Pre-diabetes is a condition where a person’s blood glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. Having pre-diabetes can increase your risk of developing type 2 diabetes by 10 to 20 times. However, by making lifestyle changes, you can manage the condition and, in some cases, prevent or delay the onset of type 2 diabetes. In this article we’ll examine what those lifestyle changes are and how you can make them to live a healthier life.
Pre-diabetes: what is it and who’s at risk?
Pre-diabetes is a condition where a person cannot process glucose well. To be diagnosed with pre-diabetes, your blood glucose levels must be:
- higher than normal
- not high enough to be diagnosed as type 2 diabetes.
How does pre-diabetes develop?
Pre-diabetes develops when the body becomes unable to manage the amount of glucose in the blood. Glucose is the body’s main source of energy. When we consume foods that contain carbohydrates, the carbohydrates are broken down into glucose. This glucose enters our bloodstream, causing the pancreas to release the hormone insulin. Insulin helps to move glucose from the blood into the cells to be used up as energy. If the glucose/insulin system isn’t working well, a person can develop a condition called insulin resistance.
Insulin resistance and pre-diabetes
Insulin helps to manage the amount of glucose in the blood. It does this by ensuring that excess glucose moves from our blood to our cells. When a person has developed insulin resistance, it means that their cells are not reacting well to insulin, hindering the movement of glucose into the cells. This results in too much glucose being in the blood, causing the pancreas to try to regulate it by producing more and more insulin. This eventually wears the pancreas out and it becomes unable to produce enough insulin to keep blood glucose levels within a healthy range. As a result, blood glucose levels rise to the point of pre-diabetes. Having high blood glucose levels is called hyperglycaemia.
Signs and symptoms of pre-diabetes
Pre-diabetes often has no signs or symptoms, but hyperglycaemia does. They include:
- frequently needing to urinate
- increased thirst
- tiredness
- weight loss
- blurred vision
- infections.
If you have any of the above symptoms, you need to speak to your doctor.
Who’s at risk of pre-diabetes?
Pre-diabetes has the same risk factors as type 2 diabetes. Some are modifiable (meaning that they can be changed) and others are non-modifiable (they cannot be changed). Modifiable risk factors include:
- Having excess body fat.
- Having too large a waist measurement.
- Being physically inactive.
- Having high levels of triglycerides (a type of fat in your blood) and low levels of HDL-C (the ‘good’ cholesterol).
- Having high blood pressure.
- Smoking.
Non-modifiable risk factors include:
- Having a close relative such as a parent or brother/sister with type 2 diabetes.
- Having an ethnic background of Aboriginal and Torres Strait Islander, Pacific Islander, Asian (including Chinese and the Indian sub-continent), Middle Eastern or North African.
- Age–although diabetes can develop at any age, the risk of pre-diabetes increases after age 35.
- Having Polycystic Ovarian Syndrome (PCOS).
- Having had diabetes in pregnancy (gestational diabetes) or giving birth to a big baby (more than 4.5kgs).
How is pre-diabetes diagnosed?
Pre-diabetes is usually diagnosed when a person’s doctor is concerned that they have the symptoms of hyperglycaemia and sends them for a blood test. A type 2 diabetes risk assessment is easy using The Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). This is a short questionnaire that is designed to estimate the risk of progression to type 2 diabetes over five years. It will tell you if you are at high risk, in which case it would be helpful to speak to your doctor to arrange blood tests. The test to confirm hyperglycaemia is a fasting glucose test (FGT)/blood glucose test. This is where a blood sample is taken that shows the level of glucose in your blood after fasting (not eating or drinking anything other than water) for 8–10 hours. If the results show a level of hyperglycaemia that suggests pre-diabetes, your doctor will ask you to have an oral glucose tolerance test (OGTT). Again, a blood sample is taken from a vein in your arm to check the level of glucose in your blood after fasting. You then have a glucose drink and another blood sample is taken after 1 or 2 hours. This test shows how your body responds to glucose. Your doctor may then ask you to take an HbA1c test. This is useful for diagnosing pre-diabetes as it checks your average blood glucose level over the past three months. If the tests show you have pre-diabetes, it means you have one or both of the following conditions:
- impaired glucose tolerance — your blood glucose level is above normal but not high enough to be diagnosed as diabetes
- impaired fasting glucose — your fasting blood glucose level is above normal but not high enough to be diagnosed as diabetes.
Can pre-diabetes go away?
Pre-diabetes can be managed so that it doesn’t develop into type 2 diabetes. This is achieved by tackling your modifiable risk factors. For most people, this means eating healthily, being physically active and maintaining or reaching a healthy weight. It’s also helpful to manage your stress levels and, if you smoke, to quit.
Eating healthily
Eating a healthy diet is all about enjoying a variety of foods from each of these food groups:
- vegetables and legumes/beans
- fruit
- cereal foods such as bread, cereals rice and pasta, mostly wholegrain varieties
- lean meat, fish, poultry, tofu, tempeh and nuts and seeds
- milk, yoghurt, cheese (mostly low-fat varieties) or non-dairy, calcium-fortified plant-based alternatives.
