Prediabetes: A Warning Sign You Shouldn’t Ignore

According to the CDC, one out of every three people has prediabetes. Yet, shockingly, 84 percent of them have no idea. Prediabetes is a pervasive problem that too often goes undiagnosed. Here’s what you should know about this significant threat to public health and how you can protect yourself and your loved ones against potentially dangerous complications and the progression to type 2 diabetes.

What is Prediabetes?

Prediabetes happens when the body doesn’t respond well to insulin—a condition that’s also known as insulin resistance. Insulin is a hormone made by the beta cells of the pancreas. Normally, insulin tightly controls the amount of sugar in our blood and helps regulate other materials, like blood lipid levels. By helping to move sugar from the bloodstream and into our cells, insulin plays a crucial role in the process of turning food into energy.

When blood sugar levels remain high because of insulin resistance, impaired beta-cell function, or a combination of both, this excess sugar causes damage throughout the body. High sugar levels are tough on delicate areas, like our eyes and nervous system. Instead of getting absorbed for use or storage, insulin resistance shifts blood sugar to be filtered out by the kidneys, leading to kidney damage that can be permanent.

Experts estimate that prediabetes is associated with a 70 percent chance of developing type 2 diabetes later in life. But it’s possible to intervene and reduce your risk once you know your numbers.

Measuring the Biomarkers of Prediabetes

Fortunately, your doctor can identify prediabetes using routine blood tests. The hemoglobin A1c test measures average blood sugar control over the past three months since that’s how long it takes for red blood cells to turn over (meaning the older cells die off and new cells are created). Glucose molecules circulating in the bloodstream attach to hemoglobin, a component of red blood cells. Measuring the percentage of hemoglobin with sugar on it, called glycosylated hemoglobin, provides a picture of how concentrated with sugar the bloodstream has been.

A hemoglobin A1c level below 5.7 percent is considered “normal.” Prediabetes can be defined as a hemoglobin A1c between 5.7 percent and 6.4 percent. If hemoglobin A1c gets to 6.5 percent or higher, it is considered diabetes. Like many health conditions, insulin resistance occurs along a continuum. It’s usually possible to move it one way or another based on your habits and, in some instances, the addition of insulin-sensitizing medications, like metformin.

A standard test used to detect gestational diabetes in pregnant women is the oral glucose tolerance test. During this test, women are advised to drink a sugary solution, and blood sugar is measured over the next few hours to see how quickly their levels return to the normal range. It’s also possible to measure fasting blood sugar levels, insulin levels, and the ratio of glucose to insulin in your body. These tests are used for various conditions, like polycystic ovary syndrome (PCOS).

Other assessment tools have been developed but aren’t as widely available outside of a research setting. “Clamp” techniques, such as the hyperinsulinemic-euglycemic clamp, are considered the gold standard assess insulin resistance. During clamp techniques, the healthcare provider administers intravenous insulin into the patient’s arm. Then, variable amounts of glucose are infused into the bloodstream while multiple blood samples are taken. Clamp testing helps show how well the body tissues can use insulin to absorb sugar and maintain normal blood glucose levels in real-time. The less glucose taken in by the tissues, the higher blood sugar levels remain, signifying greater insulin resistance.

Insulin sensitivity tests (IST) and insulin tolerance tests (ITT) provide a fixed amount of insulin, either as a continuous infusion over three hours or as an immediate one-time dose. IST also requires participants to be given a measured load of glucose. Blood sugar changes are observed using blood tests to assess the degree of insulin resistance during the testing period.

If you’re concerned about prediabetes, talk to your doctor to learn what tests are available to you. A fasting blood sugar test and hemoglobin A1c can be sufficient in many cases to see if there might be a problem. Along with lab results, a review of your medical history and lifestyle will paint a more complete picture of your risk for insulin resistance.

