Prediabetes means a person has a higher than normal blood sugar level, but it is not yet high enough to be considered type 2 diabetes. According to the CDC, approximately 96 million American adults—more than 1 in 3—have prediabetes (PD). Of those individuals with prediabetes, more than 80% do not know they have it. If untreated, 37% of the individuals with prediabetes may have diabetes in four years. This condition significantly increases the risk of developing type 2 diabetes, kidney damage, and cardiovascular diseases. So, prediabetes is a serious business indeed!
Three tests help to confirm the diagnosis of prediabetes or diabetes: a fasting blood glucose level, an oral glucose tolerance test, and the A1C (which measures your average blood glucose level over the past two or three months),
Test Results Speak Volumes:
Fasting blood sugar:
- Normal: less than 100 mg/dl
- Prediabetes: 100 to 125 mg/dl
- Diabetes: 126 mg/dl to 124
- Normal: less than 5.7%
- Prediabetes: 5.7-6.4%
- Diabetes: 6.5% or greater on two occasions
Oral Glucose Test
- Normal: Less than 140 mg/dl
- Prediabetes: an OGT test 2 hours (after eating) of 140-199 mg./dl
- Diabetes: Any value over 200 mg/dl.
*Please note: Kidney disease, liver disease, anemia, early and late pregnancy, and certain medications reduces the accuracy of the A1C test. Thyroid medications decreases the accuracy of the A1C test. For individuals who have these conditions, the authors recommend using two different tests instead of just repeating the A1C test. Two consecutive tests or two different tests are needed to confirm the diagnosis of diabetes.
- Impaired glucose test previously
- Being 45 or older
- Having a family history of diabetes
- Being overweight, especially having belly-fat
- Having a waist size greater than half your height
- Being sedentary
- Having high pressure and/or elevated triglycerides, or low levels of HDL cholesterol
- Having/had gestational diabetes or a baby weighing 9 pounds or more at birth
- Blacks, Latinos, Asians, Pacific Islanders, Native Americans, and natives to Alaska have a higher risk for diabetes.
Additional risk factors not commonly mentioned include sarcopenia (loss of skeletal muscle mass and strength), liver inflammation, a low level of vitamin D, and heavy alcohol consumption.
Dangers from Prediabetes
Just as diabetes impacts virtually every body system and many vital organs including the heart, brain, kidneys, and liver, prediabetes also compromises many organs and systems. Prediabetes increases one’s risk for the risk of unwanted blood clots, stroke risk, chronic kidney disease, and cardiovascular diseases. In other words, you do not have to develop frank diabetes to be in serious trouble. Even though one might not have any noticeable symptoms with prediabetes, trouble is brewing. Over time, prediabetes:
- Impairs the ability of blood vessels to dilate
- Damages both large and small blood vessels
- Increases risk for heart attack and stroke
- Damages kidneys as indicated by protein in the urine
- May lead to the development of neuropathy, or disease of the nerves, eventually leading to numbness, tingling, and burning sensation in your extremities, slowing of reflex, and muscle atrophy
- Greater risk of brain shrinkage that occurs with aging and diseases such as dementia
- Increases the risk for cancer by 15% 1
Fully developed diabetes accelerates, intensifies, and increases the risk of the above conditions even more.
Prediabetes Harms the Brain
In a study consisting of 500,000 individuals (average age 58) with blood sugar levels in the prediabetes range were 42% more likely to experience cognitive decline over an average of four years. They also were 54% more likely to develop vascular dementia over an average of eight years. People with diabetes, meanwhile, were three times more likely to develop vascular dementia than people who had normal blood sugar levels. They were also more likely to develop Alzheimer’s disease.2
Insulin Made Simple
Insulin is the hormone the pancreas makes that allows our bodies to utilize and store glucose. Insulin lowers blood glucose levels by helping cells in the skeletal muscle, adipose tissue, and liver to absorb glucose from the bloodstream. It stimulates the liver and muscle tissue to store excess glucose as glycogen. Additionally, insulin also lowers blood glucose levels by reducing glucose production in the liver. Insulin also promotes the entry of amino acids and fatty acids into the cells. Whatever hinders insulin from performing its jobs is doing a disservice to the entire body because each cell needs fuel (glucose) to function properly and suffers when deprived.
