Basics of diabetes, prediabetes, and blood sugar

Glucose is a form of sugar, which all the cells in your body need to function. Insulin is a hormone that tells cells to take up glucose from the bloodstream. The pancreas is an organ in your abdomen that produces insulin. In type II diabetes and prediabetes, the body becomes resistant to the action of insulin, so the pancreas has to work harder to make more insulin. Eventually, the pancreas fails, and there is not enough insulin to signal the body to use glucose. As a result, blood glucose levels rise, eventually causing damage to blood vessels and various organs.

What is prediabetes?

Prediabetes is a state where the body has started to become resistant to insulin. As a result, blood sugars are slightly elevated. It is exactly what it sounds like – a condition that occurs before you develop full blown type II diabetes. Your doctor may call it “impaired fasting glucose” or “impaired glucose tolerance” or “metabolic syndrome,” but the important thing is, at this point, you can still reverse the process and prevent diabetes! Your pancreas is still pumping out insulin (possibly more than normal) and if you can limit how hard it has to work, it can recover. Prediabetes is reversible, and type II diabetes is preventable!

“How do I know if I have prediabetes?”

Most people don’t have any symptoms of prediabetes, just like hypertension. That is why testing is important. The easiest tests to perform are a fasting plasma glucose (blood sugar after an overnight fast) and a hemoglobin A1c level. The hemoglobin A1c, or HgbA1c measures how much sugar is attached to the hemoglobin in your red blood cells. Since red blood cells last a few months in your body, the HgbA1c estimates your average blood glucose over the last 2-3 months. The numbers below are the cutoffs for diagnosis:

Keep in mind that normal values only mean that you are ok right now. You could still develop prediabetes or diabetes in the future. If you have any family history of type II diabetes, it puts you at significant risk for developing diabetes (I call this pre-prediabetes).

Having a family history of diabetes = “pre-pre-diabetes”, because it is such a powerful risk factor.

– Doctor T

If you have a family history, it would make a lot of sense to follow the same preventative measures as someone with prediabetes. Obesity is the biggest preventable risk factor for diabetes. Other risk factors include: sedentary lifestyle, tobacco use, high blood pressure, abnormal cholesterol, and a history of gestational diabetes (diabetes during pregnancy).

“Why should I care?”

Anyone with prediabetes or risk factors for diabetes (especially a family history), should be very concerned. Diabetes is a life-altering diagnosis, requiring medications (often via injection), frequent blood sugar checks (via fingersticks), and terrible complications, such as heart attacks, strokes, blindness, kidney failure, and vascular disease that can lead to amputations.

Fortunately, diabetes can often be prevented. The most important step is weight loss. Fat cells make the body resistant to insulin. Shedding the fat will make your body more responsive to insulin, so your pancreas doesn’t have to work so hard. The second thing that can help is avoiding carbohydrates. This is almost redundant, since weight loss strategies nowadays often involve carbohydrate restriction. Additionally, exercise has been associated with a decreased risk of developing type II diabetes. Aerobic activity alone leads to fat loss, but also leads to muscle loss. Since muscle utilizes glucose, weight training is important to help maintain muscle mass and decrease insulin resistance.

Of course all of these things are easier said than done. Stay tuned to the blog for a wealth of posts on strategies to achieve weight loss, improve nutrition, and increase activity!