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Taking Control of Pre-Diabetes

Say you’re shoveling coal into a boiler that runs a steam train. The train isn’t going anywhere, so the coal isn’t being used to power the locomotive. The boiler is already full, but you keep on shoveling. The engineer keeps turning up the heat in the boiler to burn all that coal, but eventually the machine can’t keep up and starts to break down.

This is a very simplified description of what happens to a person with diabetes or pre-diabetes.
Dr. Matthew Davies, an endocrinologist at Swedish Medical Center, puts it this way. We are living a relatively sedentary lifestyle. We have a high calorie/high carbohydrate diet. This means we are “trying to stuff sugar and other carbohydrates into muscles that are already full.” We need more of the hormone insulin to help glucose (digested sugars and carbohydrates) enter the cells and be used for energy. “Eventually, the pancreas can’t make all of the insulin the person needs and begins to wear out,” Davies says.

The pancreas either ceases to produce enough insulin or the body ceases to use the insulin correctly (insulin resistance). Glucose then builds up in the bloodstream where it can be measured with blood tests. A person with high levels of blood sugar is diagnosed with type 2 diabetes. A person with blood sugar levels higher than normal, but not as high as the threshold for full-blown diabetes, has pre-diabetes.

Diabetes is a train wreck for the body. The excess glucose can attach to proteins in the blood vessels and alter their normal structure and function. One effect of this is that the vessels become thicker and less elastic, making it hard for blood to squeeze through. If blood sugar levels are not controlled, a diabetic person is two to four times more likely to suffer heart disease or stroke than a person with normal blood sugar. She is more susceptible to blindness, kidney disease, nerve damage and circulatory problems, which, in the worse case, can lead to infections and amputations.

It is a disease to be avoided at all costs, and yet its incidence has been steadily rising, in tandem with a rise in the number of people who are overweight or obese. Presently, 23.6 million Americans — about 7.8 percent of the population — have diabetes.
This doesn’t sound so bad until we consider three other statistics:

  • One in three Americans born in the year 2000 will develop diabetes if current trends continue, according to a U.S. Centers for Disease Control and Prevention (CDC) report.
  • 54 to 57 million of us — that’s one in four adults — have pre-diabetes. This level has risen over the past 20 years, partly because more of us are overweight and partly because guidelines have become stricter.
  • People with pre-diabetes are five to 15 times more likely to develop diabetes than the general population, depending on their genetic makeup. For many people, it will occur within 10 years.

The good news is that “progression to diabetes in not inevitable,” according to the CDC. The onset can be delayed or even prevented. In comparison with many diseases, “the patient with pre-diabetes or diabetes has a lot of control,” says Dr. Paul Anderson, a Seattle naturopath and associate professor of pharmacology and clinical medicine at Bastyr University. He is a diabetic and has been able to “step back” from dependence on insulin and drugs through diet and exercise.

The experts we talked to all repeated the same statistic from the landmark 2002 Diabetes Prevention Program study sponsored by the National Institutes of Health: Just 30 minutes a day of moderate physical activity combined with a 5 to 7 percent reduction of body weight (7 to 11 lbs. for a 150-lb. woman) produced a 58 percent reduction of diabetes onset among people with pre-diabetes.

Here are answers to frequently asked questions about pre-diabetes.

How is Pre-Diabetes Diagnosed?

Three blood tests may be used to determine borderline high glucose levels. A fasting plasma glucose (FPG) test measures the milligrams of glucose in each deciliter of blood plasma after the person has fasted for at least eight hours. An oral glucose tolerance test (OGTT) measures blood glucose levels up to five times over a period of three hours, and involves a baseline blood count and tests after drinking a glucose solution.

The new “gold standard” is the glycated hemoglobin/A1C test, which measures glucose attached to hemoglobin, a protein found in red blood cells. The non-fasting test uses a single blood sample to get a reading of sugars in the blood over the past two to four months.

As the medical profession’s understanding of diabetes has improved, the benchmark for healthy glucose levels has shifted. Levels that are now labeled pre-diabetic used to be considered good blood sugar levels. “Sadly, what we believed to be good blood sugar control a little over a decade ago led to many patients not being diagnosed early enough and developing the unwanted effects of diabetes,” notes Anderson.

Should I Be Tested for Pre-Diabetes?

Yes, if you are older than 45 and/or you are overweight or obese. If the blood sugar levels are normal, you should be retested every three years.

Because pre-diabetes often occurs in tandem with high blood pressure and abnormal cholesterol levels, you should be tested if you have either of these conditions. The National Diabetes Information Clearinghouse, part of the National Institutes of Health, also suggests that you get tested if you have:

  • a parent, brother or sister with diabetes
  • a family background that is Alaska Native, American Indian, African American, Hispanic/Latino, Asian American or Pacific Islander
  • a history of cardiovascular disease
  • other clinical conditions associated with insulin resistance, such as acanthosis nigricans,
  • a condition characterized by a dark, velvety rash around the neck or armpits
    polycystic ovary syndrome
  • had gestational diabetes or gave birth to a baby weighing more than 9 pounds
  • had impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) on a previous test.

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