Compromised Insulin Efficiency
When our fasting blood glucose (sugar) level begins to rise to prediabetes levels, the doctor may refer to it as insulin resistance, a condition in which the body produces insulin but does not use it effectively. When people have insulin resistance, glucose builds up in the blood instead of being absorbed by the cells, leading to prediabetes or type 2 diabetes. What do the experts say causes insulin resistance? In simple terms, excess weight and lack of exercise significantly contribute to this condition. Saturated fats and trans fats are two dietary culprits that damage insulin receptors. Excessive amounts of cortisol can do it also. Belly fat plays an important role in insulin resistance and is more than just a storage area for future fuel. It produces hormones and inflammatory agents that can cause serious health problems such as insulin resistance, high blood pressure, elevated cholesterol, and cardiovascular disease.
To compensate for this problem, the pancreas releases more insulin. However, this does not help because the problem is that the insulin receptors on the cells are damaged. Unfortunately, excess insulin (especially if other cardiovascular factors are present) accelerates the process of atherosclerosis, increases the risk of cancer, and makes appetite more challenging to control. Eventually, the pancreas’ beta-cells that manufacture insulin become dysfunctional.
Lifestyle Changes Help!
Professor Guangwei Li presented the results from the 23-year follow up of the Da Qing Diabetes Prevention Study. It showed that people with impaired glucose tolerance who followed improved lifestyle interventions had significantly reduced death rates from cardiovascular disease and all-causes, compared to those patients in a control group.3 Professor Nick Wareham of Cambridge University, UK, and author of a linked comment on the study, describes the results as “a real breakthrough, showing that lifestyle intervention can reduce the risk of long-term cardiovascular consequences of diabetes.”4
Weight Loss Helps Prediabetes.
Weight loss helps to reduce the risk for developing diabetes in individuals who are obese. If one is obese, just losing 5-7% of his body weight is definitely helpful even if one does not reach his ideal weight. A 200 pound man could lose 10 to 15 pounds and reduce his risk substantially. This is certainly achievable.
One study suggests a 58% reduction of prediabetes progression to diabetes on a program consisting of a healthful diet, regular exercise, and a 5-7% weight loss.5 If these lifestyle changes are not within your grasp, consider coming to Wildwood Lifestyle Center where a professional staff will make an achievable, tailor-made program that will help to reverse your prediabetes and improve type 2 diabetes.
Enjoy a Whole Food, Plant-Based Diet!
As for lifestyle strategies, a healthful, plant-based diet and consistent exercise remain the cornerstones in diabetes prevention and treatment. Meat-eaters have a significantly higher risk of developing diabetes, compared with people who avoid meat.6 7 In contrast, a well-balanced, plant-based, high fiber diet (whole grains, whole fruits, vegetables, legumes, nuts and seeds) combined with exercise helps to reduce elevated glucose levels even when not accompanied by weight loss. At least six studies have demonstrated that a vegetarian diet improves A1C.8
Prediabetes and diabetes increase the risk of cardiovascular disease. Several studies show that consumption of a vegetarian diet is associated with lower blood pressure.9 Plant-based diets―i.e., eating patterns that emphasize legumes, whole grains, vegetables, fruits, nuts, and seeds and discourage most or all animal products―are especially potent in preventing type 2 diabetes. They have been associated with much lower rates of obesity, hypertension, hyperlipidemia, cardiovascular mortality, and cancer. 10 Additionally, a whole food, plant-based diet suppresses inflammation.11 so common in obesity, prediabetes, diabetes, and hypertension.
Researchers from Loma Linda University examined 8,401 participants (ages 45-88 years) and followed them for 17 years.12 They discovered:
- Subjects who were weekly consumers of all meats were 29% more likely to develop diabetes than those who ate no meat.
- Subjects who consumed any processed meats (salted fish and frankfurters) were 38% more likely to develop diabetes.
- Long-term adherence (over a 17-year interval) to a diet, that included at least weekly meat intake, was associated with a 74% increase in odds of diabetes relative to long-term adherence to a vegetarian diet (zero meat intake).
- Although some of this might be attributable to obesity, the researchers found that, “even after control for weight and weight change, weekly meat intake remained an important risk factor.”
When adopting a vegetarian diet, be sure to keep your B-12 and vitamin D levels within good (not low normal) range.
Replacing meat with refined grains and carbs is counterproductive. Brown rice is much better than white rice as far as blood sugar goes, Intact grains (such as whole oats, barley, bulgur or cracked wheat, quinoa, and millet) improve blood sugar levels. Whole-grain bread made with more intact and coarsely ground whole grains reduced postprandial glucose in adults with type 2 diabetes than whole-grain bread made with finely milled whole grains.13
Eat Whole, Low-Glycemic Fruits.
