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    What does PREDIABETES mean?
    Michael Dansinger, MD posted:
    Many folks come to the diabetes community upon being diagnosed with "prediabetes". These people are usually concerned about progressing to type 2 diabetes and want to know how to delay or prevent such progression. The diagnosis of prediabetes also typically serves as a "wake-up call" to make healthier lifestyle choices.

    Interestingly, the term "prediabetes" was recently discredited by the concensus panel of diabetes experts. The experts encouraged replacing "prediabetes" with the concept of "increased risk of diabetes" which is reflected by a continuum of risk ranging from A1c levels of around 5.8 to 6.5. The experts argued that not everyone in this range progresses to diabetes and it is more accurate to see it as a risk spectrum rather than as a category unto itself.

    I personally favor the old system of calling it "prediabetes" rather than "increased diabetes risk". I just like the name better. It used to be called "borderline diabetes", but that name seems so outdated to me. In any case, I urge people to see this as a strong warning that diabetes is probably coming, and lifestyle changes are the main way to slow or stop the progression.

    For the sake of the new members who come with prediabetes in search of advice, how do you believe a person should react to a new diagnosis of "prediabetes"? What should they do to fight it? Do the principles of "prediabetes" management differ from the principles of "type 2 diabetes" management?

    I appreciate any insights. They will probably match my own views quite well.

    Michael Dansinger, MD
    Louise_WebMD_Staff responded:
    Wow. Increased risk of diabetes just doesn't carry the same weight in my mind. Increased risk sounds like just another "meh, I might, I might not." My daughter once had a pair of roller skates that said "Warning: Increased Risk of Falls Possible"

    People with diabetes risk factors like obesity and sedentary lifestyles often get told they have an "increased risk" for diabetes. They file that away but when the doctor says "You have Prediabetes." that is when they make the decision to change their life and come here for help.
    xring responded:
    I'd say they should act as if they're already diabetic & start to make some changes:

    1. Take off any extra weight

    2. Think about what they're eating & why they're eating it (are they hungry or just in need of comfort) Also, ask themselves: "What is in this food besides calories? What is this food going to do for me besides relieve hunger?"

    3. Increase activity level - make daily exercise a priority instead of "if I feel like it" (like I did before my diagnosis).
    BextaJ responded:
    As one of those who came here after the words 'Pre-Diabetes' were mentioned by the doc I first would like to thank everyone for the great advice I received when I was confused and worried.

    Personally I think the best thing you can do is test, test, test! (That is of course if you Doc/finances/insurance companies will allow you to acquire a meter and strips.) Seeing what food does to your body early can be like a huge slap in the face and will hopefully motivate you to make better choices.

    Activity is also important, even if it's just a walk around the block every day. Doing something everyday is better than doing nothing, and there's always time to increase your activity level.

    Diet. Eat better foods. Make healthier choices and cut back on carbs. Every little thing you do now counts.

    If you can control it in its early stages you have a very good chance of not progressing to Type 2. (This is what my Doc said to me). Basically it should be a wake-up-call and time for a lifestyle makeover, and I don't think "Increased Risk of Diabetes" will kick start people into making that change.
    DavidHueben responded:

    I think that any person who presents with a fasting blood glucose level that is 100 - 126 should be treated as a candidate for diabetes.

    The label that is put on someone in that range, whether it is "pre-diabetic", "increased risk of diabetes", or "borderline diabetes" seems like nothing more than sematics to me.

    They should be treated with encouragement to change nutritional habits, increased exercise, losing weight, and medications as necessary.

    Same as if they presented with glucose levels that are considered diabetic.

