Pre-Diabetes

Are you one of the estimated 41 million people in this country who have pre-diabetes?

If you have pre-diabetes, you are at high risk of developing type 2 diabetes and also are at increased risk of developing heart disease. Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be classified as full-blown diabetes. Those with pre-diabetes are at increased risk of developing type 2 diabetes within a decade unless they adopt a healthier lifestyle that includes weight loss and more physical activity.

First, let's define what "pre-diabetes" is and is not. Diabetes is defined as having a fasting plasma blood glucose level of 126 mg/dl or greater on two separate occasions. If diabetes symptoms exist and you have a casual blood glucose taken at any time that is equal to or greater than 200 mg/dl, and a second test shows the same high blood glucose level, then you have diabetes.

In general, people who have a fasting plasma blood glucose in the 100-125 mg/dl range are defined as having impaired fasting glucose. If your doctor gives you an oral glucose tolerance test, and at two-hours your blood glucose is 140-199 mg/dl, you have "impaired glucose tolerance." Either of these is medical terminology for what your doctor is probably referring to when he says you have "pre-diabetes." Be sure to ask your doctor what your exact blood sugar test results are when he tells you that you have "pre-diabetes." Some physicians are not as familiar as they should be with the new national guidelines for diagnosing diabetes. They may be telling you that you have pre-diabetes, when in fact you have actual diabetes.

Among those who should be screened for pre-diabetes include overweight adults age 45 and older and those under age 45 who are overweight and who have one or more of the following risk factors:

are habitually physically inactive
have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
have a family history of diabetes
are members of certain ethnic groups (including Asian American, African-American, Hispanic American, and Native American)
have had gestational diabetes or have given birth to a child weighing more than 9 pounds
have elevated blood pressure
have an HDL cholesterol level (the “good” cholesterol) of 35 mg/dl or lower and/or triglyceride level of 250 mg/dl or higher
have polycystic ovary syndrome
have a history of vascular disease

That all said, if you have pre-diabetes diabetes, what should you do? Results of a large U.S. nationwide study released in August 2001 showed that even if you are at risk for developing type 2 diabetes, you can reduce your risk by 58% through sustained modest weight loss and increased moderate-intensity physical activity, such as walking 30 minutes a day.

What Should I Eat?

It's not so much "what" you should eat, but how much. If you are overweight, your first and foremost goal should be to lose weight. This means working with a Registered Dietitian to determine the quantity and type of food you should eat at each meal. One of the key issues in losing weight is controlling portion size. Your dietitian will also direct you how to make food choices that cut down on the amount of fat you eat because each gram of fat has significantly more calories in it than a gram of carbohydrate or protein. This means:

eating more foods that are broiled and fewer foods that are fried.
cutting back on the amount of butter you use in cooking.
eating fish and chicken more, and only lean cuts of beef.
eating more meatless meals, or re-orienting your meals so that your dinner plate has more vegetables, fruit and starches on it, and less meat.

Your dietitian will show you how you can continue to eat all the foods you love — just probably not in the same proportions as you have in the past. Having diabetes or having "pre-diabetes" does not mean that you can't eat certain foods. The solution isn't "avoid foods with sugar in them." Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or pie.

Physical Activity

Along with weight loss, your goal will be to begin program of physical activity, if you aren't getting regular exercise now. Why? Because physical activity will help you use the insulin you produce to convert the food you eat into energy. This will help keep your blood glucose lower. If you have a small piece of cake with a meal, follow it up with a brisk walk.