Best science-based resources to help me understand pre-diabetes?
September 19, 2009 8:10 PM Subscribe
Help me understand pre-diabetes.
Friend recently had a physical and the fasting glucose number was just under 125.
Please point me to scientific (but readable), evidence-based resources that will help me be a supportive friend.
About Friend
Friend has had varying glucose numbers at various physicals (for example, over 110 one year, then below 100 the next, without any change or effort).
Friend has a pretty good diet, preferring whole grains over refined and not being particularly into sweets.
Friend could stand to drop 10-20 pounds and has been pretty sedentary for the past couple of years. Friend is highly motivated to start exercising seriously and IMHO seems highly likely to drop 10 pounds and be exercising 3-5 days a week within 6 months.
Friend has no other risk factors - no diabetes in the family, normal blood pressure - except somewhat high cholesterol, which seems likely to respond well to the exercise.
Friend is taking this seriously and wants to get the number down pronto, but wants to start with exercise before going the medication route.
Friend's doctor wants Friend to get tested again (which friend will do soon; looking into low-cost testing locations now) and go on medication (no specific medication has been mentioned yet).
Friend and I want to understand this as well as we can, and we have tons of questions, like:
My Question
What other resources will help me answer the kinds of questions above and help Friend and me understand the best approaches to improving Friend's health?
YANMD. YANMFD. YAHTAHM.
(You Are Not My Doctor. You Are Not My Friend's Doctor. You Are, However, The Awesome Hive Mind.)
Thanks!
Friend recently had a physical and the fasting glucose number was just under 125.
Please point me to scientific (but readable), evidence-based resources that will help me be a supportive friend.
About Friend
Friend has had varying glucose numbers at various physicals (for example, over 110 one year, then below 100 the next, without any change or effort).
Friend has a pretty good diet, preferring whole grains over refined and not being particularly into sweets.
Friend could stand to drop 10-20 pounds and has been pretty sedentary for the past couple of years. Friend is highly motivated to start exercising seriously and IMHO seems highly likely to drop 10 pounds and be exercising 3-5 days a week within 6 months.
Friend has no other risk factors - no diabetes in the family, normal blood pressure - except somewhat high cholesterol, which seems likely to respond well to the exercise.
Friend is taking this seriously and wants to get the number down pronto, but wants to start with exercise before going the medication route.
Friend's doctor wants Friend to get tested again (which friend will do soon; looking into low-cost testing locations now) and go on medication (no specific medication has been mentioned yet).
Friend and I want to understand this as well as we can, and we have tons of questions, like:
- How reliable are fasting glucose tests at physical centers (places where bunches of people go to get a physical exam)? blood labs? home glucose testers?
- How common is it for fasting glucose levels to vary widely (from day to day or month to month or year to year) for the same individual?
- Is the 126 diabetes cut-off point a magic number where, once you test over 126 twice, you are permanently and irrevocably diabetic? or can a person who's tested over 126 twice bring fasting glucose down below 100 permanently?
- How fast does the number need to come down? In a week? 6 months? A year? (That is, how long do you try just diet and exercise before considering medication?)
- How strictly does fasting glucose correlate with development of symptoms? (I know a woman who had cholesterol levels over 300 her entire adult life and no actual heart problems. Does that sort of thing ever happen with glucose numbers?)
- Can you go off metformin, and what happens when you do?
My Question
What other resources will help me answer the kinds of questions above and help Friend and me understand the best approaches to improving Friend's health?
YANMD. YANMFD. YAHTAHM.
(You Are Not My Doctor. You Are Not My Friend's Doctor. You Are, However, The Awesome Hive Mind.)
Thanks!
Best answer: Hi, Type II diabetic here.
How reliable are fasting glucose tests at physical centers (places where bunches of people go to get a physical exam)? blood labs? home glucose testers?
