Pre-diabetes is a metabolic condition that affects millions of people worldwide, often, with them being unaware of it.
It is typically described as a warning signal from the body to tell you that your blood sugar (glucose) levels are higher than normal, but not yet high enough to be classified as full-blown diabetes.
The medical term used in this instance is impaired glucose tolerance or impaired fasting glucose.
While pre-diabetes may not sound as serious as diabetes, it is a crucial phase that should not be ignored as if it is left unaddressed, it will progress to type 2 diabetes.
Type 2 diabetes is a metabolic disorder that is characterised by insulin resistance and high blood sugar levels.
With insulin resistance, the body does not respond well to the hormone insulin, which transports glucose from the blood to the body’s cells.
Thus, the condition makes it harder for the cells in the body to utilise glucose for energy.
Excessive body fat, especially around the abdomen, is a primary contributor to insulin resistance.
Type 2 diabetes typically develops over time and is a result of a combination of genetic and lifestyle factors, including poor dietary choices, sedentary habits and obesity.
Beware of these
The risk factors for pre-diabetes are the same as those for type 2 diabetes.
Common ones include a family history of diabetes; overweight or obesity; age over 45 years; physical inactivity; a diet high in processed food, sugar and unhealthy fats; and high blood pressure.
Women who had diabetes during pregnancy (i.e. gestational diabetes) or who have polycystic ovarian syndrome (PCOS) are also at an increased risk of pre-diabetes and diabetes.
Pre-diabetes usually does not present with any noticeable symptoms, which is why it is sometimes referred to as a “silent” condition.
However, some individuals may experience subtle signs that could indicate the presence of pre-diabetes.
These include:
- Increased thirst and hunger
- Frequent urination, particularly during the night
- Fatigue (as the body is not efficiently using glucose for energy)
- Blurred vision (as changes in blood sugar levels can affect the lens of the eye)
- Darkened skin, or acanthosis nigricans (often on the neck, armpits, or groin, and is mainly associated with insulin resistance).
It is important to recognise that these symptoms are not unique to pre-diabetes and can be caused by various other factors.
Nevertheless, it is a red flag that should prompt you to get tested to see if you might have pre-diabetes.
Testing for pre-diabetes (and diabetes) involves a blood test to measure your blood sugar levels.
There are a few common tests that healthcare professionals use to diagnose pre-diabetes.
This test is done after an overnight fast, typically for about eight hours.
It measures your blood sugar level in the morning before you have breakfast or any other food.
A fasting blood sugar level between 5.6 to 6.9 mmol/L is indicative of pre-diabetes.
The HbA1c test provides an average of your blood sugar levels over the preceding three months.
It is accurate and convenient as it does not require an overnight fast.
A HbA1c level of between 5.7% to 6.3% is indicative of pre-diabetes.
For this test, an overnight fast is required with the blood sugar levels being measured in the morning before you have breakfast.
After the initial fasting blood sugar test, you will be given a sugary solution to drink.
Your blood sugar levels will then be tested again after a period of time – usually two hours after drinking the solution.
An OGTT result showing a blood sugar level between 7.8 and 11 mmol/L suggests the diagnosis of pre-diabetes.
In most cases, a random blood sugar test may be used as a preliminary screening tool, particularly if you are experiencing symptoms indicative of pre-diabetes or diabetes.
If a random blood sugar reading is higher than 11 mmol/L, then your healthcare provider would recommend further tests, such as those mentioned above, to confirm if you have pre-diabetes or diabetes.
Path to reversal
The comforting news is that pre-diabetes is essentially reversible through lifestyle changes.
The idea is to achieve and maintain normal blood sugar levels without the need for medication.
It is crucial to work with a healthcare provider, such as your primary care doctor or a registered dietitian, to develop a personalised plan for managing and potentially reversing pre-diabetes.
The steps that your healthcare provider may advise you on include:
Adopting a healthier eating pattern is essential.
Aim for a well-balanced diet, with a focus on whole grains, lean proteins, fruits, vegetables and healthy fats.
Limit the intake of sugar and processed foods.
The Mediterranean diet, low-carbohydrate diets and plant-based diets have been shown to be effective in managing blood sugar levels.
Excess body fat is a major cause of insulin resistance.
Weight loss, achieved through a balanced diet and increased physical activity, can help improve insulin sensitivity.
Losing even a modest amount of weight, such as 5-10% of your current body weight, can have a significant impact on reducing your blood sugar levels, and thus, reversing pre-diabetes altogether.
Aim for gradual, sustainable weight loss.
Regular exercise helps lower blood sugar by increasing insulin sensitivity.
A combination of aerobic exercises and strength training is recommended.
Aim for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.
Start slow and gradually increase the intensity and duration of the workouts.
Regularly check your blood sugar levels and record it down.
Also list down the foods you have consumed, particularly on a day when your blood sugar level is higher than usual.
This is a good way to track your progress and will aid in making any necessary changes to your diet.
This is a crucial component of diabetes care, although it tends to be frequently overlooked.
During a period of stress, the body releases stress hormones such as cortisol and adrenaline, which cause the fight-or-flight response.
These hormones can cause blood sugar levels to rise, which can be a problem for individuals with pre-diabetes, especially if stress is a chronic issue.
Stress can also lead to insulin resistance.
Relaxation methods such as deep breathing, meditation and yoga, can help to reduce stress and manage emotions.
This, in turn, will help you maintain better blood sugar control.
It is important to remember that reversing pre-diabetes is an individualised path; there is no single method that fits all individuals.
Nevertheless, it is an achievable goal in order to prevent the onset of full-blown type 2 diabetes, which may eventually require you to go on medication to control your blood sugar levels.
But do remember that you should always consult with your healthcare provider before making significant lifestyle changes.
Dr Harpreet Kaur is a consultant internal medicine physician. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this article. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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