Is Pre-diabetes really that big of a deal?

I have a friend who approached me with this question.  Her husband Jack had been for a yearly physical.  He came home and reported that everything was good but his blood sugar was “slightly high.”  When my friend inquired how high, Jack responded “the Dr said it was no big deal.” Jack was definitely trying to downplay the problem.
 
My response to her question was a definite YES!  It is a huge deal!  Blood sugar high enough to be considered pre-diabetes is a warning sign, a cry for help from the beta cells that make insulin. If we catch problems in the pre-diabetes state and take care of them, we can eradicate Type 2 diabetes.  It’s the closest thing we have to a cure!
 
Type 2 Diabetes is a progressive disease.  It starts with the body being resistant to insulin (the hormone that clears sugar from the blood).  Insulin resistance correlates with a variety of things like being overweight, not being active enough, smoking, genetics, aging, ethnicity, some medications, and sleep problems.  If any of these issues cause the body not to use insulin well, it causes an overworking of the beta cells that produce insulin and can lead them to fail.  If the beta cells fail completely, insulin from an outside source (injections) will be needed to keep blood sugar at a healthy level.  The progression is a gradual death of the beta cells.  If we find Pre-Diabetes we might be able to “Save the Beta Cells”!
 
The CDC says one out of three people have pre-diabetes and 90% of them don’t have a clue!  Sometimes there are red flags that the body is struggling to clear sugar like high blood pressure, high triglycerides, and weight gain around the waist.  But usually there aren’t obvious symptoms.  For that reason, the American Diabetes Association (ADA) recommends testing everyone over 45 years old for pre-diabetes.  They also recommend testing anyone under 45 who is overweight with an additional risk factor like family history, cardiovascular or polycystic ovary disease, or Latino, Native American, Asian, or African ethnicity.
 
So many times, when I have a group diabetes education class, there will be a patient who says “I’m just pre-diabetic”.  I quickly tell them they are the most important person in the room.  They are at a point in the diabetes progression where they have the most control over how things turn out.  So many times, the issues are missed at this stage and the beta cell failure progresses to a point where it takes more than diet and exercise to gain control of the blood sugars.  I have so many others in my classes who tell me they were diagnosed with pre-diabetes years back but nothing was ever done about it and now they are on insulin. This makes me sad and a little angry!
 
I met with Jack and told him about the progression of diabetes.  We talked about his family history, his usual day’s food intake and activity, and the medications he takes.  It turned out Jack had many of the causes of insulin resistance previously stated.  He had a family history, he had a sedentary job and got little exercise, and he was on a mood- altering medication that was causing weight gain.  This medicine was greatly improving his quality of life and he had no intention of stopping it.  So, we talked about the lifestyle changes that could help lighten the load on his beta cells.  We discussed ideas for increasing his activity and spreading his carbohydrate intake out throughout the day.  And we talked about testing his blood glucose periodically to make sure it was remaining in goal.
 
Last I heard Jack is still trucking along with no diagnosis of diabetes.  I’m sure his provider is keeping a close eye on his blood sugar. If you have been told you have pre-diabetes, “borderline diabetes”, or the sugars are running “slightly high”, take it seriously.  There is no guarantee you can prevent Type 2 Diabetes but at least you can give it your best shot-wait and see should never be the plan.  Small changes now could prevent big changes in the future.  It is a very big deal! pre-diabetes.docx 
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