Pre Diabetes Drift

As boomers drift into old age, their aging metabolism wanders into a precarious state called “pre diabetes.” The American Diabetic Association estimates 50% of boomers are afflicted by this benign sounding diagnosis that silently morphs behind the scenes into full blown- type 2 diabetes. How soon? The data indicates pre diabetics wind up as confirmed type 2 diabetics within 5 years. This is where I found myself a year ago when I became an official “pre.”

Two years ago, my blood glucose numbers were normal.  A year later they were in the pre diabetic range.  This didn’t come as a total surprise.  I have a strong family history of diabetes and my blood lipids have been creeping up for years.   And then there was the “zonk” factor, waves of low energy and compulsive napping after foods with a high glycemic index.  My glucose metabolism was definitely off.

My wise internist said, “It’s not your lifestyle; it’s your genes.” She was right. I was not hypertensive, or overweight or lacking exercise.   My family history was the issue.  I was born downstream from ancestors filled with cardiovascular disease, high blood lipids and early onset diabetes.  My father suffered horribly from all three most of his life with his first heart attack at 32 and a fatal one at 63.

I was grateful that my lifestyle choices delayed these issues 30 years longer for me, but the grace period was over.  Lifestyle was no longer enough.  My internist suggested I try a low dose of an extended release Metformin at bedtime, an “off label” use of a medication that reversed pre diabetes in some cases.  In my case, it worked.

Six months later with some adjusting of my diet and daily metformin, my blood lipids were lower and more importantly my blood glucose levels returned to normal

Officially, pre diabetes is fast blood glucose levels of 100 to 125 and A1C levels of 5.7 to 6.4.

Officially, diabetes is fasting blood glucose level of 126 or higher and an A1C levels of 6.5 or greater.

Both diagnoses have the same risk factors:

•   45 years or older

•    Gestational diabetes during pregnancy

•    Parent or sibling with diabetes

•    Overweight

•    Hypertension

•    Sedentary lifestyle

•    Low HDL or high triglycerides

You go from pre to full blown diabetes if you do nothing, usually within five years.  Simply being a pre puts you at risk for the same complications associated with full blown diabetes including heart dseases, strokes, kidney failure, amputation and blindness.  Pre is silent but far from benign.  Most people don’t have a clue they’ve moved into the danger zone.

Once labs confirm you are a pre, treatment usually starts with lifestyle changes, depending on your risk factor profile.  For most Americans lifestyle changes include diet, weight loss and exercise.  This lowers the risk of diabetes by improving the body’s ability to use insulin and process glucose.

The Diabetes Prevention Program, using individual counseling and motivational support directed toward reducing weight and increasing exercise, reduced the risk of developing diabetes by 58%.  Studies show lifestyle changes worked particularly well for participants aged 60 and older.  Clearly, this is very effective but also very hard to do on your own.

Then there is the issue of Metformin.  Although less than 4% of pre diabetics are treated with it, metformin can help delay the risk of developing diabetes by 31% according to the Diabetes Prevention Program from the National Institute of Diabetes, Digestive and Kidney Diseases.  An impressive outcome for an “off label” use of medication.

Maybe it’s time to call pre diabetes what it really is “early stage diabetes” that unlike full blown diabetes, is reversible.  Yes, it is reversible.

In most diseases that are progressive like cancer, we identify the disease by stages so we can treat each stage appropriately and stop the progression of the disease.  Not so with pre diabetes.

If pre diabetes was considered early stage diabetes,  it would be treated more aggressively by health care providers and health care organizations would fund programs that provide much needed lifestyle coaching that many boomers can’t afford on their own.

As it is, most pre diabetes falls into an area of medicine that I call self care, meaning you are on your own, until the signs and symptoms of diabetes show up. Once declared diabetic, then the health care system begins doctor centered treatment that includes frequent testing, brief physician visits, a referral to a nutritionist and multiple medications.

If you have pre diabetes you may need to take the initiative with your doctor requesting treatment. It’s the right time too to hire a professional health coach as your personal champion for setting lifestyle goals and implementing sustainable behavior change.

In professional health coaching, self care is what we do. A big part of the power to improve health lies in what you can do through lifestyle changes including diet, exercise, and stress management.