November - December 2018

Written by Steven Burns
From his column To Your Health

“Now, Ron, let’s go over your lab tests,” I said to the heavy-set man in my exam room. “The results show you have an elevated blood sugar reading.”

“Yeah, doc, we’ve had a lot of family in town, and, well, I haven’t been eating right. I think I gained a few pounds, didn’t I?”

“Yes, you have. But right now that’s not what I want to talk about. Your blood sugar was 112 mg/dL, and your hemoglobin A1c was 6.1%. That means you’re headed toward diabetes. You’re not diabetic yet, but without some serious change, it’s likely you will be a diabetic in the next couple of years.”

He sighed. “I know I’m not eating right, but I’ll do better, lose weight, exercise, all that stuff you always tell me about.”

I returned the sigh. “The problem is, we have had this conversation several times over the past couple of years. You always have family in town, you always travel, you always have the holidays. One of my pastors used to say that an excuse is the ‘skin of a reason, stuffed with a lie.’ When are you going to stop lying to yourself?”

Nearly 50% of individuals over
age 65 have prediabetes. Only
11.6% of them are aware of the
fact they have it.

I have this conversation with my patients at least once a week. Ron has a condition that has been called Impaired Fasting Glucose. At one time referred to as “Hypoglycemia,” today’s preferred term is “Prediabetes,” and it is part of a continuum that culminates in Type 2 Diabetes Mellitus. People with prediabetes do not meet the criteria to call them diabetic, but their bodies do not handle sugar normally. Many of them would fail a glucose tolerance test if it was given, and then would be labeled diabetic−many, but not all.

In the United States, there are over 100 million people, nearly 1 in 3, who are prediabetic or diabetic, according to the Centers for Disease Control (CDC). Of those, about 30 million are actually diabetic, and 84 million have prediabetes. If people with prediabetes are not treated (usually with diet and weight loss), many will transition to diabetes within 5 years.

As we get older, the number rises. Nearly 50% of individuals over age 65 have prediabetes. Only 11.6% of them are aware of the fact they have it.

So, what is the definition of prediabetes? A fasting blood glucose consistently between 100 and 125 mg/dL, or a hemoglobin A1c between 5.7% and 6.4% define prediabetes. If the values are greater than those two ranges, the term is diabetes. Some people will have a normal fasting glucose but a high hemoglobin A1c, and some have a normal hemoglobin A1c but their fasting glucose is high. In both cases, that person is still classed as prediabetic.

There are no symptoms of prediabetes. It is a diagnosis by lab test alone, and should not properly be termed a disease. It is instead a risk factor for a disease—a way to find people at-risk and to take steps to prevent the development of diabetes, which is a disease.

When our bodies start to become insensitive to our own insulin, blood sugar rises. The cells that make insulin (pancreatic beta cells) then make more insulin, starting a vicious cycle. Our sugar levels rise with eating, and then insulin increases to meet the demand. But it does not work well, so the beta cells make more insulin, which brings the sugar back down eventually. Then there is too much insulin, making us hungry again. The result is overeating and gaining weight. Since fat cells are insulin-resistant, the beta cells make more and more insulin, putting on more and more weight. When the beta cells can no longer make enough insulin, the blood sugar rises and stays high—Type 2 Diabetes Mellitus.

Some organs can be damaged even before we reach the point of diabetes. Non-alcoholic fatty liver is a common finding in patients who are overweight and prediabetic. In that condition, fat deposits in the liver, a scarring process. It can lead to cirrhosis in some people. Blood vessels tend to build more plaque during prediabetes. Some begin to see the loss of nerve function, or a reduction in kidney function, while they are still prediabetic. These are usually thought to be complications of diabetes, but they can occur earlier in the continuum.

So, what can you do to treat prediabetes and prevent the progression to Type 2 Diabetes Mellitus?

    1. Start by exercising. 30 minutes of aerobic exercise, 5 days a week.
    2. Stop eating simple carbohydrates. Sugar, obviously, but starch is also a part of the problem. Starch is contained in bread, rice, pasta, and potatoes, so reducing those items in your diet will help with lowering your blood sugar and insulin levels. Replace them with fruits and vegetables.
    3. Lose weight. Dropping 5 to 10% of body weight will cause amazing improvements in your metabolism, improving the effectiveness of insulin and dropping your blood sugar. To illustrate, for a 200-pound person, that’s 10 to 20 pounds. Very “doable.”
    4. Go to your doctor and get tested. A simple fasting blood sugar and hemoglobin A1c will either rule out prediabetes or indicate you need to make some changes.

So, get out there, eat a banana, get on your walking shoes, and take a brisk walk. A couple of miles will definitely reduce blood sugar and your risk of prediabetes. And when you get back, stay away from the carbs!

Dr. Steven Burns is board-certified in family medicine and has been in practice for more than 30 years.