Prediabetes (Part 1, by Lynn)

Prediabetes: What it means and what you can do about it? (part 1 of 2)

by Lynn Lanza, Registered Dietitian and Certified Diabetes Educator

Have you been told by your medical provider that you have Prediabetes or High Blood Sugar? Well, you’re not alone — 86 million American adults have Prediabetes. Look around in your office, doctor’s waiting room or church — statically speaking, 1 out of 3 people sitting next to you likely have Prediabetes. And what’s even more surprising is that  roughly 90% of them don’t know they have it! So, let’s answer a few questions about Prediabetes.

  1. What is Prediabetes?

Prediabetes is when your blood sugar level is higher than normal but not high enough to be diagnosed with type 2 diabetes. In diagnosing terms, we generally use 2 measures to diagnose: Fasting blood sugar and Hemoglobin A1C.  


So, let’s break down what each one of these means:

a) Fasting blood sugar: this is the measure of the sugar level in your blood after an 8 hour fast without food or calorie yielding beverages. In someone without diabetes, one could expect this reading to be less than 99 mg/dL. Diabetes is suspected if one’s fasting blood sugar is 126 mg/dL or greater. Prediabetes is in the middle of these 2 numbers: 100-125 mg/dL

b) Hemoglobin A1C: In our blood we have red blood cells. Think of these doughnut shaped structures as very sticky, kind of like doughnuts. The higher our blood sugar, the more sugar we find stuck to our red blood cells, which naturally die and reproduce about every 3 months. Therefore, Hemoglobin A1C is a measure of average blood sugar for the last 3 months. In someone without diabetes, one can expect this reading to be about 4.8-5.6%. Diabetes is suspected when readings exceed 6.5%. Again, Prediabetes is diagnosed somewhere in the middle with readings from 5.7-6.4%.

2.  Why does blood sugar get elevated in the first place?

In order to understand what goes wrong in diabetes and prediabetes, we have to have a good understanding of normal blood sugar control: Let’s say I eat a delicious apple, which contains carbohydrates.  Through digestion, the apple gets broken down into glucose. This then gets absorbed from my small intestines into my blood, causing my blood sugar to rise. My pancreas sees this and releases the hormone insulin, which acts as a key to unlock the door to my cells to allow sugar to move from my bloodstream into my cells.  Without insulin, the cells in my muscles, brain and other parts of my body are essentially locked, preventing the uptake of needed glucose.

Prediabetes: So what those slightly elevated fasting blood sugar and Hemoglobin A1C readings tell your provider is that some of your cells have “changed the locks” and the insulin “key” is not working in the same fashion it was before. Therefore your blood sugar levels are slightly more elevated than they have been in the past. You may have heard the term “Insulin Resistance” before — well this is essentially some of your cells “changing the locks” and this is why your blood sugar is slightly elevated. There are other things occurring in different parts of the body as well, however this is the most essential.

Look for the article next week (part 2), where Registered Dietitian and Certified Diabetes Educator, Lynn Lanza, discusses what actions you can take when presented with a prediabetes diagnosis.


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