Dr Philippa Kaye: Pre-Diabetes
Dr Philippa Kaye explains why it’s so vitally important to diagnose pre-diabetes, as well as what to do to help combat it…
Dr Philippa Kaye
Amelia had a set of blood tests requested by a colleague as she had been complaining of tiredness and that her hair was thinning. She had also developed very heavy periods in the perimenopause (the lead up to the menopause). The blood tests showed she had become anaemic, likely to be related to those heavy periods. Of the options we discussed Amelia was keen to try the hormone coil to control the periods and some iron supplements.
Among the blood tests requested was a test for blood glucose and although the reading was not in the normal range, it also was not high enough to diagnose diabetes.
Instead Amelia’s blood glucose level suggested that she had a condition called pre-diabetes, where the levels of her blood glucose were high, but not high enough to be diagnosed with diabetes.
Pre-diabetes symptoms
Pre-diabetes does not have symptoms, but if it is picked up during a blood test, it is important because having pre-diabetes increases your risk of developing type 2 diabetes later on, as well as increasing the risk of cardiovascular disease. You may also hear other terms to describe the condition, such as impaired glucose tolerance, impaired fasting glucose, impaired glucose regulation or sometimes borderline diabetes, but essentially they all mean the same thing.
What is an HbA1C test?
A blood test to look at blood glucose, be that a random or a fasting sample, gives a one-off measurement, a snapshot in time. Another test, called HbA1c looks at average blood glucose over the last two or three months and this may be used instead to diagnose pre-diabetes. An HbA1c level between 42-47mmol/mol indicates pre-diabetes, and a level over 48mmol/mol diabetes.
What to do if diagnosed with pre-diabetes
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Amelia’s first question after I explained the situation was what could be done. Having pre-diabetes increases your risk of developing type 2 diabetes and cardiovascular disease.
There are risk factors for these conditions which cannot be changed, such as getting older, your ethnicity, and family history. However, there are also other modifiable factors, which we can change.
Although losing weight is often difficult, if you have obesity or are overweight, even losing small amounts can be helpful. Weight loss and increasing physical activity reduce the body’s resistance to insulin, so that your body responds better to insulin which helps control your blood sugar levels.
Any diet which is too restrictive is unlikely to be achievable and maintained, so instead aim to eat a healthy, well balanced diet. Add lots of fruit and vegetables with wholegrains to give sustained energy release. Whole grain cereals, brown rice and pasta have a lower glycaemic index than white, meaning they are absorbed more slowly. The fibre content of fruit and veg also help control blood glucose.
Keep moving, in whatever form you like, aim to get slightly out of breath – you can still have a conversation but not enough puff to sing!
Reducing alcohol intake to below the guidelines of a maximum 14 units a week, and stopping smoking if you smoke, are also beneficial. Your GP practice is likely to have a smoking cessation service to help you give up.
Treatment for pre-diabetes
Lifestyle measures are generally the treatment for pre-diabetes but in some situations – for example, if you also have high blood pressure or high cholesterol – your doctor may consider putting you on a medication, such as metformin.
Take a 5-year health check
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If you have a health condition, you may be offered regular testing, for example if you have high blood pressure you will be offered an annual blood test to check kidney function, cholesterol levels, and to check for diabetes.
If you do not have a health condition which requires regular testing, the NHS offer a health check every five years to people between 40 and 74, which aims to pick up health conditions such as high blood pressure and diabetes. As part of the health check you will be offered blood tests to check your cholesterol levels and for diabetes.
Advice given in this article and on the My Weekly website and magazines is not meant to replace personalised medical advice from your doctor. If you have any health concerns please see your doctor.
Article written on May 11, 2023; article reviewed and updated on July 17, 2024.
Each week we’ll ask Dr Philippa Kaye to talk about a prominent health issue, so look out for more articles in our health and wellbeing section in coming weeks. Read her advice on Skin Cancer, Allergies, Parkinson’s Disease, Shingles, Ovarian Cancer, Endometriosis, Long Covid and Ticks and Lyme Disease.
