As Americans continue to pack on the pounds, doctors are seeing a surge in weight-related health problems. One such common condition that now affects about 40% of American adults is prediabetes, characterized by blood glucose (sugar) levels that are higher than normal but not yet at diabetic levels. People with prediabetes are five to 15 times more likely to develop full-blown diabetes than people without this condition.

These are alarming statistics. Diabetes has serious potential consequences, including blindness, kidney failure, nerve damage, erectile dysfunction, heart failure, stroke and circulation problems that can necessitate amputation.

Good news: Diabetes and its devastating consequences often can be prevented—by reversing prediabetes.

How The Disease Progresses

The development of type 2 diabetes—which accounts for about 90% of all diabetes cases—is greatly influenced by prediabetes and excess weight. An obese person is 80 times more likely to develop type 2 diabetes than a person of normal weight. With type 2 diabetes, the pancreas usually does produce insulin, but the body's cells cannot use it properly. A person often passes through many stages on the way to developing type 2 diabetes. What happens…

When we eat, the amount of glucose in our blood rises, alerting the pancreas that it needs to release insulin. Excess fat, nutritional deficiencies and the stress hormone cortisol interfere with cells' ability to accept and use insulin, leaving excess glucose in the blood. When this happens, a person is said to have insulin resistance.

Sensing that the insulin is not doing its job, the pancreas churns out even more. But since the pancreas churns out the cells cannot accept the excess insulin, it remains in the blood, along with the excess glucose. When blood glucose levels reach a certain point (as measured with blood tests), the condition qualifies as prediabetes...and if levels climb higher still, it qualifies as diabetes.

High blood glucose levels cause many of the complications of diabetes, including damage to the kidneys, nerves and eyes. However, while prediabetes and diabetes are developing, a bigger problem is high blood insulin.

Reason: Insulin helps produce muscle—but when insulin levels get too high, the hormone instead promotes formation of belly fat, which in turn makes insulin resistance even worse. Insulin elevations also increase production of triglycerides and cholesterol, which clog arteries...of C-reactive protein, which promotes damaging inflammation and of cortisol, which contributes to various diseases.

What The Tests Should Tell Us

Too many doctors use antiquated guidelines for interpreting test results, then tell patients all is well when, in fact, the patients are at risk. I urge you to ask your doctor for the specific results of your tests and compare them with my guidelines below, which I have based on the most recent evidence. You may spot a warning sign that your doctor missed.

  • Fasting glucose test. This test involves fasting for at least eight hours (optimally 12 hours), usually overnight, then having blood drawn to measure glucose levels.

Problem: The range generally accepted as "normal"—from 65 milligrams per deciliter (mg/dL) to 99 mg/dL—is much too broad.

Evidence: A study published in The New England Journal of Medicine found that men with a fasting blood glucose level of 87 mg/dL had almost twice the risk of developing diabetes as did men whose level was 81 mg/dL or less. My guidelines…

  • Optimal-76 mg/dl to 81 mg/dl.
  • Normal-82 mg/dL to 85 mg/dL.
  • At risk 86 mg/dL to 99 mg/dL .Prediabetic—100 mg/dL to 125 mg/dL.
  • Diabetic--126 mg/dL and above.

Though most doctors don't order it routinely, you can ask your doctor to have your insulin levels checked as part of your fasting glucose test. These results are not used to officially diagnose diabetes, but they do provide additional information about your risk. Although the generally accepted guidelines put the normal range for blood insulin levels at six micro-international units per milliliter (mcU/ml) to 35 mcU/ml, I think this range is far too wide to be meaningful. My guidelines…

