'Prediabetes is a Wake-Up Call,' Says Dr. Zara Frankel

Prediabetes Raises Risk for Heart Attack, Stroke.
Getting diagnosed with prediabetes—which means your blood sugar level is higher than normal—is a serious wake-up call. Without intervention, prediabetes often leads to type 2 diabetes, which puts you at increased risk for heart disease, stroke, blindness, kidney failure and other serious health problems.

"But having prediabetes doesn't mean that you will definitely develop diabetes. Taking corrective actions now could delay and even prevent the onset of the disease," BCH family medicine physician Zara Frankel, MD, told a crowd of 220 people during a free health lecture held at the Boulder Jewish Community Center.

“In fact, you can reverse prediabetes,” she said.

What Causes Prediabetes?
About 84 million American adults—more than 1 out of 3—have prediabetes. Up to 70 percent of them will go on to develop diabetes within 10 years. What causes this very serious and common condition?

The pancreas releases a hormone called insulin. Its job is to move sugar (glucose) from the blood and into the cells for use as energy. When you have prediabetes, the cells aren’t responding properly to insulin.

“This is called insulin resistance,” Dr. Frankel said. “Your pancreas increases its insulin production to try to get cells to respond. Eventually, the pancreas can’t produce enough insulin to overcome the insulin resistance and blood sugar rises, setting the stage for prediabetes—and type 2 diabetes later on.”

Key Risk Factors
You can have prediabetes but have no clear signs or symptoms, so it’s important to talk to your doctor about your risk factors and whether you should be tested.

Being overweight is strongly linked to the development of prediabetes. Other important risk factors include a family history of diabetes, gestational diabetes, physical inactivity, age of 45 years or older and being of African American, Asian American, Hispanic/Latino, American Indian or Pacific Islander descent.

Diagnosing Prediabetes and Diabetes
Prediabetes and diabetes are diagnosed using blood tests that measure blood sugar levels:

• Fasting blood sugar requires a blood sample taken after you’ve fasted for at least eight hours.
• Random plasma glucose (RPG) is a test performed when you aren’t fasting. It measures the sugar level in your blood at that particular moment in time.
• A1C testing provides a picture of your average blood sugar control over the past two to three months. You don’t need to fast for this test.

“However, fasting sugars can vary day to day based on meals or activity the day prior. That’s why A1C can often provide greater insight by looking at a two- to three-month average for blood sugar control,” stated Dr. Frankel.

Keeping Diabetes at Bay: Steps to Take
If you have prediabetes, losing weight and getting regular physical activity can lower your risk for developing type 2 diabetes.

“You don’t have to lose 100 pounds. Losing even 10 to 15 pounds can make a huge difference in your risk. Nor do you need to become an exercise fanatic,” Dr. Frankel emphasized.

She explained that research shows losing just 5 to 10 percent of your body weight, along with 30 minutes a day five days a week of moderate physical activity, can result in a 58 percent reduction in risk for type 2 diabetes.

Weight Loss and Exercise Strategies
Dr. Frankel offered this advice: “Your optimal goal should be a sustained weight loss of 7 percent. This is not a sprint, it’s a long-term goal. Target losing about one pound per week by reducing your calorie intake an average of 500 calories per day.”

Suggestions she had for weight loss include learning what foods are healthy and examining eating habits such as the following:

• Avoid fad diets. Instead, Dr. Frankel recommended looking at MyPlate on www.myplate.gov. MyPlate creates a personalized food plan for you based on your age, sex, height, weight and physical activity level.
• When eating out at a restaurant, ask your waiter to box up half of your meal before it gets to the table.
• Chew slower. She said research suggests you can reduce what you eat at each meal by 100 to 120 calories by taking twice as long to eat as you normally do.
• Put away your phone during meals. Dr. Frankel explained how one study showed that those who keep their phones out during a meal felt less full and snacked more after the meal.
• Use smaller plates. Studies suggest that using a smaller plate, such as a 10-inch plate, can reduce the amount of food you eat by 25 percent.
• Get support from people with similar goals and challenges. Or, join support groups such as a Weight Watchers group.

Exercise should go hand in hand with diet. When it comes to fitting into your schedule 30 minutes a day five days a week of physical activity, Dr. Frankel said, “This can also be a total of 150 minutes per week, any way you can get it. Ten minutes three times per day is just as good as 30 minutes in a row. It can be brisk walking or a similar activity.” However, she advised to first talk with your doctor before starting an exercise program.

The American Diabetes Association also recommends strength training for optimal physical fitness. Small, low-weight dumbbells or stretchable bands can be helpful for building upper and lower body strength.

“The best time to prevent type 2 diabetes is now. Take small, manageable steps. With exercise and weight loss you can reverse prediabetes,” Dr. Frankel declared.

Zara Frankel, MD, is a family practice physician with Boulder Creek Family Medicine. To make an appointment, call 303-415-7450.

Click here to view PowerPoint slides from Dr. Frankel’s lecture on “How to Stop Prediabetes From Becoming Diabetes.”

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