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How You Can Be Prediabetic and Not Even Know It

By Maggie Moon, MS, RD ; Updated August 14, 2017

You consider yourself healthy. You’re young, work out regularly and maintain a relatively healthy weight. You may be shocked to learn that you could have prediabetes.

It can even happen to nutrition experts: Just ask Dina Garcia, registered dietitian nutritionist and former prediabetic. It was during Garcia’s first year as a dietitian that she learned she was prediabetic.

Her new job was sedentary, and the stress led to occasional overeating. She exercised regularly and ate a fairly healthy diet, but experienced moderate weight gain that put her just a few pounds into the overweight category.

She was shocked to learn the news. “I was floored when my doctor told me all my labs looked great, then, when I requested a copy and reviewed them at home, I found out that I was prediabetic.”

In fact, even though more than a third of U.S. adults are prediabetic, most are unaware of it. The staggering truth is that nine out of 10 people with prediabetes have no idea they have it, according to the Centers for Disease Control.

With the whole month of November dedicated to Diabetes Awareness, how is it possible that 90 percent of the 86 million Americans with prediabetes are in the dark about their condition? For one, prediabetes can be stealthy and easy to ignore because it doesn’t arrive with obvious symptoms. In fact, it affects many people who seem generally healthy.

Secondly, most primary doctors aren’t discussing it with their patients. In a study of more than 11 million doctor visits, physicians missed nearly 80 percent of the opportunities to counsel patients with prediabetes. The study appears in the March 2016 issue of Journal of the American Board of Family Medicine.

Why Aren’t Doctors Talking About Prediabetes?

To be fair, there are those rare few doctors who do discuss prediabetes with their patients and responsibly refer out to qualified registered dietitians and certified diabetes educators. But there is plenty of room for improvement.

To help understand the problem, Dr. Barry Sears, a leading authority on anti-inflammatory nutrition and president of the nonprofit Inflammation Research Foundation, offers, “Part of the problem is that prediabetes is not a disease condition, and therefore there is no financial incentive for the physician to address it.”

Nitin Kumar, M.D., Harvard-trained and board-certified gastroenterologist and weight management specialist adds, “A physician overwhelmed with paperwork and pressed for time is more likely to address an immediate medical issue that can be treated with a prescription or a referral than to undertake a restructuring of the patient’s lifestyle.”

What’s at Risk?

The clear risk is that prediabetes increases your likelihood of developing Type 2 diabetes. It also raises the risk of heart disease and stroke. Without lifestyle changes, up to 30 percent of prediabetics will have Type 2 diabetes within five years.

Dr. Kumar reminds us that diabetes is the number-one cause of amputations, adult-onset blindness and kidney failure requiring dialysis in the United States. “All of these issues are devastating our health care system and bankrupting Medicare,” says Kumar.

However, it’s not just the threat of diabetes that is a concern. Prediabetes itself causes nerve damage, and more than previously thought, according to a three-year Johns Hopkins study published in April 2016’s JAMA Neurology. The type of motor nerve damage seen in the study (it’s called small fiber neuropathy) is most common in full-blown diabetes; it can cause burning pain in the feet and is a sign of greater nerve deterioration to come.

Surprisingly, people with prediabetes and diabetes experienced similar rates of small fiber nerve damage over the course of the study. These findings, added to the public health concerns, should motivate physicians to be extra vigilant in screening for prediabetes.

The Good News

Prediabetes is 100 percent reversible. Garcia says, “Reversing my prediabetes was from a combination of weight loss (which happened very slowly), learning how to better balance (not eliminate) my carb intake, mindful eating, adequate sleep, improved stress management and meditation.”

She focused on ways to improve blood sugars and let the weight loss happen naturally. She adds, “Many people don’t realize what a huge factor stress plays in blood sugar management.” She credits mindful eating as the most important tool she had to solve her stress eating and overall portion control.

The first step is awareness. At your next annual physical be sure your blood work includes a screening for prediabetes. If you do have prediabetes, the good news is that simple diet and lifestyle changes can go a long way toward preventing a diabetes diagnosis in the future.

Lauren Harris-Pincus, M.S., RDN, owner of shares, “A registered dietitian nutritionist is the perfect resource to help someone create a personalized diet and lifestyle plan to control their blood sugar and halt or reverse the development of diabetes.”

What You Can Do Today

Healthy lifestyle habits are your best defense. Exercise to immediately improve insulin sensitivity. If you have a sedentary job, make a point of moving for at least five minutes of every hour at your desk. Garcia recommends walking, climbing stairs and stretching.

Next, keep meals balanced for even-keeled blood sugar levels. Garcia coined the acronym PF3, which stands for protein, fat, fiber and fluid. She uses the PF3 concept to create meals and snacks that thwart blood sugar spikes and keep her satisfied. Here are her top seven healthy snack ideas:

• Orange + pistachios

• Boiled egg + apple slices

• Turkey + avocado + whole-grain bread (half sandwich)

• Cottage cheese + sunflower seeds + sliced cucumbers

• Kefir + strawberries + baby spinach + avocado + hemp seeds (small smoothie)

• Cheddar + spinach + whole-grain tortilla (quesadilla)

• Broth + kale + mushrooms + cannellini beans + olive oil (soup)

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