What You Need to Know About PREDIABETES
Have you ever had your blood drawn and sent off to the lab for interpretation? Most likely you have and one of the factors that was probably evaluated was your blood sugar.
There are several ways that blood sugar can be evaluated.
One of the ways is by testing your fasting level, which will show up on your lab results as “glucose.” Fasting means you haven’t had anything to eat or drink (other than water) for at least 8 hours before the test.
If you don’t have diabetes, fasting levels of glucose are expected to be between 70 and 99.
Another common lab that looks at glucose over a longer period of time (2 to 3 months) is called “hemoglobin A1c.” It’s expected that an A1c is under 5.7% for those without diabetes.
You may be told you have “prediabetes” if your fasting blood sugar is between 100 and 125 or your A1c is between 5.7% and 6.4% at any point in time.
However, there’s some controversy around this “diagnosis.”
According to investigative journalist Charles Piller, the term resulted from a brainstorming session of six diabetes thought leaders hoping to elevate the level of concern in patients and doctors for high blood sugar that was not quite diabetes (Piller 2019).
Despite other specialists in the field citing weak support and even scaremongering, the American Diabetes Association (ADA) and Centers for Disease Control and Prevention (CDC) went on to declare prediabetes as the first step on the path to diabetes.
BUT…to this day, the World Health Organization (WHO) and other medical authorities remain unconvinced that prediabetes routinely leads to diabetes or that existing treatments do much good, rejecting the idea of a prediabetes label diagnostic category altogether.
And it makes sense.
A 2018 comprehensive review of 103 studies showed that most people in the prediabetes range never actually progressed to diabetes over any period studied. In fact, 59% of the prediabetes patients studied returned to normal blood sugar values in one to 11 years without any treatment (Richter et al. 2018)!
Still, the diagnosis of prediabetes remains common.
Piller points out how the realities of the medical establishment and its financial ties, particularly in the US, complicate matters even further. There is no Food and Drug Administration (FDA) approved treatment for prediabetes, so many clinicians prescribe diabetes medications “off label” that carry the risk of side effects.
The American College of Physicians has rated the ADA’s financial conflicts with drug companies as among the most extreme.
In fact, seven of the fourteen ADA experts who wrote the 2018 standards of care for prediabetes received between $41,000 and $6.8 million from diabetes drug and device companies between 2013 and 2017 (Piller 2019).
If most people with elevated blood sugar are never actually going to progress to diabetes, what’s the point in adding unnecessary stigma and stress? Not to mention the expense of more frequent visits, tests, and possibly medications.
Many public health organizations agree that an overly clinical approach to diabetes prevention is ineffective. The WHO has argued instead for society-wide solutions aiming to address the health impacts of social stratification, urban planning, and improved nutrition—all of which can affect the high sugar levels that are a trigger for the prediabetes diagnosis.
Now, if you’ve had labs indicating blood sugar in the “prediabetes” range, I am not saying you should ignore those results.
What I am saying is that I’d recommend remaining curious about those results.
Here are some ways you can stay curious rather than fearful about a prediabetes diagnosis:
Look at your glucose trends over time; does this lab result seem out of place or have things been trending up?
Make note of what was going on in your life when the labs were taken. Blood glucose can be influenced by many factors, including stress, hydration, sleep patterns, nutrition, certain medications and supplements, illness, and activity levels.
If you think there is a habit or pattern that could use improvement, see what you can, add, ADD, such as an extra 30 minutes of sleep or a 10-minute walk after lunch.
Having these answers at hand and then unpacking the science behind them will help you figure out how to create a self-care routine that works for you.
I cover all of this and more through the four pillars approach in my book, Intuitive Eating for Diabetes: The No Shame, No Blame, Non-Diet Approach to Managing Your Blood Sugar. LEARN MORE AND ORDER at IntuitiveEatingForDiabetes.com