Understanding the Relationship Between Prediabetes & Type 2 Diabetes

Intro: We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Bill Klaproth (Host): I'm Bill Klaproth, in for Deborah Howell. In 2012, 86 million Americans over the age of 20 had prediabetes. Before people develop type 2 diabetes, they almost always have prediabetes. And here to tell us more today is Dr. Linda Kerr, she's the Director of the Diabetes Program at Long Beach Memorial. Dr. Kerr, thank you so much for being on with us today. So much to talk about, let's jump right in. What is prediabetes?

Linda Kerr, MD: Prediabetes is such an interesting topic and it's very important to really know that one in seven adult Californians, and that's 41% of adults in California, have prediabetes. And so it's very, very common. Prediabetes is a state where the body regulates blood sugar fairly well, but there are times when the blood sugar does run high and it stays higher. And so this is a state of having prediabetes. When a person has diabetes, diabetes is a state where the body fails to regulate blood sugar and the blood sugar runs high pretty consistently. So again, prediabetes, it doesn't run consistently high, it's not necessarily noticeable, you don't know you have higher blood sugars or moderately elevated blood sugars. And so it's very important then to think about, well, how would I prevent or how would I treat prediabetes, how would I even know that I have prediabetes?

Bill Klaproth (Host): So the difference between type 2 diabetes and prediabetes is in type 2 diabetes the blood sugar always consistently runs high, prediabetes it kind of spikes up and down?

Linda Kerr, MD: Yes, that's a pretty good analogy. And in prediabetes because the blood sugars will be modestly elevated, not consistently, but just at some points during the day or the week, then the treatment when we talk about prediabetes is diet and exercise, and then the treatment for type 2 diabetes is diet, exercise, and includes medication.

Bill Klaproth (Host): How do you know if you have prediabetes then? How can the average person even know this?

Linda Kerr, MD: To know if you have prediabetes, we would do a lab test that you can ask your doctor about, and the test would be it's called an hemoglobin A1c. And it's just a simple lab test, a simple blood draw, and we would know definitively if prediabetes is here. But we all have to assume that perhaps there is a risk for prediabetes. Am I a person at risk for prediabetes? You would ask yourself, if you are overweight or obese, if you already have blood pressure or cholesterol issues, if you are a woman and you've had a history of gestational diabetes where you've had diabetes during your pregnancy, you may be at risk for type 2 diabetes or prediabetes. And so if you fall into one of those categories, if you have diabetes in the family, and you don't yet have diabetes, but you wonder if it's coming, you can have a conversation with your physician about having labs, but most of all you can look to your own helpful practices with nutrition and physical activity, exercise.

Bill Klaproth (Host): So there aren't any really any outward symptoms of prediabetes?

Linda Kerr, MD: People will not necessarily notice that your blood sugars are running modestly higher at any point during the day or the week, just as somebody with diabetes would not necessarily notice a modestly elevated blood sugar, similar to if you have blood pressure, high blood pressure, or if you have high cholesterol, you wouldn't necessarily notice that you have poorly controlled blood pressure or cholesterol, same is true for blood sugar.

Bill Klaproth (Host): So if you're paying attention to your health, you've really got to ask yourself, am I overweight? Do I have high blood pressure? Do I have high cholesterol, etc.? And if you really are concerned with your health and you have any of those you may say "I better get tested for this".

Linda Kerr, MD: You could get tested and then you could also think about you know, what should my nutrition and my physical activity look like, but you know there hasn't been a diabetic diet since 1994, and so it's been over 20 years, there's it's something that all of us whether we have diabetes, or we do not have diabetes, or we have prediabetes, we all need to think about you know, good nutrition and exercise.

Bill Klaproth (Host): What causes prediabetes?

Linda Kerr, MD: Prediabetes again, it's an insulin resistance, it's kind of complicated when you talk about insulin, but really what it, what you need to know is that you can't use your insulin very well always, consistently, so it's, what causes that type of condition, being overweight, being obese, having more weight around the middle. Women who have more than 35 inches around the middle, men over 40 inches right around the middle where the belly button sits, that raises your potential for having prediabetes.

