at serious risk for developing type 2 diabetes. That’s 1 in 3 US adults.
Type 2 diabetes is a life-threatening, life-long condition that requires constant care. Millions of Americans are at a tipping point in their health, and worse, many of the people at risk of developing type 2 diabetes haven’t even heard of “prediabetes.” If all of this is news to you, keep reading. You might be one of the 86 million people with prediabetes at risk of developing type 2 diabetes. Luckily, there’s something you can do about it. If you act soon enough.
What is Prediabetes?
Diabetes is a condition where your body has lost the ability to regulate your blood sugar. This happens for one of two reasons:
- Type 1 Diabetes: Your immune system attacks the cells that produce insulin, so you don’t make any insulin
- Type 2 Diabetes: Your body makes plenty of insulin (too much in the early stages!), but your cells don’t respond to insulin. We call this “insulin resistance” and it’s the defining feature of type 2 diabetes. As type 2 diabetes progresses your damaged pancreas produces less insulin.
86 million Americans are at extreme risk for developing type 2 diabetes
Like the name suggests, prediabetes is when your body first begins showing signs of trouble regulating your blood sugar levels. You haven’t quite reached the tipping point where you have full blown type 2 diabetes, but make no mistake, prediabetes is a tipping point.
In a very real sense, a prediabetes diagnosis is your last opportunity to intervene before type 2 diabetes fundamentally changes how your body works. Not to be a bummer, but once you cross that threshold into type 2 diabetes, your health outcomes and quality of life change. And there’s no going back.
The Health Risks of Prediabetes
Type 2 diabetes dramatically increases your risk of heart attack, stroke, kidney failure, erectile dysfunction, nerve damage, and can even cause blindness. In some extreme cases non-healing ulcers on the feet can even lead to amputations. Ok, diabetes is bad, but if prediabetes is treatable, what’s all the fuss about?
Prediabetes, if left untreated, often develops into type 2 diabetes within five years—if not sooner. About 5-10% with prediabetes develop type 2 diabetes each year. That might sound like a low percentage, but what that stat means is every year you have prediabetes, your risk for developing type 2 diabetes increases. Substantially.
If you diagnose prediabetes early enough, you can prevent or even reverse the onset of type 2 diabetes. But you have to know if you have it. Which means it’s time to get your glucose levels tested.
Diagnosing Prediabetes: Glucose Levels
Doctors typically use one of three tests to screen for diabetes or prediabetes.
- Fasting plasma glucose: You fast for eight hours (no food or drinks, only water), then measure your base blood sugar levels
- Hemoglobin A1C: This is an overall measure of how many hemoglobin particles in your blood contain sugar molecules.
- 2-hour Oral Glucose Tolerance Test (OGTT): Involves drinking 75g of glucose (sugar) then measuring your blood sugar two hours later.
Your body is always processing glucose and using it for energy. That means your glucose levels can be drastically different throughout the day or after certain activities like eating, sleeping, or exercise. This constant flux makes accurately measuring glucose levels tough. That’s why doctors have to create artificial circumstances (like making you fast) or wait a few hours to get accurate results.
Each glucose test has its pros and cons, and your doctor may prefer one test over another, depending on your symptoms, risk factors, and lifestyle. For instance, the OGTT test is rarely done, outside of diagnosing pregnant women for gestational diabetes. In comparison, the Hemoglobin A1C test is a great initial glucose test because it isn’t affected if you eat right before the test. It’s important to ask your doctor which glucose test is right for you.
How to Read Your Glucose Test
Your glucose test result ranges should fall in one of three categories: Normal, Prediabetic, and Diabetic. In case these sections aren’t highlighted, here are the glucose ranges for normal, prediabetes, and diabetes in each test:
Fasting Plasma Glucose
- Normal: 70-99mg/dL
- Prediabetes: 100-125mg/dL
- Diabetes: >125mg/dL
- Normal: <5.7%
- Prediabetes: 5.7-6.4%
- Diabetes: >6.4%
2-Hour Oral Glucose Tolerance Test (OGTT)
- Normal: <140mg/dL
- Prediabetes: 140-199mg/dL
- Diabetes: >199mg/dL
The “Easy” Glucose Test: RPG
There’s one final glucose test that’s both easy to do and specifically useful for diagnosing prediabetes. The Random Plasma Glucose test (RPG) is great because it can be done anytime and doesn’t require you to fast beforehand. Basically, this test takes a random sample of your blood to get an overview of your glucose levels. The problem with a “random” glucose sample is consistency.
Odds are your glucose levels will be significantly higher during this test than the ranges in other tests, so don’t freak out. It’s supposed to be that way. Just remember that the RPG screening is just that—a screening. It isn’t perfect. It is useful for getting a sense of your overall glucose levels—and possibly ruling out diabetes. It’s not great for pinpointing your ranges with surgical precision.
If you have really high levels during a random glucose test—between 140-199 mg/dL—you likely have prediabetes. However, you’ll want to get one of the other tests to follow up.
Also remember that your blood sugar fluctuates throughout the day. If your RPG results are inconclusive (aka you’re right on the borderline) or you have clear diabetic symptoms but a negative result, take one of the other more targeted tests to double check your diagnosis.
