It’s estimated that one out of every three of us in the United States has prediabetes—”a condition where if you don’t change your lifestyle or diet or reduce weight, you’ll eventually become a full diabetic,” said Dr. Rene Harper, an endocrinologist at Augusta University Health.
Are you at risk?
While there are no early signs of prediabetes, your inclination to eat sugary snacks, processed foods and the wrong kind of carbs are a risk factor. Not exercising doesn’t help either. If your BMI is more than 25, you’re also at risk—and, for women, if you had gestational diabetes during pregnancy.
One factor that many may not know about is family history—if say, your mother, father, brother or sister have diabetes. Having more than one family member with diabetes may not increase your chance of developing the disease, although it may mean shared environmental factors have come into play.
“Obviously, the risk may increase if you as a family eat the same food, and you live in the same environment watching TV all day and not exercising,” Harper said.
And—lucky us—where we’ve all chosen to live also makes a big difference: Augusta is right in the middle of a swath of Southeastern states where the prevalence of smoking, stroke, heart disease and obesity are all higher than the rest of the nation. All of these are closely linked with having diabetes.
About gestational diabetes: Maternal obesity is an important risk factor for gestational diabetes; women who are obese or severely obese before pregnancy are four and eight times more likely to develop the disease. A family history of diabetes and previously having a large baby are also important risk factors. If your glucose screening or a glucose tolerance test indicates that you do have gestational diabetes, then your physician will work with you on a management plan, which could include medications or insulin therapy. The good news is that after birth, gestational diabetes may go away—although moms who have had the condition are now at higher risk for diabetes.
Know your risk—then cut it in half
Think you might be one of those three at risk for prediabetes? The first step is to get screened. Three blood tests are available: The A1C and fasting blood glucose tests are most commonly done, but your doctor may also perform a two-hour glucose tolerance test. If your A1C falls between 5.7 to 6.4 percent or your fasting glucose is 100 to 125 mg/dL you have prediabetes. Higher results mean that you can be clinically diagnosed as diabetic.
However, whether you’re prediabetic or have full-blown diabetes, you can actually turn back the clock by doing one thing: losing weight.
“The American Diabetes Association recommends an initial weight loss target of about 5 to 10 percent,” Harper said. “So if you are 250 pounds, that’s between 10 to 25 pounds. Losing weight may reduce your risk of diabetes by about half.”
A healthy diet that reduces carbs and calories and increases protein and vegetables, along with exercise for 30 minutes a day at least five days a week (aiming to increase heart and respiratory rate) are key. Just know this: It’s the combination of the two—diet and exercise—that are the most effective. In other words, you can’t just starve, then sit all day and expect to see a difference in your weight.
“It’s very easy to recommend these steps, but they can be very hard to implement,” Harper admitted. “What I tell patients is, don’t give up. If you slip up, then try again, and as long as you keep trying to reduce calories in your diet and burn more through exercise, you should lose some weight. Make 5 percent weight loss your target and start there.”
One medication, metformin, can help manage blood sugar levels for prediabetics, diabetics and women with gestational diabetes. It may be recommended in particular if you are a prediabetic who has failed the diet and lifestyle modifications, or if you are obese.
If you fall into the category of being extremely obese—a BMI above 35 if you are diabetic or have another major chronic illness, or a BMI above 40 without those conditions—then bariatric surgery should be considered, said Harper.
“I’ve been amazed,” Harper said. “Some very obese patients who have fully established, insulin-resistant diabetes and are using hundreds of units of insulin a day, after bariatric surgery and losing 80 to 100 pounds, have been able to come off all insulin therapy—from several hundred units to zero.”
So yes, even if you have been diagnosed with diabetes, it’s possible to reverse it—which is something you can’t say about most chronic diseases.
“I call it remission—I don’t want to say ‘cured’,” Harper said. “Then it becomes vitally important to maintain those changes to your diet and lifestyle over time. Although your family history is important—you can’t get rid of that—it’s your lifestyle that really makes the difference. Eating healthy and staying physically active provides a huge benefit.”