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What Should You Do if You Have Been Diagnosed with Prediabetes?

How Simple Changes Can Help You Prevent Type 2 Diabetes

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Updated July 11, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

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If you’ve just been told you have prediabetes you are certainly not alone. The Center for Disease Control estimates that 57 million people in the United States are considered to have prediabetes. While the diagnosis can be scary and overwhelming, it may actually alter your life for the better.  I have witnessed patients with prediabetes completely change their life, in a good way, because they become empowered to eat healthier, exercise more, lose weight and prevent diabetes. The American Diabetes Association Standards of Care reports that you can prevent or delay Type 2 diabetes with lifestyle changes. For most, prevention relies heavily on weight loss. The amount of weight loss needed to prevent or delay diabetes varies from person to person. On average, a loss of about 7% of your body weight can help reverse diabetes. For a person weighting 200 hundred pounds this would be a 14 pound weight loss. Each individual is different, but the bottom line is that prevention of Type 2 diabetes is possible. Sometimes all you need to do is make small changes. 

What is Prediabetes? 
Prediabetes is a term used for individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). IGF and IGT are associated with obesity (particularly belly fat abdominal or visceral obesity). Your body uses glucose as its primary source of energy. Insulin –  the hormone produced by the pancreas – is responsible for taking sugar from your blood to your cells to use for energy. In someone who has prediabetes, this mechanism of sugar utilization is not working properly; sugar in the blood stays elevated, but not high enough to have full blown diabetes. 

What is Impaired Fasting Glucose? 
Fasting glucose is defined as a blood sugar reading taken in a fasting state (you have not eaten in 8 hours or more). A standard blood test can provide this measure. 

Fasting Glucose Ranges in mg/dl
Normal Less than 100 mg/dl
Prediabetes 100-126 mg/dl
Diabetes  Greater than 126 mg/dl

 

What is impaired glucose tolerance? 
Impaired glucose tolerance is a measure of how your body responds to a glucose load. For example: each time you eat carbohydrate, the food is broken down and converts into sugar. Insulin is secreted from the pancreas to take the sugar from the blood to the cells to use as energy. If your blood sugar remains elevated 1-2 hours after a meal, your body is unable to keep up with the glucose load. This can be determined by an Oral Glucose Tolerance Test (OGTT). OGTT is a test is done by testing the blood before and after given a glucose load (a 75g carbohydrate drink). 

OGTT: 2-hour Blood Results after a 75g Glucose Load in mg/dL
Normal <140 mg/dL
Prediabetes 140-199 mg/dL
Diabetes Greater than 200 mg/dL

 

What about HgbA1c?

A person can fall into the prediabetes range by having an elevated Hemoglobin A1c (HgbA1c). The HgbA1c is a three month average of the blood sugars. Where the fasting glucose and glucose tolerance test give a snap shot of what the blood sugar is doing at a given time, the HgbA1c gives an average of 24 hours over the course of three months. 

Results of HgbA1c Test

Normal

<5.7%
Prediabetes 5.7-6.4%
Diabetes Greater than or equal to 6.5%

 

So How Can I Prevent or Delay Type 2 Diabetes? 

Get Support: First, start off by getting support – join a program targeting weight loss or meet with a Registered Dietitian or Certified Diabetes Educator. Programs or one-on-one counseling directed towards weight loss can help you learn what foods impact blood sugars the most, portion control and how to eat a healthy, well-balanced diet. You will also want to move more – aiming for at least 150 minutes per week. The most successful people are those that follow-up consistently. Follow-up counseling is motivating and helps to facilitate change. Ask your physician if he or she has someone or a program they can refer you to. 

Monitor your Carbohydrate Intake: Carbohydrates are the bodies’ primary source of energy, but when eaten in excess, they are stored as fat. And when your body is not using sugar efficiently, excess carbohydrate intake can cause blood sugars to remain elevated. In order to lose weight and lower blood sugars, you should reduce the intake of carbohydrates, particularly sugary beverages (including fruit juice), white breads, cookies, cakes and ice cream. The key is to eat a modified carbohydrate diet, not a carbohydrate free diet. Eliminating carbohydrates altogether can result in fatigue, vitamin deficiencies, and constipation, to name a few. Even low carbohydrate diets contain some sources of carbohydrates such as fruit, yogurt, and whole grains. When choosing carbohydrates you will want to choose complex, high fiber ones that are portion controlled. It’s best to meet with a Registered Dietitian or Certified Diabetes Educator to come up with the right diet plan for you. However, some simple tips for modifying your carbohydrate intake include: 

  • Eat a High Protein Breakfast:  A recent study showed that eating a breakfast rich in protein can aid in weight loss and blood sugar control. For some people starting the day off with a high carbohydrate breakfast can cause sugar cravings throughout the day. And the more carbohydrates you eat the more stress you put on the pancreas to make insulin. I tell my patients to avoid – sugary cereals, muffins, bagels and granola as often as they can, but especially in the morning. 
  • Practice the Plate Method: Aim to make ½ your plate non-starchy vegetables (salad, broccoli, spinach, cauliflower, onions, peppers, eggplant, etc). This will provide volume, water, fiber and limited carbohydrate. ¼ of your plate or about 1 cup should be dedicated to your starch – whole grains such as quinoa, barley, bulgar, and other complex carbohydrates including, sweet potato (with the skin), squash, and beans. And the other ¼ of your plate or about the size of a deck of cards should be lean protein – white meat chicken, turkey, fish, lean beef. 
  • Eliminate all Sweetened Beverages and Added Sugars: Sugary beverages can cause fluctuations in blood sugar and weight gain. Avoid juice, soda, sweetened iced tea, and adding sugar to your coffee. Instead, drink water with lemon or lime, unsweetened tea and coffee and seltzer. 
  • Snack Mindfully: Picking on chips, crackers and cookies can hinder weight loss and contribute to elevated triglycerides and blood sugars. Snack on nutrient rich, low carbohydrate snacks:
    • 1 small apple (size of tennis ball) with 1 tablespoon of nut butter
    • 3 cups are popped popcorn with 1 slice of low-fat cheese
    • Cut up vegetables with two tablespoons hummus or guacamole 
    •  ¼ cup unsalted nuts: almonds, cashews, pistachios, walnuts, etc
    • 1 small low-fat plain Greek yogurt with 1/2 cup berries 

Consider Medicine: While lifestyle modifications are usually preferred, The American Diabetes Association suggests that the use of Metformin may be considered in those with impaired fasting glucose, impaired glucose tolerance or elevated HgbA1c. For those with a BMI of >35 kg/m2, aged <60 years old or women with prior Gestational Diabetes, this may be more suitable. Metformin is a medication that helps with insulin resistance by utilizing the insulin the body makes and sending a signal to the liver to stop making excess sugar. It is a weight neutral medication and used as a first line of treatment in those with diabetes. It should not be taken unless prescribed by a doctor. 

Sources:
American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. 2014 Jan; 37 Suppl 1: S14-80.
Center for Disease Control and Prevention. Type 2 Diabetes Prevention and Control. Accessed on line: January 30, 2014: http://www.cdc.gov/workplacehealthpromotion/implementation/topics/type2-diabetes.html 

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