Pre-diabetes: Halt the progression

Stop pre-diabetes in its track through timely action


The philosophy that, “An ounce of prevention is worth a pound of cure,” continues to take front seat in preventing all lifestyle-related problems like diabetes, hypertension, obesity and heart diseases. We’re becoming more aware of our health and there seems to be a surge of wellbeing experts and products. Yet, the irony remains that India is an emerging capital of diabetes. Diabetes leads to complications, both small and big, which translate in the early stages of the disease, into reduced productivity, increased cost of care, a constant underlying worry about what to eat and what to avoid. Ask any diabetic what would be the best help s/he could have got in the management of this disease and the reply would surely be, “If only I could have seen it coming as pre-diabetes and stopped it right there before it touched me!”

The concept of pre-diabetes evolved out of this necessity to prevent diabetes and its complications and nip them in the bud. That is possible by its early detection and thereby preventing it from becoming full blown diabetes mellitus, commonly known as type 2 diabetes.

The grey zone

Pre-diabetes, as the name indicates, is the stage of diabetes before it becomes overt and needs medical treatment. When you get your fasting blood sugar levels checked and find them to be more than 125 mg/dl or if your HbA1c is more than 6.4, that’s when you have diabetes. Pre-diabetes is that grey zone between normalcy and diabetes. You will know you have pre-diabetes if your fasting blood sugars are between 100-125 mg/dl [also called as impaired fasting glucose] or your post meals sugar is between 140-200 mg/dl on doing oral glucose tolerance test [after drinking sugary syrup and checking blood sugar after 2 hrs]. You may of course be alarmed to get a high reading like this, but the bright side is that you’re in a zone from where you can return back to normalcy and not proceed to develop diabetes. But that is only if you take the necessary precautions and follow your doctor’s advice as suggested.


Now this is the tricky bit, because there are no symptoms seen with pre-diabetes, some people may have signs of insulin resistance like black patches over the neck, armpits or elbows also called as ‘acanthosis nigricans’. Skin tags or warts also indicate that the person may develop diabetes and should be screened.

Risk factors for pre-diabetes

Read this list carefully because it is the give-away on how you can detect this condition in time and reverse it before it’s too late. So get yourself checked if:

  • You have a family history of type 2 diabetes
  • If you have low level of physical activity
  • If you’re a smoker
  • If you have high blood pressure and/or abnormal blood fats
  • If you have some heart related diseases or blockages in the heart
  • If you’ve had gestational diabetes during pregnancy or polycystic ovarian syndrome [PCOD]
  • If you’re on some anti psychotic medications
  • You have central obesity with a waist circumference of more than 90 cm
  • If you have a BMI higher than 25
  • Strong family history of diabetes mellitus.

Studies have shown that 15 – 30 per cent of individuals with pre-diabetes will progress to full fledged diabetes mellitus in a year if left untreated. Once you’ve been detected with pre-diabetes or even if you have more than a few of the above risk-factors, put an action plan in place.

Management strategies

Diet: Reducing all the sources of total fat, saturated fats and transfat from your diet is recommended. Indian diet is  carbohydrate centric, but restricting carbohydrates will help. Coconut and coconut oil in the diet should be restricted. Diet high in fibre, fruits and vegetables is advised. Reduce intake of excess sugar, cheese, butter, fried foods, chips, pickles and processed foods.

Exercise: If you’ve always had a sedentary lifestyle, just deciding or knowing that you need to exercise is not going to help. You’re going to have to take a more committed step towards your health. Engage a personal fitness trainer, or find an exercise buddy who is more motivated than you are. If you know you can’t rely on yourself to be regular at this, share the responsibility with another person.

Moderate physical activity like swimming or brisk walking for 30 minutes is good enough to result in weight loss of 5 – 10 per cent which can reverse pre-diabetes and normalise your blood sugar. If you are obese, it is recommended to increase the physical activity duration to 60 minutes. Remember, losing weight and maintaining it for long term is most important to prevent diabetes. Seek help to reduce your smoking frequency and limit alcohol intake to only 1 – 2 units per week.

Lifestyle management: Since this is a lifestyle disease, to reverse it too, you have to tweak your lifestyle to make it more favourable towards your health and wellbeing. Allow your physician to decide whether or not you may require any medication too, in order to accelerate the process of reversal of sugar levels to normal. This may be needed particularly for those with heart problems, morbid obesity or strong family history of diabetes. Drugs like metformin and acarbose can be used to normalise blood sugars. Other goals should be to keep blood pressure around 130/80mmHg

Total cholesterol levels should be below 200 mg/dl, LDL should be less than or equal to 100 mg/dl and HDL cholesterol should be more than 40 mg/dl in men and 50mg/dl in women.

Other strategies

Apart from lifestyle and diet changes the only other recommended strategy to reverse pre-diabetes is bariatric surgery which is done only in obese patients who have failed to lose weight despite repetitive attempts or extremely obese patients. These patients tend to have other complications of obesity and pre-diabetes is one of them.

I’d like to reiterate that to have pre-diabetes is good news. Good news because early detection will drive you to be motivated, control your food habits and exercise to get your blood sugars to normal. So go for it!

 This was first published in the January 2013 issue of Complete Wellbeing.

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