Prediabetes is often called 'borderline diabetes' and occurs when a person's blood sugar levels are higher than normal, but not high enough to be diabetes.
Around 1 in 3 US adults have prediabetes; that means as many as 1.4 million adults in Minnesota have prediabetes and will potentially have type 2 diabetes.
More startlingly is that only 1 in 10 is aware they have prediabetes.
Before the disease progresses, you can take control and prevent or delay the development of diabetes.
How? June Van Valkenburg sheds light on this increasingly prevalent disease.
Selected Podcast
All About Prediabetes
Featured Speaker:
June Van Valkenburg, CNP – Geriatric Medicine/Internal Medicine
June Van Valkenburg is a certified adult-gerontology nurse practitioner at Allina Health Edina Clinic. She has a specialty in advanced diabetes management as well as professional interests in women's health, travel medicine and geriatric medicine. In her free time, June enjoys spending time with her husband and three daughters, running with her dog, biking, reading and participating in international medical missions. For the more than 10 years June has been involved with medical missions, her travels have taken her to Peru, Guatemala, Nicaragua, Rwanda, and most recently, Ecuador. Transcription:
All About Prediabetes
Melanie Cole (Host): Prediabetes is often called borderline diabetes, and it occurs when a person’s blood sugar levels are higher than normal but not high enough to be considered full-blown diabetes. My guest today is June Van Valkenburg. She’s a certified adult-gerontology nurse practitioner at Allina Health Edina Clinic. Welcome to the show, June. Tell us a little bit about prediabetes, and how does that differ from diabetes type one or two?
June Van Valkenburg (Guest): Well, what prediabetes is, it’s a condition where the blood sugar is a little bit elevated but it’s not elevated high enough to give you a diagnosis of type two diabetes. Type one diabetes is usually found in children and young adults, and in type one diabetes, the pancreas just stops producing insulin. People always have to go on insulin injections. Type two diabetes is the most common form of diabetes, and it’s a chronic condition which affects the way your body metabolizes glucose, and there is an insulin resistance that develops and the body doesn’t create enough insulin like it should. Prediabetes is actually a precursor to type two diabetes. There’s really no such thing as borderline diabetes anymore, but prediabetes is related to inactivity and excess weight. What it really is is a warning sign to our body that we’re going down the wrong metabolic pathway. It’s similar to a flashing yellow light when you’re driving. When the light is green, you can keep going. But when it’s turned yellow, it’s a warning that you need to stop. That’s what prediabetes is.
Melanie: Really only about one in 10 are aware that they even have prediabetes, and this is kind of staggering to me. Tell us how a listener would know that they are at risk of getting full-blown diabetes, that they’re subject to prediabetes. And how would they even know what their blood sugar levels are?
June: Well, most people don’t know what the risk factors are for prediabetes, but being overweight, a BMI higher than 25, being inactive, or a family history of diabetes, or having had gestational diabetes in pregnancy, all put you at higher risk for prediabetes. The only way to know would be to have a blood test done.
Melanie: Are there symptoms that would show up that would send someone to their doctor to get checked?
June: Oftentimes there is no symptoms of prediabetes. People might complain of a little fatigue or malaise. Sometimes there is some darkening of the skin, a skin condition called Acanthosis nigricans. Most often, people would not have any symptoms. The classic symptoms of diabetes, such as unusual thirst, unusual urination, weight loss, don’t show up in prediabetes.
Melanie: There are some factors. Certainly with diabetes there is a genetic factor involved. But what about with prediabetes? And are there certain factors that we can control?
June: There are some genetic factors, such as family history of diabetes, body type, age over 45, certain ethnic groups, such as African American, Hispanic, American Indian, Asian American, or Pacific Islander. All those genetic factors can put someone at higher risk. The factors that we can control are being overweight and inactivity. That’s the main problem in America with prediabetes.
Melanie: What would you advise as your most important information, June, for people who suspect or are told that they are prediabetic, and what would be their first step towards preventing full-blown diabetes?
June: The first thing they should do is just go into their clinic and have a fasting blood sugar and a hemoglobin A1c checked. The fasting blood sugar gives you a measure of what their blood sugar is that point in time. The hemoglobin A1c is a really nice test. It measures the amount of glucose that attaches on to a red blood cell. And since the red blood cell has a life of 90 days, it gives us a reading of what that blood sugar reading has been over the last 90 days.
Melanie: Then what if somebody gets that diagnosis? What does that mean for their future? It’s not definitive that they will get diabetes from this diagnosis, correct?
June: That’s correct, but a diagnosis of prediabetes is exactly where we want to find people. We should be diagnosing them there rather than when they become diabetic, mainly because they can make some changes. They can make some lifestyle changes that can prevent the development of diabetes. What we know now is when a person is diagnosed with type two diabetes, at that point in time, they have already lost 50 percent of their beta cell function. The beta cells are cells in the pancreas that control glucose metabolism. For about 10 years before the diagnosis of diabetes, these beta cells have been becoming less and less active. By the time that diagnosis is made, 50 percent of that function was already lost. We want to make the diagnosis 10 years earlier and make some changes. It’s a sign to assess, a time to make a U-turn when you get an elevated blood sugar in the prediabetic rate. We don’t want to keep going straight ahead. We got to turn around and make some major changes in lifestyle.
