Pre-diabetes? Me? Risks, Tests, and Lifestyle Change

By Kat Kleman

I’ve been very successful at ignoring the fact that I’m getting older. Hair dye and the good fortune of looking –or at least acting– a little younger than I am are a big part of this feat. And a steady diet of fast food, Chinese food, and pizza, with Denny’s and IHOP occasionally thrown in, hasn’t killed me, which has only enabled me in my denial.

Except,  as much as I don’t want to admit it, I am getting older. On my honest days, I can see 50 coming (ok, hurtling toward me at breakneck speed,) and I’m pretty sure I’m closing in on my lifetime threshold of fast food consumption, after which I will most likely spontaneously combust. As for exercise, well, I think about exercising a lot. That counts for something, right? All of these bad habits make me a likely candidate for being one of the 1 in 3 Americans with pre-diabetes.

Pre-diabetes is exactly what it sounds like. You have elevated blood sugar levels, but not full-on diabetes. Because the symptoms are not always obvious, 90% of people with pre-diabetes don’t even know it(or, like me, are avoiding knowing it!) With so many people unaware of pre-diabetes, it’s important to know some of the warning signs. People who are over 45 who don’t exercise regularly, are overweight, and/or have a family history or prevalence of diabetes are at a higher risk of having pre-diabetes, as are African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans. If any of these factors apply to you, talk to your doctor, who will give you a test to determine your blood sugar levels.

There are three different diagnostic tests you can take to confirm a diagnosis of pre-diabetes. The A1C test measures your average blood sugar levels over the course of the past 2-3 months. You can also take a test after fasting for 8 hours or two hours after a meal. Table 1 shows the results for each type of test.[2]

Test Normal Pre-diabetes Diabetes
A1C < 5.7% 5.7% – 6.4% 6.5% or greater
Fasting (mg/dl) < 100 100 – 125 126 or greater
2 hours after eating (mg/dl) < 140 140 – 199 200 or greater

Table 1: Comparison of the results of blood sugar tests.[3]

Not everyone with pre-diabetes  develops full-on-type 2 diabetes. However, 70% of cases do progress to type 2, and pre-diabetes comes with its own set of complications.  For example, pre-diabetes increases your risk of heart disease. Scientists at Wake Forest University discovered  that the risk of developing cardiovascular disease increased in. people with diabetes:  “. . . the risk for CVD [cardiovascular disease] ranged from 15 percent (non-diabetic) to 38 percent (diabetic) among women and from 21 percent (non-diabetic) to 47 percent (diabetic) among men.”[4] While there wasn’t an increased absolute risk for developing cardiovascular disease, because so many people with pre-diabetes end up with type 2 diabetes, the connection is there. Additionally, when you reach mid-life the risk of having diabetes and developing CVD increases even more.[5] The risk for stroke also increases in people with pre-diabetes. One study found the risk to be 21% higher, but that number varies depending on the definition of pre-diabetes. Regardless, the correlation is there.[6]

The good news in all of this is that pre-diabetes can be reversed or at least slowed down through diet and lifestyle change. If you’re overweight, losing even a small amount of weight can help (5-7% of starting rate, which would be 10-14 pounds for a 200 lb. person). Increasing your exercise to 150 minutes per week of brisk walking (or an equivalent activity) can change your risk for developing pre-diabetes[7]. Changes in diet such as eating more fruit, vegetables, beans, and whole grains can also lower the risk. Finally, avoiding sweets, fatty or fried food and refined carbohydrates like those found in white bread or pasta can actually slow down the progression of pre-diabetes[8]. The CDC’s National Diabetes Prevention Program has a lifestyle program to help make these changes; joining this program can reduce your risk of developing type 2 diabetes by 58%, or 71% if you’re over 60.[9]

Are you at risk for Pre-diabetes?

Many people with pre-diabetes are unaware of their condition. Here are some risk factors:

  • 45 years old or older
  • Overweight
  • Physically active less than 3 times a week
  • Close family members (mother, brother, sister) with type 2 diabetes
  • Having gestational diabetes or giving birth to a baby who weighed more than 9 pounds
  • Having polycystic ovary syndrome

If you have one or more of these risk factors, talk to your doctor about being tested for pre-diabetes.

Ok. I can check 2 of those boxes, and I know I’ve had some high blood pressure in the past. Combined with my not-so-stellar diet, I’m thinking it’s time to check in with my doctor. I’m not ready to give up pancakes for dinner just yet, but it’s definitely worth digging out the last decade’s worth of New Year’s resolutions and start making some changes.

[1] https://www.cdc.gov/diabetes/basics/pre-diabetes.html

[2] https://www.diabetes.org/a1c/diagnosis

[3] ibid

[4] https://medicalxpress.com/news/2019-01-early-pre-diabetes-cardiovascular-disease.html

[5] Ibid.

[6] https://www.medicinenet.com/script/main/art.asp?articlekey=159101

[7] https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/pre-diabetes-insulin-resistance#pre-diabetes

[8] https://www.lark.com/blog/2018/4/23/pre-diabetes-diet

[9] https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/pre-diabetes-insulin-resistance#pre-diabetes

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