I'm Pre-Diabetic, What Should I Do?

What causes prediabetes and what you can do to avoid it

What is prediabetes?

Prediabetes is a condition that develops when blood sugar levels are dysregulated and higher than they should be. It is a precursor to diabetes.  

What’s blood sugar?

It’s how much sugar, specifically glucose, is dissolved in your blood at any given time.

Why is this important?

Glucose is vital. It’s the starting ingredient for energy production in the body in a process known as glycolysis, which breaks down sugar in the pathway to forming ATP.  ATP is what allows our bodies to do everything, from maintaining basic organ functions to digesting food,healing wounds and moving around.

If it’s so important, why is too much of it bad?

Our bodies like to keep things nice and balanced. This is called homeostasis, and is part of why we aren’t cold-blooded. A number of hormones keep the levels of glucose in check. If your blood sugar is too high, and it’s left untreated, there are consequences to your kidneys, extremities, vascular system, and brain. Diabetics have trouble controlling their blood sugar levels. If your blood sugar is too high, this is referred to as hyperglycemia. Hypoglycemia is when your blood sugar is too low.

But where does it go if I can’t have it in my blood?

Good question! Sugar that’s not being made into energy for the body is stored in the liver in the form of glycogen. This is achieved by an essential hormone called insulin. Glycogen is like a big 3-D chain of glucose, from which enzymes can slice off little sections as needed. People with diabetes can’t effectively make glucose into glycogen, (their bodies develop “resistance” to insulin) so glucose stays in their blood.

But I have prediabetes!

Your blood sugar is higher than the average person’s, but not high enough for you to be classified as a diabetic. It’s very important to state that if you have prediabetes you’re not definitely going to have diabetes — only about 5-10% of prediabetics develop diabetes annually. However, this doesn’t mean that you should ignore pre-diabetes.  Some organizations refer to it as “high risk state of developing diabetes” or “intermediate hyperglycemia”.

How common is it?

Unfortunately, prediabetes is very common. The CDC wrote a report on diabetes in 2017 and the results are shocking: 33.9% of American adults have prediabetes — that’s 84.1 million people —  more than the combined populations of Texas, Florida, New York and Pennsylvania — and 48.3% of Americans over the age of 65 have it. What’s more startling is that only 11.6% were even aware of it.

How bad is that?

While prediabetes can progress to diabetes, there are a variety of associated health risks. As we mentioned earlier, higher blood sugar has consequences. For prediabetics, these can include kidney damage that can result in kidney failure, nerves not working as they should, which can mean heart trouble, erectile dysfunction and either being less able to feel pain, or alternatively feeling too much pain (nerve pain). It can also affect your eyes and blood vessels. 

So what does this mean for me?

You’re probably going to have to change your lifestyle, and that’s most likely going to be through weight loss: for each kilogram (that’s about 2lbs) of weight lost, the chance of developing diabetes in the future is reduced by 16%. Diet, weight loss and exercise are very effective at combating prediabetes: a 2016 meta-study (a study that combines the findings from multiple studies) showed that glycemic control (that is, careful monitoring and restriction of blood sugar levels) resulted in people who were prediabetic developing normal blood sugar levels. 150 minutes of exercise weekly feed into both good glycemic control, and greater physical fitness. When it comes to weight loss, however, it’s important to take it slowly: small, incremental, sustained weight loss is ideal.

You can also take medicine. Options include drugs designed to fight diabetes, such as biguanides (which stop the liver from making glucose and makes muscles more sensitive to insulin), thiazolidinediones (which make insulin more effective), alpha-glucosidase inhibitors (which stop you from digesting carbs at all) and  anti-obesity drugs like Orlistat, a drug that stops the enzymes that help us consume fat.

There are also surgical options, which include gastric bypasses or gastrectomies.

What should I eat if I’m prediabetic?

Eat more high fiber fruits, vegetables, beans, pulses, whole grains and nuts. But tea, coffee, chocolate and red wine can also be helpful in moderation (without added sugar). Both lists of foods contain compounds called polyphenols. A particular class of polyphenols are called flavan-3-ols, and they’re especially rich in tea and chocolate. Here’s the great part: these compounds may reduce the degree to which the body doesn’t respond to insulin, which in turn could help people who are prediabetic. Now, this doesn’t mean that you should consume lots of  Hershey’s chocolate and expect to be healthier. Dark chocolate without lots of added sugar is healthier. Furthermore, there’s an association with the Mediterranean Diet and lower risk of developing Type-2 Diabetes.

A different study surveyed 6798 Dutch people, and ranked their diets on a degree of plant consumption, from 0 to 92, where people scoring 92 ate exclusively plants. The study found that for every ten points higher on the score meant a statistically significant lower insulin resistance, and a lower chance of developing either pre- or Type-2 diabetes. While the study had limitations — it counted food items per day rather than grams per day of food — its findings are remarkable.

In general, though, if you’re prediabetic, the Michael Pollan line of “Eat food, not too much, mostly plants” is a good idea. That doesn’t mean utterly relinquishing steaks and cupcakes, it just means less of them and in moderation.

References

  1. Centres for Disease Control and Prevention National Diabetes Statistics Report
  2. Guasch-Ferré M, Merino J, Sun Q, Fitó M, Salas-Salvadó J. Dietary Polyphenols, Mediterranean Diet, Prediabetes, and Type 2 Diabetes: A Narrative Review of the Evidence. Oxid Med Cell Longev. 2017;2017:6723931.
  3. Chen Z, Zuurmond MG, van der Schaft N, et al. Plant versus animal based diets and insulin resistance, prediabetes and type 2 diabetes: the Rotterdam Study. Eur J Epidemiol. 2018;33(9):883-893.
  4. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379(9833):2279-90.
  5. George Kerrison, Richard B. Gillis, Shahwar I. Jiwani, et al., “The Effectiveness of Lifestyle Adaptation for the Prevention of Prediabetes in Adults: A Systematic Review,” Journal of Diabetes Research, vol. 2017, Article ID 8493145, 20 pages, 2017
  6. Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296-303.

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