What is Pre-diabetes? 

When the blood glucose levels are above normal levels but below the defined threshold of diabetes, the condition is called pre-diabetes. With high chances of developing diabetes, this condition is considered at risk. There is always the presence of pre-diabetes before the onset of diabetes. The elevation of blood sugar is a continuum and hence pre-diabetes cannot be considered an entirely benign condition.

Diagnosis of prediabetes can be alarming. The condition is mainly due to insulin resistance. Prediabetes is often a precursor of type2 diabetes. According to a study, people with prediabetes are always at a higher risk of developing type2 diabetes. The risk of cardiovascular disease also increases in pre-diabetic people.

However, being pre-diabetic doesn’t mean that you will get type2 diabetes. Early intervention, that is diet and physical activity are the two keys to getting your blood sugar out of the prediabetes range. Now, this is an alarm for you, to know the right kind of food to eat.

Diagnosis of Pre-diabetes

The criteria for pre-diabetes are different for different organizations. WHO has defined pre-diabetes as a state of intermediate hyperglycemia using two specific parameters, impaired fasting glucose (IFG)  defined as fasting plasma glucose of 6.1-6.9 mmol/L (110 to 125 mg/dL) and impaired glucose tolerance (IGT) defined as 2 h plasma glucose of 7.8-11.0 mmol/L (140-200 mg/dL) after ingestion of 75 g of oral glucose load or a combination of the two based on a 2 h oral glucose tolerance test. On the other hand, the American Diabetes Association (ADA), has the same cut-off value for IGT (140-200 mg/dL) but has a lower cut-off value for IFG (100-125 mg/dL) and has additional hemoglobin A1c (HbA1c) based criteria of a level of 5.7% to 6.4% for the definition of pre-diabetes.

According to American Diabetes Association (ADA), diabetes screening for adults begins at the age of 45 years. If you are overweight and have an additional risk for prediabetes, you are advised to start early screening for diabetes.
 

There are several blood tests available for pre-diabetes. Let's discuss it one by one

Glycated hemoglobin (A1C) test

Your average blood sugar level for the past three months is shown in this test. This test measures the percentage of blood sugar attached to the hemoglobin. (oxygen-carrying protein in red blood cells) 

An HbA1C level below 5.7% is considered normal.

An HbA1C level between 5.7% and 6.4% is considered prediabetes.

An HbA1C level of 6.5% or higher on two separate tests indicates type 2 diabetes.

In some conditions, like if you have an uncommon form of hemoglobin or if you are pregnant- HbA1C results can be inaccurate.

Fasting blood sugar test

Blood samples are collected after you fast for at least 8 hours or overnight.

 A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 2 diabetes.

A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L) is considered prediabetes.

A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal.

Oral glucose tolerance test

This test is mainly used to diagnose diabetes in pregnant women. An 8-hour fasting blood sample is taken. Then you'll drink a sugary solution, and then again your blood sample will be taken after 2 hours.

A blood sugar level of 200 mg/dL (11.1 mmol/L) or higher indicates type 2 diabetes.

A blood sugar level from 140 to 199 mg/dL (7.8 to 11.0 mmol/L) is considered prediabetes.

A blood sugar level less than 140 mg/dL (7.8 mmol/L) is considered normal.

If you come under the category of pre-diabetic, your doctor will typically check your blood sugar levels at least once a year.

Prevalence of Pre-diabetes 

There have been reports of increased mean FPG and prevalence of diabetes in developed as well as developing countries.

