It was almost a throw away comment.
It was at the end of a consult with my lovely GP who I’d been to see to discuss my latest well-woman blood checks, where he had been expressing his concern about my cholesterol levels…
As I stood up to leave, he finished the conversation saying, “And by the way, you’re pre-diabetic.”
Stunned, I replied, saying, “Well, I think I’d better deal with that as a priority first!”
I went home angry, because I don’t think anyone is ready to be diagnosed with a potential chronic disease, especially when you think you’re already doing all the things to keep you well!
Luckily for me, as a doctor, I’m fully aware of the implications of being pre-diabetic and, as a Lifestyle Medicine Physician, I know this is readily fixable.
My remaining thought being, “What about others told the same thing, who are not doctors or health professionals and have no understanding of what it means?”
The difference between Pre-Diabetes and Diabetes.
Diabetes is a chronic health condition where the body is no longer processing glucose properly.
There’s a lot of it about.
In Australia we have 1.5 million people known to be living with diabetes.
And according to Diabetes Australia over 300 Australians are diagnosed with diabetes every day.
However, there are another 2 million people living with what’s called Pre-diabetes.
This is where blood glucose levels haven’t risen to diabetic levels yet.
Pre-diabetes is a condition where the blood glucose levels are higher than normal but haven’t reached the threshold for an official diagnosis of diabetes.
One reason we have so many people with pre-diabetes and oblivious to the fact, is it’s asymptomatic, so there’s nothing to suggest anything is wrong.
Essentially, prediabetes is a red flag indicating the body is struggling to process insulin effectively i.e. insulin resistance is developing, and without direct intervention 5-10% per year will go onto develop type two diabetes. Though it’s important to note, becoming diabetic is not inevitable.
When we eat, the glucose that comes from the breakdown of carbohydrates is absorbed into the blood stream. This stimulates the release of the hormone insulin produced by the pancreas and regulates the supply of glucose to cells where it is used to manufacture energy. Excess glucose not immediately required is converted to glycogen and stored in the liver and muscles where it can be used later.
When I was in medical school, I was taught about Type 1 (then known as Juvenile diabetes) occurring in childhood as the result of an autoimmune process and required lifelong treatment with insulin, and Type 2 (then known as Maturity Onset diabetes), which occurs in midlife and was associated with obesity and other risk factors like a family history.
Then there is gestational diabetes associated with pregnancy, LADA or Latent Autoimmune Diabetes in Adults, MODY or Maturity-onset Diabetes of the Young and several others.
Why Pre-Diabetes and Diabetes Matter
Diabetes is a common chronic and preventable condition.
Diabetes affects the entire body increasing your risk of developing heart disease, kidney disease, atherosclerosis and stroke, peripheral vascular disease and eye disease.
Prolonged elevated blood glucose can lead to peripheral neuropathy where the nerve damage is associated with numbness or tingling, especially in the feet and hands.
The other worrying condition associated with poor blood sugar control is the increased risk of Alzheimer’s or other form of dementia. This is why Alzheimer’s is sometimes unofficially called Type 3 Diabetes.
Prevention starts here.
Attending for your regular GP check-ups is the opportune time to get a fasting blood sugar or HbA1c screening test arranged.
The latter has become the preferred test because it gives an indication of your average blood sugar over the previous two to three months, rather than a single static reading.
HbA1c varies with age, your health and other factors.
Here are the common percentages used.
- Normal: A1C below 5.7%
- Prediabetes: A1C between 5.7% and 6.4%
- Diabetes: A1C of 6.5% or higher
If your test result is higher than normal, it’s usual to repeat the test along with other tests including a fasting insulin which is used as an indicator of your overall metabolic health.
You’re Pre-diabetic, now what?
Rather than falling into an abyss of doom and despair, your prediabetes diagnosis can be seen as a helpful wake-up call and an opportunity to improve your health before diabetes develops.
The ‘now what’ begins with a thorough (and honest!) appraisal of your lifestyle.
Because lifestyle intervention has been shown to prevent progression to diabetes.
The Diabetic Prevention Program in 2002 published a paper comparing the reduction of progression to diabetes with lifestyle intervention where the aim was to lose 7 % of body weight and to undertake 150 minutes of physical activity each week, along with a 16-week curriculum to assist with behaviour modification, or metformin with follow up over 2.8 years.
