Ep. 21 - Pre-diabetes - What is it and what can be done about it?

What is pre-diabetes? What can you do about it? What is impaired fasting glucose vs impaired glucose tolerance? If you have ever been told you have elevated glucose levels, but not to the point of being diagnosed with Type 2 Diabetes, this episode is for you. Jaimee talks about what pre-diabetes is and what it means. She shares some tips on how you can reduce your risks of going on to develop Type 2 Diabetes.

Did you know up to 50% of people with pre-diabetes will go on to develop Type 2 within 5 years? Did you also know you can reduce the chances of this being you?

Link to join Jaimee's health support group on Facebook
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Resources:
Journal - Diabetes Care
https://doi.org/10.2337/dc22-2376

Pre-diabetes – NDSS

Risk Calculator | Diabetes Australia

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Transcript

0:04

Welcome to Diabetes in the Raw podcast. I'm Jamie. I'm Hayley. And together we are Diabetes in the Raw. We both live with diabetes, but in different ways. Jamie has type 1 diabetes and has lived with it for over 25 years and is also a credentialed diabetes educator. Hayley has two boys who both have type 1 diabetes. Listen in as we share our lived experiences and our guest share theirs. Please get in touch via our socials or email if you would be interested in coming on as a guest. Our contact details will be in the show notes. Nothing in this podcast is intended as individual medical advice. Always talk to your healthcare team before making changes to your diabetes management.

