Is pre-diabetes just diabetes?

Maybe it’s obnoxious to pose this question since pre-diabetes is well established in medicine. However, I think it can be confusing. Am I diabetic? Not at all? A little bit? With ten minute appointments at your doctor’s office, does anyone take the time to explain to you what’s really going on?

There are several tests used to diagnose pre-diabetes and diabetes, but the two most popular are Hemoglobin A1C (HbA1C) and fasting blood sugar (fasting plasma glucose).

HbA1C: The American Diabetes Association recommends that this be used as the primary diagnostic test. Hemoglobin found in red blood cells forms linkages with glucose molecules (this is called glycation). In a healthy person glucose is taken up by the body easily and doesn’t hang around in the blood stream too long, so the maximum percentage of glycation should average no more than 5.6%. Pre-diabetes is diagnosed at 5.7% to 6.4%, diabetes at 6.5% or above.

Red blood cells live on average up to 120 days so the test measures how well your body did processing sugar over the last few months, and this is why the test is a strong one.

Fasting blood sugar: Normally after eight hours of fasting, blood sugar levels should be no more than 100 mg/dL (milligrams/deciliter). The pre-diabetic range is 100 to 125 mg/dL; it’s diabetes at 126 mg/dL and above.

According to the Mayo Clinic, pre-diabetes means “that your blood sugar level is higher than normal but not yet high enough to be classified as type II diabetes.” The difference between pre-diabetes and diabetes is really just a matter of numbers.

I’ve always thought that the term pre-diabetes was a misnomer because it’s really not a condition that comes before diabetes. It is type II diabetes; pre-diabetes and diabetes are on a continuum. Pre-diabetes is the onset of diabetes, a disease that begins with insulin resistance, a condition that can last for many years prior to the manifestation of high blood sugar.

Insulin resistance occurs when the body stops responding normally to insulin, usually due to excess weight, and as a result can no longer take up sugar efficiently. The pancreas must pump out more and more insulin in an effort to drive sugar into the cells. Over time the pancreas becomes less able to cope with the demand, and blood sugar levels start to rise. This is when pre-diabetes presents, and “without intervention, pre-diabetes is likely to become type 2 diabetes in 10 years or less,” the Mayo clinic states.

Here’s the true grey area: how much do the numbers really tell you?

The numbers dictating the classifications of pre-diabetes and diabetes can be misleading. They are simply guidelines for making diagnoses. What I mean by this is, once you are confirmed to have pre-diabetes, it’s a problem. Don’t wipe your brow and say, “phew, at least I don’t have diabetes yet!”

The Mayo Clinic stresses a very important point:  “If you have pre-diabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.” This was exactly the case for me.

When I was confirmed to have pre-diabetes, my fasting blood sugar was 104 mg/dL and my A1C a 5.7, both just above normal range. However, I was already having symptoms of diabetes and displaying signs of metabolic distress: my HDL cholesterol levels were too low and my triglycerides, fats found in the bloodstream, were too high. I also had high blood pressure. This group of disorders is known as metabolic syndrome, which arises and worsens in direct relation to insulin resistance. I’ve even seen it referred to as insulin resistance syndrome.

Do the numbers mean you’ll definitely have symptoms of diabetes when your fasting blood sugar levels surpass 125 mg/dL? No, in fact according to the Joslin Diabetes Center, approximately one third, or 8 million out of the estimated 24 million people with diabetes don’t even know they have it.

I was already well on my way to heart disease with low pre-diabetic numbers. For me, the numbers were mild but the problems were definitely not.

Is pre-diabetes over-medicalized?

Some medical professionals have questioned the pre-diabetic condition, wondering if it is over-medicalized and that healthy people are being treated unnecessarily with drugs. Do I agree that pre-diabetes is over-medicalized? Yes, I do, because it does not need to be treated with drugs at all. However, I cannot agree that it be treated lightly.

Pre-diabetes is a serious SOS to your future health, particularly your heart health, and is completely reversible with weight loss accomplished by dietary changes and exercise. Do not despair thinking that you have to lose a ton of weight to see significant changes. Even losing just 10% of your body weight can start to reverse insulin resistance and the upward trend in your blood sugar levels.

In my next post I’ll be explaining more about insulin resistance and how you can start to lose weight with small changes.