Your Doctor

Prediabetes = preventdiabetes. All you need to know…

This week is Diabetes Prevention Week. What’s it all about….

Diabetes is a complex, progressive and multifaceted disease. Probably a fact that is less well understood is that prediabetes is following in close pursuit and it (type 2 diabetes) is totally preventable. We all need to do something to stop this exploding disease to save lives and reduce complications.

There are currently four million people diagnosed with diabetes in the UK and this number is rising. Ten percent of the NHS budget is spent managing diabetes and its vast array of complications. As the prediabetes rates rise, we are looking at an exponential rise in prevalence of this problem, and thus morbitiy, mortality and cost implications.

What is pre diabetes?

Pre-diabetes (or non-diabetic hyperglycaemia) is a state categorised by a slightly elevated blood sugar. It is not quite high enough to call it diabetes, but these people are at risk of developing it if changes are not made.

If no action is taken, 33 out of 100 people with pre-diabetes will develop type 2 diabetes within 6 years. Out of 100 people with pre-diabetes who make ‘healthy lifestyle’ changes, only 13 will develop diabetes (compare this with 33 out of 100 if no action is taken!).

Doctors use a blood test called HbA1c to help us gauge whether a person is at real risk or not.

What is the HbA1c blood test? 

It is a very useful, non-fasting blood test used to screen and diagnose diabetes and pick up prediabetes. The test is measuring the amount of blood glucose attached to the haemoglobin (red blood cell) molecule over the last three months. It does not vary with a specific meal type, or activity levels on the day the sample is taken. Thus is more accurate overall.

For patients with diabetes the higher the level of HbA1c, the greater the risk of complications related to diabetes, such as heart, kidney and eye disease.

The normal range for HbA1c is less than 42 mmol/L. If you have diabetes it will usually be above 48 mmol/L.

Between 42-47mmol/L we call this pre-diabetes or non-diabetic hypeglycaemia. A proportion of people who fall within this range will over time develop type 2 diabetes if they do not address diet and lifestyle accordingly.

This test can be done with your GP.

What are the risk factors for prediabetes?

Risk factors include; 

• Aged 45 and above

• Being overweight – particularly if you carry your weight around the waist

• Have a sibling or parent with diabetes – you are two to six times more likely to develop diabetes!

• Had gestational diabetes (diabetes in pregnancy) – you are twice as likely to develop diabetes

• Lead a sedentary lifestyle 

• High blood pressure

• South Asian or Afro Carribeans have an increased genetic risk for type 2 diabetes.

Diabetes UK have a useful website where you can spend a few minutes calculating your risk and see where you could improve.

How can you prevent Type 2 diabetes?

Making changes to your lifestyle can delay or even prevent the development of type 2 diabetes and reduce the risk of heart disease too. It is possible to reverse out of pre diabetes, it is not possible to do the same with diabetes.

1. Keep your weight in a healthy range. Aim for a BMI between 20-25.

2. Eat a healthy diet. This is not simply about avoiding eating sugar. Increasing fibre, and limiting refined/processed sugars and fat intake can help prevent type 2 diabetes. 

3. Eat regularly. Have 3 meals a day. For example, breakfast, lunch and evening meal. This will help keep your blood glucose levels steady and control your appetite.

4. Include a high fibre, complex carbohydrate food at each meal, such as grains, brown rice. Watch the carbohydrate content of foods, aim for 130-150gm per day as a start. There are great apps (e.g. Low Carb Program and alike) and books (Low GI diet, Carbs and Cals) which provide really useful tips and ways to monitor carbohydrate intake.

5. Consume less sugar. Too much sugar and foods containing sugar can cause the blood glucose levels to rise. It is best to replace these with lower sugar and sugar free foods instead

6. Eat less fats. High fat diets are linked to heart disease and reducing your fat intake will help you lose weight. 

7. Keep active and exercising. Adults should be doing 150 minutes of aerobic exercise per week (brisk walking, cycling etc.) and strength exercises twice weekly, that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms). Try and get your heart rate up to a level to make you short of breath for 20 mins, this way we know your body is working!   

8. Stop smoking and limit alcohol. Alcohol is high in energy and may cause weight gain therefore sensible drinking is essential. The recommended amounts of alcohol for people with pre-diabetes and the general population are exactly the same. 

a. For Men No more than 3 units/day (no more than 21 units in a week) 

b. For Women No more than 2 units/day (no more than 14 units in a week) 

c. Everyone should have at least one or two alcohol-free days a week. 

Making changes to your lifestyle can delay or even prevent the development of type 2 diabetes and reduce the risk of heart disease too. It is possible to reverse out of pre diabetes, it is not possible to do the same with diabetes.

Think of prediabetes as a fork in the road: Ignore it, and your risk for type 2 diabetes goes up. Lose a modest amount of weight (5-7% of your body weight), adjust your diet and get regular physical activity, and your risk goes down.

Test yourself on line, if at risk see your doctor for further investigations and advice.

At Your Doctor we offer the HbA1c test & consultation privately for £140.00. Contact us if you'd like to make an appointment.