Everything I know about Prediabetes
I’ve recently been doing a lot of reading into blood glucose, diabetes and prediabetes, and this is a summarization my understanding (I have no medical experience, so take all this with a grain of salt - pun very much intended).
The first thing to understand is that prediabetes and type 2 diabetes are diseases whose underlying cause is insulin resistance, and one manifestation of insulin resistance is a poorer response to blood glucose.
Since an effect of diabetes is high blood glucose, we can measure someone’s propensity to diabetes by measuring their blood glucose. This is done using a Haemoglobin A1C test which measures (roughly) the amount of glucose that is bound to red blood cells in your body. Since RBCs have a lifespan of about 3 months, this is a fairly effective measure of long term glycation levels independent of your fasting state.
Diabetes is often referred to as a lifestyle diseases. This is true in two ways:
- A poor lifestyle can (but will not always) lead to diabetes. I’ll enumerate the specifics of this below.
- To control the effects of diabetes (high blood glucose) it may be necessary to change your lifestyle.
The latter differs from the former in that you are simply trying to control the negative effects of diabetes, and not trying to fix insulin resistance.
As an aside, the word lifestyle doesn’t quite hammer home the changes required - you have to change, fundamentally, how you live your life in certain ways, for the rest of your life. It is insufficient to simply put in a burst of one time effort to bring down your Haemoglobin A1C levels.
So what causes diabetes? It varies, but among other things (in no particular order): high abdominal fat, chronically high insulin, low muscle mass, poor sleep, stress and a poor diet are all correlated with insulin resistance. This is important because some of these are levers you can control, and is often why losing weight (especially if you lose visceral fat) will improve your A1C numbers and reverse insulin resistance.
Crucially, high carb diets have not been shown to definitively cause insulin resistance, nor have low carb diets been shown to help in reversing insulin resistance (when controlled for caloric intake and fat loss). Low carb diets can help control the effects of diabetes (high glucose), but they may not help with the underlying pathology. That’s not to say that spiking your blood sugar constantly is okay - it just may not help you reverse your diabetes.
This is also why a CGM for someone with prediabetes doesn’t feel particularly useful. As a prediabetic, your body is still able to control glucose levels reasonably well, so trying to keep your glucose levels low doesn’t do much towards helping you reverse insulin resistance. Instead, it might be better to focus on reducing visceral fat, getting better sleep and building up your muscle mass.
Questions I still have
- How can you make sure that you are really insulin resistant? LIPR test
- What average blood glucose translates into what HA1c?
- Do drugs like Metformin treat the underlying pathology or are they symptom controllers? Do you have to be on Metformin for life?