This article is the first in a three-part series about prediabetes. This article reviews the increasingly common health condition of prediabetes and describes how you can find out if you have or are at risk for this condition. Subsequent articles will address common misconceptions about prediabetes and action steps that we can take as individuals and as communities to prevent and reverse this condition.
What is prediabetes?
Prediabetes is a condition where individuals have elevated blood sugars but these sugar levels are not quite high enough to meet the criteria for diabetes. Someone who has one of the following (on repeated testing) meets the definition of prediabetes: a fasting blood sugar between 100 – 125, a blood sugar 2 hours following a standardized glucose challenge test between 140-199, or a Hemoglobin A1c (a number that provides a sense of average blood sugar over the past 3 months) of ≥ 5.7 and less than 6.5.
A silent health epidemic in our communities
The majority of people who have prediabetes do not even know it. It is estimated that approximately 80 million Americans (one quarter of the US population!) have prediabetes, and a significant number of these individuals will go on to develop full blown diabetes each year. The number of prediabetics (and diabetics) is expected to climb over the next decade and research has shown that many individuals in the prediabetes range are already at increased risk for heart disease and other cardiovascular complications. However, with knowledge and the motivation to make lifestyle changes, it is often possible to reverse the metabolic changes that lead to prediabetes.
It is more than just high blood sugar
In many ways the term prediabetes is an oversimplification. It makes people think that it is all about the blood sugar. However, as I often discuss in this column, health and disease involve an interplay between many factors. In the case of prediabetes, it is more than just high blood sugar. The high blood sugar is a symptom of the underlying dis-ease process. The food we eat, how we sleep at night, how we manage stress in our lives and how much we move our body, all of these affect our health and can have impacts (directly and indirectly) on our blood sugar.
If my blood sugar is high, don’t I just need to lose weight?
Oftentimes, prediabetes is diagnosed when individuals begin to put on more weight (especially around the middle) and for many individuals a weight loss program can improve blood sugars. However, many individuals who are considered to be a normal weight or even look thin may still be carrying around excess fat around their middle that is not readily apparent. So, it is not just about losing a certain number of pounds. When attempting to lose weight, it is important to maintain a balanced eating plan that provides enough calories so that your body does not end up burning muscle. This is also why physical activity during weight loss is so important. Regular physical activity (walking, bicycling, some weight training, etc.) while losing weight will assist your body in maintaining needed muscle.
What can you do? First assess your risk
Knowledge can often provide the motivation and power we need to make changes. So first, find out and assess your situation and risk factors for prediabetes. Some of these tests you can do yourself. First, measure your waist. (Waist circumference is a more valid health measurement than weight/BMI across body types, different ethnic groups.) You can do this by getting a flexible tape measure and measuring the distance around your waist which is located 1/2 way between the top of your hip bone and your bottom rib. This may or may not be where you wear your pants. For women, an ideal waist circumference is 35 inches or less and for men it is 40 inches or less. If your waist measures more than this, it is a sign that you are likely carrying excess fat tissue around your middle. This increased fat distribution around the middle can lead to higher risk for prediabetes.
Next, see your healthcare provider or participate in a health screening. Get your blood pressure, blood sugar and your cholesterol checked. I recommend that you do not just get a fasting blood sugar, as individuals who have prediabetes may often have normal fasting blood sugars but have elevated blood sugars following eating. An A1c or glucose challenge test will give a more accurate picture of your blood sugar control. Also, get your cholesterol checked, as individuals at risk for developing prediabetes will often have cholesterol test abnormalities.
In the coming weeks, I will discuss common misconceptions regarding prediabetes and steps that you can take to lessen your chances to develop prediabetes and diabetes and to help reduce your blood sugars if you already have these conditions. In the meantime, work on gathering your numbers and thinking about your personal health priorities for the coming year.
The information contained herein should not be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a healthcare provider if you suspect you are ill.