Frederic J. Vagnini, MD
The late Frederic J. Vagnini, MD, a cardiovascular surgeon and medical director of the Heart, Diabetes and Weight Loss Centers of New York in New York City. He was coauthor of The Weight Loss Plan for Beating Diabetes.
One of the best ways to prevent diabetes is to spot blood sugar (glucose) problems before the full-blown disease develops. But most people don’t realize that diabetes — and its precursor, prediabetes — can cause no symptoms at all or a wide range of symptoms that often are misinterpreted.
Common mistake: Because diabetes is strongly linked to excess body weight, many people who are a normal weight assume that they won’t develop the disease. But that’s not always true. About 15% of people who are diagnosed with diabetes are not overweight. And paradoxically, even weight loss can be a symptom of this complex disorder in people (normal weight or overweight) who have uncontrolled high glucose levels.
Shocking new finding: The Centers for Disease Control and Prevention now estimates that more than 84 million Americans have prediabetes—that’s one out of three adults—and 90% of them don’t know they have it..
However, most primary care doctors aren’t diagnosing and treating prediabetes early enough in their patients — often because they fail to order the necessary screening tests. And because the symptoms of prediabetes can be subtle, especially in its early stages, most people are not reporting potential red flags to their doctors.
Fortunately, prediabetes can virtually always be prevented from progressing to diabetes if the condition is identified and treated in its early stages (by following a healthful diet, exercising regularly and taking nutritional supplements and medications, if necessary).
Being overweight (defined as having a body mass index, or BMI, of 25 or higher) is perhaps the best-known risk factor for diabetes.* The more excess body weight you have, the more resistant your cells become to the blood sugar–regulating effects of the hormone insulin, ultimately causing blood glucose levels to rise.
Greatest danger: Abdominal fat, in particular, further boosts diabetes risk. That’s because belly (visceral) fat hinders the processing of insulin. The single biggest risk factor for prediabetes is having a waistline of 40 inches or more if you’re a man… or 35 inches or more if you’re a woman. Lesser-known red flags for prediabetes (and diabetes) — if you have one of these symptoms, see your doctor…
Prediabetes occurs when the body’s cells no longer respond correctly to insulin, a hormone that regulates blood sugar. With prediabetes, blood sugar levels are higher than normal but not high enough to warrant a diagnosis of diabetes.
Prediabetes affects about 57 million Americans — most of whom are unaware that they have the condition.
If you suspect that you may have prediabetes, ask your doctor to order the following tests…
Fasting blood glucose. This traditional blood test for diabetes is usually part of a standard physical. Until recently, a result over 125 mg/dL was considered a sign of diabetes, while 100 mg/dL to 125 mg/dL indicated prediabetes.
New finding: Standard guidelines established by the American Diabetes Association have not changed, but recent data suggest that a person who has a fasting blood glucose reading over 90 mg/dL should be evaluated by a physician.
Hemoglobin A1C. This blood test, also included in many annual checkups, measures the average blood glucose level over a two- to three-month period. An A1C result of below 5/7% is considered normal… 5.7% to 6.4% indicates prediabetes… and two separate readings of 6.5% or above indicate diabetes.
Oral glucose tolerance test. Administered over two hours in your doctor’s office, this test can spot problems with blood sugar regulation that may not show up in the other tests. For the oral glucose tolerance test, blood levels of glucose are checked immediately before drinking a premixed glucose formula and two hours afterward.
A result of 140 mg/dL to 199 mg/dL is a sign of increased risk for diabetes…200 mg/dL indicates high risk for diabetes… and over 200 mg/dL signals full-blown diabetes. Also ask your doctor to measure your insulin levels—insulin fluctuations can be an even earlier predictor of prediabetes than the tests described above.
*For a BMI calculator, go to the website of the National Heart, Lung and Blood Institute.