Ricardo Banderas, 66, of Miami always considered himself healthy. He didn’t have a weight problem, worked out a couple of times a month, and regularly enjoyed his bread, rice and potatoes.
Then after a routine physical a couple of years ago, he learned he had prediabetes.
“I was very concerned,” Banderas said. “Thank God my family doesn’t have a history of diabetes, but I know the consequences of it and what damage it can do to your health.”
With prediabetes, blood sugar levels are higher than the normal range, but not high enough to be classified as diabetes. The normal fasting blood sugar range is under 100. The range for prediabetes is 100-125, and the range for diabetes is 126 or higher.
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“As long as people stay in this ‘borderline’ range, a word we don’t like to use anymore, they appear not to be at the same risk of health problems as established diabetics,” said Dr. Ronald Goldberg, associate director of medical affairs for the Diabetes Research Institute at the University of Miami Miller School of Medicine.
Typically about half of prediabetics will develop diabetes over time, though some stay in the gray zone for decades, he said. “They should be identified and monitored, because diabetes can develop silently over time and lead to other health risks,” Goldberg said.
There are no specific warning symptoms, but patients may see increased thirst, weight loss or excessive urination, said Dr. Tessey Jose, an endocrinologist with Cleveland Clinic in Weston.
“Most people usually do not have symptoms, but if they do, they should get checked out,” she said.
Risk factors for prediabetes and diabetes are the same. Being overweight, not exercising and having a family history of the disease elevates risk, said Dr. Anaisys Ballesteros with Baptist Health Primary Care in Miami. Ethnicity also plays a role. “Hispanics are at a major risk compared to other ethnic groups,” she said.
Other risk factors include health problems, such as high blood pressure, and eating a lot of carbohydrates and sugar, which contributes to weight gain. “Being overweight or obese is so prevalent in this country. I think that’s why we see so much prediabetes leading to diabetes Type 2,” Ballesteros said.
An at-risk patient should ask their primary care doctor for not only a fasting blood test, which measures blood sugar — also known as glucose — levels that day, but a Hemoglobin A1C test, which averages glucose levels for the past three months.
“If a patient is at risk, I think it’s important for the doctor to go that extra step. And if the doctor doesn’t do that, the patient should ask,” Ballesteros said. “That extra test could save lives.”
Making the diagnosis early can help avoid major health complications later. “It cannot be cured, but it can be controlled,” she said.
If you are diagnosed with prediabetes, the American Diabetes Association recommends weight loss, an increase in moderate physical activity, such as walking, screening for risk factors that contribute to cardiovascular disease, including high blood pressure and high cholesterol, and counseling for smoking cessation.
In the Diabetes Prevention Program study funded by the National Institutes of Health, Goldberg and other researchers are looking at how lifestyle changes, including reducing calories and increasing exercise, as well as medication affect whether prediabetes progresses to diabetes. The study used a reduced-fat diet to decrease calories, and increased physical activity by 150 minutes of moderate activity per week.
“If you do some aggressive lifestyle changes to lose weight, you can reduce the chance of getting diabetes, particularly in the short term, over the first three or so years, by almost 60 percent,” Goldberg said.
“It does show you can make a difference with these interventions,” he said. “We found through this study that the ability to prevent diabetes was directly related to how much weight you lost.”
The problem comes over time, he said, because it’s harder for patients to keep up with intense lifestyle adjustments.
In the study, Metformin, a popular drug used to lower blood sugar in diabetics, helped in about 30 percent of cases in the first three years. The question is whether you should expose people to a lifelong drug treatment when only half would eventually become diabetic and suffer its complications, Goldberg said.
“Until you can actually show that long-term administration of a medication for prediabetes can actually benefit a patient’s health long term, instead of just keeping the sugar a little lower than it was before, you can make a good argument that you shouldn’t start it until the blood sugar indicates diabetes,” he said.
Generally, prediabetes patients should eat a low-carb diet, said the Cleveland Clinic’s Jose. “We like to send them to a nutritionist, but the problem is, sometimes an insurance company won’t pay for it, so what we generally advise is with a nine-inch plate, half the plate should be vegetables, a quarter of the plate should be a protein and a quarter should be a complex carbohydrate,” she said.
For exercise, any aerobic activity, with or without weight training is recommended. If they are just starting, they can begin with walking 30 minutes a day, five days per week, Jose said.
Blood sugar levels should be monitored every six months. If your levels go below 100, in the safe zone, don’t let go of your good habits, she said.
“They are still at higher risk for developing prediabetes and/or diabetes in the future, so I would counsel them to continue exercising and continue watching their diet,” Jose said. “I don’t think it’s safe to stop.”
After being diagnosed with prediabetes, Banderas starting exercising three to four times a week and trimmed his portion sizes. He stopped eating a big, carb-laden lunch that led to an afternoon siesta and added a weekly portion of fish to his diet. He also has his blood sugar monitored regularly.
“After the diagnosis, I began to change things slowly,” Banderas said. “It’s not easy to change bad habits overnight, but I became more aware of ways to reduce the risk.”