What you need to know about prediabetes

Transcript

Editors note: At time of recording, Dr. Sara Henriques went by Dr. Sara Nelson-Owens. Transcription has been edited to reflect a change of name, but the recording will still have that prior surname.

Deborah Howell: So we all know a bit about diabetes, but perhaps a little less about pre-diabetes. So let’s take a deep dive into this subject with an expert in the field. Here to tell us more is Dr. Sara Henriques, a family medicine physician with Prisma Health.

This is Flourish, a podcast brought to you by Prisma Health. And I’m your host, Deborah Howell. Welcome, Dr. Henriques.

Dr. Sara Henriques: Thank you for having me.

Deborah Howell: Oh, a pleasure. Well, we all know a little bit about diabetes, because it’s pretty much all around us, but what is pre-diabetes versus diabetes?

Dr. Sara Henriques: So pre-diabetes, which luckily they gave it a very easy name to remember. It’s that stage that comes before diabetes. We use numbers as a cutoff when it comes to diabetes. And your number to remember is 6.5%, because at that point you have developed diabetes. So the stage before that and that’s for people that have what we call a hemoglobin A1c between 5.7% and 6.4%, that is what we call pre-diabetes.

Deborah Howell: That is very specific. Now, your healthcare provider can do this test for you, correct?

Dr. Sara Henriques: That is correct. It is a lab test. So any healthcare provider, whether you see a nurse practitioner or a physician assistant, a DO or an MD, they can all draw this particular test.

Deborah Howell: There’s also another test I hear often about called the fasting blood sugar test. Can you tell us a little bit about that?

Dr. Sara Henriques: So fasting for us is somebody that hasn’t had anything to eat for at least eight hours. So there is a range that occurs between 70 and 100. And that is the level somebody’s blood sugar would be if they were fasting. So people with pre-diabetes, they normally have blood sugars that are greater than 100 because they do not have normal fasting blood sugars, so that’s another way to test individuals.

Deborah Howell: Okay. And when we talk about blood sugar, we’re not just talking about stuffing, you know, 20 Twinkies into your daily eating. You know, it’s more than sugar as we perceive it. Can you tell us a little bit about that?

Dr. Sara Henriques: So that common misconception. Everything that’s a sugar is not sweet. So when we talk about sugars, we talk about the family called carbohydrates. So that includes your rice, your pasta, your bread, your beans. If you’re eating chips, if you’re eating, you know, any derivative of a potato at all, for that matter, all of those are processed in the body as sugars.

Deborah Howell: That’s unfortunate. Isn’t it?

Dr. Sara Henriques: The comfort foods. That’s what we call them, the comfort foods.

Deborah Howell: So why should we care about, you know, what our levels are?

Dr. Sara Henriques: The reason we care is pre-diabetes is a risk factor for diabetes. So not to make it seem like once you develop diabetes, it’s too late. But when you give this category of pre-diabetes, it allows people that time they need to make some changes in their life to prevent that progression to diabetes. So we all know that diabetes is associated with a number of health complications, you know, from blindness to kidney failure to heart disease. And those are the things that we’re trying to prevent in our community.

Deborah Howell: For sure. What should you do if you’re diagnosed with pre-diabetes?

Dr. Sara Henriques: So ideally, your healthcare provider should contact you. They should make you aware of it. And the actual cure for pre-diabetes is weight loss. Like you are guaranteed to reverse your pre-diabetes if you’re able to lose weight. And the first step with that would actually be changing your diet. So I always tell people, abs are made in the kitchen, not the gym. So you kind of want to take all of those wonderful comfort foods that you love to eat that most of us are probably eating every day and sometimes two to three meals out of our day, and just cut it back by at least 50%, and you’ll see a big difference in your numbers as well as your weight.

Deborah Howell: So there is such a thing or is there not, maybe you could tell us, you know, thin people who eat only sugars and carbs and potatoes and all that, can they develop prediabetes? Is it strictly a weight thing?

Dr. Sara Henriques: It is not strictly a weight thing. So yes, there’s an association between obesity and pre-diabetes, but there are individuals who are normal weight and still, unfortunately, develop diabetes. So if you are a high carb intaker, even if you are normal weight, you’re still at risk.

Deborah Howell: And what can you do to reverse pre-diabetes and can you reverse regular diabetes?

