Today not only do a number of people who have type 2 Diabetes not know they have it, but the number of people with pre diabetes who don’t know they are prediabetic is probably much higher. But the good news is there is hope if your doctor told you you have pre diabetes and you’re worried about developing type 2 diabetes.
So what I want to do is give you a thorough education of what prediabetes and Type 2 diabetes actually mean. Because I’m a firm believer that knowledge is power. And the more you know, the better you’ll be able to take corrective or preventative action.
What does prediabetes mean anyway? This is when your fasting blood glucose levels (fasting plasma glucose), which means 8 hours without a meal, are between 100 mg/dL and 126 mg/dL. This is referred to as impaired fasting glucose.
Pre diabetes is also measured when your blood glucose levels after an oral glucose tolerance test are in the range of 140 mg/dL and 200 mg/dL 2 hours after the oral glucose tolerance test and this person is said to be impaired glucose tolerant and also prediabetic. These levels are above normal but not quite high enough to be diagnosed as diabetes.
The oral glucose tolerance test is when a fasting patient is given 75 grams of glucose in a liquid solution. The patient’s blood is then drawn to measure glucose levels 2 hours after the glucose drink. Normal ranges after a meal are below or equal to 140 mg/dL. A blood glucose level of 200 mg/dL or above during this test would indicate diabetes.
Some people with impaired glucose tolerance may have normal fasting blood sugar levels, but aren’t able to handle a glucose load effectively. In many ways, most of the physicians that I work with feel that the oral glucose tolerance test is a better diagnostic test for type 2 diabetes screening. One big reason, is because the first thing to go in most type 2 diabetics is their postprandial, or post meal glucose control. Fasting blood sugar levels are usually the last thing to go.
Both impaired glucose tolerance and impaired fasting glucose increases the risk for developing both type 2 diabetes and cardiovascular disease. Hence the term pre diabetes because of an increased risk of progression to type 2.
The US population is said to have around 15-20% of the population to be prediabetic with those with impaired glucose tolerance developing type 2 diabetes at a rate of about 5% per year.
The key thing to know is diabetes develops when the beta cells of the pancreas can no longer produce enough insulin to overcompensate for insulin resistance and can’t maintain normal blood sugar levels.
By the time fasting blood sugar levels reach an average of 115 mg/dL, the first-phase response to increases in blood sugar is lost. This results in not enough sugar being removed from the bloodstream, new glucose being produced from the liver, and fat cells releasing increased amounts of free fatty acids.
The main thing to keep in mind with type 2 diabetes is that almost all people with type 2 diabetes have insulin resistance.
But most people who have insulin resistance don’t go on to develop diabetes. This is important to note. And if you can reduce insulin resistance, you stand a good chance of being able to prevent type 2 diabetes.
I can remember when the concept of insulin resistance was new to so many physicians many years ago. I would tell them what this meant and they looked at me like I had two heads. As science has evolved and the treatment for type 2 diabetes has improved, insulin resistance has become a term that is very well understood by most doctors. But just understand that it wasn’t always this way and some doctors are still a part of the old guard.
And something that must be pointed out is that insulin resistance is usually the first thing to happen before a person goes on to develop type 2. This process can take place up to 15-20 years prior to being diagnosed with diabetes. Once insulin resistance starts to increase, the next thing to happen after that is blood sugar levels start to increase and then following that insulin levels start to increase to overcompensate for the increase in blood sugar.
When the pancreas can no longer keep up, diabetes is the result and the pancreas looses it’s ability to produce enough insulin. Not to mention the insulin that is being secreted isn’t doing it’s job effectively because the cells of the body are resistant to it.
Pre-Diabetes And How To Prevent Diabetes
First, the underlying problem must be addressed. Diabetes is a progressive disease. And most treatments out there don’t really address the heart of the problem. Most of the times treatments are simply band-aids to the real problem.
So if you want to prevent developing type 2 diabetes here are some things that you can do:
- Eat foods with a lower glycemic index such as whole foods that don’ t work the pancreas as much.
- Keep your blood sugar levels at normal levels.
- Cut down on your portion sizes. Our bodies just are not equipped to deal with large amounts of food. And this is what leads to diabetes.
- Eat sweets and high sugary foods in moderation. In fact, you might want to cut these out for a while until you have gotten your blood sugar levels in check for a good period of time.
- Exercise. This is one of the best ways to reduce insulin resistance.
- Test your blood sugar regularly and see where you’re at.
- Make your doctor your friend instead of your enemy. If you have prediabetes, it’s not time to run from the doctor because you were told what you didn’t want to hear. In fact, it’s all the more reason to start visiting your doctor more.
- Go easy on the carbohydrates. Carb overload is a big reason for development of type 2 diabetes. Try to keep your carbs per meal to 1/4 of your total meal. The other 1/2 should be non-starchy vegetables. Leafy green ones. And the other 1/4 should be protein like fish. Of course speak to your doctor first before making any changes as this is just to give you an idea. Not a rule.
Why A Prediabetes Diet And A Type 2 Diabetes Diet Should Be Similar
Pre diabetes is a wake up call. And you should look at it this way. It’s not as bad as you may have been told or you may have read. With lifestyle modification and changing your diet, you can greatly reduce your chances of developing type 2 diabetes. If you have prediabetes it is just a symptom or result of an underlying problem. Address that underlying problem and you can change the result.
The same rules apply for type 2 diabetes. Fix the underlying problems. This is why a prediabetic diet and a type 2 diabetes diet should be similar. Because both prediabetes and diabetes have to do with insulin resistance.
So before I wrap this up, I want you to have a few understandings about Type 2 diabetes.
How Type 2 Diabetes Works
Here are the chain of events that take place and how diabetes happens:
- Your body turns sugar (carbohydrates) that you eat into glucose
- Insulin produced by the pancreas is secreted and joins glucose in your bloodstream
- Insulin unlocks the cells in your body to allow glucose to enter your cells to be used as energy
- When insulin can’t unlock the cells of your body, because of the cells being resistant to the effects of insulin your blood sugar levels gradually increase over time
- The higher your blood sugar levels rise, the more toxic it is on your organs
- As you eat more food this problem is complicated
- As cells of your body can’t get the energy (glucose) they need and are starving, your body produces more glucose in the liver because your body is tricked into thinking you’re fasting (hungry) and need glucose for your cells
- This further increases your blood sugar levels
- The end result is clinical diagnosis of diabetes as your blood sugar rises to diabetic levels
Understanding the two core defects of Type 2 Diabetes: Insulin Resistance and Beta Cell Dysfunction
What insulin resistance means is your cells are resistant to insulin. So insulin can’t unlock the door on the cell to let sugar in. So with no place to go it stays in your bloodstream and gradually your blood sugar levels rise over time.
Beta cell dysfunction refers to the following:
- The first-phase insulin secretion is delayed after a meal and then lost
- The second-phase secretion is decreased
- Insulin secretion isn’t secreted to throughout the day to maintain normal basal (between meals and overnight) insulin levels
- The total mass of beta cells diminishes which means fewer beta cells are around to produce insulin
Armed with this knowledge you now have all the tools you need to prevent type 2 diabetes. Or if you have been told by your doctor that you have diabetes, control or reverse it. Prediabetes and Type 2 diabetes in no way mean the end of the world. In fact, they really aren’t as bad as you may have been told. All it takes it changing your habits and an awareness.
Prior to using any of this material, please consult with your doctor. There are a number of situations and circumstances out there, which make a one-size-fits-all solution impossible.