Pre-diabetes
1. How the body works without diabetes:
Your body's primary source of energy is sugar (glucose). Sugar comes from breaking down carbohydrate foods. These foods include fruits, milk and yogurt, sweets, rice, pasta, beans, and starchy vegetables such as corn, potato, and green peas. When you have type 2 diabetes your body has a hard time changing the sugar from these carbohydrate foods into energy.
The following diagram shows how your body uses sugar for energy when you do not have diabetes:
Carbohydrate from the food you eat is broken down through your digestive system into sugar and released into your blood. The blood acts as the transportation system and carries the sugar to all the cells of your body. In order for sugar to move into the cells, insulin, which is produced by the pancreas, must be present. You can think of insulin like the key to the door of the cell. Insulin unlocks the door to the cell allowing sugar to move in and provide energy.
2. Pre-diabetes:
When you have pre-diabetes your body has a hard time using the insulin you produce. This is called insulin resistance. With insulin resistance the cells of your body do not easily recognize your insulin. If the insulin is not recognized, the door will not open and allow sugar to move from the blood into the cell. Sugar remains in the blood leading to higher than normal blood sugars.
For those with a family history of type 2 diabetes, weight gain and an inactive lifestyle can increase insulin resistance. As insulin resistance increases your body fights to maintain normal blood sugars. It does this by increasing the amount of insulin made in the pancreas. During this phase you may develop pre-diabetes (glucose intolerance). It is estimated that 41 million Americans aged 40 to 74 have pre-diabetes. The extra insulin helps for awhile but eventually your pancreas becomes tired and can no longer produce enough insulin to maintain normal blood sugars. At this point you may be diagnosed with type 2 diabetes.
Fasting blood sugar: 101-125mg/dl
Blood sugar after a 2 hour oral glucose tolerance test: 140-199mg/dl
4. Screening for pre-diabetes:
People that should be screened for pre-diabetes include:
- Overweight with one or more of these risk factors:
- Physically inactive
- History of impaired fasting glucose or impaired glucose tolerance
- Family history of diabetes
- Members of certain ethnic groups (including Asian American, African-American, Hispanic American, and Native American)
- History of gestational diabetes or had a baby weighing over 9 pounds
- Elevated blood pressure
- HDL cholesterol level (the “good” cholesterol) of 35 mg/dl or lower and/or a triglyceride level of 250 mg/dl or higher
- Polycystic ovarian syndrome (PCOS)
- Vascular disease
5. Treatment of pre-diabetes:
There is evidence that even though you have been diagnosed with pre-diabetes, you can reduce the risk of developing type 2 diabetes. The results of a large study published in 2001 (the Diabetes Prevention Program) showed that you can reduce this risk by 58% through modest weight loss and increased physical activity, such as walking 30 minutes a day.
What can I eat?
It's not so much "what" you should eat, but how much. If you are overweight, your first and foremost goal should be to lose weight. This means working with a registered dietitian to determine the quantity and type of food you should eat at each meal. One of the key issues in losing weight is controlling portion size.
Your dietitian will also direct you in how to cut down on the amount of fat because each gram of fat has more calories than a gram of carbohydrate or protein.
This means:
- Eating more foods that are broiled and fewer foods that are fried
- Choosing fish and chicken more frequently and lean cuts of beef
- Reducing the amount of butter and fat you use in cooking
- Re-organizing your meals so that you eat more vegetables, fruit and healthy starches, and less meat
Your dietitian will show you how you can continue to eat all the foods you love — but probably not in the same proportions as you have in the past. Having diabetes or having "pre-diabetes" does not mean that you can't eat certain foods. The solution isn't "avoid foods with sugar in them." Rather, you need to lose some weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or pie.
Physical Activity
Along with weight loss, your goal will be to increase your physical activity, especially if you aren't getting any regular exercise now. Why? Because physical activity will help you use the insulin you produce to change the food you eat into energy. This will help keep your blood glucose lower. Physical activity will also help reduce insulin resistance. If you have a small piece of cake with a meal, follow it up with a brisk walk.