Melanie: If those beta cells are damaged or destroyed and making them resistant to the actions of insulin in the blood, then is there a way to prevent type two diabetes from coming on? It doesn’t mean that they’re going to get it, right?
June: Well, the best information we have on prevention of type two diabetes is the study that was done called the Diabetes Prevention Program that was done in 2002, and that was a randomized control trial of more than 3,000 people. What they did in that study was they put a third of the people into a lifestyle intervention group where they worked on diet, exercise, weight loss and lost around 7 to 10 percent of their body weight. A third of the group were put on a medication that’s oftentimes used to treat type two diabetes called Metformin, and then a third of the group were put in a control group. What they found was that the people in the control group ended up developing diabetes at a rate of 11 percent per year. Basically, if you do nothing, in nine years, 99 percent of those people had type two diabetes. The treatment group with the medication, the Metformin group, they decreased their risk of getting type two diabetes by 31 percent. The lifestyle intervention group and those people who lost maybe 7 to 10 percent of their body weight—so if you weighed 200 pounds and you lost 20 pounds—for most of those people in this study, they did not get down to an ideal weight, but they lost a little bit of weight, and they decreased their risk of developing type two diabetes by 58 percent.
Melanie: That’s really amazing statistics. And are there any resources you would recommend to people who are worried about prediabetes?
June: Yes, there are. There are some prediabetes classes taught at the Allina clinics by our diabetic educators. Also, the American Diabetes Association has information on prediabetes on their website at diabetes.org. One of the best resources is through the YMCA, and what they’ve done is replicated the Diabetes Prevention Program and made a 12-month program consisting of 16 one-hour weekly sessions and then monthly sessions after that and working on diet, exercise, weight loss as the goal. The interesting thing they found with the Diabetes Prevention Program was that the lifestyle intervention was effective for everyone, men and women, people of all ages and people of all ethnic groups, and that that lifestyle intervention persisted over 10 years. We have very real medications that have those kind of results, and this is something that people can do for hardly any cost and no side effects.
Melanie: That certainly is the best information as exercise has that insulin-like effect, so being physically active is certainly one of the best bits of information you’re giving here today. June, in just the last minute or so, give your best advice for someone who suspects that they might have prediabetes or has already gotten that diagnosis and how they can change that course or path thereon.
June: The best advice that I can give them is to start exercising and to work up to a goal of 150 minutes a week, so 30 minutes five days a week. Doesn’t have to be strenuous. Going out for a walk is great. Working on changing their diet so that it’s healthier. And to lose weight, they do need to eat less calories than they’re burning up. So it usually involves some calorie restriction along with healthy diet. There’s some great community-based programs out there. I think most people know what they need to do to lose weight; it’s mainly just getting going on it.
Melanie: Thank you so much. You’re listening to the WELLcast by Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.
All About Prediabetes
Melanie Cole (Host): Prediabetes is often called borderline diabetes, and it occurs when a person’s blood sugar levels are higher than normal but not high enough to be considered full-blown diabetes. My guest today is June Van Valkenburg. She’s a certified adult-gerontology nurse practitioner at Allina Health Edina Clinic. Welcome to the show, June. Tell us a little bit about prediabetes, and how does that differ from diabetes type one or two?
June Van Valkenburg (Guest): Well, what prediabetes is, it’s a condition where the blood sugar is a little bit elevated but it’s not elevated high enough to give you a diagnosis of type two diabetes. Type one diabetes is usually found in children and young adults, and in type one diabetes, the pancreas just stops producing insulin. People always have to go on insulin injections. Type two diabetes is the most common form of diabetes, and it’s a chronic condition which affects the way your body metabolizes glucose, and there is an insulin resistance that develops and the body doesn’t create enough insulin like it should. Prediabetes is actually a precursor to type two diabetes. There’s really no such thing as borderline diabetes anymore, but prediabetes is related to inactivity and excess weight. What it really is is a warning sign to our body that we’re going down the wrong metabolic pathway. It’s similar to a flashing yellow light when you’re driving. When the light is green, you can keep going. But when it’s turned yellow, it’s a warning that you need to stop. That’s what prediabetes is.
Melanie: Really only about one in 10 are aware that they even have prediabetes, and this is kind of staggering to me. Tell us how a listener would know that they are at risk of getting full-blown diabetes, that they’re subject to prediabetes. And how would they even know what their blood sugar levels are?
June: Well, most people don’t know what the risk factors are for prediabetes, but being overweight, a BMI higher than 25, being inactive, or a family history of diabetes, or having had gestational diabetes in pregnancy, all put you at higher risk for prediabetes. The only way to know would be to have a blood test done.
Melanie: Are there symptoms that would show up that would send someone to their doctor to get checked?
