Prediabetes: What Does It Mean?

Prediabetes -- where blood sugar levels are high, but not high enough for a diagnosis of type 2 diabetes -- is not something you should dismiss.

Prediabetes can have long-term effects, including damage to blood vessels, heart and kidneys, increasing your risk of type 2 diabetes, heart attack and stroke. However, it is possible to halt the progression of prediabetes so that it doesn't become type 2 diabetes.

Tyler Feldman, DO, family medicine physician with Franciscan Physician Network in Mooresville, discusses the risks, causes and symptoms of prediabetes, as well as ways to improve your diet and lifestyle.

Listen Now: Prediabetes

Dr. Tyler Feldman, family medicine doctor with Franciscan Physician Network in Mooresville, discusses what people should know about prediabetes in the Franciscan DocPod Podcast.

What Is Prediabetes?

According to the CDC, prediabetes is caused by the cells in your body not responding normally to insulin. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into cells for use as energy.

In prediabetes, your cells develop insulin resistance, making it difficult for the hormone to transfer glucose into your cells. This triggers your pancreas to produce even more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes—and type 2 diabetes down the road.

“Your blood sugar is elevated, but it's not elevated to the extent of what we would categorize as diabetes. But it's certainly not normal either,” Dr. Feldman said.

What Happens To Your Body When You Have Prediabetes?

Without enough insulin, extra glucose stays in your bloodstream rather than entering your cells. 

People with prediabetes have up to a 50 percent chance of developing diabetes over the next 5 to 10 years, according to the NIDDK.  But your risks go beyond type 2 diabetes.

Other long-term effects of prediabetes may include damage to blood vessels, heart, kidneys and eyes. It also increases your risk of heart attack and stroke.

However, it is possible to halt the progression of prediabetes.

How Common Is Prediabetes?

More than one-third of Americans 18 or older (88 million) have prediabetes, according to the U.S. National Institutes of Health. Nearly 29 million of them are under 45 years old.

What Are Symptoms Of Prediabetes?

Prediabetes can be difficult to recognize. Of the 88 million Americans with prediabetes, more than 84% don’t know they have it. People usually find out that they have the condition after being tested for diabetes. This is in part because prediabetes often doesn't have symptoms.

The National Institute of Diabetes and Digestive and Kidney Diseases says some less typical symptoms of prediabetes include:

• Darker skin on the back and sides of the neck or near the armpits
• Growth of new skin tags
• Changes in how the eye works due to damaged blood vessels (retinopathy)

Am I At Risk For Prediabetes?

While scientists don’t know the exact causes of prediabetes, excess weight and lack of exercise are two of the leading risk factors.

Your weight

“One would be, being overweight and that doesn't mean necessarily obesity, that just means being overweight. If your BMI is over 25 and above that's a risk factor,” Dr. Feldman said. “You’re at an even higher risk factor if you have a lot more belly weight.”

Your health history

Other risk factors for prediabetes include:

• High cholesterol
• High blood pressure
• A family history of diabetes
• A personal history of gestational diabetes (diabetes only during a pregnancy)
• Having given birth to a baby that weighed more than 9 pounds

Your age

“As you get older, your pancreas gets older too. It doesn't make as much insulin producing cells that will release this insulin. It has more trouble fighting insulin resistance,” said Dr. Feldman. “So, as you get older and a lot of people would say over the age of 45, you're at higher risk, regardless of other risk factors.”

Your ethnicity

“Different ethnicities, such as Hispanic, African-American, Native American, Asian-American, have an increased risk due to genetics, nothing that they can control,” said Dr. Feldman.

The reality is, at some point, your doctor may say it's time to be screened for prediabetes.

“Everyone is at risk. About 34% of the United States right now has prediabetes. And if you look at the criteria with all the risk factors and when you should screen, at some point in someone's life, they're probably going to meet enough of those risk factors to be screened,” said Dr. Feldman.

Should I Be Screened For Prediabetes?

The American Diabetes Association says if you're over 45 years old without any other risk factors for diabetes that you should be screened for prediabetes.

“Everyone at some point in life should be screened for prediabetes,” said Dr. Feldman.

As the risk of diabetes grows, so does the need for testing. If you're older than 45 and overweight, "considering" such a test isn't enough. If you haven't already had the fasting plasma glucose test, make an appointment. Generally, you're considered to have diabetes if your A1C on two separate tests is 6.5 or higher, or if your glucose reading after fasting -- confirmed by a second test -- is 126 or higher, or if you have a level of more than 200 plus symptoms of high blood sugar.

According to the American Diabetes Association, the test is also a good idea for anyone under 45 who is overweight and has another risk factor for diabetes or heart disease. If the test results come back normal, you can wait up to three years before being retested -- unless your doctor recommends testing more frequently due to an increased risk of diabetes.

How Do I Get Tested For Prediabetes?

It’s important to know the types of tests available for prediabetes.

“There are many tests you can do,” said Dr. Feldman. “One is called a fasting blood sugar test, which means before you get your labs to check your cholesterol, the night before you don't eat and then you can only have water after dinner. That's going to show what your blood sugar is when you haven't had a meal. If it's 100 or higher, that would indicate a level that is in the prediabetes range, but you should get a confirmatory test.

“Another very common test is called a hemoglobin A1C. This is looking at is your average blood sugar over three months.”

An A1C reading between 5.7% and 6.4% is considered prediabetes. A higher A1C reading could indicate diabetes.

Can I Prevent Prediabetes?

There are ways to help prevent prediabetes. Studies show at least 150 minutes a week of moderate physical activity (such as walking or jogging) and a diet that's low in fat and rich in produce and whole grains can help prevent or delay diabetes. If you're overweight, losing just 5 percent to 10 percent of your body weight can make a big difference.

“Once you convert to diabetes, almost every organ you can think about could be damaged by diabetes, so it is really important to try to prevent that,” said Dr. Feldman. “Even if you're thinking you're living a very healthy life, but you realize you have some of the risk factors, checking with your doctor and seeing if screening for diabetes would be appropriate for you. Also, you can reverse the pathologic processes of metabolic syndrome and insulin resistance, by exercising, portion sizing, dieting and if overweight, trying to lose 7% of your body weight.”

According to the CDC, a small amount of weight loss means around 5% to 7% of your body weight, which is 10 to 14 pounds for a 200-pound person. Regular physical activity means getting at least 150 minutes a week of brisk walking or a similar activity. That’s just 30 minutes a day, five days a week.

How Do I Treat Prediabetes?

Learning how to reverse prediabetes through healthier diet and lifestyle choices is one of the main treatment strategies recommended by the NIDDK.

A study of more 1,000 people published in the journal JAMA Internal Medicine revealed that even “modest” lifestyle changes, including losing 4.5 to 6.5 pounds and increasing exercise, reduced the risk of developing diabetes by 40% to 47%.

The NIDDK also notes that your doctor may prescribe a medicine called metformin for your prediabetes to help delay the onset of diabetes.

Can You Reverse Prediabetes?

The good news? If you have a prediabetes diagnosis, lifestyle changes may enable you to reverse prediabetes. Learn more about the steps to help reverse prediabetes.

If you need additional support, Franciscan Health offers a Diabetes Prevention Program to help you invest in your long-term health and help prevent diabetes. 

HealthDay News contributed information to this article.