If you are among the 84 million people in the United States who have prediabetes, there is one important thing to know: Developing diabetes is not inevitable.
Those who learn they have prediabetes can often reverse their condition and prevent diabetes through lifestyle changes alone, or with medication.
Diabetes is a worldwide epidemic. More than 30 million Americans have this disease, tripling their chances of heart attack and stroke. In the United States, diabetes is also the leading cause of adult blindness, kidney failure, and non-traumatic foot amputations.
Diabetes occurs when there is too much glucose, or sugar, in the bloodstream. Having prediabetes means that you have a blood sugar level that is higher than normal, but not quite high enough to be considered diabetes.
The excess blood sugar in diabetes is caused by problems with how the body produces or uses insulin, a hormone that transfers the sugar from the bloodstream into the body’s cells for nourishment. Everyone needs some sugar, but too much of it in the bloodstream damages the arteries, kidneys, eyes, and nerves over time. Diabetes is generally classified as type 1 or type 2, although our research shows that there are probably several subtypes:
Type 1 diabetes. With type 1 diabetes, formerly known as juvenile diabetes, people’s bodies do not make enough insulin to manage the sugar. Taking insulin is the only treatment for this class of diabetes. Type 1 diabetes is thought to be an autoimmune reaction and is unrelated to obesity or prediabetes.
Type 2 diabetes. In type 2 diabetes, the body’s cells are resistant to the effects of insulin and so need more and more of it to properly clear the bloodstream of sugar. This is known as insulin resistance. Over time, the cells that make insulin become exhausted and stop working properly.
Prediabetes refers to the susceptibility of developing this type of diabetes. More than 90% of all Americans who have diabetes have type 2.
There are many things that make developing prediabetes and type 2 diabetes more likely, such as family history and age, but obesity is the No. 1 risk factor.
A history of diabetes during pregnancy (gestational diabetes) and giving birth to a baby weighing more than nine pounds are also significant risk factors. You can calculate your risk with a user-friendly online tool provided by the American Diabetes Association.
Testing. Most people are unaware they have diabetes or prediabetes unless they are tested for it. The same tests are used to detect both conditions:
Hemoglobin A1c test, a blood test that estimates your average blood sugar for the last three months;
Fasting blood sugar test, which checks your blood sugar at a single point in time after you fast overnight;
Oral glucose tolerance test, which indicates how much your blood sugar, increases a certain amount of time after you drink a sugar solution.
At your next physical, ask your doctor if you should be tested, and he or she will determine which one is right for you.
Doctors might be arguing over the best blood sugar target for patients with diabetes, but they all agree on one thing: The earlier you catch elevated blood sugar, the easier it is to turn back the clock.
It has been clinically proven that those with prediabetes who participate in a structured lifestyle change program can drastically reduce their risk of developing type 2 diabetes — by 58% or more. In fact, the U.S. Centers for Disease Control and Prevention (CDC) is recognizing and promoting such programs, and Medicare will start covering them in mid-2018.
Lifestyle changes include eating healthier, getting more physical activity, and decreasing stress. The key is integrating these changes into your daily life, rather than, say, going on a crash diet or occasionally taking an intense exercise class.
Some people with prediabetes can also benefit from a generic medication called metformin, which has been in use for decades. An inexpensive drug with few side effects, it is recommended in combination with lifestyle changes to help prevent diabetes.
Tips for Success
Changing your eating habits, activity levels and daily routine can be difficult. Here are a few tips that may help you succeed:
Join a lifestyle change program. Learn to build new habits with the support of a group of people with similar goals. You can find a class near you through the CDC website. The YMCA also offers diabetes prevention programs across the country.
Partner with a professional. Working with a health coach or dietitian can be very helpful in making prudent and lasting changes in your diet. Check in with them, even if it is just a phone call for 15 minutes once a week, to set goals and discuss barriers. I recommend taking photos of everything you eat and drink, and sharing them at your first meeting.
In addition, people who associate comfort with food may benefit from seeing a mental health professional who can help them find healthier ways to stimulate the reward center in the brain.
Focus on physical activity. Increasing your physical activity doesn’t necessarily mean going to the gym. Choose an activity that you can work into everyday life, like brisk walking. For instance, if you take public transportation, get off one stop early and walk the rest of the way. If you drive, park in the farthest part of the parking lot. If you have a favorite TV show, watch it at the gym or on your treadmill, rather than on the couch while snacking.
When it comes to exercise, working out with a personal trainer or exercise buddy, such as a friend or neighbor, can help motivate you and keep you on track. In addition to getting cardiovascular exercise, it is important to build muscle mass when possible, as muscle burns calories even when you are at rest. If you suffer from knee or ankle pain while walking or doing other weight-bearing exercise, try swimming instead, which is easier on the joints.
By altering your lifestyle now, you can improve your health for years to come as you stave off diabetes and lower your risk for deadly hearts attacks, strokes, and other devastating conditions.
In my experience as a diabetes specialist, I have found that you are more likely to succeed if you make just one change at a time.
Ronald Tamler, MD, PhD, is Medical Director of the Mount Sinai Clinical Diabetes Institute and Associate Professor of Medicine (Endocrinology, Diabetes and Bone Disease),
Icahn School of Medicine at Mount Sinai
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