PRE-DIABETES

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Pre-diabetes is a condition where your blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. It’s a serious health condition that increases your risk of developing type 2 diabetes, heart disease, and stroke, and a warning that you need to reevaluate your lifestyle choices.

Pre-diabetes includes two health conditions: impaired fasting glucose and impaired glucose tolerance. Higher glucose levels are associated with a significantly higher risk of developing cardiovascular disease as well as diabetes.

Impaired fasting glucose is diagnosed by measuring your blood glucose levels after not eating or drinking for eight hours. If they are consistently high (between 6.1 and 6.9 mmol/L), you are at risk.
Impaired glucose tolerance is diagnosed by measuring your blood glucose levels two hours after drinking 75g of glucose. If your levels are high (between 7.8 and 11.0 mmol/L) you are considered significantly at risk of developing type 2 diabetes.

The good news is that it is possible to reverse pre-diabetes and prevent your progression to diabetes. The earlier you are diagnosed, the better your chances of success. As you are unlikely to have any symptoms of pre-diabetes, it is essential that blood glucose screening be part of your annual health check, especially if you are over 45 or overweight.

PRE-DIABETES IN SOUTH AFRICA

Diabetes prevalence, as well as that of pre-diabetes, is rapidly increasing in South Africa. The South African Demographic Health Survey of 2016 found that 22% of the population was diabetic, and a whopping 67% were pre-diabetic. This means a large proportion of the South African population remains undiagnosed, with severe public health implications for our country.

SYMPTOMS OF PRE-DIABETES

It’s unlikely that you will have any specific symptoms of pre-diabetes. As the glucose levels in your blood increase, you may experience thirst and weight loss. Other possible signs of pre-diabetes include skin tags and/or darkened skin on certain parts of the body, like the neck, armpits and groin. In many cases, pre-diabetes is only detected when tests are done to investigate other complaints, like:

Peripheral neuropathy: damage to the small nerves of the feet that causes pain and discomfort like burning, pins and needles, or sensitivity
Cardiovascular disease: angina, heart attack or heart failure, or stroke
Kidney disease

In very rare cases, pre-diabetes may show symptoms associated with diabetes, like loss of sight, poor wound healing, or recurrent infections.

SYMPTOMS OF PRE-DIABETES IN WOMEN

Some early pre-diabetes symptoms that could affect women in particular are:

Yeast and urinary tract infections
Longer and heavier periods
Reduced interest in sex
Vaginal dryness that can make sex uncomfortable
Trouble getting pregnant

RISK FACTORS FOR PRE-DIABETES

Being overweight is the greatest risk for developing pre-diabetes. Carrying your excess body fat in your belly and around your organs is particularly dangerous. A waist circumference of 83 cm or more is considered an optimal cut-off point for identifying pre-diabetes in women.

Other risk factors include:

Eating highly processed, high-carbohydrate foods and saturated fats frequently
Being physically active less that three times a week
Smoking
Your risk increases after age 45
Sleep apnoea
A family history of diabetes
In South Africa, our Indian community has a particular increased risk
Women with a history of gestational diabetes (diabetes developed during pregnancy) and polycystic ovarian syndrome
Health conditions like high blood pressure, abnormal cholesterol levels, heart disease, or stroke

DIAGNOSING PRE-DIABETES

Regular blood glucose screening is essential in order to diagnose pre-diabetes as early as possible. The Society for Endocrinology, Metabolism, and Diabetes of South Africa (SEMDSA) guidelines recommend that all adults be screened for high glucose from the age of 45 years, and that adults who are overweight be screened at any age.

Fasting blood glucose test results:

Less than 5.6 mmol/L = normal
1 – 6.9 mmol/L = pre-diabetes
Over 7.0 mmol/L = diabetes

Oral glucose tolerance test results:

Less than 7.8 mmol/L = normal
8 – 11 mmol/L = pre-diabetes
1 mmol/L and over = diabetes

REVERSING PRE-DIABETES

If you have pre-diabetes, the long-term damage of diabetes — especially to your heart, blood vessels and kidneys — may already be starting. There’s good news, however. Progression from pre-diabetes to type 2 diabetes isn’t inevitable. By making healthy lifestyle changes, you can bring your blood glucose level back to normal, no matter what your age.

Weight loss
Even small amounts of weight loss are beneficial. Studies have shown that for every 1kg of weight lost, there was a 16% decrease in the risk of developing type 2 diabetes. There are lots of ways you can lose weight; focus on getting the right support and finding out what works best for you.

Start with little changes such as:

Eating smaller portions. You can still gain weight / fail to lose weight if you overeat healthy foods.

Adding vegetables to your dinner. Ideally, half your plate should consist of vegetables or green salad.

Roasting or baking foods instead of deep-frying them

Eating a meat-free meal every week

If you need help with managing your weight a dietitian can help you. Your healthcare provider can also help you find weight management services in your local area. If you are a member of Bonitas, you have access to a Weight Management Programme free of charge.

Regular activity

Getting regular amounts of moderate-intensity physical activity helps increase glucose usage and improves muscle insulin sensitivity. A single session of moderate-intensity exercise can increase glucose uptake from your blood and into your muscles by at least 40%. This helps lower blood sugar levels. Aim for 30 minutes a day, five days a week, for a total of 150 minutes a week. Try walking or another activity you enjoy.

Eat a nutritious, balanced diet
Foods to avoid:

Sugary drinks like fizzy cooldrinks and fruit juice

Baked and fried foods, especially deep-fried foods

Ultra-processed, low-fibre foods

Instead:

Choose foods low in sugar, salt, fat and calories and high in fibre, like whole fruits and vegetables.

Eat a variety of foods to help you achieve your goals without compromising taste or nutrition.

Drink 1.5 to 2.5 litres of water every day

Replace simple, processed carbohydrates like cereals, white bread and potatoes with complex carbohydrates like whole grains and vegetables

Eat less red and processed meat like beef, lamb, pork, ham and sausages; and more lean protein like nuts, lentils, poultry and fish

Choose good fats like olive and vegetable oils rather than margarine, lard or butter

The Glycemic Index Foundation of SA has a full food list where they rank foods based on their immediate effect on blood glucose levels. You will find it here: gifoundation.com

Other positive lifestyle changes include:
Quit smoking. High levels of nicotine make it hard for your body to control your blood glucose.

Don’t have more than one alcoholic drink a day. Alcohol affects blood glucose levels.

Reduce stress. Stress makes it harder for your body to process blood glucose properly.

Address any sleep disorders. Studies show sleep loss can make it harder to control your blood glucose and appetite.

Manage chronic conditions and take any medication your healthcare provider has prescribed

Have regular check-ups which include blood glucose screening

Medication

In some cases, your healthcare provider may recommend taking certain oral diabetes medications. This is more likely if lifestyle changes haven’t helped improve your blood sugar levels and/or you have multiple risk factors for type 2 diabetes. The most common medications providers prescribe for pre-diabetes are metformin and acarbose.

PRE-DIABETES

PRE-DIABETES

The following information is to be used as a guide to and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

PRE-DIABETES IN SOUTH AFRICA

SYMPTOMS OF PRE-DIABETES

SYMPTOMS OF PRE-DIABETES IN WOMEN

RISK FACTORS FOR PRE-DIABETES

DIAGNOSING PRE-DIABETES

REVERSING PRE-DIABETES

FURTHER READING