Jaimee 0:42

Hi everyone, welcome back to another episode of Diabetes in the Raw for 2024. This is our first episode, um, late in January. It is just Jamie today. My co host Hayley is not able to join this one, but she will be back very soon. And we have some guests line up for this year as well, which is very exciting. Today's topic is going to be on pre diabetes. And that's something that I am super passionate about because it's something that you can be diagnosed with, but you can also do something about it. And it's a great stage in the diabetes, uh, continuum to actually. do the best you can to reduce the chances of going on to develop type 2 diabetes. So I wanted to talk a little bit about, some of the latest research in this area, and also just give people some tips on what they can do if you have been told that you have got prediabetes. I'll go on in a second to sort of outline what prediabetes is and how you are diagnosed with it. It leads into insulin resistance, which we are going to do a lot more about this year as well. We did a lot of episodes on type one diabetes in 2023, because Hayley and I are both obviously living. In that world, with Hayley having her two boys with type 1 diabetes and myself having lived with it for, gosh, must be going on 27 years or something crazy now. But I'm keen, or we're both keen, to do some more in the pre diabetes, type 2 and gestational diabetes space. So, we're going to kick off January with pre diabetes. So pre diabetes is basically diagnosed in a few different ways. One is with impaired fasting glucose levels, and the other is impaired glucose tolerance. So basically, if you've ever been for a blood test and been told that you have an elevated glucose level, it should be explored in more detail. and if it was an elevated fasting level of 6. 1 to 6. 9, the World Health Organization would consider that. um, elevated and impaired fasting glucose. Basically it means that your glucose level upon waking, having fasted overnight, is elevated. And impaired glucose tolerance is actually elevated glucose levels at the two hour mark if you've had a glucose tolerance test. So that's where you go in and you have the green horrible drink, um, 75 grams of glucose, and they'll do the test. on fasting. So as soon as you go in before the drink at one hour and at two hours, and if that two hour test is between 7. 8 and 11. 0, and I'm talking millimoles per liter here in Australia, that would be considered impaired glucose tolerance. So basically, your body is having some difficulty dealing with the amount of glucose that was given to you and your levels have not been able to come back down to where they would if you didn't have any impaired glucose tolerance or insulin resistance. So the only other thing that may be considered is an HbA1c which is the three month average that the doctors can order and that doesn't require fasting or any sort of preparation. But it's not, there's no real consensus on, on what the levels are for that. the American Diabetes Association is endorsing 5. 7 to 6. 4 percent as their HbA1c range. which would be considered having pre diabetes, and the International Expert Committee is endorsing 6. 0 to 6. 4, so a more specific range for HbA1c. So, yeah, basically the impaired fasting glucose and impaired glucose tolerance, uh, the most common ways to be diagnosed with pre diabetes. So pre diabetes is basically a condition characterized by elevated glucose levels, but they're below the criteria, required to be diagnosed as having type 2 diabetes. So the concerning part about this is that up to 50 percent of people with Impaired fasting glucose or impaired glucose tolerance will go on to develop, type two diabetes within five years, or diabetes. Australia actually say that five to 10% of people will go on to develop type two diabetes each year if they've been diagnosed with pre-diabetes. So, there's a few different stats out there, but basically the risk of type two diabetes is real and it's a great stage to. really think about what you can do to reduce your risk of going on to develop type two diabetes. We will do another podcast on, reversing type two diabetes or type two remission, cause that is a very interesting subject and we will. you know, go into that, separately. But if you can avoid or delay the onset of type 2 diabetes, that's really where you want to go. And that's where my passion lies, having worked as an exercise physiologist for many years before venturing into nursing, and specifically to diabetes, education. So, the treatment for pre diabetes is usually lifestyle interventions, so exercise, diet, and sometimes medication. And I think it's potentially minimized a little bit because, you know, so many people go to the GP and are told that they need to exercise more, eat less, lose weight, um, to improve everything, basically. But it is the treatment and it is something that you have the ability to change and do. And it doesn't mean that if you hate gyms, you have to go and join a gym. It doesn't mean you have to restrict your diet so much that you're not enjoying anything you're eating. It just means you need to change a few things. And the one percent is. Do add up. You didn't get to pre diabetes overnight. And you're not going to change things overnight unless you do make dramatic changes, of course. And when I say overnight, I'm talking sort of months or a year rather than 2, years. But, you know, I've seen some people make some really great. small, realistic, sustainable lifestyle changes and, um, and reduce their chances of developing type 2 and not going on to develop type 2. We are going to have a guest on in the next few months who has been diagnosed with type 2 diabetes, but he has made huge, um, I wouldn't even say huge changes, but a big commitment to reduce his chances of needing medication and keeping his glucose levels In saying that, if you have been diagnosed with prediabetes, you do have increased risk of cardiovascular disease, chronic kidney disease, and mortality, so that sounds really negative. It's not meant to put, um, the guilt on anyone. It's more trying to empower and motivate people to think, Okay, I've been diagnosed with this, I haven't yet got diabetes. There is something I can do, and there's lots of things you can do. It's finding a team or a health care professional