Health risks associated with pre-diabetes
 

Progression to diabetes

There are two factors associated with conversion from pre-diabetic to diabetic- population characteristics and criteria used to define pre-diabetes. According to a study, in India, among those with pre-diabetes, 58.9% converted to diabetes (52.8% among i-IGT, 47.8% among i-IFG, and 84.1% among those with combined IFG and IGT).
Retinopathy

According to a study, 8% of participants with prediabetes were found to have evidence of diabetic retinopathy. Although pre-diabetes has been associated with an increased risk of retinopathy in some studies, these findings vary depending on the method used for detection.
Nephropathy and kidney diseases

Several studies have shown an association between increased risk of chronic kidney disease and early nephropathy with pre-diabetes. The causal nature of this relationship remains unclear as this association may be due to increased incidence of diabetes in this group or the presence of other factors associated with both hyperglycemia and nephropathy rather than the effect of pre-diabetes itself.
Neuropathies

Prediabetes is also found to be associated with dysfunction of cardiac autonomic activity, reflected by reduced heart rate variability, decreased parasympathetic modulation of the heart, and increased prevalence of male erectile dysfunction in individuals with pre-diabetes. 
Macrovascular disease

Prediabetes has been associated with an increased risk of developing macrovascular disease, but whether this elevated risk is due to pre-diabetes itself or due to the development of diabetes remains unclear. Some studies have shown an increased prevalence of coronary heart disease in individuals with pre-diabetes but this relationship may be confounded by the common risk factors present between cardiovascular diseases and pre-diabetes.

Relation between diet and prediabetes

Many factors increase your risk for prediabetes. Genetics plays a role, especially if diabetes runs in your family. Some other factors play a larger role in the development of pre-diabetes. Overweight and very low physical activity are potential risk factors. 

In the case of pre-diabetes, sugar from food begins to build up in your bloodstream because insulin can’t easily move it into your cells.

The amount and type of carbohydrates consumed in a meal influence blood sugar level and causes pre-diabetes. The sugar level in the blood increases, when your diet is filled with refined and processed carbohydrates that digest quickly.

It is difficult for the body to reduce blood sugar levels after a meal. Avoiding blood sugar spikes by watching your carbohydrate intake can help.

When you eat more calories than your body needs, they get stored as fat. This causes you to gain weight. Body fat, especially around the belly, is linked to insulin resistance. This is why many people with prediabetes are also overweight. 

How healthy eating can be a game changer to control prediabetes

Although you can’t control the risk factors associated with prediabetes, some can be managed. Measures taken to stay within a healthy weight range and to balance blood sugar levels may help you.

Select carbs with a low glycemic index

You can determine how a particular food could affect your blood sugar by the use of a glycemic index. High GI food will increase your blood sugar faster. Foods ranked lower on the scale have less effect on your blood sugar spike. High fiber foods are low on the GI. Highly processed foods, refined foods, foods low in fiber and nutrients, register high on the GI.

Refined carbohydrates are high in the GI. These are the products that digest quickly in your stomach. Examples are white bread, russet potatoes, and white rice, along with soda and juice. Restrict these foods if you are pre-diabetic.

Although foods that rank medium on GI are fine to eat, still not as good as foods that rank low on the GI. Examples include whole-wheat bread and brown rice.  Foods that rank low on the GI are best for pre-diabetics.

Add the following items to your diet

Steel-cut oats

Whole wheat pasta

Whole wheat bread

Corn

Non-starchy vegetables

Sweet potatoes

Beans

GI of food is not mentioned on the labels of food items. Instead, check the fiber content listed on the label to help determine a food’s GI ranking. Restrict the intake of saturated fat to reduce the risk of developing high cholesterol and heart disease, along with pre-diabetes. You can lower the GI of a given food item by taking mixed meals. For example, if you plan to eat white rice, add vegetables and chicken to slow down the digestion of the grain and minimize the spikes in blood sugar level.

Control portion size

You should have good control over the portion size to keep your diet on a low GI. This means you should limit the amount of food you eat every meal. Often, portions are higher, which creates problems and results in spikes in blood sugar levels.

Food labels can help you much regarding the proper portion size. The label will list calories, fat, carbohydrates, and other nutrition information for a particular serving.

It is important to understand that it will affect the nutritional value if you eat more than 1 serving listed. A portion of food may have 30 grams of carbohydrate and 200 calories per serving. But if you have two servings, you’ve consumed 60 grams of carbohydrate and 400 calories.