    Red meat is not bad for you. Now blue-green meat, that's bad for you! -Tommy Smothers
    betaquartz responded:
    When told I had prediabetes in January, I sluffed it off as we had been baking cookies, sampling as we went, etc. I was not overweight at 165-170, and was feeling well. If I had listened then, and been told more about what it meant at the time, I might not be where I am now-diabetic. So I think prediabetes should be explained thoroughly to the patient, whether overweight or not. The idea of a low carb diet to help change the course of the disease at the top of the to do list. Unfortunately, back in 2009 the types of diets I saw for diabetes were low fat.
    Louise_WebMD_Staff replied to betaquartz's response:
    I didn't understand cholesterol testing the first time I had a high level. It came up astronomically high and I explained, completely oblivious that the night before the test I had had an exceptionally high fat meal. I was very young at the time, still in my 20s. What surprises me now is that the doctor made no effort to say "No, one high fat meal wouldn't do this to your cholesterol." He just said I should be more careful. No re-test scheduled, no follow-up.
    auriga1 responded:
    I had bloodwork done by my doctor's office and BS was part of that panel. My sugar at the time was 123. I was 39 years old. All my PCP said to me was that it was higher than he would have liked it. The word "diabetes" was not mentioned, despite my medical history which indicated diabetes ran in my family. All I was told to do was drop any sugars from my diet. Carbohydrates were not mentioned. Did what I was told and my sugar came down. I didn't have any eating problem and was (and am not) obese or carried any extra weight.

    A lot is going to depend on the individual's doctor. Will the doctor mention diabetes, pre- or whatever? Will the doctor mention you should watch your diet and add exercise to your daily routine? Will the doctor indicate you should be testing and watching your numbers? Where does one start with all this? I didn't know. Nothing was mentioned about testing and watching my blood sugars. A little education goes a long way, particularly if you could get a jump start from your physician.

    Most people rely on their doctors for some guidance. It has to start there besides giving a diagnosis of prediabetes. As another posted stated, an individual in this category needs encouragement (I believe it should start from their doctor) to get a jump-start on things such as a healthier eating lifestyle, weight management and physical activity. Most don't know where to go or what to do when they hear these words. Either panic sets in or as someone else said "I might, I might not." Education is first and foremost. It shouldn't be left to "you have prediabetes, so you have to start fixing it now before it gets any further." People need guidance.

    With that said, what they should do to fight it? Same thing the rest of us do. Eating healthier, counting carbs (major) and exercising, Lose weight, if necessary. Yes, I do believe prediabetes management should BE THE SAME principles of type 2 management. Get their A1C done on a regular basis to see how well they are managing.
    MSUphysicsFRIB responded:
    I was diagnosed with prediabetes in 2005. I was confused when I found out. I actually cried, but I was a bit nutty back then.

    My endocrinologist said that since I was young, thin, ate a balanced whole-food vegan diet, and exercised regularly, there was an 80% chance of me developing full-blown diabetes within the next two years if I didn't take medication--in other words, he didn't think there was any sort of lifestyle change I could make that would help. By the way, I'm pretty sure I didn't have a high a1c--just "impaired glucose tolerance." In other words, my blood sugar was around 180 two hours after I drank the glucose solution. I recall my fasting blood sugar being low before the test--around 70 or so.

    My general practitioner actually ordered the test because she suspected hypoglycemia. I complained of extreme sleepiness--I had actually started falling asleep in class, which was not normal for me.

    Anyhow, my endocrinologist gave me a meter, and I was able to see what my blood sugar did after meals, and when I was stressed or sleep-deprived. I actually have a calendar from 2007 where I recorded when my blood sugar was over 200 after a meal. It used to happen 2-3 times per week. I wrote down which foods caused the spikes--my "bad" list contained lentils, pintos, apples, grapes, bananas, and a bunch of other foods. For some reason now I can eat those foods without a spike. Maybe it's because I ate really low-carb for a while and gave my body a break.

    The first med that my doctor put me on--Actos--didn't seem to help at all. In 2006 he switched me to Metformin. That seemed to help, but also around that time I started to eat lower carb.

    I would say overall I have everything under control; although my fasting blood sugar has been a bit high for the past 6 months (today it was fine--86!), my postprandial levels are usually less than 150.