Bill Klaproth (Host): And through early diagnosis and prevention, many people with prediabetes can delay or even prevent the onset of type 2 diabetes right? So how would a person do that?

Linda Kerr, MD: Excellent. So this is what we spend a lot of time talking to people about in terms of activity and nutrition. For prediabetes, activity and nutrition is everything, and it's what we all have to do whether we have prediabetes or not. And you ask yourself, am I getting plenty of fresh fruit, fresh vegetables, and whole grains in my diet? Am I having consistent exercise every day, 30 minutes minimum? And the interesting thing about exercise is you don't have to do the full 30 minutes all at the same time, you could break that up into two 15-minute sessions, allowing you to have a little more freedom with your schedule, but you're still getting your activity in, you're still looking after your nutrition, and this in and of itself can help delay or prevent the onset of prediabetes.

Bill Klaproth (Host): Dr. Kerr, that just sounds like good health advice. If you exercise, you eat well, take care of yourself, you're not going to be overweight, you're not going to have high blood pressure, you're going to lower your cholesterol. It just sounds like good health advice.

Linda Kerr, MD: It's excellent health advice that we all need to think about. And with 41% of adults in California having already prediabetes, it's something that is, it should be on all of our agendas.

Bill Klaproth (Host): Absolutely. It's so easy to eat junk food and fast food and processed food. It's just too easy nowadays. You really just have to take a step back and say, what am I really eating? How can I eat better? And I need to start exercising. Those are all good questions for all of us. So what happens then if prediabetes is left untreated?

Linda Kerr, MD: If left untreated, prediabetes can advance to diabetes. And so it doesn't necessarily have to, but if you continue along the lines of being inactive and overweight or obese, and choosing more times than not the fast food and the processed foods and high fructose corn syrup-filled foods, then you are really setting yourself up to advance to type 2 diabetes.

Bill Klaproth (Host): So for anyone listening that says "Boy this might be me, I need to check this out." What is it again they should ask for from their primary physician when they go see the doctor?

Linda Kerr, MD: If you have a family history of diabetes, if you have a waist circumference of greater than 35 for women or 40 for men, or you feel that maybe you are at risk for prediabetes or diabetes, do have the conversation with your physician about having a hemoglobin A1c lab test drawn. It's a simple blood draw, very easy, and you can discuss with your physician what the results mean, and it'll really let you know if you are at risk for prediabetes.

Bill Klaproth (Host): And through what you were talking about before, exercise, proper diet, nutrition, you can really delay this or even, if you stay on that type of a regimen, you can prevent this throughout the rest of your life. Am I correct in that?

Linda Kerr, MD: Absolutely correct, and we have seen many people who will present with features of prediabetes, maybe the lab work is suggesting that prediabetes is here, they're heavier, they're not very active, and then through application of good nutrition and activity, all of the features of prediabetes goes away. And so it's very, very possible to pull yourself back into a place where you are living healthfully and mindfully about your nutrition and activity and free of prediabetes.

Bill Klaproth (Host): Great advice. And Dr. Kerr, last question, what is it should we specifically stay away from? Should we stay away from grains and alcohol and sugary things? Can you just give us a real quick overview, like your top three things people need to avoid?

Linda Kerr, MD: Top three things to avoid is processed foods, and fast foods, and high-fructose corn syrup. But what I really like to focus on are the top three things that you need to embrace, and that is fresh fruit, fresh vegetables, whole grains, and with that, you're going to really jumpstart your body into a healthier place and a place where your body actually wants to crave those more natural foods as opposed to processed foods.

Bill Klaproth (Host): Great advice, and if you break it down to those three simple things, it seems a lot more doable. Dr. Kerr, thank you so much for being on with us today. For more information on prediabetes, visit memorialcare.org, that's memorialcare.org. This is your Weekly Dose of Wellness. I'm Bill Klaproth in for Deborah Howell. Thanks for listening.