Elimination of carbohydrates from the diet is not necessary. Recent research has shown that a diet containing less than 40 percent is associated with the same mortality risk as a diet containing 70 percent carbs.

A minimal risk was reported when the intake of carbohydrates was 50 to 55 percent. For example, on a 1600-calorie diet, you should take 200 grams of carbohydrates. Spreading intake of carbohydrates evenly throughout the day is best.

As recommended by the ‘National Institutes of Health’ and the ‘Mayo Clinic’, 45 to 65 percent of calories should come from carbohydrates per5 day. Individual carbohydrate needs differ based on a person’s stature and activity level. It is recommended to consult with a dietician to know about your specific needs.

Mindful eating is the best way to keep control of your portion size. Eat only when you are hungry, and stop when you feel full. Sit properly and concentrate on the food and flavors while eating.

Include plenty of fiber-rich foods

Fiber is essential and beneficial for you. It has several benefits. It helps you feel fuller for a long time. It adds bulk to your diet, making bowel movements easier.

Since fiber-rich foods add bulk to your diet, you are less likely to overeat. You are also able to avoid the ‘crush’ which results from eating high sugar food. These types of foods will often give you a big boost of energy, but make you feel tired shortly after.  

Examples of some foods high in fiber

beans and legumes

whole wheat pasta

whole-grain bread

whole-grain cereals

whole grains, such as quinoa or barley

fruits and vegetables that have an edible skin

Restrict sugary drinks

A single can of soda can give you the carbohydrates recommended for a meal. A normal can of soda, 12 ounces, can contain 45 grams of carbohydrates. This number is the recommended carbohydrate serving for a meal for women with diabetes.

Sugary sodas give you only empty calories and are readily digested. Water is always a better choice to quench your thirst.

If alcoholic, drink alcohol in moderate amounts

In most instances, moderation is a healthy rule and it also goes well in the case of alcohol. Several alcoholic beverages are dehydrating. The sugar level in most of the cocktails is very high, enough to spike your blood sugar level. According to research, women should only have one drink per day, while men should limit themselves to two drinks per day. Portion control is very important in the case of alcohol. Following are the measurements for an average single drink:

1 bottle of beer (12 fluid ounces)

1 glass of wine (5 fluid ounces)

1 shot of distilled spirits, such as whiskey, gin, or vodka (1.5 fluid ounces)

Keep your drink simple. Avoid adding sugary juices or liqueurs. Drink plenty of water to avoid dehydration.
 

Include lean meat in your diet

If you are a pre-diabetic, it is recommended for you to avoid cuts of meat with visible fat or skin. A low saturated and trans fat diet will help you reduce your risk of heart disease.

However, meat doesn’t contain carbohydrates but can be a significant source of saturated fat in your diet. Eating fatty meat in moderation can lead to high cholesterol levels.

Choose your protein sources from here

low-fat Greek yogurt

chicken without skin

egg substitute or egg whites

turkey without skin

lean beef cuts, such as flank steak, ground round, tenderloin, and roast with fat trimmed

shellfish, such as crab, lobster, shrimp, or scallops

fish, such as cod, flounder, haddock, halibut, tuna, or trout

beans and legumes

soybean products, such as tofu and tempeh

Very lean cuts of meat have about 0 to 1 gram of fat and give you 35 calories per ounce. High-fat meat, such as spareribs, can have more than 7 grams of fat and will provide 100 calories per ounce.
 

Drink plenty of water

Water is an essential part of any healthy diet. Drink plenty of water to avoid dehydration. For pre-diabetics, water is a healthier option in place of sugary sodas, juices, and energy drinks.

Average daily intake of water should depend upon your body size, activity level, and the climate you live in.
You can determine if you are taking enough water or not, by monitoring your urine volume and color. The color of your urine should be pale yellow.

Read the article Pre-diabetes - The Younger Brother of Silent Killer Diabetes

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