It is frequently suggested that during the prediabetic time, pancreatic function is declining. However, this is not always the case.
The pancreas is the organ that makes insulin and other hormones and during prediabetes, it's often overworking, producing higher amounts of insulin (hyperinsulinemia) to try to get blood glucose levels lower. This higher production of insulin is frequently driven by insulin resistance, where the cells in the body are blind to the actions of insulin (which is to help glucose clear from the bloodstream).
And unfortunately, the combination of high glucose and insulin in the blood stream causes the body’s cells to become more resistant to the insulin – meaning, though the pancreas is pumping more insulin, your cells are still not responding.
If this continues to go on, your pancreas can eventually wear out and deteriorate, increasing risk of a type 2 diabetes diagnosis. So, identifying prediabetes early is the key.
You can have pre-diabetes/insulin resistance for 5-10 years before an ‘official’ diagnosis and for this reason diabetes often gets overlooked, meaning many people are walking around not knowing they are prediabetic or diabetic.
An important point to mention is that a lot of the damage to the body occurs during this insulin resistant phase because it’s the insulin resistance and consequently the high insulin and blood glucose levels that cause havoc in all the body's cells, increasing inflammation and driving the development of disease.
If you have prediabetes, take action and do something now. When it comes to diabetes, prevention is better than cure because there currently is no cure!
Unfortunately, there are usually no symptoms associated with prediabetes. And even when people know they have prediabetes, people often don’t take disease states seriously until they start experiencing pain or discomfort.
It is very important to take action before symptoms appear, as this is your best shot at preventing complications and possibly even a full blow diabetes diagnosis.
An exception to having no symptoms, is the appearance of dark spots on the back of the neck, armpits or elbows in some people, called Acanthosis Nigricans. However, this is not common to all people with diabetes so the best way to screen is to have your blood glucose checked periodically at office visits.
Prediabetes Blood Sugar Levels
Diagnostic ranges for prediabetes are as follows:
- Fasting blood glucose that ranges between 100-125 mg/dl (5.6-7 mmol/l)
- Hemoglobin A1C levels between 5.7-6.4
- Oral Glucose Tolerance Test (OGTT) 140-199 – although this is rarely used anymore
Risk Factors for Prediabetes
Risk factors that increase your odds of developing prediabetes are similar to type 2 diabetes.
You should be tested if you are:
- Overweight (this is the top risk factor)
- Large waist size (>35 in women or >40 in men)
- Hyperlipidemia (high LDL and triglycerides, low )
- Sedentary lifestyle (lower activity increases risk)
- Older (risk seems to be higher after the age of 45)
- Family history (having a parent or sibling with diabetes)
- Race (people of Asian, African, Hispanic, Indian, or Pacific Island descent are at greater risk than Caucasian)
- Prior gestational diabetes (or having given birth to a baby >9 pounds)
- Polycystic ovarian syndrome
- Sleep problems (sleep apnea, shift working)
There is an online risk assessment along with some other resources available here.
What is the Prediabetes Diagnosis Procedure?
Both the fasting glucose test and A1c tests are simple. Blood gets drawn and the test can be done in the doctors office – sometimes the A1c is a send out and you may need to wait a few days.
If OGTT is performed, the doctor will take a fasting glucose sample, then you get to drink a very sweet beverage containing 75 grams glucose and hang around for 2 hours. They will then take another sample to test the effect of the drink on your blood glucose.
If it is >140 (7.8), you’ve not produced or utilized sufficient insulin to bring glucose levels back down to normal healthy blood sugar levels. Sometimes doctors will do two tests to confirm a diagnosis.
How Do You Cure Prediabetes?
In many cases prediabetes can be reversed to normal glucose levels. In fact, it is much easier to reverse prediabetic levels than if you're already diagnosed with diabetes. There is great evidence to suggest that small changes can prevent a new diabetes diagnosis in anywhere from 50-70% of cases.
The greater the metabolic derangement (negative changes in your body), the harder it is to achieve normal control apart from taking medication.
So if you or someone you know has been diagnosed with prediabetes, now is the time for urgency!
Prevention measures are the exact reverse of the associated controllable risk factors above:
- If you are overweight, this is likely to have the most significant effect on reducing your risk for developing diabetes.
- Note that weight loss as little as 5-10% has been shown to produce great results.
Improvement in Diet
- Follow a balanced carb-controlled diet consisting of lots of non-starchy vegetables, unprocessed protein foods and healthy fats.
- Avoid sweetened beverages, pre-packaged snack foods, deep-fried choices, sugar, refined white flour and hydrogenated oils.
- Regular consistent exercise is key to reversing insulin resistance and for weight management.
- Walking, squats, leg lifts, and bridges are all examples of simple activities you can try to include in your exercise routine.
Improved Sleep Habits
- Sleep is crucial to proper healthy hormonal maintenance, including those needed to regulate blood glucose levels.
- Check out this article for tips on the importance of sleep and tips on getting better sleep.
Metformin and Prediabetes
Metformin is sometimes, but not always prescribed in prediabetes.
It is a great first line medication for people who don’t have kidney problems as it's low cost, does not cause weight gain, and may even help with weight loss.
What To Eat With Prediabetes
Non-starchy vegetables should fill your plate and be your main source of healthy carbs. And include healthy sources of protein – chicken, beef, fish, turkey and so forth, along with healthy fats like olive oil, nuts and avocado.
We have a couple of sample healthy meals and menus over here.
And, please download our food list below as it outlines all the healthiest foods to eat.