People with pre-diabetes live in that uncertain realm where one is not quite normal and not quite diabetic. Of course, the definition regarding who is and who is not a diabetic is arbitrary, and based on a strict numerical determination. A fasting blood sugar more than 125 milligrams per deciliter automatically puts you in the diabetes category, while a fasting sugar less than 100 mg per deciliter qualifies you as “normal” (at least where blood sugar is concerned). If you have a fasting sugar between 100 to 125 mg per deciliter, you fall in that no man’s land called pre-diabetes. To make it more confusing, diabetes can also be defined in terms of the blood sugar level 2 hours after ingesting 75 g of glucose (the fasting method is more commonly used). A level of at least 200 mg per deciliter renders you diabetic, while a level below 140 mg per deciliter confers normalcy. A level between 140 to 199 mg per deciliter earns the pre-diabetes designation. Researchers and physicians alike are concerned with this group of individuals because experience has shown that people with pre-diabetes are at increased risk of developing diabetes. In fact pre-diabetics have a six-fold increased risk of developing diabetes compared to individuals with normal blood sugars. Also, even among those pre-diabetics that do not develop diabetes, the risk of complications (kidney disease and eye disease are the most important) is increased. In 2007 the US Department of Health and Human Services estimated that 57 million people had pre-diabetes. It is obviously a huge public health issue.
Scientists are still working on the exact cause of pre-diabetes. However, several factors have been associated:
A family history of diabetes
Previous gestational diabetes
High blood pressure
African Americans, Alaskan Natives, Asian Americans, American Indians, Hispanics, Pacific Islanders
In terms of blood chemistry, people with pre-diabetes have been found to have a condition called insulin resistance. With insulin resistance, insulin has diminished effectiveness in transporting glucose from the bloodstream into cells. Glucose therefore accumulates in the bloodstream (resulting in higher blood glucose), while the cells may be relatively deficient in glucose, its chief source of energy.
The Diabetes Prevention Program was a study involving over 3,000 participants. The study participants were randomized into different groups: a group receiving intensive diet and exercise counseling, a group receiving the diabetes drug Metformin, a placebo group, and a group receiving the diabetes drug Rezulin. This arm of the study was discontinued because a high incidence of liver problems with Rezulin. The study found that the group who exercised and change their diet lowered their risk of developing diabetes by 58%, while the group that took Metformin lowered their risk of developing diabetes by 31 %. The lifestyle intervention group ate less fat and ingested less calories and exercised 30 minutes at a time at least 5 days a week and were able to lose 5 to 7 % of their body weight.
Our message here is simple
• About a quarter of US adults have pre-diabetes
• If you have not been tested, especially if you are in a high risk category, please get tested now
• Simple lifestyle changes, including modifying your diet and exercising about 2-1/2 hours per week can result in a significant reduction in your risk of developing diabetes.