As a recently diagnosed prediabetic, you likely have questions. What does all of this mean, exactly? What types of dietary changes should you make? Can you ever eat sugar again?
It can be a bewildering time, especially if your diagnosis caught you by surprise, as mine did.
In this post, I offer some definitions and a glimpse at what can happen if your prediabetes progresses, along with a few notes about my experience.
NOTE: Your first source for answers should be a medical professional, whether a doctor or dietitian. I’ve written this blog series to act as a sort of supplement to medical advice and a reference you can consult as needed but it is not intended as a replacement for medical advice.
Type 1 vs. Type 2 Diabetes
You may have heard the terms “type 1” and “type 2” used in reference to diabetes. Both affect insulin, the hormone your body uses to control the level of sugar in your blood, but the two types of diabetes are quite different:
- Type 1 is considered an autoimmune disease that affects the pancreas and its ability to make insulin. Research into the causes of type 1 is ongoing but, at this point, there is no way to prevent it. Type 1 is far less prevalent than type 2, affecting about 5-10% of people who have diabetes. (Source:HealthLinkBC)
- Type 2 diabetes occurs when the body cannot use insulin in the right way. It develops insulin resistance – that is, a state where the sugar in blood “is not able to enter the cells where it should get used for energy.” (Source: Diabetes Canada) As type 2 diabetes progresses, the pancreas may make less insulin, leading to insulin deficiency. Type 2 is the most common form of diabetes, affecting 90-95% of individuals who have diabetes. (Source: HealthLinkBC)
Prediabetes occurs when blood sugar levels are elevated, but not to the level where type 2 would be diagnosed. Not everyone who is prediabetic will develop type 2 diabetes, but without taking steps to manage their blood sugar, many will.
The importance of treating prediabetes cannot be understated. According to Diabetes Canada:
If your body can’t use its insulin properly, glucose (sugar) builds up in your blood instead of being used for energy. This excess sugar in your blood causes problems and can lead to serious health complications…It’s important to take a prediabetes diagnosis seriously because some long-term complications associated with diabetes—such as heart disease—may begin during prediabetes.
For a visual on how your body uses insulin, watch the video at the bottom of MyHealthAlberta’s insulin resistance page.
No Warning Signs
In its earliest stages, prediabetes does not typically come with warning signs which is why it is so important to get regular blood tests, especially if you have any of the following risk factors: being overweight or over age 40, having high blood pressure or high cholesterol, or having a family history of type 2 diabetes. For a full list of the risk factors, visit Diabetes Canada or HealthLinkBC.
Diabetes Canada recommends that you be tested every three years if you are over the age of 40 or more frequently if you have any of the risk factors.
A1C and Fasting Blood Glucose
If you have prediabetes, you’ll hear a lot about A1C and fasting blood glucose tests, both of which are used to assess blood sugar levels and diabetes risk.
An A1C test does not require fasting, as it looks at average blood sugar levels over the previous two to three months, not the immediate period before the test.
It’s important to understand the time frame of the A1C, especially if you are of the mindset that I was when I was first diagnosed. Like a kid trying to cram for an exam, I would spend a week or so eating well and exercising, hoping that would move the needle.
It did not.
(Please note that my point here is not that there are better ways to cheat the A1C but that prediabetes is not “solved” by improving numbers on one blood test. The required changes take effort and long-term commitment to eating better and exercising more.)
A1C is given as a percentage: normal is less than 6.0; prediabetes is 6.0% to 6.4%; 6.5% or higher indicates diabetes.
My first A1C score was 6.5%, clearly in the diabetes range. It was the fasting blood glucose test that designated me as prediabetic rather than diabetic – a very narrow escape and a wakeup call for me.
As the name implies, the fasting blood glucose test requires a fast of at least 8 hours beforehand. (If you also need a lipids test for cholesterol, that fast is 12 hours. Be sure to check your requisition and all fasting requirements the day before you head to the lab.)
Measurements of blood sugar from this test are done in mmol/L. A fasting blood sugar result of 7.0 mmol/L indicates diabetes. While I don’t have the results from my first blood test, my subsequent fasting blood glucose results, taken over three years, are all around 5.0. My highest score was 5.5 which I found alarming despite it being normal, but it has come down since then.
There are other types of diabetes screening tests but the A1C and fasting blood glucose are commonly used to assess prediabetes and type 2. If you have a test result that indicates type 2 diabetes, your doctor will likely order another test to confirm.
Associated Health Concerns
If left untreated, prediabetes can develop into type 2 diabetes. And if that happens, you will have an increased risk of heart attack and stroke, kidney disease, nerve damage, and vision problems that can lead to blindness.
As the saying goes, an ounce of prevention is worth a pound of cure. That is definitely the case with prediabetes. Taking steps to prevent its progression can potentially save you from far more serious and debilitating illness.
I will talk about prevention in subsequent posts, but before I do that, I’ll consider prediabetes through the lens of women in the menopausal years, when their risk increases. As a woman who has gone through that transition and been diagnosed as prediabetic, I want to share what I know so other women will become aware of the risks and the steps they can take to mitigate them.
To read this entire series, visit the Prediabetes Series page.
Disclaimer: I am not a dietitian but have worked with one to learn all I can about prediabetes. I have also done a lot of my own research, from valid sources like Diabetes Canada and books and news articles written by dietitians and doctors. I am speaking here of my own experience and nothing I say should be taken as a substitute for advice from a medical professional. Always consult with a doctor or dietitian before making any lifestyle changes for prediabetes or any other condition.
Photo of sugar cubes by Mae Mu on Unsplash.