About 40% of adults in Michigan between the ages of 40 to 74 have pre-diabetes, a condition that occurs when one has higher than normal blood glucose levels, but not high enough to be diagnosed as having type 2 diabetes. When you have pre-diabetes your body has a hard time using the insulin you produce. This is called insulin resistance, a state in which the cells of your body do not easily recognize your insulin. If the insulin is not recognized, the "door" into your cells will not open to allow sugar to move in from the blood stream. Sugar remains in the blood leading to higher than normal blood sugars. Some research shows that, if action is taken to control glucose levels, those with pre-diabetes can prevent or delay the onset of diabetes. For those with a family history of type 2 diabetes, weight gain and an inactive lifestyle can increase insulin resistance. As insulin resistance increases, your body fights to maintain normal blood sugars by increasing insulin production in the pancreas. During this phase you may develop pre-diabetes (glucose intolerance). The extra insulin helps for a while but eventually your pancreas becomes tired and can no longer produce enough insulin to maintain normal blood sugars. At this point you may be diagnosed with type 2 diabetes.
Screening for pre-diabetes
People who should be screened for pre-diabetes include those who are overweight, with one or more of the following risk factors:
- Physically inactive
- History of impaired fasting glucose or impaired glucose tolerance
- Family history of diabetes
- Members of certain ethnic groups (including Asian American, African-American, Hispanic American, and Native American)
- History of gestational diabetes or a baby weighing over 9 pounds
- Elevated blood pressure
- HDL cholesterol level (the “good” cholesterol) of 35 mg/dl or lower and/or a triglyceride level of 250 mg/dl or higher
- Polycystic ovarian syndrome (PCOS)
- Vascular disease
Treatment of pre-diabetes
There is evidence that even though you have been diagnosed with pre-diabetes, you can reduce the risk of developing type 2 diabetes. The results of a large study published in 2001 (the Diabetes Prevention Program) showed that you can reduce your risk of developing type 2 by 58% through modest weight loss and increased physical activity, such as walking 30 minutes a day.
What can I eat?
It's not so much "what" you should eat, but how much. If you are overweight, your first and highest priority should be to get back to a healthy weight. This means working with a registered dietitian to determine the type and quantity of food you should eat at each meal. One of the key factors in weight loss is controlling portion size. Your dietitian will also help you learn how to reduce the amount of fat in your diet, because each gram of fat has more than twice the calories than a gram of carbohydrate or protein. This means:
- Eating more foods that are broiled and fewer foods that are fried
- Choosing fish and chicken more frequently, and selecting lean cuts of beef
- Reducing the amount of butter and fat you use in cooking
- Re-organizing your meals so that you eat more vegetables, fruit and healthy starches, and less meat
Your dietitian will help you learn how to continue to eat all the foods you love by learning about portion control. Having diabetes or having pre-diabetes does not mean that you can't eat certain foods; the solution is not to "avoid foods with sugar in them." Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or pie.
Along with weight loss, your goal will be to increase your physical activity, especially if you aren't getting any regular exercise now. Why? Because physical activity will help you use the insulin your body produces to change the food you eat into energy. This will help keep your blood glucose lower. Physical activity will also help reduce insulin resistance. For example, if you have a small piece of cake with a meal, follow it up with a brisk walk.
Get help at the University of Michigan
If you are worried that you may have pre-diabetes or be at risk for diabetes. There are several ways you can be involved with the care and resources at U-M. To be screened by a clinician, reach out to one of the locations listed below.