You Just Found Out You Have Pre-diabetes - Now What?

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First, take a deep breath and know that you’re not alone: Some 84 million American adults have prediabetes - roughly a third of the population, according to the 2017 National Diabetes Statistics Report. And the majority of prediabetics don’t realize they have the condition. “Prediabetes by definition is asymptomatic,” explains Jonathan Leffert, MD, president of the American Association of Clinical Endocrinologists. “Most people don't have any symptoms of prediabetes, so they don't know they have it.”

And while ignorance might sound like bliss, the opposite is actually true. That’s because when you know you’re prediabetic, you can make the lifestyle tweaks now to potentially stop the condition from progressing to full-on diabetes. Here’s how to understand your condition and take control of your health’s future.

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Understand the Label…

Your doc says that you’re prediabetic. What does that mean? Well, as the “pre” suggests, it means your blood sugar levels are higher than normal, but not high enough to be classified as Type 2 diabetes. The diagnosis is based on a reading of your blood glucose levels, says Leffert. If your fasting blood sugar levels (or blood sugar levels tested after you've been avoiding food and liquids other than water, for eight hours) are at or between 100 and 125 mg/dL, that's a sign of prediabetes. If your doc wants a more long-term view of your glucose levels, she may have ordered a hemoglobin A1C test. This measures your average blood sugar for the last two to three months. An A1C result at or between 5.7 percent to 6.4 percent signals prediabetes.

…And What’s at Stake

Because prediabetes, as its name suggests, is a prelude to full-blown type 2 diabetes, it's not uncommon for patients to be “laissez-faire” about the condition, says Kirsten Ward, a certified diabetes educator and life coach at Fit4D in New York City. “It's the attitude that it's just a touch of sugar. 'It's not diabetes, I just have a sugar problem.'” Even doctors aren't always vigilant, research has shown. In a study published this past July, Johns Hopkins researchers surveyed 140 primary care physicians and found that “the vast majority” of them could not identify all the risk factors that experts say qualify patients for prediabetes screening. (Risk factors include: high blood pressure or cholesterol; a close family history of diabetes; having developed gestational diabetes or delivered a baby over nine pounds; physical inactivity; being overweight or obese; having a condition, such as polycystic ovarian syndrome, associated with insulin resistance; elevated A1C levels; or being part of a high-risk race or ethnicity, such as African-American, Latino, or Asian-American.) But while most doctors don’t spot every potential red flag, prediabetes is something serious, says Ward. It’s a warning sign that diabetes may be on the horizon without diet and lifestyle modifications, and it’s also associated with other serious illnesses like heart disease and stroke.

Put the Brakes on Diabetes

For many people, lifestyle changes alone can actually reverse the trend toward diabetes, says Leffert. For overweight prediabetics, weight loss is one of those most concrete and effective methods of action. A study published in 2016 found that patients who lost 0.1 to 3 percent of their body weight in a year and/or reduced their weight circumference by more than 3cm (or just over an inch) were much more likely to revert to normal glucose tolerance, and reduce their likelihood of getting diabetes. The Diabetes Prevention Program recommends starting with a goal of losing 5 percent of your weight, to experience real health benefits.

That said, don’t resort to a fad diet. While it might result in a temporary weight drop, “it won't have the long-lasting efficacy that's necessary to maintain someone's weight in a range which will keep them from presumably moving onto diabetes,” says Leffert. Instead, talk to your doctor about what dietary tweaks make sense. The American Diabetes Association, for instance, suggests that many people would benefit from initially swapping their dinnerware. Smaller plates may naturally keep portions in check better than standard dinner plates. Other people may find that a low-carbohydrate or Mediterranean diet works best for their lifestyle and health goals, says Ward. For others, adopting a vegan or vegetarian diet, or eschewing all processed foods, may do the trick.

If you’re able, focus not just on nutrition but also activity. Doctors recommend at least 150 minutes of moderate or 75 minutes of vigorous aerobic exercise a week, but don’t panic if you can’t cram hourlong sweat sessions in your schedule. Short but intense bursts can be just as effective. In fact, in a 2015 study, researchers at the University of Western Ontario compared people who aimed for 30-minute blocks of moderate exercise with those who split that time up into three 10-minute bouts of high intensity, for three months. They found that those who worked out just 10 minutes at a time improved their hemoglobin A1C levels by around twice as much as the 30-minute exercisers. And they lowered their body mass index by nearly three times as much!

If the advice to curb your portions and get moving sounds familiar, that's because it is. All these dietary and physical activity recommendations are not “special,” says Ward. "These are recommendations that every person should be doing, regardless of whether or not they have diabetes, pre-diabetes, or none of the above."

Reach Out for Support

Any prediabetes diagnosis should be followed by a discussion with your doctor. Your doctor may recommend a lifestyle change program, like Real Appeal, which follows a curriculum and involves a lifestyle coach and support group. You can also try talking to your doctor about whether meeting with a diabetes educator or specialist makes sense.

Holding on to a sense of agency in the face of prediabetes can be tough — especially if you’re at risk of getting diabetes because of genetic factors and feel the illness is unavoidable. But if “genetics loads the gun, environment pulls the trigger,” Ward says, and patients should feel empowered to slow or even reverse their rising blood sugar levels. “If you actively make changes now, there’s still a chance you might develop diabetes down the road — but you’re going to postpone it for sure,” she says. “And you’ll have these other lifestyle habits in place which are needed for healthy living.”

KATE ROCKWOOD, Rally Health 
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