Diabetes and Prediabetes Symptoms
Not to get all “WebMD” on you, but it’s important to be aware of the early symptoms of diabetes. These include, but aren’t limited to:
- Blurry vision
- Frequent urination (more than 5-7 times a day)
- Dry mouth
- Slow healing cuts or sores
- Numbness or pain in feet or legs (nerve damage)
- Extreme thirst
The interesting thing about prediabetes is that it often occurs without any of these symptoms. That’s why glucose tests are so important.
“Generally, there are no symptoms to indicate pre-diabetes,” notes Dr. Jack Tseng, DO. “Patients often find out incidentally through lab work which is why it’s important to have regular check ups with your primary care provider.”
However, if these symptoms persist, get your glucose levels tested to find out if you have prediabetes.
Treating Prediabetes: Lifestyle Changes
Now for the good news. *Deep breath* Prediabetes isn’t the end of the world. In fact, if you catch it early enough, prediabetes doesn’t won’t have any long term health effects. Generally speaking, things go one of three ways with prediabetes:
- You don’t change anything and your prediabetes progresses into type 2 diabetes (Common)
- Glucose levels stay within prediabetic levels and symptoms and risks remain the same (Common)
- You reverse prediabetes with lifestyle changes and/or medication and go back to having normal blood sugar (The best outcome!)
That’s it. Either you take action to reverse prediabetes or your glucose levels worsen and you develop type 2 diabetes along with all those brutal health risks.
Preventing & Reversing Prediabetes: Lifestyle Changes
It’s easy to say “lifestyle changes are the cornerstone of treating and preventing type 2 diabetes,” but what does that really mean? How does changing your diet and exercising more reverse prediabetes?
“Being overweight or obese is a primary risk factor for diabetes,” argues Dr. Tseng. “Fatty tissue—and where the fat is stored in your body—causes insulin resistance. Fat around the abdomen increases risk of diabetes type 2 much more greatly than fat stored around your hips and thighs.”
“Inactivity is another risk factor for diabetes type 2,” argues Tseng. “Physical activity not only helps with weight management, but allows your cell to utilize more glucose and be more sensitive to insulin.”
Exercise reduces chemical (inulin resistance) and physical (obesity) risk factors. Inactivity and obesity—aka a body mass index (BMI) over 30—increase your risk of developing prediabetes or type 2 diabetes. So change your risk factors.
You can enter your height and weight here to find out your BMI in seconds.
Exercise and Diabetes: It’s Not About Weight Loss
One study from the NIDDK showed that “150 minutes of physical activity a week and weight loss of 7% body weight resulted in a 58% reduction in progression to type 2 diabetes.” While losing weight is certainly helpful for reducing certain risk factors associated with type 2 diabetes, the interesting thing about the health effects of exercise is that it’s not all about weight loss. It’s about improving insulin sensitivity.
Being overweight or obese is a primary risk factor for diabetes.
Don’t get me wrong, if you’re overweight or obese losing 10 or 20 pounds is a step in the right direction. However, multiple studies have shown that regular activity combined with healthy eating habits were responsible for changing how your process insulin—even without significant weight loss.
I know exercise isn’t an option for everyone. Injury, age, and reduced mobility can limit your options for “regular activity.” And that’s ok. Diabetes medication can provide some relief for many people.
The same NIDDK study that looked at the effects of exercise showed that metformin, a medication used in the treatment of type 2 diabetes, decreased the risk of people developing diabetes by 31%. That’s why I often prescribe a combination of lifestyle modifications and metformin.
Finally, it’s worth noting that type 2 diabetes is technically reversible, but it doesn’t happen very often. Bariatric surgery as well as medical weight loss have both been shown to be capable of this in some cases, but the effectiveness hinges on timing. The longer people have been diabetic, the less likely this is to happen, most likely due to longterm pancreas damage. Reducing the impact of fat cells on insulin resistance is proving successful as a treatment for type 2 diabetes.
Talk to your doctor about treating prediabetes with lifestyle modification, medication and/or surgical intervention.
Prediabetes: Next Steps
86 million Americans are at risk of developing type 2 diabetes. You don’t have to be one of them. Take control of your health with regular checkups, blood sugar tests, and doable lifestyle changes like regular exercise.
Prevention and awareness are the keys to making your prediabetes diagnosis the starting point for a healthier life. And you’re reading this, so you’re already halfway there. Now go get tested and make some changes!
Geek Out: More Prediabetes References
Need to know more about prediabetes? Geek out on these clinical trials, studies, and stats from the most trusted health sources on the interwebs. And if you have any questions or you think we missed something important, leave a comment or book a consultation with me or one of these trained professionals and we’ll get you sorted out in no time.
- Prediabetes: A high-risk state for developing diabetes (Lancet)
- Leading Causes of Death (CDC)
- Type 2 Diabetes Prevention Program (CDC)
- Diabetes Prevention Program (NIDDK)
- National Diabetes Statistics Report – 2017 (CDC)
- Classification and Diagnosis of Diabetes (American Diabetes Association)
- Prevention or Delay of Diabetes (American Diabetes Association)
- Bariatric Surgery and Diabetes Treatment (Amer J Med)
- Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention of Metaformin (N Engl J Med)
This information isn’t a substitute for professional medical advice, diagnosis, or treatment. You should never rely upon this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.