Scott Webb (Host): Pre-diabetes can lead to type 2 diabetes, but remission is possible through diet and lifestyle modification. Joining me today to tell us more about pre-diabetes is Vera Bartasavich. She's a diabetes educator with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

Vera, it's nice to have you here today. We're going to talk about pre-diabetes. And I have a lot of conversations about diabetes, type 1, type 2, but I like when we talk about pre-diabetes, because I think it's something that's sort of in and of itself. It's its own thing and we should talk about it. So, what is pre-diabetes and is it different than diabetes?

Vera Bartasavich: Yes, there's a difference. Pre-diabetes means your blood sugars are elevated, they're higher than normal, but not as high as a type 2 diabetes. Why does blood sugar tend to be higher in people with pre-diabetes? There's really two different main reasons. First, the pancreas, our body's insulin factory starts to slow down. The pancreas is not making as much insulin as it used to, and insulin is the hormone that helps move glucose out of the blood and into our body's cells, where it can be used for energy. And glucose is our preferred energy for our body.

Second, the body starts to develop what is called insulin resistance. This means the cells do not respond to insulin the way they should, it's like the cells are ignoring insulin's knock on the door. With both of these happening, less insulin is being made, and insulin that is there is not working as efficiently. Glucose builds up in the bloodstream instead of getting into the cells. So, the good news is that pre-diabetes, these two issues are not as advanced as with type 2 diabetes. Pre-diabetes is the early warning a chance to make changes before things get more complicated.

Host: Right. Yeah. And as you say, it is that early warning. So, let's talk about that then. Like what are the symptoms, if there are any, of pre-diabetes, and how do you diagnose?

Vera Bartasavich: Most people with pre-diabetes do not feel any symptoms at all. Some individuals have symptoms that a type 2 is diagnosed with. But for the most part, there are no outstanding symptoms. That is why pre-diabetes is often called the silent condition, and many do not know that they have the condition. It is projected that there are approximately 98 million people in the U.S with pre-diabetes, which is astounding. And eight out of ten do not even know they have it.

So, let's go into the symptoms of type 2 diabetes. That can be fatigue, frequent urination, thirst, blurred vision, slow healing of cuts or infections, tingling of the hands or feet, dark patches on the skin, often on the neck, the armpits or the groin, and even skin tags.

So, diagnosis for pre-diabetes or diabetes is just a simple blood test, such as fasting glucose, A1c or glucose tolerance test. Fasting glucose requires not eating for more than eight hours, while the A1c does not even require fasting. The glucose tolerance test requires drinking a sugary drink, then testing the blood glucose two hours later. Fasting glucose for non-diabetics is less than a hundred milligrams per deciliter. Pre-diabetes is ranked from a hundred to 125 milligrams per deciliter, and anything above 125 is a diabetes diagnosis. A1c requires no fasting because it is the average of the blood glucose over two to three months versus a point in time. So, what happens is the blood cell is coated with glucose, and they're able to measure that. The cell only lasts for two to three months, so that's why that test is two to three months out. If blood is drawn, that shows less than 5.7%, so A1c is in a percentage versus the fasting, which is actually a number, a full number. If it's less than 5.7%, that means there's no diabetes or pre-diabetes. If it's 5.7 to 6.4%, that indicates there is pre-diabetes, and greater than 6.4% is a diabetes diagnosis.

Host: Okay. So then, let's talk about prevention, if you will. You know, you said that basically that, pre-diabetes is this warning for folks. So, can we prevent pre-diabetes from progressing to diabetes?

Vera Bartasavich: Research shows that even small changes in the daily habits can lower your risk by more than 50% of moving into type 2 diabetes. And that's what we're trying to stop, is having pre-diabetes move into diabetes. There's some proven steps. Eating more whole foods, fewer processed foods, managing carbohydrate intake and pairing proteins with healthy proteins such as eggs, nuts, cheese, seeds, chicken, beef, pork, fish, or tofu. Carbohydrates are in all foods except protein and fat. So, there can be a learning curve of how to eat the right amount of carbs. Following portion control is a big win when fighting pre-diabetes. Moving more, exercise, getting our heart rate up. Aim for about 30 minutes a day, five days a week. Add resistant activities two times a week to your routine, like small weights or resistance bands.