June: Oftentimes there is no symptoms of prediabetes. People might complain of a little fatigue or malaise. Sometimes there is some darkening of the skin, a skin condition called Acanthosis nigricans. Most often, people would not have any symptoms. The classic symptoms of diabetes, such as unusual thirst, unusual urination, weight loss, don’t show up in prediabetes.
Melanie: There are some factors. Certainly with diabetes there is a genetic factor involved. But what about with prediabetes? And are there certain factors that we can control?
June: There are some genetic factors, such as family history of diabetes, body type, age over 45, certain ethnic groups, such as African American, Hispanic, American Indian, Asian American, or Pacific Islander. All those genetic factors can put someone at higher risk. The factors that we can control are being overweight and inactivity. That’s the main problem in America with prediabetes.
Melanie: What would you advise as your most important information, June, for people who suspect or are told that they are prediabetic, and what would be their first step towards preventing full-blown diabetes?
June: The first thing they should do is just go into their clinic and have a fasting blood sugar and a hemoglobin A1c checked. The fasting blood sugar gives you a measure of what their blood sugar is that point in time. The hemoglobin A1c is a really nice test. It measures the amount of glucose that attaches on to a red blood cell. And since the red blood cell has a life of 90 days, it gives us a reading of what that blood sugar reading has been over the last 90 days.
Melanie: Then what if somebody gets that diagnosis? What does that mean for their future? It’s not definitive that they will get diabetes from this diagnosis, correct?
June: That’s correct, but a diagnosis of prediabetes is exactly where we want to find people. We should be diagnosing them there rather than when they become diabetic, mainly because they can make some changes. They can make some lifestyle changes that can prevent the development of diabetes. What we know now is when a person is diagnosed with type two diabetes, at that point in time, they have already lost 50 percent of their beta cell function. The beta cells are cells in the pancreas that control glucose metabolism. For about 10 years before the diagnosis of diabetes, these beta cells have been becoming less and less active. By the time that diagnosis is made, 50 percent of that function was already lost. We want to make the diagnosis 10 years earlier and make some changes. It’s a sign to assess, a time to make a U-turn when you get an elevated blood sugar in the prediabetic rate. We don’t want to keep going straight ahead. We got to turn around and make some major changes in lifestyle.
Melanie: If those beta cells are damaged or destroyed and making them resistant to the actions of insulin in the blood, then is there a way to prevent type two diabetes from coming on? It doesn’t mean that they’re going to get it, right?
June: Well, the best information we have on prevention of type two diabetes is the study that was done called the Diabetes Prevention Program that was done in 2002, and that was a randomized control trial of more than 3,000 people. What they did in that study was they put a third of the people into a lifestyle intervention group where they worked on diet, exercise, weight loss and lost around 7 to 10 percent of their body weight. A third of the group were put on a medication that’s oftentimes used to treat type two diabetes called Metformin, and then a third of the group were put in a control group. What they found was that the people in the control group ended up developing diabetes at a rate of 11 percent per year. Basically, if you do nothing, in nine years, 99 percent of those people had type two diabetes. The treatment group with the medication, the Metformin group, they decreased their risk of getting type two diabetes by 31 percent. The lifestyle intervention group and those people who lost maybe 7 to 10 percent of their body weight—so if you weighed 200 pounds and you lost 20 pounds—for most of those people in this study, they did not get down to an ideal weight, but they lost a little bit of weight, and they decreased their risk of developing type two diabetes by 58 percent.
Melanie: That’s really amazing statistics. And are there any resources you would recommend to people who are worried about prediabetes?
June: Yes, there are. There are some prediabetes classes taught at the Allina clinics by our diabetic educators. Also, the American Diabetes Association has information on prediabetes on their website at diabetes.org. One of the best resources is through the YMCA, and what they’ve done is replicated the Diabetes Prevention Program and made a 12-month program consisting of 16 one-hour weekly sessions and then monthly sessions after that and working on diet, exercise, weight loss as the goal. The interesting thing they found with the Diabetes Prevention Program was that the lifestyle intervention was effective for everyone, men and women, people of all ages and people of all ethnic groups, and that that lifestyle intervention persisted over 10 years. We have very real medications that have those kind of results, and this is something that people can do for hardly any cost and no side effects.
Melanie: That certainly is the best information as exercise has that insulin-like effect, so being physically active is certainly one of the best bits of information you’re giving here today. June, in just the last minute or so, give your best advice for someone who suspects that they might have prediabetes or has already gotten that diagnosis and how they can change that course or path thereon.
June: The best advice that I can give them is to start exercising and to work up to a goal of 150 minutes a week, so 30 minutes five days a week. Doesn’t have to be strenuous. Going out for a walk is great. Working on changing their diet so that it’s healthier. And to lose weight, they do need to eat less calories than they’re burning up. So it usually involves some calorie restriction along with healthy diet. There’s some great community-based programs out there. I think most people know what they need to do to lose weight; it’s mainly just getting going on it.
Melanie: Thank you so much. You’re listening to the WELLcast by Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening, and have a great day.