Why prediabetes is the time to take action

For people with risk factors, she has this advice: “Anyone with a body mass index higher than 25, irrespective of their age, and presenting additional risk factors such as high blood pressure, non-typical cholesterol levels, an inactive lifestyle, a history of polycystic ovary syndrome, heart disease, and/or having a close relative with diabetes must get tested to rule out any possibilities.”

When you test you might get higher-than-normal blood sugar levels, within the 100-125mg/dL range, which is diagnosed as prediabetes.

“In general, fasting blood sugar less than 100 mg/dL is normal while 100-125mg/dL is diagnosed as prediabetes,” explains Dr Mehrdad Mirouliaei, Paediatric Endocrinologist at Iranian Hospital. “And 126ml/dL or higher on two separate tests is diagnosed as diabetes.

“In people with prediabetes, Hb1AC, the average level of blood sugar over the past three months, will be between 5.7 per cent and 6.4 per cent.”

Dr Satendra Kumar Multani, Consultant Endocrinologist at Prime Medical Center – BurJuman and Deira, explains that prediabetes develops in genetically predisposed individuals if they become overweight or obese and follow sedentary lifestyle with unhealthy eating habits. “The presence of prediabetes denotes the presence of insulin resistance, which means the body requires more insulin to maintain blood glucose levels and pancreas must work more for that. Eventually, this leads to failure of B-cell function and reduction in insulin secretion, thus heralding the onset of type 2 diabetes.”

However, Dr Omran Bedir Gatee, Consultant Endocrinology, Diabetes and Metabolic Disorders at Burjeel Hospital, Abu Dhabi, is of the opinion that prediabetes should not be viewed as a clinical entity but rather as a risk factor for diabetes and cardiovascular progression. “Prediabetes is the term used for individuals whose glucose levels do not meet the criteria for diabetes yet have abnormal carbohydrate metabolism.”

But do consult your primary care provider with the prediabetes results. They may refer you to a specialist in diabetes treatment (endocrinologist), a dietician or a certified diabetes educator.

“Healthy lifestyle choices can help you bring your blood sugar level back to normal, or at least keep it from rising towards the levels seen in type 2 diabetes,” says Dr Seyed Mehrdad Solati Dehkordi, Endocrinologist at Iranian Hospital.

He suggests eating healthily and being active: Eat a variety of fruits, vegetables, nuts and whole grains. Use more olive oil, which is associated with a lower risk of prediabetes. Go for foods low in fat and calories and high in fibre without compromising taste or nutrition.

Dr Ahmed A. K. Hassoun, Senior Consultant Endocrinologist at Fakeeh University Hospital, Dubai Silicon Oasis, agrees and brushes aside the notion that people with diabetes, or for that matter prediabetes, should follow very restrictive diets, completely cutting all foods with sugar.

“People with diabetes are regularly advised to eat a healthy, balanced diet, much like everyone else.

“There are misconceptions that diabetic patients must avoid all starchy foods and cut out all fruits from their diet. This is not completely true — diabetic patients can eat healthy, complex carbohydrates such as brown rice, whole grain, whole sprouts, and more. These, in fact, help balance and control sugar levels in the body. Furthermore, most fruits are high in nutrients and low in fat and sodium. Diabetics should prefer fresh or frozen fruit with low glycaemic index to processed fruits or fruit juices with high glycaemic index.

He suggests following a nutrition plan tailored to the specific nutritional needs and food preferences of the patient created in consultation with expert medical professionals.

Dr Ajaz says prediabetics too should try to eat a balanced diet with carbohydrates, fats, protein and fibre. “Most people assume that since they have prediabetes, they have to now eat different foods and cut out sugar completely. Such high standards for the diet cause non-compliance with dietary changes.

“The American Diabetes Association had specific recommendations about the quantity of carbohydrates prediabetics and diabetics could eat, however, they have since changed those recommendations. Now, they recommend that carbohydrates in the diet should be from vegetables, legumes and fruits, rather than processed items.”

He says it’s best prediabetics avoid white bread, rice and pasta as much as they can as they are the worst foods for blood sugar management. Moreover, they should try to avoid processed sugar in the form of candy, sweet syrups, and sugary sodas. Eating fresh fruits and vegetables is recommended for prediabetics to replace sweet cravings.

He also strikes at the root of the perception that diabetics should not exercise because it is not safe for them. “Diabetics are in fact encouraged to work out as that helps reduce the risk of complications,” he says. “Prediabetics are also encouraged to exercise as that can help slow or prevent the progression to diabetes.”

Dr Dehkordi explains that physical activity helps with weight control, uses up sugar for energy and helps the body use insulin more effectively. “Aim for at least 150 minutes of moderate or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous exercise.”

And if you are prediabetic, make sure to test your blood sugars every year, along with checks for cholesterol and high blood pressure.