Understanding Your Risk Factors and Symptoms

Some risk factors for prediabetes are uncontrollable, but others aren’t. Non-modifiable risk factors include:

• Age: Being older than 45 
• Family history: Having a parent or sibling with diabetes
• Genetics: Certain mutations are likely to contribute to insulin resistance
• Personal medical history: A record of gestational diabetes or polycystic ovary syndrome (PCOS)
• Racial or ethnic background: Asian Americans, American Indians, African Americans, and Hispanics are considered higher-risk groups

Potentially modifiable risk factors include:

• Eating habits: Processed meats, saturated fat, and refined grains (lacking in fiber) can promote insulin resistance
• Sleep habits: Not sleeping enough or not getting good quality sleep raises the risk of prediabetes
• Smoking: Smoking tobacco increases the risk of diabetes and other health problems
• Waist size: Women with a waist over 35 inches and men with a waist size above 40 inches are more likely to have prediabetes

Changing your behavior and losing weight isn’t necessarily easy. But with the right tools and support, it’s possible to take control of your health. Unfortunately, most people don’t notice pre diabetes symptoms because they come on gradually and may start to feel “normal.” Signs that your body is trying to rid itself of excess blood sugar include increased thirst and urination. Blurry vision or fatigue can also point to a problem.

Another tell-tale sign of prediabetes is the appearance of dark patches on the skin called acanthosis nigricans. This is partly because higher insulin levels increase the production of skin cells, leading to patches of hyperpigmentation. Skin with acanthosis nigricans looks and feels different from the rest of the body. It’s darker, thicker, and has a velvety texture. The areas most likely to be affected include the hands, feet, back of the neck, groin, armpits, and skin folds. Insulin resistance is not the only cause of acanthosis nigricans, so it’s important to be evaluated by a medical professional before jumping to conclusions. Getting an official diagnosis can be a helpful first step towards making changes.

What to Expect After a Prediabetes Diagnosis

Every year, about 5 to 10 percent of people with prediabetes will end up progressing to type 2 diabetes. Some people assume that there’s nothing to worry about as long as you don’t get diabetes. However, prediabetes comes with its own set of risks that shouldn’t be underestimated.

Living with elevated blood sugar and insulin levels promotes systemic inflammation, a common denominator in several health problems. For example, insulin resistance raises the risk of heart disease, kidney disease, and other complications, including cognitive decline, non-alcoholic fatty liver disease, and breast cancer. Instead of just trying to delay diabetes, aim to target the underlying drivers of insulin resistance and lessen your degree of prediabetes.

If you’re one of the lucky people with prediabetes who actually gets diagnosed, see it as an opportunity to reach out for help. Ask your physician about diabetes counseling and education classes. Getting a referral to a physical therapist, personal trainer, dietitian, or social worker can provide you with the tools necessary to stop insulin resistance from negatively affecting your future. Take advantage of the resources available to you, including the support of healthcare professionals and other people facing similar challenges, to change the trajectory of your health and quality of life.

Significant Cost of Insulin Resistance

Diabetes is considered a global pandemic that impacts more than 400 million people. Serious consequences like infections, amputations, blindness, and kidney failure make it impossible for some people with diabetes to work or care for themselves. The rapid growth of diabetes and its associated complications have skyrocketed disability rates worldwide by 22 percent over the past decade. 

In the United States, Americans with diabetes have 2.3 times more healthcare costs than those without, amounting to $90 billion in lost productivity and $237 billion in direct medical expenses. That’s not counting the vast number of people with prediabetes, which is believed to cost individuals an extra $500 each year. The top five states for prediabetes are Hawaii, Nebraska, New Mexico, Florida, and Mississippi. Identifying prediabetes opens the door for early intervention to help reduce the physical and financial burdens.

What You Can Do

Prediabetes doesn’t have to seal your fate for a future with type 2 diabetes. Studies show that lifestyle changes can go a long way to preventing and sometimes even reversing the road to diabetes.

