Prediabetes

Prediabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes (i.e. a fasting plasma glucose level of 7.0 mmol/L or higher).

Normal fasting glucose- 70 – 100 mg/dl
Pre-Diabetes (impaired fasting glucose)- 101 – 125 mg/dl
Diabetes- 126 mg/dl or higher on 2 occasions

Although not everyone with prediabetes will develop type 2 diabetes, many people will. It is important to know if you have prediabetes as research has shown some long-term complications associated with diabetes, such as heart disease and nerve damage, may begin during prediabetes.

Like type 2 diabetes, prediabetes can occur without you knowing it, so being aware of your risks and being tested are important. This is especially true if you have prediabetes as part of the “metabolic syndrome,” meaning you also have high blood pressure, high levels of low-density lipoprotein cholesterol (the “bad” cholesterol) and triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C, the “good” cholesterol), and a tendency towards abdominal obesity. The risk for type 2 diabetes is higher as you grow older, so the Canadian Diabetes Association recommends screening by testing fasting plasma glucose for everyone once they reach age 40 and every three years after that. If you have risk factors that increase the likelihood of developing type 2 diabetes, you should be tested more frequently or start regular screening earlier.

Risk factors for type 2 diabetes
 Being 40 years of age or older;
 Having a close relative (parent or sibling) who has type 2 diabetes;
 Being a member of a high-risk population, such as those of Aboriginal, Hispanic, Asian, South
Asian or African descent;
 Having a history of impaired glucose tolerance or impaired fasting glucose;
 Having some evidence of the complications of diabetes, such as eye, nerve or kidney problems;
 Having heart disease, hypertension;
 Having a history of gestational diabetes mellitus;
 Being overweight, especially abdominal obesity and dyslipidemia

If you take steps to manage your blood glucose when you have prediabetes, you can delay or prevent type 2 diabetes from developing. You may be able to reduce blood glucose levels with simple lifestyle changes, such as increasing your physical activity and enjoying a healthy, low-fat meal plan.

Losing even a modest amount of weight (5 to 10 per cent of total body weight) through healthy eating and regular physical activity can make a huge difference in your health and quality of life. The effectiveness of lifestyle changes in preventing the progression to type 2 diabetes has been proven in two large studies: the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. Both of these studies showed that a low-calorie meal plan with reduced fat intake and moderate-intensity physical activity of at least 150 minutes per week resulted in a 58 per cent reduction in the number of people who progressed from prediabetes to diabetes over the next fouryears, even though weight loss was modest. When lifestyle changes are not enough to normalize blood glucose, at least two medications have been shown to be effective in preventing type 2 diabetes in people with impaired glucose tolerance or prediabetes: metformin, proven effective in the Diabetes Prevention Program, and acarbose, shown to be effective in another study called STOPNIDDM (non-insulin-dependent diabetes mellitus). If you have prediabetes, you are at increased risk for heart disease or stroke. Your doctor may also wish to treat or counsel you about cardiovascular risk factors such as tobacco use, high blood pressure and high cholesterol. The important thing to remember about prediabetes is that it doesn’t always lead to diabetes. Determining whether or not you have it gives you a chance to change your future to one that does not include type 2 diabetes.

Here are some tips on how to keep pre-diabetes from turning into diabetes:
1) Include daily physical activity: Because muscles use sugar/glucose for energy, activities like walking, bicycling and gardening help to lower your blood glucose. Aim for 30 to 60 minutes or more per day.
2) Lose weight if you are overweight: Extra body fat contributes to “insulin resistance” and pre-diabetes. Look for areas in which you can cut your calorie intake by 250 to 500 hundred calories per day. For example, you can:
• Reduce your portion sizes.
• Reduce your intake of high carbohydrate foods such as cookies, other desserts, bread, pasta, tortillas, rice, crackers, pretzels and chips.
• Choose calorie-free beverages in place of regular sodas, fruit juices, lemonade, “smoothies,” sweetened coffee and tea drinks, and alcohol.
• Choose low-calorie dressings or use regular salad dressing sparingly.
• Limit nuts to a small handful (1/4 cup or less) per day.
3) Reduce intake of carbohydrates: Because carbohydrates cause blood sugar levels to rise, carbohydrate intake usually needs to be reduced and spread evenly throughout the day.

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