As well as doing that, try to reduce the amount of processed foods, ‘junk foods’ and sugar-sweetened beverages you consume, including takeaway food, cakes, biscuits, soft drinks, potato chips, salty snacks and lollies. Making sure the amount of food you eat matches the amount of energy you use throughout the day. And don’t forget to check portion sizes too.
Be physically active
To help maintain a healthy weight, it’s important to be active regularly. Aim to do at least 30 minutes of ‘moderate intensity’ physical activity most days. Moderate intensity activity could be fast walking, swimming or bike riding. Simply walking more is a great way of being active, and it may lower your weight and improve your cardiovascular health. You can also choose to do three short bursts of 10–15 minutes. The National Physical Activity Guidelines for Australian Adults recommends:
- Think of movement as an opportunity, not an inconvenience.
- Be active every day in as many ways as you can.
- Engage in at least 30 minutes of moderate-intensity physical activity on most—preferably all—days of the week.
- Do muscle-strengthening activities at least 2 days per week.
- Break up long periods of sitting as often as possible.
If possible, also enjoy some regular, vigorous activity for extra health and fitness benefits. Being active also helps your body use insulin better. It will also help you feel mentally and physically better and will improve your sleep. Don’t forget to speak to your doctor if you’re starting any new type of physical activity.
Maintaining a healthy weight
Reaching and maintaining a healthy weight helps the insulin in your body work better and lowers your blood glucose levels. If you have excess body fat, particularly around your midsection, losing just 5% to 7% of your body weight can significantly reduce the risk of type 2 diabetes. To keep your weight in a healthy range, focus on making small and realistic changes to your lifestyle to improve your diet and increase your physical activity.
Stop smoking
Smoking is a risk factor for type 2 diabetes. Having pre-diabetes increases a person’s risk of diabetes and heart disease, and smoking further increases that risk. If you are considering quitting smoking:
- call Quitline on 131 848 or visit the Quitline website
- speak to your doctor or chemist.
Manage stress
High stress levels can contribute to raised blood glucose levels. However, there are many things you can do to manage and reduce your stress:
- exercising regularly
- working out the types of situations that make you stressed and, if you can, avoid them
- giving yourself some time to relax each day
- making time to socialise and have fun
- eat healthily
- having a healthy sleep schedule.
Lifestyle changes for long-term pre-diabetes management
The period of time required to manage pre-diabetes to the point where onset of type 2 diabetes is prevented would vary from person to person. Factors such as age, weight, diet, physical activity level and overall health would influence the outcome. For long-term pre-diabetes management, it’s crucial to work with a healthcare provider to devise a personalised plan. An exercise physiologist can help you develop an exercise plan and show you how to exercise safely and a dietitian can help you to devise a diet you can stick with long-term.
The importance of regular monitoring and follow-up in pre-diabetes management
Regular monitoring and follow-up are crucial in the management of pre-diabetes. Regular re-testing of your blood glucose levels is recommended, based on your health professionals recommendations of how often to be checked. Any test that shows that blood glucose levels are higher than is recommended should prompt further investigation. Other health outcomes, such as weight and blood pressure, can be reassessed more regularly to see how well your prevention plan is working.
Getting support
The evidence shows that type 2 diabetes can be prevented in up to 58% of cases of pre-diabetes. If you’ve been diagnosed with pre-diabetes, there are many positive steps you can take. Most of us know that we have to eat well, exercise more and maintain a healthy weight, but it’s easier said than done. A great way to achieve this is to join a healthy lifestyle program and to have the support of health professionals. This is where the Life! program can help. Life! is a free healthy lifestyle program that helps you improve your eating habits, increase your physical activity and manage stress. You can choose from a group course or our telephone health coaching service. The Life! program will support you to reduce the risk of your pre-diabetes progressing to type 2 diabetes. Life! is run by experienced health professionals, including dietitians and exercise physiologists, who guide and support you to make realistic healthy lifestyle changes that suit your needs. The program includes 7 sessions delivered over a 12-month period. Since 2007, over 75,000 Victorians have learnt more about living a healthy life with the Life! program. It is the largest prevention program of its kind in Australia. Life! is funded by the Victorian government and managed by Diabetes Victoria. Find out more about this fantastic program and check your eligibility for joining with this simple online health test.
Sources
Australian Guide to Healthy Eating – Eat for Health Diabetes – Pre-diabetes – Better Health Channel What Is a Serve? – Eat for Health What is insulin resistance? A Mayo Clinic expert explains – Mayo Clinic What To Do If You Have Pre-diabetes: Choose Healthy Habits – Life! program What To Do If You Have Pre-diabetes: Choose Healthy Habits – Life! program
Reviewers
Kristie Cocotis, Head of Prevention and Health Promotion
Sarah Dubé, Strategy and Engagement Lead
Ria Cheripuram, Digital Communications Officer
Tegan Kohlman, Communications and Social Marketing Officer
Elaine Osei-Safo, Program facilitator and Health Coach