People who consume two servings of whole fruit (not fruit juice) per day have 36 percent lower odds of developing type 2 diabetes than those who consume less than half a serving.14 Emphasize whole fruits that have a low glycemic index score: apples, berries, cherries, grapefruit, oranges, pears, and plums. Avoid fruit juices and seriously limit tropical and dried fruits that have high glycemic index scores.
Watch the Fat!
We need to eat fats to live, but a high saturated fat diet activates immune cells to produce an inflammatory protein, called interleukin-1beta. It acts on tissues and organs such as the liver, muscle and fat (adipose) to turn off their response to insulin, making them insulin resistant.15
In contrast to saturated fats, monounsaturated fats help prediabetes and type 2 diabetes. A few studies show that incorporating almonds into the diets of participants with type 2 diabetes positively affected blood sugar and reduced the risk of cardiovascular disease.16 17 Unsalted nuts are the best because prediabetes increases the risk of heart disease and hypertension. It is much healthier to consume unprocessed nuts than the nuts with added salt and oil. Usually the serving size for nuts is 1/4 cup.
Pistachios are high in monounsaturated fats. In a controlled, cross-over study, prediabetic participants who consumed pistachios for four months reaped health benefits. Compared to the participants on the control diet, those who ate the pistachios had significantly lower fasting blood glucose levels and improved measurements for insulin resistance. Consistent pistachio consumption has the potential to reduce the risk for undesirable clotting seen in prediabetes.18
Go Easy on the Salt!
Everyone needs some salt for the nerves, heart, and muscle cells to function. Excessive sodium intake has been linked to increased risk for both type 2 diabetes and Latent Adult Autoimmune Diabetes (LADA).19 LADA is is a form of type 1 diabetes, in which an autoimmune process destroys the insulin-producing cells in the pancreas.
Unlike typical type 1 diabetes, it occurs in adulthood instead of in childhood, As mentioned in our last chapter, prediabetes increases the risk of chronic kidney disease. Excessive salt intake has been consistently linked to worsening kidney function as well as increased risk for heart disease. Salt intake accelerated kidney scarring in rats with chronic kidney disease.20
Your Teeth Are More than for Smiles!
Periodontitis is associated with the prediabetic condition. Good control in prediabetic patients can reduce the severity of periodontal disease. Diabetes is a significant risk factor for periodontitis. The risk of periodontitis in diabetes will be greater if blood glucose control is poor.21
The relationship between diabetes and periodontal disease is bidirectional. Periodontal inflammation makes it more difficult to control blood sugar. Periodontal disease triples the risk of dying from heart and renal diseases in those who have elevated blood sugar! Treatment of periodontitis is associated with HbA1c reductions of approximately 0.4%.22
Move to Live!
Exercise just 30 minutes, five days a week, and improve your cells’ ability to respond to insulin. As you can tolerate include some mild weight training and resistant exercise. Fifteen minutes of interval training in which one alternated high intensity exercise with lower intensity exercise is particularly helpful if one can tolerate it. A short walk after each meal lowers the blood sugar just as effectively as one moderately paced 45 minute walk during the day.23 Moderate-intense exercise reduces the amount of fat stored around the heart, in the liver, and in the abdomen of people with type 2 diabetes mellitus. Additionally, moderate exercise reduces the risk of chronic kidney disease and inflammation—all of which are important for the individual who has either prediabetes or diabetes.
Losing extra pounds, regular brisk exercise, and a healthful diet significantly improve the chances of elevated blood sugar in prediabetes returning to normal levels and reducing cardiovascular diseases. You are important! Perhaps with all of life’s responsibilities, burdens, and perplexities, prediabetes crept up on you. Now is your day of opportunity. Grab it! C.S. Lewis observed. “You can’t go back and change the beginning, but you can start where are and change the ending.” What an encouragement! Too often, in the rush of life, we run on emergency-mode thinking. Now we need to breathe and devote some time to helpful self-care. You are definitely worth the investment!
The information in this article is educational and general in nature. Neither Wildwood Lifestyle Center, its entities, nor our blog contributors intend it to substitute for individual diagnosis, treatment, or counsel by a qualified health care provider or professional.
copyright 2023 by Wildwood Sanitarium, Inc.