If you smoke or are overweight, addressing these two risk factors first will move you in the right direction. Increasing your physical activity level can also help boost insulin sensitivity. Experts recommend losing 5 to 7 percent of your body weight and getting your heart rate up for 30 minutes a day to make a measurable impact on your diabetes risk.

Even a seemingly minor change, like standing up more often, can make a big difference. Prolonged periods of sedentary behavior are strongly associated with insulin resistance, even if you work out. Replacing some of the time you usually spend sitting or lying down with standing, stretching, or walking leads to real metabolic benefits. 

In one study, interjecting two-minute walks after every 20 minutes of sitting improved insulin response and blood sugar control. Along with regular physical activity, think about creative ways to modify your environment to help you move more. For example, using a standing desk, putting a stationary bike in front of your television, or setting a reminder on your phone to take short movement breaks throughout the day can help you combat the hazards of a sedentary lifestyle.

Modifying your diet to require less insulin is another proactive way to reduce insulin resistance. Along with eating less saturated fat and refined sugar, it’s vital to consume protective compounds with antioxidant and anti-inflammatory properties. These include anthocyanins, resveratrol, isoflavones, quercetin, vitamins, and minerals. In addition, studies on curcumin, the active molecule in turmeric, show promising effects on blood sugar and lipids for people with insulin resistance.

Rather than looking to supplements, plant-based recipes with beans, nuts, soy, fruits, vegetables, spices, and olive oil help supply your body with an array of nutrients to support optimal functioning. Traditional dishes from Mediterranean and Asian countries incorporate many of these beneficial compounds in delicious and exciting ways that feel more like a treat than a sacrifice.

DishQuo Can Help

Prediabetes can serve as a vital wake-up call to take action for better health. Always remember, it’s not too late to turn things around. If you’re tired of deciphering mixed messages about nutrition, DishQuo takes the guesswork out of what to eat—offering tasty food options to fit your preferences. Don’t go it alone. DishQuo is your roadmap to circle back on the healthy track.

DishQuo offers a convenient meal plan app that can help you reduce stress and save time around what to eat each day. Have freedom around food and create a long-term healthy lifestyle. Sign up today and start your free, no commitment trial.

References

1. Bennasar-Veny M, Fresneda S, López-González A, Busquets-Cortés C, Aguiló A, Yañez AM. Lifestyle and progression to type 2 diabetes in a cohort of workers with prediabetes. Nutrients. 2020;12(5):1538. Published 2020 May 25. doi:10.3390/nu12051538
2. Centers for Disease Control and Prevention. Prediabetes – your chance to prevent type 2 diabetes. Updated June 2020.
3. Huang D, Refaat M, Mohammedi K, Jayyousi A, Al Suwaidi J, Abi Khalil C. Macrovascular complications in patients with diabetes and prediabetes. Biomed Res Int. 2017;2017:7839101. doi:10.1155/2017/7839101
4. MedlinePlus. Hemoglobin A1c (HgA1c) test. Updated August 2021.
5. Mayo Clinic. Prediabetes. Updated September 2020.
6. Medical University of South Carolina. Measuring insulin resistance.
7. Mirabelli M, Chiefari E, Arcidiacono B, et al. Mediterranean diet nutrients to turn the tide against insulin resistance and related diseases. Nutrients. 2020;12(4):1066. Published 2020 Apr 12. doi:10.3390/nu12041066
8. Pivari F, Mingione A, Brasacchio C, Soldati L. Curcumin and type 2 diabetes mellitus: prevention and treatment. Nutrients. 2019;11(8):1837. Published 2019 Aug 8. doi:10.3390/nu11081837
9. American Diabetes Association.  The cost of diabetes.
10. Berg S. American Medical Association. How prediabetes exacts a $43 billion toll on U.S. economy. Updated November 2019.
11. Diabetes UK. Sitting for long periods increases risk of type 2 diabetes. October 2012.
12. Pandarakalam JP. Acanthosis nigricans in pre-diabetic states. BJMP. 2018;11(1):a1105.