that you're comfortable with to help you on that journey. there's lots of ways of doing it. As I said, you don't have to go hit the gym to increase your exercise. It might be that you just. sit less and move more. Sitting is the new smoking. It's, it's really bad for us. We weren't made to sit. I say that as I'm recording this, I got myself a sit to stand desk because my job is very sedentary and I do work from home some days and I would not get up from the desk for four or five hours at a time if I didn't have a sit to stand desk. So for me, that was a massive investment. I do have to remind myself to use it. it's a bit like a treadmill. A lot of people end up hanging their clothes on it and that sort of thing. So I'm very mindful and I guess it's easier for me when I'm, you know, constantly talking about this sort of thing on podcasts and to clients and, you know, really in that space, it reminds myself and I'm very fortunate for that. And. you know, you guys help keep me honest as well, especially those people that are in my, my little closed Facebook group, who are, you know, helping each other on their journey to either, better glucose management or just helping keep each other accountable with, you know, healthy living. So I will pop. My link in the show notes, if you are interested in that, because we are finding it helps, you know, helps each other when we share our goals and maybe when we've fallen off the wagon and things like that. Um, I digress. So coming back to pre diabetes, this is just a bit of a short podcast. Hopefully if I don't keep, going off track, like I have there are, A few different definitions endorsed by professional organisations around, you know, pre diabetes. But if we are talking in Australia, it's quite clear what the cut offs are. So if you have been told that you've got impaired fasting glucose levels or impaired glucose tolerance, or the other term is generally pre diabetes, not everyone with impaired fasting glucose will have impaired glucose tolerance. People with impaired glucose tolerance tend to be more insulin resistant in the muscle, and You know, decrease glucose uptake while impaired fasting glucose is more around insulin resistance in the liver that's why you might be waking up with elevated glucose levels in the morning because it's your liver that is potentially effecting you know, leaking out glucose overnight, so to speak. the impaired glucose tolerance is more around having high glucose levels after eating. So your body wasn't able to address the amount of glucose coming from carbohydrates that is coming from your food. And that's where learning Carbohydrates are can be really helpful. The amount, the timing, the type of carbohydrate is really important with glucose levels and insulin resistance. So if you do have, a history of polycystic ovarian syndrome. if you're above the healthy weight range for your height, if you've had gestational diabetes before, if you've got a relative, a first degree relative with type two diabetes or certain ethnicities, Are at increased risk of pre diabetes and diabetes. And some of those things you can't control, and that's why I like to go on about the things you can control, so we can empower people and not make you feel like you are doomed and that diabetes is going to get you. Even if you do have relatives. you know, lots of relatives with diabetes, you can still reduce your risks. If you have had gestational diabetes, you can still reduce your risks. And it's not to put blame or guilt on anyone. It's just to let you know that you don't have to accept that that's the way your journey's going to go as well. I do hear a lot of people thinking that they're inevitably going to get diabetes and the complications that come with it because I don't think, there's always enough information out there about what you can do and how important it is to try and reduce your risk. Just losing a centimeter or two around the waist will help your insulin work more effectively. Just moving more during the day will help your insulin work more effectively. We talk a lot about insulin resistance. But do, do we talk enough about what it is and how you can improve it? That is another whole podcast. One thing I'm passionate about is getting people to do some resistance training. It might be weight training. It might be body weight exercises. It's basically getting those muscles moving and allowing them to grow. So that they can store more glucose and they will use more glucose. If you've got muscle rather than fat mass, you're going to be able to store more glucose, use more glucose even at rest. And you're going to be stronger. Your bones will be, stronger. Your, your entire skeleton. Reduce the risk of falls. Um. Just so many benefits of resistance training. So let's get an exercise physiologist on. I did it many, many years ago, so I'm probably not up with the latest, but all we need to know is muscle mass is what we want to protect. If we go restricting diets and lose lots and lots of weight, some of that's going to be muscle mass. So it's good to talk. to a professional about how to keep your muscle, but lose some body fat. And it's very important that you talk to someone like a dietician or nutritionist about your protein requirements. And I said, as I said, learn what carbohydrates are, learn which ones are better for you and Learn about the timing and the impact it has because if you're eating carbohydrates at, you know, throughout the day, your body is going to need to produce insulin. And if you are insulin resistant and eating a lot of carbohydrate, you're making your body work harder by producing more insulin. If you're exercising when you eat carbohydrate, your body won't need as much insulin. So there's lots of things you can do. And I hope this hasn't been super confusing. Um, as I said, it was more to create an awareness. And I'm going to reel off some stats because one of these articles that I had a read of is called the global prevalence of pre diabetes and in 2021, 9. 1 percent of adults worldwide were reported to have Impaired glucose tolerance. So that's 464 million people and 5. 