Take another look at prediabetes
Last week, I did a glucose test on a 57-year-old patient because of urinary symptoms. The elevated number suggested she had diabetes. She wasn’t surprised. All her paternal aunts have diabetes. Until then, she was hoping she’d taken after her mom’s side of the family.
Later, I reviewed her old blood tests. A thought gnawed. While her previous glucose levels had been “normal,” they’d crept up into the prediabetic range. Had I told her that she was a prediabetic, could it delay her developing diabetes?
A sobering fact: Almost one in two Americans over the age 18 are either diabetic or prediabetic. Prediabetics make up 70% of that group. By the way, I’m talking about type 2 diabetes, or adult-onset diabetes, which is 90 to 95% of all diabetics.
Becoming a diabetic is very complicated. It’s genetic predisposition, inflammation (common causes are eating saturated fat, being overweight), and deconditioning (lack of exercise) – a gradual process that can take years to a decade.
At the end, organs, like the liver, become more resistant to insulin’s signals and the body can’t make enough insulin to keep up.
Parts of diabetes are irreversible. For example, insulin is made by specialized cells in our pancreas, an organ behind our stomach. For glucose to reach diabetic levels, over 60% of these cells would need to die.
Prediabetes is the 3- to 5-year window before a critical mass of these pancreatic cells are lost. I look at prediabetes not as a disease, but as a wakeup call. For some, a much-needed kick in the butt.
A big problem – and my apology to my patient – the CDC reports only 15% prediabetics were told by their doctors of their condition.
Hence the current guideline: Because the biggest risk factor for developing diabetes is being overweight, experts recommend screening for diabetes and prediabetes in adults aged 35 to 70 who are overweight (BMI over 25).
And because two out of three Americans are overweight, other expert groups recommend screening everybody over 45, and at any age if you have additional risk factors. Check out the CDC’s website, www.cdc.gov/diabetes, for an online risk calculator and other information.
In the U.S., diabetes bares its fangs as the #1 cause of kidney failure and blindness, the 7th leading cause of death. It’s a major contributor to heart diseases, strokes, fatty liver, among others.
Good news: Studies show simple lifestyle changes like better diet and exercise (150 minutes of moderate exercise per week) can prevent diabetes for 20% of people. You ask: Am I in the 20%? I don’t know – diabetes is complicated – but I do know you have nothing to lose and everything to gain.
Metformin, an inexpensive oral diabetic medication, works too, but it’s not FDA-approved for this purpose.
My patient is coming back for a repeat blood test. Because her blood glucose wasn’t really bad, I need two tests to confirm the diagnosis of diabetes. Seeing how positive and motivated she is to make lifestyle changes, I’m optimistic. Computer scientist Dr. Alan Kay once said: "The best way to predict the future is to invent it." If I missed an opportunity years ago, she’s making it up today.