September 17, 2010
Dear Mayo Clinic:
I have been told I have prediabetes. Is there still time for me to make changes that will reverse it or is diabetes inevitable?
Having prediabetes does not necessarily mean you're destined to develop the full-blown version of the disease. But to avoid diabetes down the road, you'll likely have to make some lifestyle changes now.
Diabetes affects how the body uses blood sugar (glucose). Glucose is vital to health because it's the main source of energy for the cells that make up muscles and virtually all tissues in the body. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin. The hormone insulin comes from the pancreas, a gland located just behind the stomach. When a person eats, the pancreas secretes insulin into the bloodstream. As insulin circulates, it allows sugar to enter the cells and lowers the amount of sugar in the bloodstream.
Diabetes means the blood sugar is too high, which can lead to serious health problems. As implied by the name, prediabetes is often a temporary state that leads to the development of overt diabetes. During the development oftype 2 diabetes (as in prediabetes), cells become resistant to the action of insulin, and the pancreas is unable to make enough insulin to overcome this resistance. Instead of moving into the cells, sugar builds up in the bloodstream.
A diagnosis of prediabetes means blood sugar is higher than normal, but not high enough to be classified as type 2 diabetes. Prediabetes is often diagnosed by measuring the fasting blood sugar after a person hasn't eaten for at least eight hours. The normal fasting blood sugar level is lower than 100 milligrams per deciliter (mg/dL). A level from 100 to 125 mg/dL is considered prediabetes, and a level of 126 mg/dL or higher may indicate diabetes.
Studies have shown that people diagnosed with prediabetes have a 40 percent chance of developing diabetes within 10 years. The best way to prevent your condition from progressing to diabetes is to make sure you're making healthy lifestyle choices, such as eating healthy foods, exercising regularly and losing excess weight.
The good news is that these changes don't need to be monumental. You don't have to run a marathon or climb mountains. Walking 30 to 40 minutes a day and shedding a few extra pounds can fundamentally change your chances of developing diabetes. One large research study found that diet and exercise which resulted in a 5 to 7 percent reduction in weight could lower the risk of diabetes in high-risk individuals by 58 percent. For example, someone who weighs 200 pounds could potentially prevent diabetes by losing just 10 to 15 pounds.
In some cases, medication may be an option to reduce blood sugar levels in people who have prediabetes. But, there is some debate about that because the medications used for prediabetes are the same as those used to treat diabetes itself. So it's unclear if the medication actually prevents diabetes or if it simply keeps the disease under control as it progresses. Research on this topic suggests the latter, because when the medication is stopped in people with prediabetes, their blood sugars rise to levels that would have been expected over time without the medication.
I recommend you talk to your doctor about possible lifestyle changes to help decrease your blood sugar level. By carefully following a diet and exercise plan tailored to your needs, you may be able to dramatically decrease your risk of eventually developing diabetes.
— Adrian Vella, M.D., Endocrinology, Mayo Clinic, Rochester, Minn.