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.
Pre-diabetes is a risk factor for diabetes. People with pre-diabetes have between 10 and 20 times greater risk of developing diabetes.
By making lifestyle changes, you can manage pre-diabetes and prevent or delay type 2 diabetes in many cases.
In this article we’ll examine what those lifestyle changes are and how you can make them.
What is pre-diabetes?
A person with pre-diabetes has higher blood glucose levels than recommended. You may be diagnosed with pre-diabetes if your:
- fasting blood glucose levels are between 6.1 and 6.9 mmol/L and;
- less than 11.1 mmol/L for the two-hour glucose tolerance test.
How does pre-diabetes develop?
Pre-diabetes happens when the body cannot use insulin effectively enough to meet the person’s needs, and blood glucose (sugar) levels rise. Glucose is the body’s main source of energy. When we eat or drink, glucose enters our bloodstream, prompting the pancreas to release the hormone insulin. Insulin helps to move glucose from the bloodstream into the cells that need it for energy. This process is important in helping to keep glucose levels in a certain range.
If the glucose/insulin system is not working properly, a person can develop a condition called insulin resistance.
Insulin resistance and pre-diabetes
When a person has developed insulin resistance, it means that the cells in their body are not reacting well to insulin. This results in too much glucose circulating in the blood. The pancreas then tries to regulate blood glucose by producing more and more insulin. This eventually wears the pancreas out resulting in reduced amounts of insulin production. Over time, this can lead to pre-diabetes.
Symptoms and causes of pre-diabetes
Pre-diabetes rarely has signs or symptoms. The most common way to diagnose pre- diabetes is to see your GP and have a fasting glucose, Hba1c or Glucose Tolerance Test (GTT) completed. Ensuring you have regular preventative health checks with your GP, means the warning signs are picked up in the pathology results and you can intervene early to prevent the development of type 2 diabetes.
Who’s at risk of pre-diabetes?
Pre-diabetes has the same risk factors as type 2 diabetes.
Some of these risk factors can be changed (are modifiable) and others cannot be changed (are non-modifiable).
Modifiable risk factors include:
- Being overweight
- Having too large a waist measurement (greater than 80 cm for women and 94 cm for men)
- 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
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, South-East Asian, Asian (the sub-continent), Middle-Eastern or North African.
- Age–although diabetes can develop at any age, the risk of pre-diabetes increases after the age of 35.
- Having Polycystic Ovarian Syndrome (PCOS).
- Having had diabetes in pregnancy (gestational diabetes) or given birth to a big baby (more than 4.5kgs).
Pre-diabetes is usually diagnosed when a person’s doctor or workplace arranges a routine health check and sends them for a blood test.
There are several tests available to confirm prediabetes:
A fasting blood glucose test (FBGT): This is where a blood sample is taken from a vein, usually in your arm, to show the level of glucose in your blood, this is done as a fasting blood test (8-10 hours of fasting);
Glucose Tolerance Test (GTT): If your fasting blood glucose test is high, your GP may then arrange a GTT, which looks at both a fasting reading and then at a one and two hour reading, after a glucose drink, to see your body’s response to the drink. This will take up to three hours and involves three blood tests in that time.
Hba1c: The Hba1c can be taken at any time (non fasting), as this test shows the average of your blood glucose level, over a period of three months. It looks at the amount of glucose in your red blood cells. Red blood cells turnover every three months.
A person whose blood test results indicate that they have pre-diabetes is at high risk of developing type 2 diabetes. However, healthy lifestyle changes and exercise can decrease this risk.
Type 2 diabetes
Type 2 diabetes affects how your body uses glucose for energy. It’s a combination of ineffective insulin and not producing enough insulin. The insulin producing cells in the pancreas wear themselves out, after overproducing insulin over a long period of time. Usually by the time of diagnosis of type 2 diabetes, a person may have lost between 50-70% of their insulin producing cells. Type 2 diabetes develops over a long period of time, so screening people early can make a big impact on a person’s long-term health.
Type 2 is the most common type of diabetes and almost 1.3 million Australians are currently living with type 2 diabetes.