Metformin is a widely used diabetic medication used along with diet and exercise for those with Type 2 diabetes. It works by reducing the release of glucose from the liver, and increases the body’s sensitivity to insulin enabling cells to absorb more glucose
The result?
Lifestyle intervention reduced the progression to diabetes by 58% compared to 31% for the metformin group.
Both methods worked, but the lifestyle intervention group here was significantly more effective.
The bigger question to be answered from here being how does lifestyle intervention compare to metformin in reducing the risk of multimorbidity (risk of two or more chronic diseases) developing?
A new study recently published in JAMA followed 1173 patients with prediabetes enrolled in a randomised controlled trial for 21 years. The participants were allocated to either an intensive lifestyle intervention, metformin or placebo group.
The conclusions revealed that lifestyle intervention, but not metformin, was associated with a lower risk of developing other chronic conditions.
If you’ve been wondering does lifestyle medicine work?
Yes, it does!
The Lifestyle Interventions That Make a Difference.
1. Follow a Healthy Diet
The eating pattern associated with better blood sugar control is the Mediterranean diet.
Healthy foods include a wide variety of vegetables, especially leafy greens, fruit such as berries, whole grains and legumes to provide fibre, seeds and nuts, lean protein, healthy fats like oily fish, EVOO and avocados.
Fibre matters because it slows down the rate of rise of blood sugar. Soluble fibre as found in bean, dried peas, oats and fruit helps to improve insulin sensitivity. Bonus!
You don’t need to exclude whole food groups. With carbohydrates the key is to avoid those that are highly refined like white bread, pasta and rice. Try swapping these to include sweet potato, couscous or quinoa.
Portion versus serving. A serving is a specific amount of food like one slice of bread. A portion is the amount of food you choose to eat at any one time. Portion sizes especially in restaurants have grown over time and it’s well recognised that when we’re given more, we tend to eat more! This is where choosing to eat off a smaller plate, ordering an entree rather than a main dish and putting the food away after serving at home to reduce the temptation of seconds can all help. The other tip is to enjoy a snack that you pour into a bowl rather than eating straight from the bag.
On your plate, aim for 50% non-starchy veggies – broccoli, green beans and salad, 25% your choice of protein like fish, chicken, eggs and occasional red meat, 25% carbs like grains, pasta, beans or fruit.
Enjoy water or non-sweetened drink with your meal.
2. Exercise
After eating do this…
No, you don’t have to rush off to the gym.
Walk.
For 20 minutes where possible.
Walking or another other-intensity activity after eating is a great way to improve insulin sensitivity and reduce the post-meal glucose spike.
Glucose spikes by themselves are not a problem – it’s just your body doing what it’s supposed to after eating but increasing your post-prandial activity even for a few minutes assists in glucose regulation.
If your evening habit has been to collapse onto the sofa after dinner until bedtime. Getting up instead, to move, stand or walk can make a significant difference to glucose control.
3. Sleep
The lifestyle factor often overlooked in glucose regulation is sleep. It’s normal for your blood glucose to increase during sleep, it’s part of your natural circadian rhythm.
However, disrupted sleep can lead to glucose dysregulation and it happens more quickly than you may expect. Just 5 nights of reduced sleep (4.5 hours) in otherwise healthy young men was shown to induce a prediabetic state. Yikes! Luckily this can be readily reversed by 2 nights of recovery sleep.
If sleep is an issue for you, ask for help if necessary and put those sleep hygiene practices like consistency of bed and waking up time, keeping technology out of the bedroom and being sufficiently active during the day into action.
4. Stress
High chronic stress causes cortisol and adrenaline to spike, negatively impacting glucose balance as well as contributing to poorer sleep.
This is why those activities that help you better manage your stress are so important. These may include exercise, practising yoga or meditation, deep breathing and tapping into your social support network.
Perhaps you’ve noticed how these lifestyle factors are all intertwined. Looking after one aspect helps another.
Pre-diabetes is common and an indicator of worsening metabolic health. Lifestyle interventions have been shown to help restore normal glucose regulation and prevent the progression to diabetes.
I’d love to know, how have you used lifestyle to help maintain your health and well-being?
