Tuesday, 18 September 2012

Is "Pre-Diabetes" like being "a little bit pregnant"?

Photo courtesy CollegeDegrees360, licensed CC-BY-SA
I was talking to my mother on the weekend at our regular coffee/shopping trip, and she said: "Pre-diabetes doesn't exist.  You're either diabetic, or you're not.  If you're numbers are over 6, you're diabetic."  She said it with conviction, too.

Two things to note here.  1. My mother is an insulin-dependent type 2 diabetic.  Her strong convictions come from experience.  2. My mother does not know I have fasting blood sugar levels that are higher than "normal" but less than "diabetic". Would it have changed her position if she had known?  Who knows?  She's stubborn, so I will say that the knowledge likely would not have changed her viewpoint.  She's funny that way, sticking to her guns when she thinks she's right.

In the "pre-diabetes exists" camp is the preeminent peer-reviewed medical journal, the New England Journal of Medicine.  In its August 9, 2012 edition [citation: N Engl J Med 2012; 367:542-550], Dr. Silvio Inzucchi writes:

"Type 2 diabetes is preceded by a lengthy asymptomatic stage, termed prediabetes, which is characterized by mild hyperglycemia, insulin resistance, and early decrements in insulin secretory capacity."

Given the fact that the NEJM has published an article about diagnosing diabetes that directly refers to pre-diabetes as an actual thing, presumably the leading medical establishment (not to mention the CDA and ADA) hold fast to the idea that there is a grey zone between "normal" blood sugar and a level of high blood sugar that is symptomatic of diabetes.  This grey zone is pre-diabetes.  My mom, unlike Dr. Inzucchi, has not had her opinion that pre-diabetes does not exist published in a peer-review journal.  I will have to defer to the experts, while respectfully allowing my mother to believe what she likes. 

I am able to be convinced of the existence of pre-diabetes if only for the fact that if any elevated blood sugar level meant that you are diabetic, the cutoff levels would be different.  If normal is 5.5, a diabetic would have sugars at 5.6, not 7.0, which is the current accepted level.

Compounding my frustration and uncertainty is the fact that sources do not agree.  I am frankly surprised that almost 100 years after Banting and Best discovered insulin, the medical establishment does not definitively know how to cure diabetes, or even how to define diabetes. 

I suppose the question for little miss hyperglycemic over here is: "what would I do differently if I were a type 2 diabetic, as compared to a person with pre-diabetes and a terrible family history"?  The answer is: "Nothing". 

The CDC says that healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.  Further, lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by 58% during a 3-year period in one large prevention study.

Anyone who has looked at my food diary could tell you that, thanks to the Nerd, I am well on the way to eating healthy, every day.  As for physical activity, I work out for 40 minutes on the elliptical machine, 6 days a week, and I go for incremental walks at least twice a week.  I walk to and from work.  With my job and the hours it demands, it is difficult for me to be any more physically active (although I am certain I will find a way, with time).  I also test my fasting blood sugar every morning, so I know exactly where I stand.

I am doing all the right things.  I just get frustrated that doing all the right things is not resulting in instant reductions of my blood sugar levels.  I guess the biggest problem for me is that changes in my blood sugar levels are so gradual, and intermittent, compared to my weight loss, which is more predictable. 

Lifestyle change takes time to kick in.  I just hope I have time for it to kick in before I kick over to being a full-blown diabetic.

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