Doesn't matter, as what you want is an average of readings, which can get by taking regular readings with your home meter. I've heard arguments that home meters aren't as accurate as blood tests, but to me that doesn't matter, as the home meters are accurate enough in terms of giving you a idea of how you're doing blood sugar wise. I've been using a home meter for years and however less accurate it may be, when my 7, 14 and 30 day averages are low, my health is good, no question. When those number where they aren't supposed to be, my health is bad and I can feel it.
What you friend needs is an H1c, which are done about every 4 months and measures the general level of blood sugar over that time.
How common is it for fasting glucose levels to vary widely (from day to day or month to month or year to year) for the same individual?
Very. If you've been eating like shit for weeks and a fasting test, your numbers will probably be higher, as sugar sticks around for a while. If you're eating well, exercising, then the fasting number will be low.
Is the 126 diabetes cut-off point a magic number where, once you test over 126 twice, you are permanently and irrevocably diabetic? or can a person who's tested over 126 twice bring fasting glucose down below 100 permanently?
I think the standard is once you get over 140, you're diabetic, so no 126 isn't some magic number except to indicate there's a problem going on and it needs to be fixed.
That number can be brought down permanently, but you have to work at it and eventually you'll need meds to help you do that.
How fast does the number need to come down? In a week? 6 months? A year? (That is, how long do you try just diet and exercise before considering medication?)
As fast as possible, but I'm guessing a 126 can be brought down in a few weeks if the person works at it. Keep in mind that at 126 is a pretty good number for a diabetic, but if you're pre-dibetic it's a warning sign
How strictly does fasting glucose correlate with development of symptoms? (I know a woman who had cholesterol levels over 300 her entire adult life and no actual heart problems. Does that sort of thing ever happen with glucose numbers?)
Once you're diabetic, you're diabetic. That said, you can be a diabetic with healthy numbers, it just means you're a diabetic with low numbers and you need to keep working it so you keep those numbers low.
Look, there is no cure for diabetes. Your beta cells are woring overtime to keep your blood glucose low and eventually they burn out from doing that and once they're gone, they're gone, no replacements, that's it.
Can you go off metformin, and what happens when you do?
Yes, you can get off metformin and I don't recall any side effects if you do. Keep in mind that that diabetes is a kinda personal disease, where what effects one person may not effect another and that can change over time. For instance, I never had any side effects from metaformin, while it bothers the hell out of others.
If you have any other questions, feel free to ask. The important thing to do is eat well and exercise. Look for a diabetes program at a local hospital, they can provide a lot of help, such as nutrition classes, diabetes close or just a support group. Good luck!
posted by Brandon Blatcher at 10:28 PM on September 19, 2009 [1 favorite]
How reliable are fasting glucose tests at physical centers (places where bunches of people go to get a physical exam)? blood labs? home glucose testers?
Doesn't matter, as what you want is an average of readings, which can get by taking regular readings with your home meter. I've heard arguments that home meters aren't as accurate as blood tests, but to me that doesn't matter, as the home meters are accurate enough in terms of giving you a idea of how you're doing blood sugar wise. I've been using a home meter for years and however less accurate it may be, when my 7, 14 and 30 day averages are low, my health is good, no question. When those number where they aren't supposed to be, my health is bad and I can feel it.
What you friend needs is an H1c, which are done about every 4 months and measures the general level of blood sugar over that time.
How common is it for fasting glucose levels to vary widely (from day to day or month to month or year to year) for the same individual?
Very. If you've been eating like shit for weeks and a fasting test, your numbers will probably be higher, as sugar sticks around for a while. If you're eating well, exercising, then the fasting number will be low.
Is the 126 diabetes cut-off point a magic number where, once you test over 126 twice, you are permanently and irrevocably diabetic? or can a person who's tested over 126 twice bring fasting glucose down below 100 permanently?
I think the standard is once you get over 140, you're diabetic, so no 126 isn't some magic number except to indicate there's a problem going on and it needs to be fixed.
That number can be brought down permanently, but you have to work at it and eventually you'll need meds to help you do that.
How fast does the number need to come down? In a week? 6 months? A year? (That is, how long do you try just diet and exercise before considering medication?)
