Pre-Diabetes
A Valuable Wake-Up Call

Pre-diabetes (PD) is a valuable wake-up call for the US; which has a reputation for doing everything in a big way. After all, we have big dreams and big accomplishments to back us up. Unfortunately, we're also a country that favors super-sizing everything, including our meals, which is leading us to an epidemic of obesity. The truth is, bigger isn't always better, especially when it comes to the size of our citizens. Being overweight is one of the most common causes of type 2 diabetes, and of pre-diabetes, a condition that indicates the inability to properly metabolize glucose, but not quite to the levelof diabetes.

As its name suggests, pre-diabetes can be a precursor to type 2 diabetes, the most common form of the disease. In fact, studies show that most people with pre-diabetes go on to develop type 2 diabetes within 10 years. And since the American Diabetes Association reports that it affects approximately16 million Americans age 40 to 74, that's scary news.

If that isn't enough cause for concern, other research has shown that even in the pre-diabetes stage, there's an increased risk of the kind of long-term damage to the body, particularly to the heart and circulatory system, that's associated with uncontrolled diabetes. The U.S.Department of Health and Human Services (HHS) warns that pre-diabetes can increase the risk of heart disease by as much as 50 percent.

But the news isn't all bad, because even modest weight loss and physical activity can delay or prevent the onset of diabetes in people who are diagnosed with pre-diabetes. However, given that symptoms often don't accompany pre-diabetes or even type 2 diabetes in its early stages,being aware of potential for pre-diabetes is an important prevention measure.

Something Old and Something New

Like diabetes, pre-diabetes is nothing new, but the incidence of both is becoming more frequent. Over the past 30 years, the number of people in the US with diabetes has increased ten-fold, say Richard H. Bertenshaw, M.D., an endocrinologist in La Grange, IL. Not surprisingly, thefrequency of pre-diabetes is growing at similar rate.

Also known at one time as "borderline diabetes," pre-diabetes involves one of two conditions, impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), both of which are revealed through blood tests.

"Scientifically, IFG and IGT haven't changed," Dr. Bertenshaw explains. "But the term 'pre-diabetes' is much easier for the general public to understand." And, perhaps more importantly, it's a term people are likely to pay more attention to., says Chad Hutto, M.D.,of Belmont Family Medicine in Carol Stream, IL.

"Pre-diabetes is really a new name for an old problem," he explains. "But it's part of an effort to make people understand that pre-diabetes is the beginning stage of what can become diabetes, if they don't take the proper step to prevent it."

Experts agree that the keys to turning the tables on pre-diabetes are diet and exercise. But, as Dr. Bertenshaw points out, encouraging someone who isn't experiencing symptoms to change their habits can be a challenge.

"Symptoms of diabetes, such as excessive thirst or frequent urination, don't begin to appear until the blood sugar reaches a high level, at which point the damage can already be occurring," he explains. Worse yet, Dr. Bertenshaw says, some people with pre-diabetes mayalready exhibit signs of complications by the time they are diagnosed with diabetes. Some of the most common complications of diabetes include heart disease, kidney disease, blindness, and nerve damage.

A Step In The Right Direction

For many people, the desire to avoid these serious complications may be motivation enough to take preventive steps. The old analogy, 'if it aint broke don't fix it' doesn't apply when it come to preventive practices. Fortunately, Dr. Hutto says, there's conclusive evidence that even small measures can make a big difference.

He points to the Diabetes Prevention Program (DPP, a major clinical trial involving more than 3,000 people. The DPP demonstrated that diet and exercise resulting in a 5 to 7 percent weight loss loweredthe incidence of type 2 diabetes by 58 percent. The DPP also revealed that diet and exercise were more than effective than medication in preventing or delaying the progression of pre-diabetes into diabetes.

"The participation increased their physical activity to half an hour five times a week", Dr. Hutto says. "There are a lot of simple ways for people to add that amount of exercise into their regular routine." One effective strategy he recommends is purchasing ainexpensive pedometer, which measures the distance a person walks. The goal is to walk10,000 steps a day, which can often be achieved in the course of normal activities, such as grocery shopping or walking from the parking lot at work. If that goal hasn't been reached, a walk after dinner might do the trick.

"It's my belief that exercise covers a multitude of sins," Dr. Bertenshaw adds. It improves your insulin sensitivity, helping the body better metabolize glucose, which is why it can be even more helpful than dietary changes, although those are obviously important, too."

He emphasizes that people with pre-diabetes should try exercise for a minimum of 20 to 30 minutes every day. After all, their health condition is with them every day, too. What's more, exercise that builds lean body mass, such as weight training, yoga or palates, can contribute tofurther improving insulin sensitivity, making it a helpful complement to aerobic exercise such as walking, running or cycling.

Everything In Moderation

An emphasis on exercise doesn't mean proper nutrition isn't vital to people with pre-diabetes. And although most people don't like the idea of being "on a diet," eating right doesn't have to be boring or complex. The key, Dr. Hutto says, is moderation.

"Healthy eating doesn't mean giving up fried chicken or ice cream altogether," he says. "It just means limiting them to once a week or so, and paying attention to portion sizes, which is where our country has really gotten out of control." To gauge appropriateportions, Dr. Hutto suggests using your hand as a guide: The bigger your hand, the larger the amount of food you need. A serving of meat should be the size of the palm of your hand, and a serving of starchy foods, such as rice, potatoes, pasta or starchy vegetables like corn or peas,should be the size of your fist. The rest of the plate should be filled with nutrient rich vegetables in a variety of colors. Vegetables provide the body with compounds not found in other foods including: enzymes, minerals, antioxidants and chlorophyll and nature’s richest source of carotenoids including beta carotene andlycopene. Only 9% of Americans consume the recommended 5 servings of veggies per day; even less consume 3-5 servings of green leafy vegetables. Two whole foods that have been awarded the Diabetes Resource Center's "Seal of Approval" as a beneficial food for diabetic and pre-diabeticconsumption are Perfect Food and Primal Defense, both produced by a company called Garden of Life. These whole foods enhance a healthy dietaryintake and allow for proper nutrient absorption.

Equally important is to eat three meals a day to keep blood sugar levels balanced. "People who don't eat breakfast often gorge later in the day," he says. "Eating too much at one time is more than a body can handle when there's already some insulin resistance goingon."

Although a healthy diet and exercise program is good sound advise for everyone, whether or not they have pre-diabetes, it's important for people at increased risk to discuss routine screenings with their doctor. General guidelines are that people over the age of 45 who are overweightshould be screened for pre-diabetes during regular doctor visits. However, some doctors may recommend screenings beginning at a younger age, perhaps even in adolescence, for people who are significantly overweight or who have one or more of these risk factors:

• A family history of diabetes
• Low HDL cholesterol and high triglycerides
• High blood pressure
• A history of gestational diabetes or giving birth to a baby weighing more than 9 pounds
• Belonging to a minority group that's at increased risk for diabetes: African Americans, American Indians, Hispanic Americans/Latinos, Asian Americans and Pacific Islanders

The American Diabetes Association offers a free risk test on its Web site. The risk test and other helpful information can be found in the "Basic Diabetes Information" section of the site.

The best news of all is that even if pre-diabetes does ultimately develop into diabetes, it doesn't have to negatively impact a person's quality of life. "People with diabetes who take proper care of themselves actually can be healthier and live five to ten years longer than peoplewithout diabetes who don' have healthy habits," Dr. Bertenshaw says. "Obviously, everyone can benefit from making better choices about their lifestyle.

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