- Huang Y. Prediabetes and the risk of cancer: a meta-analysis. Diabetologia, September 2014 DOI: 10.1007/s00125-014-3361-2↩
- University College London. “Prediabetes may be linked to worse brain health: People with prediabetes, whose blood sugar levels are higher than normal, may have an increased risk of cognitive decline and vascular dementia, according to a new study led by UCL researchers..” ScienceDaily. ScienceDaily, 11 February 2021. <www.sciencedaily.com/releases/2021/02/210211195335.htm>.↩
- Guangwei Li, Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: a 23-year follow-up study. The Lancet Diabetes & Endocrinology, 2014; DOI: 10.1016/S2213-8587(14)70057-9↩
- Diabetes Prevention Program, diabetes.niddk.nih.gov. Sept. 9, 2013↩
- Barnard N, Levin S, Trapp C. Meat consumption as a risk factor for type 2 diabetes. Nutrients. 2014; 6:897-910↩
- Snowdon DA, Phillips RL. Does a vegetarian diet reduce the occurrence of diabetes? Am J Public Health. 1985 May; 75(5):507-12. doi: 10.2105/ajph.75.5.507. PMID: 3985239; PMCID: PMC1646264.↩
- Yokoyama, Y. Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis. CardiovascDiagnTher. 2014 Oct; 4(5):373-82↩
- Hokoyama Y. Vegetarian diets and blood pressure: a meta-analysis. JAMA Intern Med. 2014 Apr; 174(4):577-87↩
- Dinu M, Abbate R, Gensini GF, et al. Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Crit Rev Food Sci Nutr. Published Online First: February 6, 2016. DOI: 10.1080/10408398.2016.1138447.↩
- Hardman, WE. Diet components can suppress inflammation and reduce cancer risk. Nutr Res Pract. 2014 Jun; 8(3): 233–240↩
- Katcher, HI. A worksite vegan nutrition program is well-accepted and improves health-related quality of life and work productivity. Ann NutrMetab, 2010; 56(4):245-52↩
- Joffe D. L. Processed Versus Intact Whole Grains and Glycemic Control. https://www.diabetesincontrol.com/processed-versus-intact-whole-grains-and-glycemic-contro↩
- Bondonno N. Associations between fruit intake and risk of diabetes in the AusDiab cohort. The Journal of Clinical Endocrinology & Metabolism, 2021; DOI: 10.1210/clinem/dgab335↩
- University of North Carolina School of Medicine. “Link between high-fat diet and type 2 diabetes clarified.” ScienceDaily. ScienceDaily, 26 April 2011. <www.sciencedaily.com/releases/2011/04/110411121539.htm>↩
- Almond consumption improved glycemic control and lipid profiles in patients with type 2 diabetes mellitus. Metabolism. 2011 Apr;60(4):474-9. doi: 10.1016/j.metabol.2010.04.009.↩
- Gulati, Seema et al. “Effect of Almond Supplementation on Glycemia and Cardiovascular Risk Factors in Asian Indians in North India with Type 2 Diabetes Mellitus: A 24-Week Study.” Metabolic syndrome and related disorders vol. 15,2 (2017): 98-105. doi:10.1089/met.2016.0066↩
- Hernandez-Alonso M. Beneficial Effect of Pistachio Consumption on Glucose Metabolism, Insulin Resistance, Inflammation, and Related Metabolic Risk Markers: A Randomized Clinical Trial. Diabetes Care. vol. 37:11, Nov. 1, 2014 https://diabetesjournals.org/care/article/37/11/3098/28838/Beneficial-Effect-of-Pistachio-Consumption-on↩
- “Sodium (salt) intake is associated with a risk of developing type 2 diabetes.” ScienceDaily. 14 September 2017. www.sciencedaily.com/releases/2017/09/170914210621.htm↩
- American Society of Nephrology (ASN). “Kidney-brain connection may help drive chronic kidney disease.” ScienceDaily. ScienceDaily, 29 January 2015. www.sciencedaily.com/releases/2015/01/150129185042.htm ↩
- Maboudi, A., et. al. (2019). Relation between Periodontitis and Prediabetic Condition. Journal of dentistry (Shiraz, Iran), 20(2), 83–89. https://doi.org/10.30476/DENTJODS.2019.44928 ↩
- Preshaw, P. M., et al, (2012). Periodontitis and diabetes: a two-way relationship. Diabetologia, 55(1), 21–31. https://doi.org/10.1007/s00125-011-2342-y↩
- A Short Walk After Meals Is All It Takes to Lower Blood Sugar, www.healthline.com › Healthline News June 12, 2013, Healthline Networks↩