As fast as possible, but I'm guessing a 126 can be brought down in a few weeks if the person works at it. Keep in mind that at 126 is a pretty good number for a diabetic, but if you're pre-dibetic it's a warning sign
How strictly does fasting glucose correlate with development of symptoms? (I know a woman who had cholesterol levels over 300 her entire adult life and no actual heart problems. Does that sort of thing ever happen with glucose numbers?)
Once you're diabetic, you're diabetic. That said, you can be a diabetic with healthy numbers, it just means you're a diabetic with low numbers and you need to keep working it so you keep those numbers low.
Look, there is no cure for diabetes. Your beta cells are woring overtime to keep your blood glucose low and eventually they burn out from doing that and once they're gone, they're gone, no replacements, that's it.
Can you go off metformin, and what happens when you do?
Yes, you can get off metformin and I don't recall any side effects if you do. Keep in mind that that diabetes is a kinda personal disease, where what effects one person may not effect another and that can change over time. For instance, I never had any side effects from metaformin, while it bothers the hell out of others.
If you have any other questions, feel free to ask. The important thing to do is eat well and exercise. Look for a diabetes program at a local hospital, they can provide a lot of help, such as nutrition classes, diabetes close or just a support group. Good luck!
posted by Brandon Blatcher at 10:28 PM on September 19, 2009 [1 favorite]
Best answer: Oh, this is a good book to have: The First Year Type 2 Diabetes: An Essential Guide for the Newly Diagnosed (Paperback)
posted by Brandon Blatcher at 10:31 PM on September 19, 2009
posted by Brandon Blatcher at 10:31 PM on September 19, 2009
Best answer: How strictly does fasting glucose correlate with development of symptoms? (I know a woman who had cholesterol levels over 300 her entire adult life and no actual heart problems. Does that sort of thing ever happen with glucose numbers?)
Only half of the people with heart disease have high cholesterol. 100% of the people with Type II diabetes have high fasting glucose. High fasting glucose is the key symptom of diabetes; the connection between heart disease and high cholesterol is not completely understood, though people with high cholesterol, as a group, are at higher risk for heart disease.
For most people this means you have to lose serious weight
If your friend is only 10 or 20 pounds above the healthy BMI for her height, she shouldn't lose too much weight--underweight is much riskier than overweight for almost everyone.
The glycemic index isn't only about white flour and sugar--your friend may be able to make some other changes that, if adhered to carefully, can bring her blood sugar down.
A lot of people I know with blood sugar issues swear by The Schwarzbein Principle Program.
posted by Sidhedevil at 10:34 PM on September 19, 2009
Only half of the people with heart disease have high cholesterol. 100% of the people with Type II diabetes have high fasting glucose. High fasting glucose is the key symptom of diabetes; the connection between heart disease and high cholesterol is not completely understood, though people with high cholesterol, as a group, are at higher risk for heart disease.
For most people this means you have to lose serious weight
If your friend is only 10 or 20 pounds above the healthy BMI for her height, she shouldn't lose too much weight--underweight is much riskier than overweight for almost everyone.
The glycemic index isn't only about white flour and sugar--your friend may be able to make some other changes that, if adhered to carefully, can bring her blood sugar down.
A lot of people I know with blood sugar issues swear by The Schwarzbein Principle Program.
posted by Sidhedevil at 10:34 PM on September 19, 2009
Yes. Diabetes IS a higher than what's good for you fasting blood sugar level. It's not some other disease for which the symptom is high sugar; the high sugar is the disease regardless of the cause.
There are two causes of diabetes- type 1 is where your pancreas has decided to quit making (enough) insulin and your body can't regulate blood sugar, and type 2 is where you are probably making enough, but your cells don't use it properly.
The reason pre-diabetes has become a diagnosis is that type-II diabetes is more reversable the earlier it is found. The longer one lives with unregulated blood sugar, the harder it is for the body to return to good regulation.
