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    The Most Important Things You Need To Know About Prediabetes

    What is prediabetes

    Disclaimer: The information provided is meant to be educational and should not be incorporated as a treatment plan for prediabetes without consultation with your own primary care provider

    Prediabetes is a condition in which blood sugar levels are elevated, indicating that diabetes could develop if lifestyle interventions are not made. One in three Americans have prediabetes, and up to 80% are unaware that they are prediabetic as there are typically no symptoms. In this blog post, you will glean a better understanding of what prediabetes is, what risk factors are associated with prediabetes, and how to modify your lifestyle in order to reverse prediabetes.

    What Causes Prediabetes?

    To be diagnosed with prediabetes, lab work is needed. Those at risk for developing prediabetes include patients who are overweight, physically inactive, 45 years or older, have a family history of type 2 diabetes, or have a history of diabetes during pregnancy. These risk factors often indicate that annual screening is needed to assess for prediabetes.

    The labs used to diagnose prediabetes are blood sugar and a lab called a hemoglobin A1c (sugar average over about 3 months). A fasting blood sugar between 100-125 mg/dl or a hemoglobin a1c between 5.7-6.4% is considered to be in prediabetic range.


    What Are The Chances Of Prediabetes Turning Into Diabetes?

                Insulin is a hormone produced by the pancreas that is needed to utilize and store sugar in the body for energy. If there are persistently high sugars in the bloodstream, the body then puts out a higher level of insulin, and over time, becomes resistant to that insulin.

    Insulin resistance is what then leads to prediabetes and, without intervention, type 2 diabetes. Excess carbohydrate, sugar, and processed food intake increase insulin production and, if done consistently, results in obesity, prediabetes, and eventually type 2 diabetes.


    What Are The Warning Signs Of Prediabetes?

    As there is progression from being overweight, to prediabetes, and then to diabetes, more function of the pancreas is lost, making the condition harder to reverse. Therefore, it is important to take action as early as possible with lifestyle modifications to have a better chance at reversal.

    Those with diabetes are at higher risk for heart disease and stroke and are more susceptible to developing nerve damage, kidney disease and infections. In addition to these conditions, diabetes results in high medical expenses.

    Prediabetes is a warning sign that, without intervention, diabetes will develop. Therefore, it should be taken seriously with immediate lifestyle intervention.


    Can Prediabetes Go Away?

                Prediabetes can be prevented by lowering insulin levels so that the body does not become resistant. This is done by decreasing snacking and specifically decreasing intake of high glycemic foods, carbohydrates, processed foods, refined grains, sugar, and sugary beverages. This is the first, and perhaps most important, step in prevention.

    By cutting back or cutting out these food groups, one can greatly decrease the chance of developing prediabetes.

    In addition to improving nutrition, incorporating an exercise regimen, such as walking for 30 minutes daily to meet a goal of about 150 min/week, can also be helpful in reducing the risk of prediabetes.


    What Should I Avoid Eating If I Am Prediabetic?

    Prediabetes can often be prevented through a diet that promotes the lowering of insulin levels.

    A well portioned and balanced diet full of vegetables, fiber, healthy protein and fats, and fruits is ideal to prevent prediabetes. Carbohydrates can still be eaten when trying to prevent prediabetes but they should be limited and kept to earlier in the day, if possible.

    Eating three balanced meals a day, without snacking, will help keep food off the mind and make meal prep less complicated.

    Frequent snacking can lead to overeating and become inconvenient for those on the go. We often think we are having a small healthy snack but, in reality, we are consuming more calories than necessary. For example, when snacking on almonds, we can easily exceed the recommended portion and consume calories that would be equivalent to an entire meal.

    When we snack throughout the day, especially when snacking on carbohydrates and sugary foods, we continually keep our glucose and insulin levels elevated, thus promoting insulin resistance and prediabetes.

    Sticking to foods lower on the glycemic index (see table 1), eating three balanced meals daily, and avoiding snacking will promote steady sugar and energy levels throughout the day, decreasing the chance of developing prediabetes.

    Mohammad Asif - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977406/
    Image obtained from: The Prevention and Control the Type-2 Diabetes By Changing Lifestyle and Dietary Pattern

    When Should I Eat?

