What is prediabetes? In simple terms, blood sugar is high but not high enough to be diagnosed with type 2 diabetes. It starts with high blood sugar leading to increased insulin production by pancreatic beta cells. Over time this leads to decreased insulin receptor activity causing perpetually high blood sugar. Chronic exposure to high blood sugar causes beta cell dysfunction and even cell death.
Prediabetes is a serious health condition as it increases the risk of type II diabetes, heart disease, and stroke. It is estimated that more than 1 in 3 adults in America have prediabetes! It is also estimated that >80% of these adults do not know they have prediabetes!!3 Prediabetes is often the starting point for metabolic dysfunction and metabolic syndrome. Check out my recent blog post on metabolic syndrome to learn more. https://lrxwellness.com/a-silent-killer/
I will discuss how to diagnose, risk factors, how to manage, and a few myths about prediabetes. I also address important questions and present shocking stats. Let’s go.
How is Prediabetes Diagnosed?
The two most common testing methods are listed below. The American Diabetes Association (ADA) recommends those 35 years of age or older are screened for diabetes. Or <35 years of age with risk factors (see below).4
- Hemoglobin A1c test- approximate average of blood sugar over the past 3 months
- <5.7% = normal
- 5.7%-6.4% = prediabetes
- >6.4% = diabetes
- Fasting blood sugar
- <100 mg/dL = normal
- 100-125 mg/dL = prediabetes
- >125 mg/dL = diabetes
**2 different diagnostic tests OR 2 abnormal tests on separate occasions OR abnormal test + symptoms are typically needed for a formal diabetes diagnosis
Risk Factors for Developing Prediabetes
- Overweight or Obesity
- Family history of diabetes mellitus
- Gestational diabetes
- Ethnicity
- High blood Pressure
- Physical Inactivity
- HDL <40 (men) or <50 (women) OR triglycerides >250
- Polycystic Ovarian Syndrome (PCOS)
The big questions are: 1) is prediabetes reversible and 2) how do we prevent the progression to diabetes? In short the answers are yes and yes! A prediabetes diagnosis is reversible and it is possible to prevent the progression of prediabetes.
Approximately 70% of people diagnosed with prediabetes will go on to develop diabetes mellitus. However, implementing lifestyle changes resulting in modest weight loss have shown to delay the onset of type 2 diabetes by 34% for four years compared to placebo6.
How to Manage Prediabetes
There are no ifs, ands, or buts, with a prediabetes diagnosis you HAVE to make lifestyle changes.
- Weight Loss– if you are overweight or obese, try to lose 5-10% of body weight.
- Physical Activity– incorporate daily movement with at least 20-30 minutes of moderate intensity exercise + weight training. Check out my post on exercise for more information. https://lrxwellness.com/how-to-exercise-effectively/
- Diet
- Avoid/limit added sugars. Sugar can hide in all sorts of places including: yogurt, salad dressings, sauces, etc. So be sure to read labels.
- Limit portion sizes of refined carbs (white bread, white rice, etc)
- Incorporate fiber by eating a variety of fruits, vegetables and whole grains
- Limit saturated and trans fats
- Incorporate more low-medium glycemic index (GI) foods and less high GI foods
- Glycemic Index (GI)- A measure of how much and how quickly carbohydrate containing foods increase blood sugar. Pure sugar has a GI of 100 and carb free foods have a GI of 0.
- Smoking Cessation
- Medications– if lifestyle changes are not effective then prescription medication may be considered. Most commonly used is metformin.
| Low GI | Medium GI | High GI |
| Many fruits (berries, apples, citrus) Non starchy vegetables Mixed/whole grain (seeded) breads Pasta Quinoa Oats (steel cut, rolled) Beans, nuts, legumes Plain milk products | Fruits (bananas, cherries, grapes, pineapples, figs) Pita bread Rye bread Couscous Brown rice Corn Some potatoes | Watermelon White bread Naan Many Potatoes Processed cereals/foods |
| Myths | Truths |
| I have prediabetes so I need to cut out all carbs. | Eating carbohydrates is an important part of a well balanced diet. Incorporating healthy (low GI/whole grain) carbs in addition to plentiful veggies will help manage blood sugar. |
| I need medication to treat/manage my prediabetes. | First, lifestyle changes are recommended. Many are able to prevent the progression to diabetes by commitment to these changes. When lifestyle modifications are not enough then medication therapy is indicated. |
| I need to limit fruits as they have sugar. | Fruits are a healthy carbohydrate and a must in everyone’s diet. They contain necessary micronutrients and fiber. |
| I don’t have any symptoms so I don’t have prediabetes. | Actually, most with prediabetes have no symptoms at all. As mentioned above, it is estimated that more than 80% of adults living with prediabetes don’t even know they have it! |
| Too much sugar caused my prediabetes. | This is not necessarily true. (Pre)diabetes may be caused by your body’s response to carbohydrates, genetics, obesity, and more. Just because someone indulges in sweets every now and then does not mean they will develop (pre)diabetes. |
In Conclusion
Prediabetes is a common and serious health condition. There are typically no symptoms so most don’t even know they have it! This is why it is important to get routine blood work. Prediabetes is a warning that your body is not managing blood sugar as it should. It increases risk of developing diabetes, heart attack, and stroke. The good news is: a prediabetes diagnosis is reversible and you can prevent the progression to diabetes! Lifestyle changes are a must and include: weight loss, physical activity, diet modifications, and smoking cessation. This information is applicable to all; whether you have a prediabetes diagnosis, are at risk of developing (pre)diabetes, or are an overall healthy individual. Remember food and movement are medicine. Take control of your health today!
Please reach out with any questions, comments, or for further discussion.
Lindsey, PharmD, BCPS
References
1Alvarez, S. (2023, July 17). Prediabetes. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK459332/
2Canada Diabetes Association. (2013). Glycemic Index Food Guide. DiabetesCanadaWebsite. https://www.diabetes.ca/managing-my-diabetes/tools—resources/glycemic-index-(gi)-food-guide/
3Centers for Disease Control and Prevention. (2022c, December 30). Prediabetes – your chance to prevent type 2 diabetes. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/basics/prediabetes.html#:~:text=Prediabetes%20is%20a%20serious%20health,t%20know%20they%20have%20it.
4Diagnosis. Diabetes Diagnosis & Tests | ADA. (n.d.). https://diabetes.org/about-diabetes/diagnosis
5Mayo Foundation for Medical Education and Research. (2023, November 11). Prediabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/prediabetes/diagnosis-treatment/drc-20355284
6Prediabetes Diet. Johns Hopkins Medicine. (2022, October 31). https://www.hopkinsmedicine.org/health/wellness-and-prevention/prediabetes-diet
4 responses to “Everything You Need to Know About Prediabetes”
Wow! This was so informative. I really appreciated the GI Grid with low, medium and High GI foods. Some of those were a surprise for me.
I too appreciated the GI chart. Was surprised about watermelon!
If normal fasting BG is 70-99, and your reading falls within that range, is it safe to say your A1c would be under 5.7 and be normal? I don’t think I have ever had an A1c report on my complete metabolic panel. Does the doctor decide when to screen? Or should I ask for it to be part of the screening? Diabetes does run in my family. My annual blood test this year had FBG of 89. Wondering if the prediabetes A1c could result with a normal value but on the higher end of normal. Thanks!
Hi Jenny! Typically, with a normal fasting glucose your A1C would be within normal range. However, with a family history of diabetes I think it is worth while to check a Hgb A1C. It should be covered by insurance.
Thanks!