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Know how prevent prediabetes, or how to respond if you have it: a diagnosis of prediabetes should be considered a red flag warning that you need to make changes before the condition turns into full-blown diabetes.

Prediabetes, a condition in which your blood glucose levels are elevated, but not yet high enough to be considered type 2 diabetes, should be considered a wakeup call to make changes in your life. However, a recent report from the Centers for Disease Control, notes that as many as one in three adults may have prediabetes, yet only about 11 percent of them are aware of their status.

"It is extremely important to understand that this is the most important time to intervene before full blown diabetes develops," says Cleveland Clinic endocrinologist and diabetes expert Betul Hatipoglu, MD. While many people with prediabetes are overweight or obese, Dr. Hatipoglu points out that the CDC's data indicates that many of those in the "unaware" group are younger than 45, have less than a high school education, are of normal weight, have no family history of diabetes, and often have no health insurance.

Prediabetes isn't a guarantee that you'll develop diabetes, but it is a red flag that should be observed and acted upon soon. A change in lifestyle, usually involving weight loss, can reverse the course of the condition, but the first thing you need to do is find out what's going on in your body.

Becoming aware

Type 2 diabetes is a condition in which the body either fails to produce enough insulin or the cells ignore insulin. Insulin is a hormone that helps in the metbolism and utilization of energy from food, and helps regulate glucose levels in the bloodstream. When cells in the body aren't absorbing enough glucose, that additional sugar in the blood can damage the health of blood vessels, affecting their ability to constrict and dilate as needed.

Prediabetes generally has no symptoms, but diabetes often has symptoms such as unusual thirst, extreme fatigue, frequent urination, tingling in the hands and feet, and cuts or bruises that are slow to heal.

If you are 45 or older and are overweight, you should make sure that your next blood work includes a test for fasting blood glucose. If you're of normal weight, talk with your doctor about when it's appropriate to have a prediabetes check.

A fasting blood glucose level of 100 or higher may trigger follow-up tests to learn more. A hemoglobin A1C test can determine a three-month average of blood glucose levels in your body, and a glucose tolerance test, which is a blood test done after you drink a sugary liquid, are also used to determine if you have prediabetes or actual diabetes.

It's important to note that a fasting blood glucose level can change significantly from day to day. You might have a score of 95 one day and 110 the next day. What and how much you eat can move those scores up or down, which is why the follow-up tests are needed to help confirm a diagnosis.

You should also understand that the longer your go without addressing your prediabetes or diabetes, the longer damage can be occurring in your body.

"In the literature, there is data that these individuals are at high risk for heart disease, nerve damage, even eye damage and kidney problems as well," Dr. Hatipoglu says. "They are really high risk to have heart attack or stroke--three to five times more at risk then people with no prediabetes."

Taking charge

"If people with prediabetes are overweight or obese, they have to really try to lose weight to 'unload the work' from their pancreas that provides insulin to balance the blood sugars," Dr. Hatipoglu says. "Even a weight loss of five to 10 percent can lower their risk. When trying to lose weight, individuals should understand that this will be a lifelong commitment, and learning to eat healthy and balance diet even after they lose the weight is very, very important."

She recommends a diet rich in fruits, vegetables, low-fat dairy products, lean proteins, olive oil and nuts, and low in sweets and refined goods.

"Drinks containing sugars such as soda and juices really should be avoided as much as possible," she adds.

The other aspect of your prediabetes response should include exercise. "Of course maybe the most important of all is to be active," Dr. Hatipoglu explains. "We recommend at least 150 minutes a week of moderate exercise and twice-a-week weight training if possible. But every little bit counts."

She adds that recent research suggests that sitting less during the day--even just five minutes less per hour sitting--lowers the risk for diabetes. "This tells you not to be stuck to the idea or be intimidated by the thought of having to go to a gym or break a sweat to get a benefit," she says. "Anything will count: walking, gardening, dancing, just moving around."

Results are within reach

Dr. Hatipoglu stresses that turning the course of prediabetes is a very realistic possibility. "During my career, I have been 'fired' by my patients, because of encouragement and education we provided them, they did not need my help anymore," she says. "Let me tell you, it was one of the best rewards I get from my practice'

Your odds of preventing prediabetes from developing into diabetes is as high as 80 percent if you diet and exercise and follow your doctor's advice. And that's key. Your doctor may suggest that you do blood glucose monitoring at home to check your progress.

And if your efforts to lose weight or make other needed changes aren't getting your blood gluocse levels down, you should talk with your healthycare provider about other steps you can take.

Prediabetes doesn't usually warrant medication use, but your doctor may prescribe something to help improve your body's regulation of blood glucose. Generally, though, diet, exercise and smoking cessation will get you the results you want.

Your doctor may prescribe the services of a dietitian to help you plan healthier meals.

"Please see your doctor to have a screening test," Dr. Hatipoglu says. "It is very simple and easy. Whether you have weight issues or not, learn as much as possible about healthy diet and keep moving."


* A fasting blood glucose between 100 and 125

* A glucose tolerance score of 140 to 199

* A hemoglobin A1C test between 5.7 and 6.4


To lower your diabetes risk:

* Maintain a healthy body weight and a body mass index of less than 25.

* Engage in both aerobic exercise and resistance training most days of the week.

* Make healthier eating choices, such as whole grains instead of enriched white flour, and fruit instead of sweets for dessert.

* Have your blood glucose levels checked as part of your routine annual blood work, or more frequently if your doctor recommends it.
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Title Annotation:PREVENTION
Publication:Heart Advisor
Date:Jun 1, 2013
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