Dr. Sara Henriques: Yes, yes, and yes. A lot of people get very upset, even depressed, you know, with a diagnosis of pre-diabetes or even diabetes, because they feel like it’s going to be a chronic thing that they have to live with forever. But there are many people, you know, all around the world who have actually successfully reversed their diabetes as well as their pre-diabetes, but you’ve got to be very disciplined. You know, it’s like game time, you know, fourth quarter, two minutes down, like what are you going to do? You got to commit to it. There’s like no room for mistakes.

So I live by the 45/15 rule, even for people that don’t have a diagnosis of diabetes and you’re trying to prevent it from occurring. If you could restrict yourself to no more than 45 grams of carbohydrates per meal and no more than 15 grams per snack, it will keep you from overdoing it.

Deborah Howell: Forty-five/fifteen, did you say?

Dr. Sara Henriques: Forty-five/fifteen.

Deborah Howell: All right. I’m writing that down for like lots of people I know, including myself. Okay. So when can pre-diabetes turn into diabetes?

Dr. Sara Henriques: And that’s the funny thing about it. They haven’t actually been able to give a definitive timeline, like to say, “Oh, within a year of pre-diabetes, you’ll develop diabetes.” There’s no guaranteed timeline. There are individuals that have lived with pre-diabetes, you know, five, ten years and never progressed to diabetes. So it’s based on the individual.

Deborah Howell: That is good to hear that you can actually, you know, control the trajectory. It isn’t always progressive. What can happen if diabetes is untreated?

Dr. Sara Henriques: If diabetes is untreated, I mean, your ultimate end-point would be death, but the death is not from the diabetes itself, it’s from the complications. And surprisingly, you know, one of the most common reasons people are on dialysis today is actually diabetes. So you have to worry about your kidneys failing. You have to worry about the vessels in the back of your eyes becoming so damaged that you can no longer see. You have to worry about the nerves in your body actually becoming debilitated to the point where you have numbness, you know, in your extremities. You have to worry about an inability to fight off infections and that’s something we saw a lot with this COVID-19 pandemic. You know, you have to worry about if you get a wound, that it will not heal, then you’ll develop gangrene and that’s how people get amputations with diabetes. There’s basically no part of your body that will be unaffected.

Deborah Howell: Wow. Are there any signs and symptoms of pre-diabetes?

Dr. Sara Henriques: Unfortunately, pre-diabetes, no. It is asymptomatic. Most people will not know that they have pre-diabetes, which is why the screening is actually very important.

Deborah Howell: Tell us a little bit about that before I let you go. When should you get screened?

Dr. Sara Henriques: Initially, there wasn’t a specific age. But now, the suggestion is that if somebody is age at least 45 years old, you should start honestly having screening for diabetes every year, and that’s somebody that is not at increased risk. So if you are overweight, obese, maybe there’s a family history, your mom has diabetes, your dad, your siblings or aunts, you really should start getting screened, you know, earlier as early as age 18, once you hit adulthood. And in some situations, we even screen our adolescents, especially when there’s an obesity concern.

Deborah Howell: Sure. And is counseling part of your treatment, doctor?

Dr. Sara Henriques: It is because the biggest thing with pre-diabetes, honestly, is the lifestyle change. So it all comes down to the counseling. That’s way more important than any medication.

Deborah Howell: And you have a team I’m assuming at Prisma Health, that’s going to help the patient with their entire life, right?

Dr. Sara Henriques: We do. So we have diabetic educators through Prisma Health. We also have clinical pharmacists who play a big role in our clinic in helping patients figure out, you know, different meal plans and how they can adjust things that they normally like to eat to fit their low carb diet. We also have nutritionists within the system as well. The only thing we don’t have, I guess, is like an actual personal trainer. But everything you need from a diet standpoint, we do have those resources.

Deborah Howell: I like that actually as a preventative measure, you know, to check out those menus, at least try to follow, you know, partially before you have any symptoms or signs or, you know, screenings.

Dr. Sara Henriques: Just like we want to try to all live our best lives, right? But ultimately, if you get a diagnosis, just know this, it’s not the end of the world.

Deborah Howell: Right. Bring your A game, like you said. Dr. Henriques is a family physician with Prisma Health. For more information and other podcasts like this one, go on over to PrismaHealth.org/Flourish. Dr. Henriques, thank you so, so much for being with us today.

Dr. Sara Henriques: You’re welcome.

Deborah Howell: This has been Flourish, a podcast brought to you by Prisma Health. I’m Deborah Howell. Have yourself a terrific day.