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Understanding and Managing Prediabetes

Diabetes has reached epidemic proportions, now affecting 9.3 percent of Americans. As part of the UCF Pegasus Health Seminar Series, Dr. Joyce Paulson, who is board-certified in internal medicine and treats patients at UCF Pegasus Health, spoke to a group of people from the community about ways to prevent the disease from progressing in her talk, “Understanding and Managing Prediabetes.”

Prediabetes occurs when your blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes. Cells in the body use glucose (or sugar) for energy. A hormone called insulin helps facilitate this process. If too much glucose is present for a prolonged period of time, the cells become resistant to insulin and blood sugars go up. Approximately 86 million people are living with this condition in the U.S. If not properly treated, most of those people will eventually develop type 2 diabetes.

Risk factors for type 2 prediabetes include:

  • Overweight or obese
  • Lack of physical activity
  • Poor diet (sweets, refined grains, meats, etc.)
  • Family history of diabetes
  • Diabetes during pregnancy

“There are three basic tests we use to diagnose prediabetes and diabetes,” said Dr. Paulson. The American Diabetes Association recommends the use of two of the methods listed below to confirm the diagnosis.

  1. A1C – A common blood test, the A1C reflects the average blood sugar level over the past two to three months. A normal reading is about 5; prediabetes ranges from 5.7 to 6.4; and diabetes is 6.5 or above.
  2. Fasting Plasma Glucose – This simple, noninvasive blood test is conducted first thing in the morning when a person has not eaten for 12 to 14 hours. A normal reading is 99 or below; prediabetes ranges from 100 to 125; and diabetes is 126 or above.
  3. Oral Glucose Tolerance Test – Most commonly used to check for gestational diabetes, this test first requires a fasting blood glucose level (blood taken without eating). A while after drinking a sweet liquid, additional blood is drawn to measure how the body has processed the sugar. A normal reading is 139 or below; prediabetes ranges from 140-199; and diabetes is 200 or above.

“Fortunately for most people in the prediabetes stage, the progression to type 2 diabetes can be prevented with a few lifestyle modifications like good nutrition, exercise and weight loss. Sometimes medications can be helpful, too,” she said.

“When it comes to dietary changes, I don’t suggest that my prediabetic patients start carb counting like my diabetic patients must do,” she said. “But they do need to eat the right kinds of calories, starting first by eliminating as many refined sugars as possible.” By providing basic information like height, weight, age and gender, sites like CalorieKing.com will calculate how many calories you should eat each day to lose weight.

But all calories are not equal, Dr. Paulson said. Patients must focus on healthy calories to ensure they’re eating balanced meals. When you think of a dinner plate, consider filling it like this—½ non-starchy vegetables, ¼ grains or starchy vegetables and ¼ lean proteins. Websites like ChooseMyPlate.gov are good resources.

“Some people feel overwhelmed when it comes to losing weight, but even a 7 percent decrease in body weight can be enough to reverse the course of the disease,” she said.

Exercise is an important component in preventing diabetes, so Dr. Paulson recommends at least 150 minutes of exercise a week. This must include cardio activities to increase the heart rate and break a sweat. It also must include some muscle strengthening exercises, which will help burn more calories.

“While making lifestyle changes is critical, we also understand it can be difficult. That’s why I always suggest a team approach. Begin by working closely with your primary care physician or endocrinologist to fully understand your personal health goals” she said. Most physicians will refer you to others who can support your efforts like diabetes educators and/or nutritionists. Beyond that, many of my patients find that it’s easier to integrate exercise into their lives when they join organized programs or find exercise partners who will help keep them accountable.

“With the right kind of support and hard work, it is possible to stop prediabetes its tracks, avoiding many potential health complications down the road,” Dr. Paulson said.

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