In other words, if being out of shape and a few pounds overweight causes a rise in fasting glucose, then you'd better take care of that now, because if you ignore it for 20 years, you'll be 40 pounds overweight and have 20 years of the damage that is caused by high blood sugar to fight against.
posted by gjc at 4:21 AM on September 20, 2009
There are two causes of diabetes- type 1 is where your pancreas has decided to quit making (enough) insulin and your body can't regulate blood sugar, and type 2 is where you are probably making enough, but your cells don't use it properly.
The reason pre-diabetes has become a diagnosis is that type-II diabetes is more reversable the earlier it is found. The longer one lives with unregulated blood sugar, the harder it is for the body to return to good regulation.
In other words, if being out of shape and a few pounds overweight causes a rise in fasting glucose, then you'd better take care of that now, because if you ignore it for 20 years, you'll be 40 pounds overweight and have 20 years of the damage that is caused by high blood sugar to fight against.
posted by gjc at 4:21 AM on September 20, 2009
Type 2 Diabetes (adult onset) is due to insulin resistance, as far as we know.
Yes, 126 is the magic number. You test a fasting glucose >= 126 on two occasions and you're officially diabetic. Or a random blood sugar over 200 with the symptoms of increased urination, thirst, or eating, and you're a diabetic too. You do not need a HemoglobinA1C for diagnosis, as Brandon suggestions.
As opposed to Type 1 diabetes, with weight loss and exercise, some people can reverse their insulin resistance and thereby become "not diabetic."
"Pre-diabetes" is a fingerstick glucose 100-125, meaning we're not ready to call you diabetic yet, but you're on your way. This is usually when you try diet and exercise. Once you're officially diabetic, time for meds, often metformin.
Yes, the fingerstick machines are just as good as a blood test.
Good luck to you and your friend.
posted by gramcracker at 7:11 AM on September 20, 2009
Yes, 126 is the magic number. You test a fasting glucose >= 126 on two occasions and you're officially diabetic. Or a random blood sugar over 200 with the symptoms of increased urination, thirst, or eating, and you're a diabetic too. You do not need a HemoglobinA1C for diagnosis, as Brandon suggestions.
As opposed to Type 1 diabetes, with weight loss and exercise, some people can reverse their insulin resistance and thereby become "not diabetic."
"Pre-diabetes" is a fingerstick glucose 100-125, meaning we're not ready to call you diabetic yet, but you're on your way. This is usually when you try diet and exercise. Once you're officially diabetic, time for meds, often metformin.
Yes, the fingerstick machines are just as good as a blood test.
Good luck to you and your friend.
posted by gramcracker at 7:11 AM on September 20, 2009
You do not need a HemoglobinA1C for diagnosis, as Brandon suggestions.
Didn't suggest that H1c was needed for diagnosis, but for as a more accurate gauge of of BG levels.
That said, gramcracker is correct about 126 being a magic number for fasting glucose text. It's the 2-Hour Plasma Glucose Test where 140 is considered pre-diabetes.
posted by Brandon Blatcher at 8:34 AM on September 20, 2009
Didn't suggest that H1c was needed for diagnosis, but for as a more accurate gauge of of BG levels.
That said, gramcracker is correct about 126 being a magic number for fasting glucose text. It's the 2-Hour Plasma Glucose Test where 140 is considered pre-diabetes.
posted by Brandon Blatcher at 8:34 AM on September 20, 2009
Best answer: Home meters can be very consistent and accurate. As a hospital nurse, I would frequently check blood sugars with a home meter. When I got a result that seemed wrong, I'd recheck with a different meter, or compare to a blood draw. When there wasn't something screwy going on (like testing on an arm with sugar solution running into it), different meters would show a difference of 1-2 (mg per deciliter).
Fasting glucose levels can vary widely, depending on the circumstances. People here have talked about the effects of sugar, but you have to keep in mind that insulin secretion is part of a complex hormonal pathway. There are a lot of little things that can affect it (beyond diet). One of the things that can affect it most strongly is illness or injury, but it would be silly to pretend that anybody knows everything that affects it. That's why it's not diagnosed in extraordinary circumstances (like in the hospital, unless the sugar is very high), and why it's not diagnosed with a single test. "Pre-diabetes" diagnoses reek of disease-mongering, because if the medical community complied entirely with guidelines, the majority of Americans would be found to be pre-diabetic, but research shows that the majority of us could benefit from lowering our blood sugars.
