Internal Medicine

I’m 45 and a little overweight. My doctor said I have “pre-diabetes.” Does this mean I will definitely become diabetic?

Dr. Elizabeth Helfer, an endocrinologist with The University Doctors, responds:

Your diagnosis probably stems from the results of a blood test that checked for type 2 diabetes. The test measures your digestive system’s ability to convert sugars, starches and some other foods into glucose, a type of sugar that our bodies need for energy. Insulin, a hormone, plays a key role in maintaining a healthy blood sugar level by converting glucose into the energy the body either uses immediately or stores for later use. With type 2 diabetes, the body either can’t make the right amount of insulin or is unable to use the insulin it has well enough to prevent an excess of glucose from accumulating in the blood. The results from your blood test probably indicated an elevated blood sugar level that is higher than normal but not high enough for a diagnosis of diabetes.

The good news is that you are being diagnosed with pre-diabetes. The not-sogood news is that pre-diabetes is a serious and potentially dangerous condition. Studies have shown that people diagnosed with pre-diabetes are much more likely to develop diabetes in the future. Additionally, even when your blood sugar is only at pre-diabetes levels, your risk of heart disease or stroke increases by as much as 50 percent.

A diagnosis of pre-diabetes doesn’t guarantee that you will become diabetic, but you may want to consider it to be a final warning about the need for some lifestyle changes. Some factors that increase your risk of diabetes, such as genetics and being a member of certain ethnic groups, are beyond your control. But if you are pre-diabetic and overweight, dropping some of those excess pounds will help you avoid becoming diabetic. Losing just five to ten percent of your body weight – as little as 10 to 20 pounds for a 200- pound individual – could significantly lower your blood sugar level. According to the American Diabetes Association, studies have shown that people with pre-diabetes who lose weight and who engage is some modest form of exercise (30-60 minutes per day, 5-7 days per week) can prevent or delay the development of type 2 diabetes by up to 58 percent.

Despite the fact that individuals can control or prevent diabetes through diet and exercise, this disease is quickly approaching epidemic levels in the United States. Today, more than 23.5 million Americans have diabetes and another 57 million have pre-diabetes. Even more worrisome is the growing number of children and adolescents who are at risk. One study, published in 2002 in the New England Journal of Medicine, estimated that more than 20 percent of very obese children and adolescents also were pre-diabetic. If you have been diagnosed with prediabetes, you need to do everything in your power to make sure your condition does not become worse. Your physician can advise you on dietary changes and exercise programs that will help you to lose weight and lower your blood sugar. Your physician may also prescribe medications.

Diabetes can be a devastating disease. It is the leading cause of blindness in the U.S. and can lead to amputations, kidney failure, strokes and sexual dysfunction.

Originally published in The University Doctors' MedicaLink - 6/09

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