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Pre-Diabetes: What It Is And What To Do

Most physicians, myself included, jot a personal comment on a patient’s lab tests. My favorite is “Everything’s excellent!” which can be typed quickly and concentrates good news into two words that I hope trigger a smile.

According to a recent New York Times article, doctors are writing the sentence “Your tests show you’re now in the range of pre-diabetes” more often than ever. “Pre-diabetes” means that while you’re not currently a diabetic, you have a higher risk of developing it than other people. The population with pre-diabetes is enormous: more than 70 million people translates to one in three Americans. 60% of people over age 40. Big numbers.

Pre-diabetes is diagnosed from an elevated blood sugar test or an elevated non-fasting hemoglobin A1C (A1C). The second of these, which measures your average blood sugar over the previous three months, is the superior test. It was decidedly annoying that until recently health insurance companies were reluctant to include this test as part of a general wellness exam. However, now it’s pretty routine and usually ordered after a patient shows some evidence of consistently elevated blood sugar levels.

If you hear you’re pre-diabetic, plan to make some changes
If you ignore a warning of pre-diabetes, it’s like putting your phone in silent mode while your neighbors are trying to tell you your house is on fire. If you do develop diabetes (15 to 30% of pre-diabetics do within five years), you’ll likely spend a lot of your future in healthcare-related waiting areas, including your primary care physician’s office and your pharmacy, and probably one or more of the following: cardiologist, kidney specialist, ophthalmologist, endocrinologist, vascular surgeon, and podiatrist.

You’ll take lots of pills, be checking your blood sugar regularly, and be depressed with the high premiums for life insurance because (sorry) the odds are against you for a healthy longevity.

Believe me, you’ve got better things to do with your life than be a diabetic.

Take the new online questionnaire for pre-diabetes right now. Strangely, it has come under criticism because so many people come up positive for pre-diabetes.

What good is a screening test, wondered one expert in the field, when 70-80% of the responders turn out to be pre-diabetic? His remark finally gives me the opportunity to use the phrase “That sort of begs the question.” I have been waiting years for this.

Look, if a screening test is designed to screen for an illness, the fact that it has uncovered a lot of pre-diabetics doesn’t mean the test is faulty. It signals that we’re paying the price for being overweight couch potatoes eating terribly unhealthy food. Where’s the surprise? We now know a lot of us are at risk for a chronic illness and we can start doing something about it. It begs the question to complain about the results.

Did your test come up positive for pre-diabetes?
Here’s an important point: As we age, the pancreas produces less insulin, blood sugar creeps up, and pre-diabetes becomes more likely. Take steps to reduce your risk by eating a healthful diet of whole (not processed) foods and keeping as active as possible in order to maintain a healthy weight and keep your blood pressure under control.

However, pre-diabetes at any age should be taken seriously.

Also in the New York Times piece, a doctor remarked about his own sense of helplessness once a patient was diagnosed as pre-diabetic. All he could do, he said, was to tell the patient to eat more healthfully, lose weight, and exercise, and he thought everyone should do that anyway.

Things are different at WholeHealth Chicago
We don’t have a sense of helplessness. A diagnosis of pre-diabetes means we all (patient and staff) get to work.

It does help that WHC patients are seriously oriented toward overall wellness and seem to grasp that eating healthfully and exercising regularly are fundamental to that end. We don’t diagnose pre-diabetes as frequently as other health care centers, but if you turn out to be pre-diabetic or are simply overweight and want to do something about it, one of our three nutritionists can help get you on the right track by showing you how to make smart food choices. We’ll also outline a good exercise program and ask about the status of your health club membership and whether your elliptical mainly serves as a clothes rack.

Let me add that the diabetic patients in our practice take really good care of themselves. They’re well informed, have selected a good array of specialists, and mostly do the right things. I’ve known some of my diabetic patients for decades. We’re all growing old together, which is the way it should be.

So again, please take the online test (less than 60 seconds to complete). Also check the main website for helpful information on reducing/reversing your risk.

If you’re at risk, ask your doctor for a hemoglobin A1C test. If the results confirm that you’re pre-diabetic, get to work on yourself. And remember: a chronic illness like diabetes not only shortens your life, it’s also very tedious.

Be well,
David Edelberg, MD

 

Leave a Comment


  1. Marite Plume says:

    I wish I had gotten info about type 2 earlier in life perhaps thru an employer or health care insurer. Health education should be mandatory in our school system. I am 72 now and in comparatively good health.The only thing I wish for is a group to meet with to steer me in food preparation for type 2. Recipes are available but after a lifetime of cooking a certain way it is hard follow recipes with unfamiliar flavors and strange veggies but boring to stick to the few I already use. It would be great to join a group & then discover some new tastes, one at a time.

  2. deborahbraun2@gmail.com says:

    Could you tell me what is a normal A1-c for an 83 year old woman? What is prediabetic?

  3. Calajean Kofmann says:

    Interesting! I’d like to learn more about Pre-diabetes.

  4. Dorothy says:

    What about medicines that may increase your chances of developing diabetes? I read on Medline recently about how some hypertension meds are diabetogenic.

  5. Dr E says:

    Hi Dorothy
    Yes, you are correct but you doctor can keep tabs on this. It’s not a common side effect but needs watching

  6. Kathyr says:

    Jan. 16, 2019

    Your third paragraph:

    “Pre-diabetes is diagnosed from an elevated blood sugar test or an elevated non-fasting hemoglobin A1C (A1C). The second of these, which measures your average blood sugar over the previous three months, is the superior test”

    an ELEVATED NON-FASTING A1C???

    A1Cs never need to be fasting.

    i am hoping this is just a careless typo?

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