A change that you describe, of ~10 points in a year without intervention or complicating factors, is pretty normal, just to give you an idea of the ranges involved.
Yeah, at 126, you are permanently and irrevocably diabetic, unless you happened to be pregnant at the time. But it's kind of a weird statement-- it doesn't really mean anything. If a person diagnosed with diabetes lowers their blood sugar to non-diabetic levels without medication, then I know of no doctor who is going to consider that person to be at any increased risk of disease over a non-diabetic individual. (Just as an aside-- sure, type 2 diabetes is a disease, but just like hypertension, its real significance is as a serious risk factor for other diseases.) Different doctors will tell you different things-- some would be happy to say, "You're cured!" But I don't think you'll ever meet a doctor who will say, "Well, now that your blood sugar is under control, you can stop paying attention to your diet and you can stop exercising." So that's what I mean when I say it's basically a permanent diagnosis.
With a number like 110, the doctor is probably not very concerned with seeing the blood glucose drop. What the doctor wants is to keep the blood sugar from rising. If your friend is trying to establish a reasonable goal for treatment, then it's probably more appropriate to set a goal of maintaining the current numbers. No, that's not as fun, I know. If your friend wants to lower his/her blood sugar, then I just don't know how long it'd take, at healthy-ish numbers like that. Certainly, medication would show a decrease almost instantly, but I don't know about diet and exercise.
"Symptoms" of type 2 diabetes are typically things like increased risk of renal failure, of blindness, of vascular disease. So it's not really the way you normally think of diseases having symptoms. Obesity and lack of energy can be considered symptoms of type 2 diabetes, but they're also causes, so it's hard to talk about how correlated they are as symptoms. Because the big things are risks, there isn't anything like perfect correlation. And studies rarely frame things in terms applicable to individuals.
I know these are a lot of words, without sources, when you specifically asked about authoritative sources. I think you're going to have trouble finding answers to some of these questions in controlled studies. I would, however, recommend the american diabetic association website. (www.diabetes.org). It should have the level of information you're looking for, and doesn't seem too alarmist to me. If you look for current research, you're going to find a lot of tiny, specific items that don't add up to much, and it's easy to get blinded by conflicting studies, or to focus on studies because they're available for free rather than because they're the best, most accepted research.
posted by nathan v at 10:57 AM on September 20, 2009 [1 favorite]
Fasting glucose levels can vary widely, depending on the circumstances. People here have talked about the effects of sugar, but you have to keep in mind that insulin secretion is part of a complex hormonal pathway. There are a lot of little things that can affect it (beyond diet). One of the things that can affect it most strongly is illness or injury, but it would be silly to pretend that anybody knows everything that affects it. That's why it's not diagnosed in extraordinary circumstances (like in the hospital, unless the sugar is very high), and why it's not diagnosed with a single test. "Pre-diabetes" diagnoses reek of disease-mongering, because if the medical community complied entirely with guidelines, the majority of Americans would be found to be pre-diabetic, but research shows that the majority of us could benefit from lowering our blood sugars.
A change that you describe, of ~10 points in a year without intervention or complicating factors, is pretty normal, just to give you an idea of the ranges involved.
Yeah, at 126, you are permanently and irrevocably diabetic, unless you happened to be pregnant at the time. But it's kind of a weird statement-- it doesn't really mean anything. If a person diagnosed with diabetes lowers their blood sugar to non-diabetic levels without medication, then I know of no doctor who is going to consider that person to be at any increased risk of disease over a non-diabetic individual. (Just as an aside-- sure, type 2 diabetes is a disease, but just like hypertension, its real significance is as a serious risk factor for other diseases.) Different doctors will tell you different things-- some would be happy to say, "You're cured!" But I don't think you'll ever meet a doctor who will say, "Well, now that your blood sugar is under control, you can stop paying attention to your diet and you can stop exercising." So that's what I mean when I say it's basically a permanent diagnosis.
