Pre-diabetes is not the same as diabetes. This category was created because it was recognized that people are not healthy one day and Type II Diabetics the next day. There is a period of time which may last for years when they are in this borderline range that we now call pre-diabetes. The hope is that by identifying these people we can help them make changes in their lifestyle that will reduce the risk of developing Type II diabetes and all the complications that come with that diagnosis.

Prediabetes is a condition defined as a fasting blood sugar of 100-124 on more than one occasion or a HgbA1c between 5.7  and 6.4.  HgbA1c is a test which gives us an indication of what the individuals blood sugar has been over the past 90 days. The table below summarizes how the HgbA1c is interpreted and what the approximate average sugar level is for each HgbA1c level. For example, if you were to have a HgbA1c level of 8.0 that would mean your average blood sugar over the past 90 days was approximately 188. 

Why do I have Pre-diabetes?

While genetics plays a role in the development of diabetes and pre-diabetes, diet and lifestyle have a great influence on the ability of those genetic tendencies to be expressed. When someone is pre-diabetic  that individual is not responding in a normal way when sugars enter the blood stream. Normally when we consume sugar or anything that can be converted to sugar like starches ( bread, pasta, rice, potatoes) our body releases insulin. Insulin triggers several things to happen. It opens a channel in the cell membrane that allows sugar to move from the blood stream into the cells. It also reduces the production of sugar by the liver and stimulates the conversion of circulating sugars into fats and glycogen which is stored in the liver.

Diets high in sugars and starches ( also known as carbohydrates or carbs) force the body to release large amounts of insulin. Over time the body becomes less sensitive to its own insulin most likely due to chronic exposure to high insulin levels brought on by the high carbohydrate diet. There are probably other changes that occur as well but it is clear that in addition to our genetics, high carbohydrate diets, obesity, and lack of exercise all seem to play a role in the development of pre-diabetes and eventually Type II diabetes.

What should I do?

While there is no guarantee that pre-diabetes will lead to Type II diabetes, it does increase the risk. Approximately 30% of patients with pre-diabetes will become diabetic within 5 years. Medication is not usually required at this stage though. The primary goal is to prevent the progression to diabetes through lifestyle changes.
  • Exercise regularly
  • Keep weight within guidelines - Keep your BMI ( Body Mass Index - see calculator above) less than 25. Men should keep their waist size below 40 inches and women below 35 inches. Waist size is NOT the same as pant waist size. The waist should be measured around the belly button with the stomach relaxed. This will usually be several inches larger than your pant waist size.
  • Eat a diet that has a low glycemic index and low glycemic load (Click here for an explanation of the difference).  Foods with a glycemic load under 10 are considered low glycemic load, 10-20 is medium, and above 20 is a high glycemic load food.  The resources in the right column of this page will provide a lot of information to help you improve your diet. In general you want to reduce your intake of sugars and starches and increase your intake of protein and healthy fats.
starch is just sugar in disguise
But not all starches are the same

Can I change my future?

Yes, if you are motivated. Patients who make real changes in their lifestyle can significantly reduce their risk of developing diabetes but this is a lifestyle change that needs to last a lifetime and the sooner you start the longer that lifetime will last.

Diabetes is the leading cause of kidney failure, non-traumatic lower limb amputation, and blindness in the United States, it is a major cause of heart attack and stroke and the seventh leading cause of death overall. 

The sooner you make changes and the more successfully you stick with them the better your chances are of avoiding those risks. Read the materials connected with this page and talk to your doctor to get started on the path to a healthier future.