Understanding Prediabetes

By Michelle Slowey, MS, RDN, CDCES, CDN

Many people who have prediabetes are unaware of it. Risk factors include a sedentary lifestyle, being 40 years or older, being overweight or obese, having a strong family history of diabetes, and if a woman has a polycystic ovarian disease or has had gestational diabetes. Elevated blood pressure and triglycerides above 250 mg/dL with a low HDL (good cholesterol) can also contribute to developing pre-diabetes.  

The American Diabetes Association defines prediabetes as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). IFG is a fasting blood glucose of 100 mg/dL to 125 mg/dL, and IGT is a glucose level from 140 mg/dL to 199 mg/dL two hours after consuming a glucose-rich drink. In addition, hemoglobin A1C levels of 5.7% to 6.4% identify individuals with prediabetes.

Prediabetes is associated with abdominal obesity. This visceral fat is the fat that wraps around your organs inside the abdomen. Being overweight or obese (body mass index of 30 or above) contributes to prediabetes. Visceral fat increases inflammation in the body, which can interfere with normal hormonal functions such as hunger levels, weight, and brain function. Excess sugar intake is associated with inflammation which can cause a build-up of fat in the liver and make it difficult to manage blood glucose levels. When the body’s cells don't respond well to the hormone insulin, glucose cannot enter the cells easily, so it builds up in the blood, which is called Insulin resistance.

If you are overweight, losing 5 – 7% of your weight through a healthy diet plan, such as the Mediterranean diet and moderate-intensity physical activity of at least 150 minutes per week, can help your insulin work better and lower your blood sugar. Brisk walking, biking, and swimming are a few examples of recommended aerobic activities.   

The Mediterranean diet may help manage prediabetes and prevent the development of diabetes. An unprocessed high-fiber diet, rich in whole grains (with a goal of 25 grams of fiber per day) and heart-healthy fats like nuts, seeds, and avocados, is recommended. Limit refined, highly processed carbohydrates such as white rice, sugary cereals, cookies, candy, and soda. The Mediterranean diet also emphasizes lean protein sources such as fatty fish, i.e., salmon, skinless poultry, soy, beans, and nut butter. 

Following these diet and exercise guidelines can lower your risk of developing prediabetes and type 2 diabetes.