Part I
Confronting the Prediabetes Epidemic
In this part . . .
Prediabetes is a relatively new concept. In this part I explain its meaning and who is affected. I tell you how to recognize that you or a loved one may have prediabetes. I discuss the transition from prediabetes to diabetes. And I open the discussion of how to stop prediabetes from becoming diabetes and how to return your metabolism to its normal state.
Chapter 1
The Origins and Dangers of Prediabetes
In This Chapter
Crossing the line from health to prediabetes to diabetes
Noting the recent origin of prediabetes
Figuring out who is affected
Calculating the costs
About 60 million people in the United States have prediabetes. That means if you are in a room with three other adult U.S. citizens, one of you will probably have prediabetes, and chances are that person won’t know it. The purpose of this book is to radically change that situation. Anyone who reads this book will know whether he or she has prediabetes. Anyone who follows the recommendations in this book will not proceed to diabetes and will probably return to normal health.
This book will not make you younger, but it will help you continue to get older. Diagnosing prediabetes is crucial because prediabetes is the critical step before developing diabetes. As you find out in this book, diabetes is associated with complications that may cause considerable physical and mental discomfort at best and be life-threatening at worst. So you don’t want to go there.
Even if you go on to develop diabetes, all is not lost. You can use the suggestions found here to avoid further complications. You can’t get rid of the diagnosis, but you can get rid of the problems.
In this chapter, you discover how to differentiate among three physical states: normal health, prediabetes, and diabetes. I explain that prediabetes is a recent phenomenon, which parallels the epidemic of obesity and lack of exercise in the United States and around the world.
Next, you discover who is affected by prediabetes and which groups of people are at the highest risk. I also touch on special considerations for children and the elderly at risk for prediabetes.
Finally, I focus on the costs of prediabetes, which are not only monetary. I explain that even though prediabetes is often considered a benign condition and not a disease, changes occur in the body of a person with prediabetes that may not be benign after all.
Distinguishing Prediabetes from Diabetes
Jane Johnson is a 48-year-old woman. She is postmenopausal and has gained about 15 pounds since her twenties, when her weight was normal. She complains of some fatigue. She goes to Dr. Sugarfeld, who discovers that Jane has family members with diabetes. Jane mentions that she used to be physically active but doesn’t have the time to do much exercise these days. A physical examination reveals only that Jane is overweight and has mild high blood pressure, so Dr. Sugarfeld sends her for blood tests. One of the blood tests the doctor orders is called a fasting blood glucose, and it discovers the level of sugar in someone’s blood in the morning after that person has fasted through the night. When Jane returns a week later, Dr. Sugarfeld informs her that her fasting blood glucose was 114 mg/dl (6.3 mmol/L). (In the Introduction to this book, I explain what mg/dl and mmol/L stand for, in case you’re interested.) The doctor asks Jane to have one more fasting blood glucose test. This value is 108 mg/dl (6 mmol/L). Dr Sugarfeld informs Jane that she has prediabetes.
Going from normal to prediabetes
This anecdote describes one of the most common ways that prediabetes is discovered. Another common occurrence is simply the discovery that the blood glucose — the amount of sugar in the blood — is higher than it should be in a routine blood test.
The diagnosis of prediabetes is made the same way that a diagnosis of diabetes is made: by doing a blood glucose test in the laboratory. The critical values (numbers) in the test results are as follows:
A normal fasting blood glucose result is less than 100 mg/dl (5.6 mmol/L).
Prediabetes is diagnosed when the fasting blood glucose is between 100 and 125 mg/dl (5.6–6.9 mmol/L) on more than one occasion.
Diabetes is diagnosed when the fasting blood glucose is 126 mg/dl (7 mmol/L) or greater on more than one occasion.
A normal blood glucose level two hours after eating 75 grams of glucose is less than 140 mg/dl (7.8 mmol/L).
Prediabetes is diagnosed when the glucose two hours after eating 75 grams of glucose is between 140 and 199 mg/dl (7.8–11.1 mmol/L) on more than one occasion.
Diabetes is diagnosed when the glucose two hours after eating 75 grams of glucose is 200 mg/dl (11.1 mmol/L) or greater on more than one occasion.
Table 1-1 is a summary of these values.
| Table 1-1 Normal, Prediabetic, and Diabetic Glucose Values |
| Type of Test | Normal | Prediabetes | Diabetes |
| Fasting blood glucose | Less than 100 mg/dl | 100–125 mg/dl | 126 mg/dl or greater |
| Blood glucose two hours after eating 75 grams of glucose | Less than 140 mg/dl | 140–199 mg/dl | 200 mg/dl or greater |
Here’s what I can hear you saying: “You mean if my blood glucose is 99 mg/dl after fasting I don’t have prediabetes, but if my blood glucose is 100 mg/dl — one measly milligram of glucose more — I do?” I’m afraid so.
These definitions are arbitrary. They have changed in the past, and they may do so again depending on scientific studies. For example, a fasting glucose result of greater than 140 mg/dl (7.8 mmol/L) used to be the cutoff point for a diagnosis of diabetes. Then doctors discovered that people who had fasting glucose levels below 140 mg/dl suffered from the complications of diabetes without having a diagnosis of diabetes. So they lowered the level for the diagnosis to 126 mg/dl (7 mmol/ L). Unfortunately, even some people with fasting blood glucose levels below 126 have shown up with complications of diabetes. You should be familiar with some...
