So You Have Pre-Diabetes. Now What?

A healthy plate and exercise reduce diabetes risk

If you or someone you know has just been diagnosed with pre-diabetes, all is not lost. There is actually some good news here. You and your doctor still have time to reverse the process and prevent the onset of diabetes. This is because pre-diabetes simply means diabetes has not developed just yet, but the individual is much more likely to develop diabetes in the near future.

Typically, diabetes is diagnosed by running blood tests, typically to look at fasting blood sugar levels and insulin levels. The fasting blood sugar level - how much sugar is in the bloodstream after not eating for 8-12 hours, is valuable information because it tells the doctor how your body is processing sugar. Generally, we want the sugar to get to the muscles, the liver, and the brain so that it can be used for energy. When we have too much sugar in the bloodstream (hyperglycemia), it can lead to long-term health effects, like the loss of feeling in one’s fingers and toes, changes in vision (including blindness), and an increased risk for heart disease and stroke.

How much sugar in the bloodstream is too much? The cutoff for a fasting blood test is 100 milligrams per deciliter (mg/dL) or higher. Doctors may also look at another blood test called hemoglobin A1c (HbA1c). This helps the doctor determine average blood sugar levels over the past three months. HbA1c is expressed as a percentage, where a value less than 6.5 percent is ideal.

What happens if your blood sugar is high (i.e., over 100), but not so high that you have diabetes? Well, the good news is there is still time to bring that blood sugar level back down.

Some of the most important steps an individual can take to reduce their blood sugar levels and prevent the onset of diabetes would be to do the following:

  1. Manage your body weight. Even a loss of five or 10 pounds can make a significant difference. Why is weight loss or maintaining a normal weight so important? Researchers are finding that when individuals carry excess weight, their bodies are not able to metabolize blood sugar as well.
  2. Exercise regularly. Notice, I didn’t use the term “physical activity” but EXERCISE. Exercise requires increased intensity. If it is safe for you to do so, I recommend increasing the intensity of your activity and consider incorporating high intensity interval training (HIIT). A number of studies have found this is quite effective at lowering blood sugar levels.
  3. Cut back on carbohydrates. Instead of drinking a large fruit smoothie each day for example, consume half and share with a friend or family member. Instead of having two pieces of toast with breakfast, have one instead. Instead of having a sandwich for lunch, have a salad with all the sandwich toppings.
  4. Don’t forget about fiber. Fiber can help our bodies use blood sugar more effectively. We often think of carbohydrate-rich foods as the best sources of fiber, but that’s not necessarily true. Vegetables can also be good sources especially beans, nuts and seeds. These foods are important additions to your diet if you are not consuming them already!
  5. Manage stress. Patients often look at me strangely when I suggest this. “What does managing my stress have to do with preventing diabetes?!” they’ll ask. Think about your body’s response to stress. Your muscles tense so your body can prepare to “run or fight,” your heart races and your blood pressure rises to be sure there’s enough blood flowing to your brain and muscles, your pupils dilate so you can see better… all of these responses require energy. To be sure these organs have enough energy to perform these actions, the body will actually pump sugar into the bloodstream. More stress leads to more sugar in the bloodstream. More sugar in the bloodstream means the risk for diabetes increases.

I realize that some of these suggestions may seem overwhelming. If that’s the case, please know that I understand. Instead, I recommend trying just one of these tactics… maybe the one suggestion that really jumped out at you. Or, the one you feel is most important to you right now. Or, it could be the one that you feel would be easiest to start with.

Whichever you choose, if you begin making at least one of these changes, you are on the right track. Make an appointment with a naturopathic doctor.

By Neal Malik, DrPH, MPH, RDN, Chair of Basic Sciences and Nutrition at Bastyr University California.


By Neal Malik, DrPH, MPH, RDN, Chair of Basic Sciences and Nutrition at Bastyr University California.