By: Dr. Anita Ramsetty
MIAMI – Part 1—What is it pre- diabetes and why is it important?
As you recall from last week’s review on diabetes testing, Pre-diabetes is that range of blood sugars where you are not completely normal but not yet a diabetic. The numbers will depend on the testing you have done. Pre-diabetes range is:
1) Between 5.5 and 6.9 mMol/L (100 and 125 mg/dL) fasting
2) Between 7.8 and 11 mMol/L (141-199 mg/dL) after a glucose tolerance test/glucose challenge.
It is thought that there are millions upon millions of people in the world walking around with pre-diabetes, just waiting to develop into full-blown diabetes during the next 10 years. As you can guess, most people with pre-diabetes are unaware of their condition because they have not been tested (in fact millions of people with diabetes are unaware of their diagnosis as well).
Why all the fuss? It is not yet diabetes, right? So why get worked up over it?
There are two main reasons why this is such a big deal in the medical community, fast becoming important in the public health sector, and to people on an individual basis. First, even though blood sugars are not very high during this pre-diabetes phase, some damage is already being done to your blood vessels during this phase.
That’s right, even this early. Over the years medical research has shown this through different kinds of tests. The amount of time someone spends in this pre-diabetes phase varies tremendously between individuals: you and your neighbor could both have pre-diabetes, but you become diabetic next year while he/she is still pre-diabetic 5 years later.
If this scares you a bit, good. If it does not, please think again. I have heard some interesting responses from patients over the years, but I am still amazed every time someone looks at me and says, “Well, we all have to die from something, Doc.” I have noticed that I routinely get this response from someone who has no desire to make the changes necessary to make their health better, and they use this philosophical approach as their excuse.
All I can do is shake my head in disappointment, because I know very well that if I was asking them to give up something they did not like, they would do it in a heart beat. Why am I bringing this up? Because pre-diabetes puts you at increased risk of heart disease in future, which means you are at increased risk of dying from this over the next several years. For all of you out there starting your “we all have to die of something” speech, let me ask you this:
If you got on a bus, having quite a nice ride, then the conductor turned to you and said, “By the way, at some time there is a good chance this bus will crash. I can’t tell you when or how. And I can’t say 100%, but you have a higher chance of crashing on this bus than that other one behind us.”
Truly, how many of you would stay on that bus, instead of getting off and going to the one behind, with the smaller chance of crashing? Answer honestly.
WHEN you decide to get off that bus (I am confident that you will decide your life is worth this effort), there are good options. Cont’d next week
Part 2: Slowing, or stopping, the pre-diabetes train
The second reason your doctor will get serious-talking with you about pre-diabetes is that it can be completely reversible. How many disease states are reversible once the train has left the station? Not many. But this is one, and for many people this can be a lifesaver.
A few years ago a research study came out that made everyone very excited. Some of you may have heard of this because it was all over the news: it was called the Diabetes Prevention Program. They enrolled a few thousand people with pre-diabetes and split them into three groups. One group was the “lifestyle” intervention group, meaning they had to decrease the amount of fat and calories in their diets, exercise at least 150 minutes per week, and aim for weight loss of 7% of their current weight(for the average person weighing about 150 pounds, this means loss of around 10 pounds). They had dietary counseling to assist. The second group was also told to exercise and change their diets (they did not have counseling though) and placed on a diabetes medication called Metformin (Glucophage).
For those of you interested, this medication is the most widely prescribed diabetes medication, and is also based on a plant used in the old days (interesting, eh? I thought so). The last group was not told anything, and not given any medications—so they went about their regular business.
Research found (drum roll please): The group with lifestyle changes decreased their chances of becoming diabetic by almost 60%. Remember, all they had to do was decrease their weight by 7% with exercise and diet changes. This cut their risk by more than half! The group on medication also did very well, with their risk dropping by 31%. The group that went on their merry way without changing anything of course had no benefits.
So my lesson to you is clear: with some changes in your life and diet, you can change the course of your health very dramatically. Not drastic; maybe walk an extra 25 minutes a day, have an orange instead of sweet bread at lunch, and water instead of juice at dinner. Use less oil to fry your plantain. I am not asking you to have lettuce and water all day.
It is not 100% guaranteed, but all the odds are vastly in your favor that you will benefit. It is like a scratch card sitting on the table waiting for you to win the lottery. So ask your doctor to test you for pre-diabetes, and if you have it, start working on it. No more excuses–You can do this!
Anita Ramsetty MD
Medical Director, Endocrine Care Group
www.endocrinehelp.com
[email protected]
