Pre-diabetes: Are You at Risk?

Approximately 37 million people in the United States have diabetes. Over the last decade, statistics show that the diabetes incidence rate (new cases diagnosed) has trended downward. In 2009, approximately nine out of 1,000 adults were diagnosed; in 2019 that rate declined to just under six. Statistics also show that there are more adults living with diabetes (diabetes prevalence) than a decade ago. This may be due to better detection and management of the condition.

These statistics are encouraging, but as the eighth leading cause of death in the United States, we must continue to be vigilant in identifying the risk factors.

Pre-diabetes is a condition where blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. It affects over 96 million adults in the U.S. – that’s 38% of the U.S. adult population! Caused by a condition known as insulin resistance, an abnormal response to glucose regulation, pre-diabetes increases your risk of developing type 2 diabetes, as well as other conditions such as heart disease and stroke.

While the incidence rate of pre-diabetes has remained relatively steady since 2005, there has been a significant increase in the percentage of adults aware that they had the condition. This is good news in that in many cases pre-diabetes CAN be prevented or even reversed, and knowing you have it is key. Dietary modifications and lifestyle changes are the most effective ways to return blood glucose levels to a normal range.

What are some of the contributing factors?

Sugar:

The average American consumes 152 pounds of sugar and 146 pounds of flour per year. Could this have a correlation with diabetes? Yes! Waistlines are increasing because the sugars and refined grains that we consume increase insulin levels causing belly fat (or visceral fat) to accumulate around the organs. Insulin resistance then causes the elevation of blood sugar which increases that person’s risk of developing other serious health conditions, such as heart disease, stroke, cancer, diabetic eye disease, neuropathy, and kidney disease.

There are several ways to diagnose obesity and determine if one has visceral fat accumulation. A person’s BMI, or body mass index, is one measurement to take into consideration. BMI is a measure of body fat based on height and weight, and while it does not consider lean muscle mass, the measurement is still useful, with a recommended BMI of 25 or less. Waist circumference is another important indicator. Men should aim to keep their waistline circumference under 40 inches, and women should aim for 35 inches or less, with a waist-to-hip ratio (waist circumference divided by hip circumference) of less than 0.8. This reading in particular can be helpful in detecting those we call “skinny fat” – these people look thin but have a potbelly. All of these measurements taken together are good indicators of insulin resistance. The ultimate testing however includes glucose tolerance testing (fasting blood sugar and insulin levels) and/or hemoglobin A1C, which is a blood test that provides information about a person’s average levels of blood glucose over the past 3 months.

Something else to keep in mind is that all calories are not the same. A soda which has approximately 45 grams of sugar and 150 calories, causes a spike in insulin, whereas an apple and handful of almonds with the same amount of calories, does not. A 2007 study reported in the American Journal of Clinical Nutrition, demonstrated that certain types of carbohydrates, such as wheat and potatoes, up-regulated the genes for diabetes and inflammation in the abdominal subcutaneous fat, as compared to other carbohydrates like rye and corn, even though the caloric value was the same.

Sleep:

Sleep deprivation also increases insulin resistance. One study showed that adolescents who slept less than 8 hours per night had an increase in central fat and insulin resistance. Another study recently reported that for every 30 minutes of weekday sleep “debt” the risk of obesity and insulin resistance increased by 18% and 41 % respectively over a year.

Exercise:

Besides lowering the consumption of sugar and flour and improving sleep, what else can we do to improve glucose control? Research is strongly supporting all types of exercise like walking, running, biking, and swimming for the regulation of blood sugar. Weight-training in particular increases lean muscle mass and metabolism long-term and increases a specific type of muscle (white muscle) that has been shown to lower blood sugar.

Digestive health:

Newer studies show that there is a link between the microorganisms living in your digestive system, central obesity, visceral fat, and insulin resistance. Taking a prebiotic (dietary fiber that feeds the good bacteria) and consuming foods like kefir, yogurt, sauerkraut, and supplements with probiotics, may help reduce insulin resistance.

Here is a summary of some of my recommendations:

1. Reduce sugars and processed foods, and lower or eliminate wheat products. Avoid at all costs high-fructose corn syrup which has a strong link to insulin resistance. Eat more of a plant-based diet, grass-fed meats, and fish that are high in Omega 3’s, like wild-caught salmon. Be aware if you have a food sensitivity to gluten or dairy as these are highly inflammatory and can add to visceral fat.
2. Get an activity monitor and aim for 10,000 steps per day. This is a goal, but any amount of extra steps that you can take each day towards this goal can make a difference. Consider getting a personal trainer to help you with a weight-training program, or take a yoga class at least once to twice a week or practice at home.
3. Create a comfortable sleep routine and climate, and make good sleep a priority. If sleep is poor, then ask your doctor for a sleep study to rule out sleep apnea.
4. Take a daily probiotic and switch them around every few months. Consider a prebiotic as well, but know that a good plant-based diet feeds your good bacteria too.
5. Take a few moments to practice deep breathing and meditation. Start a gratitude journal and write down something every day. This lowers stress hormones like cortisol, and thus lowers insulin resistance.
6. Get your vitamin-D checked and supplement as needed. Take 2 grams of Omega 3’s per day if you don’t consume fish regularly. Other supplements that help reduce insulin resistance include chromium and alpha-lipoic acid and magnesium.