With a number like 110, the doctor is probably not very concerned with seeing the blood glucose drop. What the doctor wants is to keep the blood sugar from rising. If your friend is trying to establish a reasonable goal for treatment, then it's probably more appropriate to set a goal of maintaining the current numbers. No, that's not as fun, I know. If your friend wants to lower his/her blood sugar, then I just don't know how long it'd take, at healthy-ish numbers like that. Certainly, medication would show a decrease almost instantly, but I don't know about diet and exercise.
"Symptoms" of type 2 diabetes are typically things like increased risk of renal failure, of blindness, of vascular disease. So it's not really the way you normally think of diseases having symptoms. Obesity and lack of energy can be considered symptoms of type 2 diabetes, but they're also causes, so it's hard to talk about how correlated they are as symptoms. Because the big things are risks, there isn't anything like perfect correlation. And studies rarely frame things in terms applicable to individuals.
I know these are a lot of words, without sources, when you specifically asked about authoritative sources. I think you're going to have trouble finding answers to some of these questions in controlled studies. I would, however, recommend the american diabetic association website. (www.diabetes.org). It should have the level of information you're looking for, and doesn't seem too alarmist to me. If you look for current research, you're going to find a lot of tiny, specific items that don't add up to much, and it's easy to get blinded by conflicting studies, or to focus on studies because they're available for free rather than because they're the best, most accepted research.
posted by nathan v at 10:57 AM on September 20, 2009 [1 favorite]
Look into intermittent fasting and interval (HIIT) training, there is literature regarding both reducing insulin sensitivity.
posted by zentrification at 10:44 AM on September 21, 2009
posted by zentrification at 10:44 AM on September 21, 2009
Is Friend also in SF? MeMail me if you need a good Endocrinologist recommendation.
posted by radioamy at 2:30 PM on September 21, 2009
posted by radioamy at 2:30 PM on September 21, 2009
Response by poster: Excellent, excellent answers from everybody - really, everything's a best answer.
Brandon, special thanks for suggesting a book.
Sidhedevil, thanks for addressing my cholesterol question so well. I knew I was kind of grasping at straws there, and I appreciate having my misconceptions corrected sooner rather than later.
And Nathan, special thanks for all your great info. It was very reassuring to learn how common varying readings are, and to know you've used home meters in the hospital. If I could mark your answer double-best, I would.
Friend is doing great so far at absorbing all the info and has gotten off to a great start on both exercise and diet changes. We're actually having a great time playing with CRON-o-Meter and geeking out with all the numbers.
Thank you all so much! I knew you'd come through.
posted by kristi at 9:27 PM on September 23, 2009
Brandon, special thanks for suggesting a book.
Sidhedevil, thanks for addressing my cholesterol question so well. I knew I was kind of grasping at straws there, and I appreciate having my misconceptions corrected sooner rather than later.
And Nathan, special thanks for all your great info. It was very reassuring to learn how common varying readings are, and to know you've used home meters in the hospital. If I could mark your answer double-best, I would.
Friend is doing great so far at absorbing all the info and has gotten off to a great start on both exercise and diet changes. We're actually having a great time playing with CRON-o-Meter and geeking out with all the numbers.
Thank you all so much! I knew you'd come through.
posted by kristi at 9:27 PM on September 23, 2009
This thread is closed to new comments.
Exercise and avoiding carbs is really the best way to address this lower level stuff. The diabetes drugs have serious side effects etc. Do your research. However, if you are going with diet and exercise you have to really do it, not just a little more exercise and a little better diet. For most people this means you have to lose serious weight, avoid large carb intakes (eating 5 or 6 small meals rather than 3 big ones helps tons here) and monitor your sugar regularly. Watch the glycemic index. For info on that check out http://www.mendosa.com/. He's a little out there but has some valuable stuff to read.
posted by caddis at 8:29 PM on September 19, 2009