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Prediabetes? What you should, and should not, do

Prediabetes? What you should, and should not, do

Timely lifestyle changes in diet and physical activity can help prevent prediabetes from progressing


Catching a condition early is almost always an advantage, but more so when it can be checked or restrained successfully.

Prediabetes is a state in which the blood sugar levels are above the normal range, but below the range of diabetes. It is also called ‘intermediate hyperglycaemia’ or ‘high-risk state of developing diabetes’ to emphasise that measures must be taken at this stage to prevent it from progressing.

If diagnosed with prediabetes, diabetes isn’t far off, but it doesn’t have to be inevitable. “With poor lifestyle, [people with prediabetes] can become diabetic in just two months,” says Dr Tharanath S, general physician at MS Ramaiah Memorial Hospital, Bengaluru. “People may not become diabetic if they follow a very good lifestyle in terms of both diet and physical activity.”

Insulin resistance

Insulin is a hormone in the pancreas made within beta cells. After having a meal, the sugar level in the blood rises. The beta cells in the pancreas then release insulin to help the body store blood glucose.

When the cells in the body don’t respond well to insulin and can’t store the glucose, the pancreas releases more insulin to compensate for the cells’ weak response. In the case of type-2 diabetes, the insulin pumped into the blood is not enough to overcome the cells’ weak response. So, more glucose remains in the blood and isn’t stored by the body’s cells, leading to a state of high blood sugar. This is known as insulin resistance.

Type-2 diabetes is not a condition that develops suddenly; it progresses in stages. In the first stage, insulin is secreted in the body at an increased rate due to insulin resistance. The second stage is the stable adaptation period where the beta cells can’t compensate for the increased insulin resistance any more.

“Resistance is at the initial level [in prediabetes] and not as much as in full-blown diabetes. That’s why lifestyle and weight loss play a greater role in prediabetes. By burning the fat cells, insulin resistance reduces,” says Dr Tharanath.

Both stages take place before the state of prediabetes is reached. Prediabetes begins when glucose levels in the body start increasing rapidly because of insulin resistance. This is the third stage, which continues till the condition progresses to diabetes.

Symptoms of prediabetes

On the outside, however, prediabetes does not have any symptoms. Even in the case of diabetes, apart from the osmotic symptoms of polyuria (increased urine), increased thirst, increased eating and weight loss, around 80 per cent of people diagnosed with diabetes are asymptomatic, says Dr Tharanath. “Because it gets picked up in a routine health check-up, we advise anybody with a strong family history to get a screening done every year. Otherwise, prediabetes doesn’t necessarily have any other symptoms,” says Dr Tharanath.

However, there are risk factors for prediabetes (such as obesity, genetic factors and a history of gestational diabetes) along with combinations of risk factors (like metabolic disorders) which help people remain vigilant in taking care of their bodies while getting health check-ups regularly.

“Obesity is related to insulin resistance and diabetes is a condition characterised by insulin resistance. The moment you gain weight and the moment your lifestyle is off track, you will attract type-2 diabetes. So, you need to focus on insulin resistance,” says Nidhi Nigam, a Bengaluru-based certified nutritionist and dietitian.

Lifestyle changes

A 2021 study found that more people regressed to normal glucose levels compared to those who progressed to diabetes. The stage of lifestyle changes for prediabetes is an opportunity to make changes in lifestyle and return to normal blood sugar levels.

Nigam recommends a diet rich in protein, fibre and complex carbohydrates while avoiding simple carbohydrates, processed food and junk food.

A comprehensive plan to reverse prediabetes involves the acronym ‘LEAN’. “It has four aspects – lifestyle, exercise, attitude and nutrition. Attitude is very important. You need to make sure that you don’t consider it a disease but a metabolic lifestyle disorder. Then, it can be reversed,” says Nigam.

The ‘right’ plate could be divided into four slices/quarters:

  1. raw vegetables
  2. cooked vegetables
  3. proteins
  4. complex carbohydrates (includes substituting white polished rice with brown rice, using millets, quinoa and whole wheat)

“Whatever you eat eventually gets converted into glucose, into carbohydrates. 1ml of insulin is equal to 15gm of carbohydrates. You must calculate carbohydrates accordingly,” Nigam says. It’s best to minimise the intake of sugar, she adds.

Dr Tharanath recommends avoiding junk food, red meat and high-glycaemic food. “Thirty minutes of physical activity every day is a must. This is a simple physical activity of moderate intensity,” he says.

Other than diet and exercise, lifestyle changes also include being hydrated, managing stress and getting sufficient sleep. “With this, you can not only reverse your diabetes but also achieve other health goals,” Nigam says.

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