8 percent worldwide or 298 million had impaired fasting glucose. So that is a lot of people out there with prediabetes who with effective lifestyle change could reduce their chances of progressing on to type 2 diabetes. And we'll do a podcast on type 2 diabetes and I'll see you next time. I guess there's a lot in the media about the negatives of type 2 diabetes. But again, a diagnosis of type 2 diabetes doesn't even mean you have to go on and develop those, those negative, complications we hear about, which, you know, the worst of the worst are things like amputations, dialysis because your kidneys have failed, going blind. They are real potential complications. But they are not inevitable, even with a diagnosis of type 2. Definitely we want to try and delay or prevent the diagnosis of type 2 diabetes from pre diabetes if we can. So that's what this podcast is about. If you haven't been tested, for a long time, it might be worth talking to your GP or your nurse practitioner, about getting your glucose levels checked. So, basically, we need to do more in the pre diabetes space. Unfortunately, the Medicare system in Australia doesn't really, support pre diabetes. healthcare because some of the sessions that are allocated via the allied health funding are not until you get type 2 diabetes. That's one of the biggest challenges, is the funding comes after. the diagnosis of type 2. And I haven't mentioned that medication may be an option for prediabetes to help delay the, the progression to type 2 as well. Metformin is just one example of a medication that can be used to enhance insulin sensitivity or reduce insulin resistance. So you might think I don't want to go on to medication. But if it's reducing your chances of developing type 2 diabetes and if it's just temporary, why you change some lifestyle factors while you lose a bit of the excess weight, it may be a positive thing and may be worth considering. So that's not a recommendation, that's just something to consider. A lot of people are very quick to think medications are negative, it means I've failed. Maybe think of it as a temporary measure. If you are to go on to an antidepressant while you get some psychological support and treatment and then come off it, that's a good use of medication. Metformin might be that for, for this. It might help you just get a bit of a kickstart. Let your body, you know, get back to working metabolically better again, and you are motivated to change a few things with your diet and exercise, and you might then come off the Metformin. I'm really looking forward to having some guests on who You know, have either been diagnosed with type two and managed to come off medication or even just reducing their medication because it is possible. And there's a lot of people out there doing it. So the global burden of prediabetes. is real. it is affecting the low income countries more so, and there's programs that need to be developed to really help people in this space. So I hope this has been helpful. I hope it's been motivating, and I would absolutely love it if someone or a couple of people, wanted to come on and talk about their experience. And I hope this hasn't offended anyone. More than happy to, you know, have multiple guests come on and share their, their side of things. Nothing's ever black and white. Usually there's multiple health conditions going on and it's not as easy as just focusing on glucose levels. normally, there's multiple things going on. So I do understand that, You know, it may not be as simple as moving more and eating less, and that's certainly not what I'm saying. But I do want people to know that there, there is help out there, there is support out there, and there's programs out there. I will put some information,, in the show notes, but do reach out if you feel like You would like to come on, or even if you'd just like to comment, please do so. We are on Facebook and Instagram, and we also have an email if you'd rather keep it private. If you do want to come on, but you don't want anyone to know who you are, we can make it anonymous as well. We're just hoping to let people share their stories, and even sharing their experiences with healthcare professionals, because I know of so many people who have gone out there to try and get help, and then they've been told that, oh, you don't have type 2 diabetes yet, come back when you do, basically. And that's just not what we need. We need to support people who want to reduce their chances of developing type 2, not just sending them on their way and waiting until they actually get the diagnosis. to get the funding to then help them, because that's crazy. That is completely backwards, there is a Diabetes Australia risk calculator that you can do to look at your score. relating to the chances of developing type 2 diabetes. It's also on my website, which I did a few years ago now, because that is something I want people to know. You know, if you know what the risk factors are, and you know what your score is, then that's something worth doing, and it might be then that you can follow up. with your health care team to do something about it.

21:39

So just to recap, at the start of the episode, I mentioned that 9. 1 percent of adults worldwide do have impaired glucose tolerance. That was 464 million. By 2045, we are looking at, An increase to 10%, which is 638 million. With impaired fasting glucose, I mentioned that 5. 8 percent of adults worldwide have been diagnosed with impaired fasting glucose, 298 million. That's projected to increase to 414 million by 2045. So the burden on the healthcare system worldwide is huge, if we don't do more in the pre diabetes space. And it's an area that We need to put more work, education, support, empowerment, and funding into. So I hope this episode has just been something that has given you a bit of extra knowledge and to help you feel more empowered that you can do something about it. And regardless of your risks, you can reduce your chances of developing type 2 diabetes.

Jaimee 22:52

Thank you so much for listening. I really appreciate it. And, Haley, we'll be back in the next episode.

23:03

We hope you enjoyed the episode. Thanks for listening. Please rate us on your favorite podcast app to help us reach more people and make them feel less alone. Remember, some days thriving, others just surviving. If you'd like to make contact with Jamie as a diabetes educator, look up the website, www.real-i-dealhealth.com. I can also be found on Instagram and Facebook under Jamie Panora Real Ideal Health.