Type 2 Diabetes

Understanding Prediabetes

An Overview of Prediabetes

Prediabetes is a major warning sign. It means that your blood sugars are high, but not high enough yet to be diagnosed with diabetes.

Hearing that diagnosis can be scary; what does this mean for your future? If you've been told that you have prediabetes, it's important to know that you are at a pivotal point in terms of your health—one that you can have a lot of influence over. You can prevent or delay developing diabetes by making changes to exercise more, lose weight, and eat healthier.

Not investing in these lifestyle changes, however, can tip the scales and lead to not only diabetes, but heart disease and stroke. 

Your body produces insulin to allow you to convert glucose (sugar from carbohydrates) into energy and to keep your sugar level in a healthy range. Prediabetes typically starts because your body is becoming resistant to that insulin, mostly because of excess weight, particularly in the abdominal area.

Your doctor may use the formal definition of prediabetes when describing it to you, which is having an impaired fasting glucose or impaired glucose tolerance. This means that you have a fasting blood sugar of 100 mg/dL to 125 mg/dL (normal is less than 100) and/or your hemoglobin A1c ( a three-month average of your blood sugar) is in the range of 5.7 percent to 6.4 percent (normal is less than 5.7 percent). 

Who Is at Risk for Prediabetes?

There are some risk factors that you can control and others that you can't:

  • Older Age: As you age, your pancreas essentially gets tired and can make less insulin, increasing your risk of developing diabetes. 
     
  • Family History: If you have a family history of diabetes, you are at increased risk of not only developing prediabetes, but developing full-blown diabetes too. Your risk increases when you have contributing lifestyle factors, such as poor diet, physical inactivity, smoking, high blood pressure, etc. 
     
  • Ethnicity: Certain ethnicities have a higher risk of developing prediabetes and diabetes. These include Latinos, American Indians, Pacific Islanders, Asian Americans and non-Hispanic blacks. 
     
  • History of Gestational DiabetesIf you've had gestational diabetes (diabetes that arises when you are pregnant) this can increase your risk of developing diabetes. 
     
  • Belly Fat and/or Obesity: If you carry most of your weight in your tummy, you are at increased risk of developing prediabetes. The reason is because belly fat, referred to as "visceral fat" increases the release of free fatty acids, which can increase insulin resistance. In addition, belly fat can also increase your risk of heart disease, as well as elevated cholesterol, blood pressure, and triglycerides. Obesity is a major risk factor for developing diabetes for the same reason (more on this below).
     
  • Sedentary Lifestyle: Exercise helps your body to use insulin. Insulin is the hormone that takes glucose from the blood to the cells to use for energy. A sedentary lifestyle can lead to insulin resistance.

How Exactly Does Obesity Result in Prediabetes? 

Obesity plays a major role in developing prediabetes and diabetes because excess fat can lead to insulin resistance. Insulin resistance is a disorder in which the cells primarily within the muscles, liver, and fat tissue do not use insulin properly. People who have prediabetes or diabetes still have the ability to produce insulin, but they can't use insulin the way the body should. As a result, the body continues to make more insulin, thinking that it needs it.

The pancreas becomes overworked and, over time, it loses the ability to make the same amount of insulin. The cells are resistant to what insulin is being produced. And if no changes are made—if a person does not lose weight, reduce their carbohydrate intake, or exercise more—the blood sugars go even higher, resulting in a diabetes diagnosis.

Are There Warning Signs of Prediabetes? 

Usually, there are no warning signs of prediabetes. You may feel tired or that you are urinating more frequently, but typically you'll feel no different and attribute your fatigue to not sleeping well or being inactive. Remember, though: By taking action—losing weight, eating a healthier diet, and moving more—you can delay or prevent diabetes.

Who Should Be Screened for Prediabetes? How Is it Diagnosed?

According to the American Diabetes Association, any person with the following criteria should be tested for diabetes:

  • All adults who are overweight with a BMI >25kg/m2; the BMI cut-off for Asian Americans is lower (23kg/m2).
     
