Diabetes Education

Pre-Diabetes
Common questions about Pre-Diabetes

The concept of pre-diabetes was unveiled to the American public by then Health and Human Services Secretary, Tommy Thompson in 2002. Currently, the American Diabetes Association warns that 57 million people have this condition. By contrast, there are 23.6 million people in the United States with diabetes, 17.9 are already diagnosed, however, nearly one quarter of them (5.7 million) are not aware they have the disease.

Q. What is pre-diabetes?

A. In layman's terms, people with pre-diabetes have blood glucose levels that fall into the range between normal and diabetic. That is, they have elevated blood sugar, but it isn't quite high enough to classify it as diabetes. Your doctor may refer to this as impaired glucose tolerance or, possibly, impaired fasting glucose. No matter what it is called, pre-diabetes means having blood sugar that is higher than it should be.

Q. What does pre-diabetes do?

A. Pre-diabetes serves as a warning. Patients with this condition have a significant risk of developing Type 2 diabetes within 10 years and are at a 50% greater risk of having a stroke or heart attack.
Pre-diabetes can also jump start damage associated with diabetes, especially to the circulatory system and the heart, before a person fully develops Type 2 diabetes.

Q. Should I get tested?

A. Perhaps. If you are aged 45 or older, it is recommended that you get tested. If you are aged 45 or older and overweight, it is strongly recommended that you get tested. If you are 44 or younger and have risk factors for Type 2 diabetes, it is recommended that you get tested.

Q. What are the risk factors for Type 2 diabetes?

A. Being overweight or obese. A family history of diabetes, especially a parent or sibling. Being of American Indian, Alaskan Native, African, Hispanic/Latino, Pacific Islander or Asian descent. A history of gestational diabetes or large babies at birth (at least 9 pounds). High blood pressure, abnormal cholesterol levels--example: low HDL and/or high LDL or triglycerides. A sedentary lifestyle with little to no exercise. A diagnosis or PCOS (PolyCystic Ovarian Syndrome, sometimes called PCOS). Any other medical condition associated with insulin resistance. A history of cardiovascular disease

Q. What is the test like?

A. Your doctor may offer you a fasting glucose test or an oral glucose tolerance test (pregnant women often receive these). The fasting glucose test will require you to abstain from food and drink for several hours and have blood drawn in a lab.

The glucose tolerance test will also require you to fast for several hours before having blood drawn. After your blood is drawn, you have to drink a glucose-rich beverage and wait approximately one hour. Your blood will be drawn a second time. An hour later, it will be drawn a third time. You will probably have a final draw one hour later.

There are a couple of things to note about the glucose tolerance test. First, individuals with sensitive skin may wish to use cotton balls and pressure to clot the draw sites rather than bandages. Removing and applying new bandages to the testing site may cause undo irritation to the skin. Second, definitely bring something to keep you busy. You probably don't want to spend three hours with only waiting room magazines to read.

Your doctor may also consider ordering a hemoglobin A1c (HB A1c or A1c) to get an idea of what your blood sugar has been like for three months prior to the test. This is a simple blood draw that can be completed at the same time as a fasting glucose test or glucose tolerance test.

Q. How long will it take to get the results of your test?

A. It should not take longer than a few business days. Your doctor will probably call with the results and let you know if further follow up is required.

Q. How is pre-diabetes treated?

A. The good news is that pre-diabetes is generally reversible with simple lifestyle modifications, including eating healthier and getting more exercise. Prescription medications are generally not included as a first line of defense against pre-diabetes. It should be noted, however, that studies indicate using Glucophage (also known as Metformin) in patients with pre-diabetes may hinder the development of Type 2 diabetes.

Your doctor will probably want you to work on losing weight, exercise more and improve your diet. You won't have to turn your lifestyle around overnight; you can incorporate improvements over a period of time to ease the transition.

Your doctor may also want to monitor your blood sugar while you are making the necessary lifestyle changes and continue to do so once you have reduced your sugar to normal levels.
Is there any good news?

Yes! The good news is that pre-diabetes is largely reversible. The better news is that, if you do reverse it, you significantly reduce your chances of developing Type 2 diabetes. As an added bonus, the lifestyle modifications required to reverse pre-diabetes may have a greater overall positive impact on your health.

Marci Sloane, MS, RD, LD/N, CDE

Article was reviewed by Marci Sloane, a registered and licensed dietitian/nutritionist and certified diabetes educator. Marci graduated with a degree in Nutrition and Physiology from Teachers College at Columbia University. Marci manages a Diabetes and Nutrition Education Center in South Florida and is the author of The Diet Game: Playing for Life! More about Marci Sloane

The goal of Destination Diabetes is to be a useful and credible resource for the more than 20 million children and adults who have diabetes in the U.S. and their families. Destination Diabetes provides information on a wide range of diabetes health and wellness topics. Articles are written or reviewed by diabetes advisors who have experience in diabetes education.