Type 2 diabetes can be prevented or delayed by effective screening and helping people who are at risk live a healthier life through healthy eating, weight management and being active.
The symptoms of type 2 diabetes usually only show once blood glucose levels are quite high for some time (usually glucose levels need to be above 12mmol) and the body will start putting its own responses in place to help reduce glucose levels. These include:
- frequently needing to urinate
- increased thirst
- feeling hungry
- having cuts that heal slowly.
Complications and risks: understanding the dangers of untreated pre-diabetes
People who leave their pre-diabetes untreated run a significant risk of developing type 2 diabetes. That in turn puts them at risk from the complications of type 2 diabetes, which include:
- bacterial and fungal skin infections, gum and teeth decay
- heart disease
- kidney disease
- nerve damage that can lead to digestive problems and loss of bladder or bowel control, impotence
- eye conditions such as glaucoma, retinopathy and cataracts, which can result in loss of vision.
If you have pre-diabetes, it is important to be aware that high blood sugar may have already begun to silently damage your body. Pre-diabetes has been linked with long-term harm to the heart, blood vessels and kidneys. It is also associated with what are known as ‘quiet’ or ‘silent’ heart attacks. These are heart attacks that cause no symptoms but are still damaging.
Medication options: understanding medications for pre-diabetes management
Although lifestyle changes and exercise can be helpful in preventing or delaying the progression from pre-diabetes to type 2 diabetes, for some people medication such as metformin is also needed.
Metformin, which lowers blood sugar levels, can help with managing feelings of hunger and managing weight, and is the most commonly prescribed medication for pre-diabetes in combination with making lifestyle changes. Increasingly, GPs are also prescribing medication for weight loss called GLP-1 agonists (Glucagon like Peptide-1) to help with weight loss and prevention of type 2 diabetes. These would be the main two medications used in pre-diabetes; there is a large number of medication options available for people with type 2 diabetes.
Can type 2 diabetes be prevented?
Having pre-diabetes does not mean that you’ll automatically develop type 2 diabetes. You can prevent or delay the onset of type 2 diabetes by making healthy lifestyle changes.
This can be achieved by tackling 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, quit.
A healthy diet includes plenty of fresh fruits and vegetables, lean meats and whole grains. Eat less junk food such as chips, biscuits and fast food. Drink more water and fewer sugary drinks. If you drink alcohol, try to reduce the amount.
Being physically active
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 can help to manage weight and improve your cardiovascular health. You can also choose to do three shorter bursts of activity for 10–15 minutes at a time. Physical activity also helps to manage blood sugar levels.
Maintaining a healthy weight
Reaching and maintaining a healthy weight lowers your blood glucose levels. If you’re overweight, losing just 5% of your body weight can significantly reduce the risk of type 2 diabetes and heart disease.
Smoking is one of the causes of type 2 diabetes. Although we don’t yet know exactly how it increases the risk of type 2 diabetes, it’s likely that nicotine (the addictive substance in tobacco) causes our cells to become insulin resistant, which can lead to pre-diabetes.
It is very important for people with pre-diabetes to stop smoking. This is because they are at high risk of heart disease, and smoking further increases that risk.
If you are considering quitting smoking, we recommend that you:
- Call Quitline on 131 848 or visit the Quitline website – https://www.quit.org.au/
- Talk to your doctor or chemist about additional options.
Manage your stress
Stress can raise your blood pressure and can also lead to behaviours such as drinking too much alcohol or overeating. The lifestyle changes you can make to reduce stress include:
- exercise regularly
- work out the types of situations that make you stressed and, if you can, avoid them
- give yourself some time to relax each day
- socialise and have fun
- eat well
- have a good sleep schedule.
The evidence shows that type 2 diabetes can be prevented or delayed in up to 58% of cases by living a healthier life.
If you’ve been diagnosed with pre-diabetes, there are many positive steps you can take. It’s important to act quickly—the sooner you start, the sooner your risk level will decrease.
But it’s not easy making lifestyle changes on your own. Most of us know that we have to exercise more and prioritise a healthy diet and weight loss, 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.
Find out more about this fantastic program and check your eligibility for joining with this simple online health test.
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
Iftu Umar, Program facilitator and Health Coach