Prediabetes: Can You Control What Comes Next?

Managing diabetes is a daily routine for about 30 million Americans. But upwards of three times that number of adults have blood sugar levels higher than they should be. If you’re among them, your doctor may describe it as “prediabetes.”

UR Medicine endocrinologist Dr. Steven Wittlin explains prediabetes and the risks it poses, and offers advice on steps you might take to prevent it from progressing into Type 2 diabetes.

Health Matters: What is prediabetes and how is it diagnosed?

Wittlin: Prediabetes is identified when your blood sugar level is higher than normal, but not high enough to meet the threshold for a Type 2 diabetes diagnosis. It means that your body isn’t processing sugar, or glucose, effectively, causing sugar to build up rather than fueling cells.

It’s a silent condition, identified by a simple blood test. However there are several risk factors, including: being overweight and over 45 years old, family history of diabetes, hypertension, poor sleep habits and late-night snacking, and polycystic ovary syndrome. It is commonly identified in people of African American, Hispanic, Native American, Asian American and Pacific Islander descent.

There are two common blood tests your primary care doctor may recommend to detect prediabetes: the hemoglobin A1c test, which shows the average blood sugar level for the past three months, or a fasting blood sugar test, which requires at least eight hours of fasting before a blood sample is taken.

Health Matters:  How is prediabetes treated? Can I stop it from becoming diabetes?

Wittlin: Physicians often recommend a combination of healthy lifestyle changes—such as diet, exercise and weight loss—and medications to lower the blood sugar level to optimal range and hopefully prevent the condition from advancing to diabetes. 

• Eat healthy foods. Choose fruits, vegetables and whole grains in an effort to follow a low-fat, low-calorie diet. The Mediterranean-style diet is ideal.
• Boost your daily activity. Aim for 30 to 60 minutes of moderate exercise at least five days a week. Walking into and out of the office isn’t exercise. Consider a brisk daily walk, riding your bike or swimming laps. The American Diabetes Association also recommends resistance training, such as weightlifting, twice a week.
• Lose excess pounds. Dropping 5 to 10 percent of your body weight can reduce the risk of developing Type 2 diabetes. The changes in your diet and exercise can jumpstart weight loss. However, working with a nutritionist or athletic trainer can help you focus on changing your habits, rather than being on a “diet.”
• Take medications. Your physician may prescribe metformin if your risk of developing diabetes is high. This oral medication is well-tolerated and effective. Other less common medications have been used to prevent diabetes as well.

Following the recommendations for diet, exercise and weight loss will have many health benefits beyond controlling your blood sugar levels. You’ll also improve your heart health, lower your blood pressure and cholesterol levels, and even boost your quality of life and self-esteem.

Health Matters: How will I know if my prediabetes has transitioned to Type 2 diabetes?

Wittlin: You may not know, since the shift from prediabetes to onset of diabetes is not obvious. Many people don’t have common diabetes symptoms—increased thirst, frequent urination, fatigue and blurred vision—for years. However, if you do, contact your doctor because ignoring them can wreak havoc on your body. It contributes to cardiovascular and kidney disease, nerve damage, foot pain, and vision and hearing loss.

If you’re in treatment for prediabetes, your physician will conduct annual tests of your blood sugar levels. If diabetes is the diagnosis, you will need to work closely with your care team to learn to manage the disease and live a full life.

Steven Wittlin, M.D., is clinical director of endocrinology and director of the Diabetes Service at the University of Rochester Medical Center. He specializes in new modalities of diabetes therapy with an emphasis on insulin pumps and continuous glucose monitoring.