    Incorporating a “time-restricted eating” pattern can also help in preventing prediabetes.

    Time-restricted eating is when there is a designated eating window or time in which all meals are eaten.

    It is different from intermittent fasting in that those on a time-restricted plan still eat daily. It is recommended to start with a 10 hour eating window (e.g. 8a-6p) and work up to a 6-8 hour (e.g. 10a-4p or 10a-6p) eating window over time. 

    Drinking water and staying well hydrated throughout the day, especially while fasting, is important. During a fasting period, plain coffee and tea are also permitted. The idea is to have nothing with sugar or calories that would require breakdown by the body.

    This practice can be done a few times a week or every day if desired. The most important aspect is to allow the body a resting period, especially at night.

    Keeping the eating window early helps prevent raising of insulin levels before bed, allowing for more restful sleep and a better fasting period.

    A fasting period allows our body rest, decreases inflammation and oxidative stress, and utilizes stored sugar and fat in the liver for energy. If we continue to snack throughout the day and have carbohydrates and sugars in excess, the body will keep storing that sugar in the form of fat, leading to metabolic disease, prediabetes, and ultimately type 2 diabetes. 


    How Can I Monitor My Progress?

    There are more ways to monitor progress than just body weight. Evaluating prediabetes must involve evaluation of sugar levels. Your provider may suggest purchasing a glucose monitor or checking the a1c every 3-6 months, depending on your levels and your individual risk factors.


    Steps To Getting Started

    1. Establish care with a primary care provider and obtain baseline lab work
    2. Set your health goals with your primary care provider
    3. Lower your carbohydrate intake and eliminate high glycemic foods and processed foods from your diet
      1. Easy to do with this free resource!
    4. Incorporate time-restricted eating and an exercise regimen
    5. Make a plan to check in on your progress regularly

    Conclusion

    You are ultimately in control of your own health, especially as it pertains to obesity and diabetes. Be honest with yourself, ask for help, and make a step by step plan for how you will achieve your goals and prevent or reverse your prediabetes.

    Understand that it takes time, a lot of trial and error, and self-compassion.

    Do not berate yourself for small mistakes or overwhelm yourself by making a long list of everything you think you have to do to lose weight.

    Make one decision, make a plan, and choose it every day.


    Want To Learn More?

    I recommend reading The Obesity Code and The Diabetes Code, written by Dr. Jason Fung which goes into further detail. You can also check out the journal articles listed in the references list for more scientific information!

    Need Self-Discipline And Accountability?

    Join the 12 Week Weight Management Program to prevent or reverse your Prediabetes!


    About The Author

    Kate Dowling, PA-C is a Family Medicine Physician Assistant, practicing outside of Philadelphia, who has a passion for counseling her patients on nutrition to prevent or reverse prediabetes and type 2 diabetes.

    She graduated undergrad from Penn State with a degree in Psychology/Neuroscience and continued her studies at Thomas Jefferson University to become a Physician Assistant.

    She is also currently studying to become a Certified Specialist in Obesity and Weight Management.


    References:

    (2020, January). Prediabetes – Your Chance To Prevent Type 2 Diabetes. Centers for Disease Control and Prevention.Retrieved from: https://www.cdc.gov/diabetes/basics/prediabetes.html

    Asif, M. (2014, February). The Prevention and Control of type-2 diabetes by changing lifestyle and dietary pattern. Journal of Education and Health Promotion. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977406/

    Tello, M. (2020, February). Intermittent Fasting: Surprising Update. Monique Tello. Harvard Medical School. Retrieved from: https://www.health.harvard.edu/blog/intermittent-fasting-surprising-update-2018062914156

    Cabo, R., Mattson, M. (2019, December). Effects Of Intermittent Fasting on Health, Aging, and Disease. The New England Journal of Medicine. Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMra1905136

    Chaix, A., Manoogian, E., et al. (2019, August). Time-restricted Eating To Prevent and Manage Chronic Metabolic Diseases. Annual Review of Nutrition. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703924/

    Sutton, E., Beyl, R. , et. al. (2018, June). Early Time-restricted Feeding Improves Insulin Sensitivity, Blood Pressure, and Oxidative Stress Even Without Weight Loss in Men with Prediabetes. Cell Metabolism. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990470/

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