  • Presence of additional risk factors such as a first-degree relative with diabetes; high-risk race/ethnicity; A1c 5.7%; impaired glucose tolerance or impaired fasting glucose; a low level of physical inactivity; hypertension with blood pressure greater than or equal to (140/90); HDL lower than 35 or a triglyceride level 250 mg/dL; gestational diabetes; polycystic ovarian syndrome; or other clinical conditions associated with insulin resistance (severe obesity, acanthosis nigricians, history of cardiovascular disease).
     
  • Children and adolescents who are overweight and have two or more additional risk factors (see above).
     
  • Anyone over 45 years of age: If results are normal, testing should be repeated a minimum of three-year intervals, with consideration of more frequent testing depending on initial results (e.g. those with prediabetes should be tested yearly). 

Doctors can diagnose prediabetes the same way they diagnose diabetes: by using a fasting blood sugar test (in which you have not eaten anything in eight hours), a two-hour plasma glucose test, or a blood test that measures your A1c (you do not have to fast for this test). 

Can You Prevent Prediabetes? 

If you are someone with a family history of diabetes, there is no definitive answer as to whether or not you can prevent prediabetes. Odds are, if you maintain a healthy weight; exercise; eat a well-balanced diet rich in vegetables, lean protein, healthy fats, and fiber-rich carbohydrates that you may be able to prevent and/or certainly delay prediabetes. As you've probably already gathered, lifestyle modifications play a huge role in prevention. 

What You Can Do Once You've Been Told You Have Prediabetes

  • Lose Weight: Studies have shown that even modest weight loss—5 percent to 7 percent of your body weight—can prevent or delay the progression of diabetes. For example, if you are a person who weighs 200 pounds, losing just 10 pounds can reduce your risk of developing diabetes. 
     
  • Reduce Your Carbohydrate Intake: Carbohydrates are the nutrient that impact blood sugar the most. You can reduce your blood sugars and lose weight by eating fewer carbs. Avoid refined carbohydrates, such as white bread, pasta, rice, and snack foods. Eliminate juice and other sweetened drinks, and increase your intake of non-starchy vegetables. 
     
  • Eat a Mediterranean Diet: A Mediterranean diet is a diet that is rich in fruits, vegetables, and most importantly, healthy fats, such as nuts, seeds, and olive oil. Some studies suggest that the quality of fat you eat is more important than the total quantity of fat. Perhaps this is why some studies have shown an association with eating a Mediterranean diet and prevention of type 2 diabetes. 
     
  • Exercise: Physical activity not only helps keep your weight in check, but it also helps you better utilize insulin. Insulin allows your cells to use sugar (glucose), which prevents it from building up in the bloodstream. Increasing your physical activity can actually help cut your risk for diabetes by half.

A Word From Verywell 

A diagnosis of prediabetes is undoubtedly concerning, but we encourage you to use this as inspiration to change any aspects of your lifestyle that may be detracting from your health. Eating healthier, losing weight, and exercising more will not only make you healthier by preventing your risk for disease, it will increase your energy levels, help you to sleep better, and improve your mood. You can change your life for the better.

Sources:

American Diabetes Association. Standards of Medical Care in Diabetes. http://care.diabetesjournals.org/content/39/Supplement_1 Accessed July 12, 2016.

American Diabetes Association. Statistics About Diabetes. http://www.diabetes.org/diabetes-basics/statistics/. Accessed July 11, 2016. 

Bansal, Nidhi. Prediabetes Diagnosis and Treatment. World Journal of Diabetes. 2015; 6(2): 296–303. doi: 10.4239/wjd.v6.i2.296.

Busko, Marlene. High-fat Diet Best for Diabetes Prevention in Obesity-prone. Medscape. http://www.medscape.com/viewarticle/865525?src=wnl_mdplsnews_160701_mscpedit_wir&uac=86320AJ&impID=1144673&faf=1 Accessed July 10, 2016.

Center for Disease Control. General Information. http://www.cdc.gov/diabetes/pdfs/data/2014-report-generalinformation.pdf. Accessed July 10, 2016.

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