Pre-Diabetes and Insulin Resistance: Heading Diabetes Off at the Pass
Published December 2008 / Reviewed November 2010
A touch of sugar? Borderline diabetes? Impaired glucose tolerance? It's been called many things, but officially it's known as "Pre-diabetes".
It may be helpful to think of diabetes as a progression that begins with insulin resistance and related metabolic disorders. Left unchecked, the stage is set for the development of pre-diabetes and eventually type 2 diabetes. The result is not only high blood sugar, but also an increased risk for heart disease. Fortunately, there's a lot you can do to reduce these risks. Dietary changes and increased physical activity can go a long way toward improving your health and decreasing risks.
A Problem of Resistance
Insulin resistance may develop because of genetics and lifestyle habits, and results when muscle, fat and liver cells don't use insulin properly. The pancreas compensates by producing more and more insulin, keeping blood glucose in check for a time. Eventually, the pancreas will not be able to keep up with demand, and blood sugar levels will begin to rise. This is why people with insulin resistance may have high levels of blood glucose and high levels of insulin circulating in their blood at the same time.
When blood sugar levels begin to exceed normal levels, it is called pre-diabetes. Pre-diabetes is becoming more common in the United States, according to new estimates provided by the U.S. Department of Health and Human Services. About 40 percent of U.S. adults ages 40 to 74—or 41 million people—had pre-diabetes in 2000. New data suggest that at least 57 million U.S. adults had pre-diabetes in 2007.
Studies show that most people with pre-diabetes will go on to develop type 2 diabetes within 10 years, but the good news is that lifestyle changes may help reduce the risk. The Diabetes Prevention Program (DPP) was able to demonstrate that type 2 diabetes can be reduced in this population with modest weight loss (about 5-7 percent of starting body weight), and through increased physical activity (about 30-45 minutes daily).
The Resistant Heart
People with insulin resistance and pre-diabetes often have other conditions, such as elevated LDL (bad)-cholesterol, low HDL (good)-cholesterol, high triglycerides, high blood pressure and obesity. Together, these factors increase the risk of heart disease, and are referred to as metabolic syndrome.
Metabolic syndrome is defined by the National Cholesterol Education Program as the presence of any three of the following conditions:
•excess weight around the waist (waist measurement of more than 40 inches for men and more than 35 inches for women)
•high levels of triglycerides (150 mg/dL or higher)
•low levels of HDL, or "good," cholesterol (below 40 mg/dL for men and below 50 mg/dL for women)
•high blood pressure (130/85 mm Hg or higher)
•high fasting blood glucose levels (110 mg/dL or higher)
Source: National Cholesterol Education Program, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), National Heart, Lung, and Blood Institute, National Institutes of Health, May 2001.
Testing for Pre-diabetes
Anyone 45 years or older should consider getting tested for diabetes. If you are overweight and aged 45 or older, it is strongly recommended that you get tested. You should also consider getting tested if you are younger than 45, overweight, and have one or more of the following risk factors:
•family history of diabetes
•low HDL cholesterol and high triglycerides
•high blood pressure
•history of gestational diabetes (diabetes during pregnancy) or gave birth to a baby weighing more than 9 pounds
•minority group background (African American, American Indian, Hispanic American/Latino, or Asian American/Pacific Islander)
A fasting blood glucose test will show if pre-diabetes is present.
Less than 10 -->Normal
100- 125 -->Pre-diabetes
126 and higher -->Diabetes
An A1c test or a single blood test that can give a picture of "average" blood sugar over a three month time is also now diagnostic for diabetes and pre-diabetes...
4.0 to 5.6 - normal
5.7 to 6.4 - pre-diabetes
6.5 and above - diabetes
Preventing Type 2 Diabetes
People who are at risk can prevent or delay the onset of type 2 diabetes through lifestyle changes. Losing weight and becoming more physically active are important steps. According to the National Institutes of Health's Diabetes Prevention Program (DPP), lifestyle changes can reduce the risk of type 2 diabetes by 58 percent and return pre-diabetes fasting numbers back to normal range.
A medication called "metformin" was also studied as part of the Diabetes Prevention Program, but it did not prevent type 2 diabetes as well as lifestyle changes.
Staying Active and Eating Right
Here are general tips to lose weight, improve blood sugar, and control cholesterol and blood pressure.
1) Use the plate method to rein in portion sizes. About one half of your plate should contain vegetables, such as cooked veggies and salads. One quarter should contain a protein, such as lean meats. The remaining quarter will hold a starchy food: potatoes, rice, pasta, etc.
2) Go lean with lower fat choices. Select low fat or fat-free milk, cheeses and other dairy foods, leaner cuts of meats with an emphasis on white varieties, and fewer fatty snack foods and desserts.
3) Focus on whole foods, such as whole grain breads and cereals, fresh fruits and vegetables, beans and nuts. These high fiber foods will fill you up, are more nutritious and may help you lose weight.
4) Spare the salt, since less sodium and more healthy minerals (calcium, magnesium and potassium) may improve blood pressure.
The DASH (Dietary Approaches to Stop Hypertension) diet gives complete menu ideas that pull all of these thoughts together. Sponsored by the National Institute of Health, their website offers tips, recipes and meal plans to put your plan into action.
Most of us don't get enough physical activity. Desk jobs, computers and video games occupy much of our day.
Get moving with your favorite activities, such as walking briskly, riding a bike or swimming for 30 minutes at least five days a week. This will aid with weight loss, improve how muscle cells use insulin, and lower blood pressure and cholesterols levels.
Jean M. Bauch, RD, CDE
Director Unity Diabetes Center and Unity Cardiopulmonary Rehabilitation. Jean is a graduate of Rochester Institute of Technology with a degree in Nutrition and Dietetics. She has over 25 years experience in nutrition counseling and diabetes management. Currently, Jean manages Unity Diabetes Center, which employs a board certified endocrinologist and a team of diabetes and nutrition educators.
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