    When I'm really sick, anything goes; my levels swing between 60 and 300.
    Manoj_in_Bangalore responded:
    Prediabetes means that the pancreas is being forced to secrete extremely high quantity of insulin. The underlying reason could be many factors, like processed foods, trans-fats, nutritional deficiency, sedentary lifestyle, lack of sunlight, irregular sleeping pattern, etc.

    Unless corrections are made to reverse prediabetes, it cannot be sustained indefinitely, and when the insulin levels cross a threshold, the pancreas lower the production of insulin and type-2 diabetes develops.
    RealityBytes replied to Manoj_in_Bangalore's response:
    Those reading the above and new to the forum should note that Manoj's OPINION is not in any way the scientifically accepted one.
    MSUphysicsFRIB replied to RealityBytes's response:
    In this case, what Manoj is saying is almost 100% correct. The only thing I would clarify is that by the time a person has prediabetes, they are already having a problem with glucose tolerance--they don't just merely have hyperinsulinemia.

    Hyperinsulinemia without elevated glucose levels precedes prediabetes.

    Hyperinsulinemia is a huge risk factor for diabetes, because it suggests that the person is suffering from some level of insulin resistance, and so the pancreas is secreted lots of insulin to compensate. Acanthosis nigricans and PCOS are two diseases that are caused or exacerbated by high insulin levels. People with these diseases are warned that they are at an increased risk for developing Type II diabetes.

    Manoj's list of factors that increase insulin resistance is also correct; I can elaborate.

    1. Processed foods are generally high glycemic. High glycemic foods can lead to high insulin levels. High insulin levels can result in hypoglycemia, so the body compensates for the high insulin levels by becoming insulin resistant--this keeps blood sugar levels from plummeting too much. This process is illustrated in a rat study . Rats that were injected with lots of insulin were initially hypoglycemic, but then they became insulin resistant and their blood sugar levels normalized.

    2. Trans fats do indeed seem to have adverse effects on insulin sensitivity. Studies: 1 , 2

    3. chromium, zinc, or magnesium deficiencies can result in insulin resistance

    4. lack of exercise can decrease insulin sensitivity

    5. Lack of sunlight could increase insulin resistance in two ways: by resulting in vitamin D deficiency, or wacky sleep patterns. Study: vitamin D and insulin resistance

    6. Lack of sleep increases insulin resistance (study ). But do we even need a study? I think a lot of us can attest to this :)
    kaydeez responded:
    I was diagnosed as prediabetic and referred to a nutritionist. After following a low carb plan for just two months, my blood sugar is down below 100 again; my cholesterol also went down below 200 just based on advice of the nutritionist. I had already begun a walking program so that "diagnosis" prompted me to stick with it. Prediabetes is a very good term; it definitely woke me up! The six pounds I've shed so far are a good start and serve as an motivator to continue watching my carbs, and just eat better.
    krhudson responded:
    I like the Prediabetes term the best. I think when Dr.s see a combination of A1C greater than 5.7 and fasting above 105 it is time to refer to the Pre Diabetes educator or Dietitian who can also discuss the excercise requirements needed to be effective in the avoidance of becoming a type 2 Diabetic.

    This would in my opinion drastically reduce the medical claims that are paid out now causing Health Insurance to sky rocket. I would bet some insurance companies are on this already in order to inform a patient at risk for type 2 to nip it in the bud.

    Not that I care about insurance more than individuals that may have to deal with this medical condition, it could save lives and prevent complications in many patients.


    An_202687 responded:
    I have been diagnosed as having Diabetes type 2. My A1c has gone from 6.1 to 6.5 to 6.9. I prefer the term Bordrline over 'increased risk''. And 'borderline' just seems more accurate.
    However I do already have a pacemaker/defib. Got that last year. am also being treated for DVT. Now "Diabetic"???
    Enough already!

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