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home : columns : ask the doctors September 30, 2020

6/19/2020 7:48:00 AM
Prediabetes diagnosis should offer wake-up call

DEAR DOCTOR: After my last physical, my doctor said my lab tests show I’ve got prediabetes. What does that mean? Do I or don’t I have diabetes?

DEAR READER: A diagnosis of prediabetes means that your blood sugar levels are elevated beyond the normal range, but are not yet high enough to be considered Type 2 diabetes. And the key word here is “yet.” Prediabetes is a clear warning sign by the body that, without certain lifestyle changes, you run the risk of developing Type 2 diabetes.

Sometimes also referred to as adult-onset diabetes, Type 2 diabetes is a condition in which the body loses the ability to respond to insulin, a hormone produced by the pancreas. Insulin’s job is to move glucose from the blood into the cells, where it is used for energy.
When someone has diabetes, it means that glucose builds up in the blood. A high level of blood glucose causes a range of damage over time, including decreased immune function and harm to the nerves, eyes, heart and kidneys. In fact, diabetes is a leading cause of kidney failure that leads to dialysis or even the need for a transplant. It is also linked to atherosclerosis, sometimes referred to as hardening of the arteries, which raises the risk of heart disease, heart attack and stroke. Although the reasons why some people develop prediabetes and Type 2 diabetes while others do not are unclear, evidence suggests that genetics and family history play a role. The conditions appear more often in overweight individuals who carry excess fat around the abdomen, and in those who are sedentary.
For most people, the shift from normal insulin function to Type 2 diabetes is gradual. With a diagnosis of prediabetes, you’ve now reached the in-between stage. The insulin your body produces is still doing its job, but not well enough. Although it’s sending some of the glucose gleaned from digestion on to the cells, it’s leaving too much behind in the blood. Not everyone has physical symptoms of prediabetes. Those who do may experience persistent thirst, frequent urination, unexplained fatigue, blurred vision and increased hunger. Anyone who notices the onset of these symptoms should see their health care provider.

The good news is that with this advanced warning, you have time to make changes that can reduce the chances of your condition progressing to a Type 2 diabetes diagnosis. Start by adjusting your diet. Skip the added sugars and simple carbs and focus on lean proteins, fresh vegetables, leafy greens, grains, legumes and fresh fruit. Choose healthful fats, and limit their use. Being active is important to all areas of good health. Adults are urged to get at least two to three hours of moderate exercise per week. And remember, excess weight is linked to diabetes risk, so it’s important to reach and maintain a healthful weight. If you haven’t done so already, follow up with your doctor to make a plan to mitigate your diabetes risk and to continue to monitor your condition.

(Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.)
(Send your questions to, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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