  • Optimal—7 mcU/ml or less.
  • At risk—8 mcU/ml to 10 mU/ml.
  • Prediabetic—11 mU/ml to 25 mcU/ml.
  • Dangerous—above 25 mcU/ml.
  • Oral glucose tolerance test with glucose and insulin levels. A more accurate way to measure blood insulin levels, this test requires fasting for 12 hours and having blood drawn... then drinking a glucose solution and having blood drawn again after one, two and up to three hours. I often order this test for patients who are overweight, have a strong family history of diabetes or have a history of elevated fasting glucose levels-even if their most recent fasting glucose test results appeared normal. In this way, I have diagnosed type 2 diabetes in several patients whose fasting glucose results did not suggest any problems. My guidelines for blood drawn at the two-bour point...
  • Normal—blood glucose below 140 mg/dL ...or insulin levels at or below 55 mcU/ml.
  • Prediabetic—blood glucose of 140 mg/dL to 159 mg/dL, or an increase in glucose of 50 mg de or more within one hour...or insulin levels at 56 mcU/ml to 90 mcU/ml.
  • Dangerous—blood glucose of 160 mg/dL or higher...or insulin levels above 90 mcU/ml.
  • Hemoglobin A1C (HbA1c). A British study involving 10,232 adults indicated that HbAlc results accurately predict health problems, including heart attacks (for which prediabetes and diabetes are risk factors). For each 1% rise in HbA1c, study participants' heart attack risk increased by 20%. My guidelines...
  • Normal—45% to 4.9%.
  • At risk—5.0% to 5.6%.
  • Prediabetic—5.7% to 6.9%.
  • Diabetic—7.0% or higher.

Steps To Take To Preempt Prediabetes

Fortunately, there is a lot you can do to prevent prediabetes—or even to reverse it if you have it.

1. Lose excess weight. This is without question the most important step. To determine if you are at a healthful weight, calculate your body mass index (BMI), a ratio of your weight to the square of your height (for a free on-line BMI calculator, go to BMI of 30 or higher indicates obesity and a strong likelihood of developing prediabetes or diabetes...BMI between 25 and 299 puts you at risk for prediabetes.

2. Reduce body fat percentage. Apart from its effect on weight, excess body fat increases prediabetes risk. I measure a patient's body fat percentage with bioelectrical impedance, a painless test that involves placing electrodes on your hand and foot. For women, an ideal range is 21% to 24%...anything above 31% is risky. For men, ideal is 14% to 17%...above 25% is risky.

Self-defense: Build muscle and banish excess fat by doing 30 minutes of aerobic exercise, such as brisk walking, five days a 30 minutes of strength training twice weekly.

3. Eat right. Good dietary habits help to control weight...prevent spikes and drops in blood glucose levels...slow nutrient absorption, giving the pancreas time to produce insulin...boost energy, making it easier to exercise...and provide nutrients that optimize health.

  • Eat three meals a day at regular times. Keep portions moderate. Never skip breakfast.
  • Keep snacks small.

Options: Nuts, seeds, low-sugar protein drinks, vegetables or fruit.

  • Include a small portion of protein at every meal.

Good choices: One or two eggs...15 ounces of nuts...or three ounces of fish, chicken, turkey or lean meat.

  • Eat at least one or two servings of whole grains daily. For variety, try quinoa, couscous, and bread made with spelt or kamut flour.
  • Avoid sugary foods, processed foods, trans fats (found in some margarines, baked goods and crackers) and saturated fats (in meats, dairy foods and many vegetable oils).
  • Have at least two servings of fruits and three or more servings of vegetables daily.

4. Take appropriate supplements. Many manufacturers offer a "blood sugar control formula" that provides a combination of nutrients to help stabilize blood glucose and promote proper insulin function. Alternatively, you can follow the guidelines below.

If you are at risk for prediabetes, take...

  • Chromium, a mineral, at 500 micrograms (mcg) daily.
  • Pycnogenol (maritime pine extract) at 200 mg daily.

If you have been diagnosed with prediabetes, also take…

  • Biotin (vitamin B-7) at 500 mcg daily.
  • Alpha lipoic acid, an antioxidant, at 300 mg daily.
  • Magnesium at 400 mg daily. .Vitamin D at 1,000 international units (IU) daily.

If you use diabetes medication, check with your doctor before taking these supplements—your medication dosage may need to be adjusted. These supplements are sold in health food stores, generally are safe, rarely cause side effects and can be taken indefinitely. Ideally, however, your improved diet and more healthful lifestyle will decrease your risk for prediabetes or reverse the condition, so the supplements eventually will no longer be necessary.

Important News for Women with Diabetes

The death rate for women with diabetes has not declined, even though the rate for men with diabetes has declined by 43% over the last three decades, says Ronald B. Goldberg, MD.

Likely reason: The primary cause of death in people with diabetes is cardiovascular disease-which appears to be diagnosed and managed less efficiently in women.

Self-defense: Women with diabetes should be in the regular care of a physician and alert to symptoms such as chest and abdominal discomfort, shortness of breath, profound weakness and unexplained ankle swelling.

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