If somebody has mobility issues, try chair yoga or chair exercises, which you can easily find on YouTube videos or books from the library. Just move your body, just get moving, right? Also, losing just 5-10% of your body weight if needed. And managing stress. Stress is a culprit for increasing blood glucose. Exercise and adequate sleep can help manage that stress. Deep breathing. Taking time for reflection, finding a hobby that you enjoy, asking help from family and friends can really help manage stress, because we can never be stress-free. Sleep management. Lack of sleep can affect glucose levels because cortisol, which is a hormone can disrupt and increase the insulin resistance. Loss of sleep means less healthy eating, because we make bad food choices or not exercising as much because we're just tired. So, we want to set small goals and change slowly, because this is a lot. You know, if we've been doing things for years and years, this is a lot to take in. So, set small goals and change slowly, so these behaviors become habits.

Host: Right. So then, Vera, what are the risks if we don't manage pre-diabetes? Is it automatically become type 2? How does that work?

Vera Bartasavich: Pre-diabetes has a lower risk for complications, but an increased risk if we don't have intervention, meaning, you know, those healthier lifestyles, pre-diabetes can turn into type 2 diabetes, that carries greater chances for complications. So, diabetes complications include heart disease, stroke, kidney damage; nerve damage, eyes and feet; osteoporosis, periodontal disease, Alzheimer's disease, and higher rates of depression.

In fact, high blood sugars affect every part of our body, every cell in our body. So, taking pre-diabetes seriously is important, because you do not feel any symptoms. That does not mean you should ignore the condition.

Host: Yeah, I want to ask you about reversal and whether or not that's the correct word, right? So, I want to ask basically, can pre-diabetes be reversed? And is that how we should think of it as we're reversing pre-diabetes? Or is there another way of thinking about it?

Vera Bartasavich: I like to think of it as remission. I do see reversal in many different publications, but remission is, I think, a little bit more accurate, because your blood sugar can go back to normal levels. However, if someone goes back to those less healthy lifestyles, too many carbs, sedentary behavior, not managing stress or sleep or whatever, your glucose level numbers can rise again. So, management often happens through consistent, healthy habits like eating well, being active and losing a little weight. It's not always easy, but it is possible. So, it is remission.

Host: Yeah, remission sounds right. And as you say, you know, it is possible. It's a lot to take in, a lot to absorb, a lot to deal with, but it is possible we just need to do our part, as you mentioned earlier, kind of get moving, right? The things that we can do to help.

Vera Bartasavich: Correct.

Host: Yeah. Things we can do to help ourselves. Let's finish up here today and just give folks some resources, ways that they can connect with other folks maybe who have pre-diabetes or experts like yourself. What can they do?

Vera Bartasavich: The best thing is to first speak with your physician. Sometimes they can give you a recommendation to someone to see, just different groups. But at Summa Health, we do hold group classes for pre-diabetes and diabetes. We hold them at Chapel Hill Medical Center and Barberton Hospital.

We have a staff that consists of registered nurses, a registered dietician, health and diabetes educator that lead the classes. And all staff are trained in teaching self-management for the person living with high glucose levels. Because you cannot see your doctor or your nurse 24/7, you have to self-manage. Knowledge is power, especially when managing this condition. The group classes are free to the public, and you do not have to be a Summa Health client. The best way to figure out, I know it's hard, you know, on a podcast here, if you Google Summa Health Diabetes Education, you can get the full information. Again, that's Summa Health Diabetes Education, for more information and for registration.

Host: That's perfect. Well, I appreciate your time today. You know, a lot of what we do here is about educating and encouraging folks if they have the signs, symptoms, whatever it might be, or maybe a family history, reach out to their own providers. You gave us some great resources there. So, thank you so much.

Vera Bartasavich: Thank you, Scott, for this opportunity. Take care.

Host: And visit summahealth.org/diabetes to learn more, or call 888-470-6962 to ask about appointments with Caroline and the team of diabetes experts at Summa Health. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.