Prediabetes occurs when blood glucose levels are elevated, but not high enough to be classified as Type 2 diabetes. Receiving a diagnosis of prediabetes is significant, as many people fear developing diabetes but are unsure how to prevent it. Although not everyone with prediabetes will develop Type 2 diabetes, it is the optimal time to initiate dietary and lifestyle changes to help reduce the risk. By adopting healthy changes, your blood sugar levels might even return to normal. Numerous studies have shown that lifestyle modifications can prevent the onset of diabetes in more than 50% of cases.
Understanding Prediabetes
For individuals who have undergone a 75-gram glucose tolerance test, a blood sugar level between 140 mg/dL and 199 mg/dL two hours post-test indicates prediabetes. A level of 200 mg/dL or higher suggests diabetes. It's important to note that glycated hemoglobin (HbA1c) levels depend on the lifespan of red blood cells. In conditions such as anemia, iron deficiency, or increased red blood cell breakdown (hemolysis), this test may be unreliable. In such cases, monitoring blood sugar through fasting finger-prick tests and one hour post-meal, or a one-time connection to a continuous glucose monitor (CGM), might be advisable.
If fasting glucose is normal but HbA1c is elevated, it raises suspicion of elevated post-meal blood sugar levels. In such cases, a one-time CGM might be considered to assess glycemic responses to different foods, allowing for personalized dietary adjustments.
Causes of Prediabetes
The causes of prediabetes are similar to those of Type 2 diabetes, primarily insulin resistance and decreased function of beta cells that secrete insulin from the pancreas. Insulin resistance occurs when cells in muscle, fat, and the liver don't respond well to insulin, the hormone secreted by the pancreas that regulates blood glucose levels by moving sugar from the blood into tissues. When there isn't enough insulin, or the body doesn’t respond properly to it, high blood sugar levels result.
Several factors can contribute to insulin resistance:
- Excess body fat, especially around the abdomen and organs (visceral fat): Fat accumulation in the liver leads to fatty liver and insulin resistance at the liver level, resulting in increased sugar production by the liver and elevated fasting blood glucose levels. Fat deposited in the pancreas impairs beta cell function and decreases the ability to secrete insulin in response to rising blood sugar levels.
- Lack of physical activity.
- Overconsumption of processed foods high in carbohydrates and saturated fats.
- Use of certain medications: long-term use of steroids, antipsychotic drugs, and immunosuppressive drugs to prevent organ transplant rejection. To a lesser extent, blood pressure medications like beta-blockers and thiazides, and a 0.5% risk associated with statins.
- Genetics.
- Hormonal disorders: such as hyperthyroidism, Cushing's syndrome (excess cortisol), and acromegaly (excess growth hormone).
- Chronic stress and lack of quality sleep.
- Polycystic ovary syndrome (PCOS).
- History of gestational diabetes.
In rare cases, prediabetes can be pre-Type 1 diabetes (an autoimmune disease where the immune system destroys beta cells in the pancreas), more common in individuals without excess weight who have other autoimmune diseases (such as thyroid dysfunction, celiac disease, adrenal insufficiency, arthritis, inflammatory bowel diseases) themselves or among first-degree relatives. In such cases, there are now drugs that modulate the immune system and can slow and prevent the onset of Type 1 diabetes. It appears that even in the case of pre-Type 1 diabetes, reducing carbohydrate intake and regular physical activity are important.
Actions to Prevent Progression from Prediabetes to Diabetes
- Weight Loss: If you are overweight, losing 5% to 7% of your body weight can significantly reduce the risk of Type 2 diabetes. To maintain a healthy weight, focus on permanent changes to your eating and exercise habits. Weight loss leads to the disappearance of sugar from the liver, deep abdominal fat, and fat deposited in the pancreas. These changes improve insulin sensitivity in the liver and the pancreas's ability to secrete insulin. If there is significant excess weight, weight loss medications may be used, but it is important to understand that their use is chronic, and stopping them will gradually lead to weight regain.
- Healthy Eating: A diet rich in fruits, vegetables, nuts, whole grains, and fish reduces the risk of prediabetes. Significantly reduce the amount of simple sugars in your diet: sugar, cakes, cookies, snacks, pastries, sweets, ice creams, sodas, juices, or sweetened drinks. Choose foods high in dietary fiber.
- Carbohydrate Control: The amount of carbohydrates in your diet affects your blood sugar level. In the case of prediabetes, it is recommended to limit carbohydrates in meals to about 1/4 of the plate. For example, pasta, rice, potatoes, sweet potatoes, peas, corn, bread, rolls, challah, pitas, groats, and other grains or starchy vegetables. Prefer non-white flours. The increase in blood sugar following carbohydrate consumption is personal and varies from person to person, so sugar monitoring with a finger-prick test one hour after eating (target is not to exceed 155 mg/dL) or a one-time CGM connection can help identify foods that cause less blood sugar increase.
- Physical Activity: Exercise helps control weight, utilizes sugar for energy, and assists the body in using insulin more efficiently. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes per week of high-intensity activity or a combination of moderate and vigorous physical activity. Physical activity improves insulin sensitivity, an effect that lasts up to 72 hours after performing it.
- Strength Training and Muscle Mass: These help control blood sugar levels, as muscles increase insulin sensitivity, thus lowering blood sugar levels.
- Quitting Smoking: Can improve insulin function and blood sugar levels.
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