Understanding & Treating Pre-Diabetes

Dr. Snodgrass dives into prediabetes—what’s going on in the body, diagnoses of prediabetes (HbA1C and fasting blood sugar level),  and treatment options (blood glucose monitor, fasting, etc.)

What is pre-diabetes?

Like the name suggests, it is a diagnosis that precedes diabetes. Most of us know that diabetes is a diagnosis made by a person having elevated blood sugar levels. You can think of it kind of like at the tip of an iceberg. So if a ship sees the tip of an iceberg out on the horizon, that ship is going to change course and avoid hitting the iceberg. Prediabetes is like the tip of a sugary iceberg.

If a person is diagnosed with pre-diabetes, that person needs to change course or possibly go on to develop full diabetes. About 25% of people with pre-diabetes, within three to five years, will go on to develop full diabetes. So if we have four people in the room, one of those people is going to go on to develop full diabetes within three to five years.

How is it diagnosed?

We typically use two different tests: the hemoglobin A1C or the fasting blood sugar level. The hemoglobin A1C is an actual measure of how much sugar is sticking to the red blood cells as it circulates around your bloodstream. And the fasting sugar is a measure of the level of sugar and a person that hasn’t eaten or drunk anything for the last 8 to 12 hours. For all of us, when we eat, food goes in our mouth, down our esophagus, in our stomach, into our intestines. And then the food that we eat, the sugars that we’ve eaten absorb across the lining of the intestine directly into the bloodstream.


Those sugars circulate around in the bloodstream and then signal the pancreas to secrete insulin. Insulin goes out into the blood attaches to those sugars and brings them into the tissues of the body. In people with prediabetes and diabetes, those sugar levels are left at a little bit of a higher level than the normal level.


What is the significance of high BGL?

Why do we care if someone has an elevated blood sugar level? Think of these excess sugars as small shards of glass, sugary, shards of glass circulating around in the bloodstream as they’re circulating, they’re making small nicks and micro damages in the walls of the blood vessel.


These small damages accumulate over time to become much larger damages. This is why people with long-standing diabetes are more likely to have heart attacks, strokes, trouble with their vision, kidney failure, and loss of feeling or nerve pain in the hands and the feet.


How can it be treated?

The treatment is primarily diet and lifestyle changes.

We don’t typically use medication at this time. So for diet changes, you will want to avoid sugars, sugary drinks, processed foods, anything that can elevate your blood sugar. And you’ll also want to try to fast between meals or fast for a portion of your day. This allows the pancreas, the organ that secretes the insulin out into the blood, to rest. You’ll want to add exercise and strength training because this helps us to metabolize those sugars that all of us are inevitably going to eat. There’s one additional thing that we’re doing with our patients these days.

We’re using continuous glucose monitoring to help the patients make changes in their diet. So as the name suggests, this is a monitor that the patient wears on the back of the arm, and it continuously monitors the patient’s glucose for 24 hours period of time. The monitor is worn for two weeks, and that entire time we’re able to see what the sugar level is in the patient’s blood. So if someone eats a meal, we can see immediately within 30 minutes what the blood sugar level change is, and that can help people make changes in their diet.

Versus a hemoglobin a one C, which we can only test about every three months to get a reliable indicator of the change that’s made or the fasting blood sugar, which can only be done on a patient that’s been fasting for eight to 12 hours.

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