DEAR DOCTOR K:
After years of normal blood sugar levels, I’m suddenly in the prediabetes range. Am I on an irreversible path to Type 2 (adult-onset) diabetes?
No, you’re not, but you’re facing a challenge. Prediabetes is an early warning signal: You are at higher risk for developing diabetes. But diabetes is not inevitable. In fact, we know more about how to reduce the risk of getting Type 2 diabetes than we know about preventing most other major diseases. There are several things you can do to reverse course.
Your blood glucose, or blood sugar, level was likely measured during routine blood work that was part of your physical exam. A normal blood sugar level is less than 100 mg/dL. You are considered to have prediabetes when your blood sugar level is between 100 and 125 milligrams per deciliter of blood (mg/dL) after an eight-hour fast. You have diabetes if your blood sugar is 126 mg/dL or higher.
If your blood test was done when you had not been fasting, then you might not really have prediabetes. It might be a false alarm.
Let’s start with a brief explanation of how your body breaks down foods. During digestion, carbohydrates are turned into simple sugars, primarily glucose. To provide energy to cells, glucose needs to leave the blood and get inside the cells.
Insulin, a hormone produced by the pancreas, signals the cells to extract glucose from the blood. When levels of glucose in the blood rise (for example, after a meal), the pancreas produces more insulin. That drives more glucose into the cells.
Type 2 diabetes occurs when your body’s cells do not react efficiently to insulin. As a result, not as much glucose is driven into the cells, and more stays in the blood. As glucose starts to build up in the blood, the pancreas makes extra insulin to maintain a normal blood sugar. The cycle escalates. Finally, the pancreas cannot keep up with the demand for more and more insulin. As a result, blood glucose levels remain elevated.
Prediabetes signals that the cells of your body are starting to have trouble extracting glucose from the blood. But you can still reverse course. Lifestyle changes are your best strategy.
If you are overweight, losing just 5 to 10 percent of your starting weight can help greatly improve your blood sugar. Eating healthy foods, but reducing the calorie count, is one part of this.
It’s also important to exercise regularly and stay physically active throughout the day. Even if it doesn’t help you to lose weight, regular physical activity will reduce your risk of getting diabetes.
If you’re a regular reader of this column, you won’t be surprised by this advice. I frequently urge a healthy lifestyle. But you may not realize just how powerful regular exercise, achieving a healthy weight and a healthy diet can be. Scientific studies of the strongest type — randomized trials — find that people can reduce their risk of developing diabetes by nearly 60 percent. No medicine yet developed can give you that protection.