What is Prediabetes? Key Symptoms, A1c Levels, and Essential Lab Values

Welcome back everyone.

We are thrilled to bring you another episode of the Diabetes Digital podcast.

And today we’re going to be talking about a condition that affects so many people and that is pre diabetes.

And I want to emphasize that it affects so many people because often times when people get a pre diabetes diagnosis, they start freaking out.

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They’re like, Oh my God, I’m going to get diabetes.

It’s the end of the world, especially if they have a family member who may had uncontrolled diabetes at some point and they had complications.

It just becomes really scary and people start to panic.

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And we want to talk about pre diabetes because the great thing about pre diabetes is that you still have opportunity to reverse it and get it back to the normal range.

And we’re going to be talking about that today.

And there’s also a lot of resources available to you, a lot of resources online, a lot of resources available through us.

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If you don’t already know, we do offer nutrition counseling for pre diabetes and for diabetes specifically.

And it’s as simple as filling out our pre diabetes quiz, which is on our website, diabetesdigital.co.

And we can see what your needs are, if you have insurance, what your benefits are, if it’s going to cover counseling, which for most people it does.

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So make sure that you check that out.

Welcome to the Diabetes Digital podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

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Visit diabetesdigital.co that’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

This episode is part one of our four part pre diabetes series.

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And the reason we’re doing this series is that we noticed that so many people who contact us about counseling have pre diabetes and they want to prevent diabetes.

So that’s why we figured let’s do a series on it.

Now in this episode, as Wendy said, we’re going to talk about what is pre diabetes key symptoms, A1C levels, essential lab values.

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This is great for people who are just getting diagnosed and really want to know what’s going on.

The second episode we’re going to talk about how long does it take to reverse pre diabetes.

We’ll get into essential strategies and key SuccessFactors.

The third episode is going to talk about exercise for pre diabetes and also we’re going to throw in diabetes there as well.

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So if you have diabetes, definitely tune into that episode.

It’s great, we’ve already recorded it, it’s with an exercise physiologist and there are so many amazing science based tips for how to regulate your blood sugar through movement.

And then of course, being intuitive eating dietitians, we’re going to talk about pre diabetes and intuitive eating because one of the things that we noticed in traditional diabetes care is there is no emphasis on intuitive eating.

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There is no emphasis on weight inclusivity, health at every size.

And we want to dive into the research and how you can do a non diet approach to pre diabetes management.

So definitely stay tuned for all the episodes.

If you like this one, you’re going to love those as well.

3:21
Exactly.

So for today, we’re going to kick things off by first defining what pre diabetes is.

So it’s a condition where blood sugar levels are higher than normal, but they’re not high enough to be considered diabetes.

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It’s a critical warning sign that indicates that you have a higher risk of developing type 2 diabetes.

And it’s really important to detect pre diabetes early so that you can prevent the progression to type 2 diabetes.

There are people that, you know, maybe they’ve had pre diabetes for years and then it ends up progressing into type 2 diabetes and they only find out when that type 2 diabetes is displaying symptoms.

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Like maybe you’re going to the bathroom a lot or you have blurry vision.

And at that point, you know there’s already been significant damage done to your organs.

And so you really want to try to make sure that you flag this early through going to your medical visits each year asking for that A1C test.

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Especially if you have a family history of diabetes or pre diabetes, you want to make sure that you let your doctor know so that you can get those tests done.

Now, what is the difference between pre diabetes and diabetes?

And I also want to use the term borderline because I know a lot of people in our community will say I’m borderline and that is the same thing as pre diabetes.

4:39
So that’s the language that you use.

That’s totally fine.

It means the same thing.

So pre diabetes is essentially characterized by elevated blood sugar levels that are not yet high enough to be diagnosed as diabetes.

So in diabetes, blood sugar levels are consistently high and can cause damage to various organs and tissues over time.

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But in pre diabetes, like I said, they’re not quite high enough.

However, it is showing that maybe your body is struggling a little bit with regulating blood glucose.

Maybe there’s some insulin resistance going on.

So for many people it might be that, you know, gentle warning sign that you know, with time they may develop diabetes.

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Now I want to be clear that the word is may majority of people who have pre diabetes will not develop diabetes.

However, many of them will.

And this diagnosis might be motivating for them to make some lifestyle changes to help reduce their risk of developing diabetes.

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If you are diagnosed with pre diabetes, there’s so many things that you can do, including lifestyle modifications like looking at your eating and maybe incorporating some more fiber, more vegetables, balancing out those carbohydrates with fat and protein.

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Also regular physical activity levels.

Many people just focus on diet, but exercise is just as, if not more effective than what you eat.

And we talked about that in the exercise episode.

So make sure to stay tuned for that one.

And these things all play a really crucial role in reversing pre diabetes.

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Also, I have to say, sleep and stress, those are huge things that we tend to overlook and they can have impacts on our blood glucose levels.

So many people who are using glucose monitors notice that when they’re more stressed or they haven’t slept enough or even they’re sick.

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That happened to me when I got sick on vacation.

My blood glucose level was insane.

I went to the hospital and it was crazy, and it was because I was sick with Covad.

So these things can all impact us, and we like to help people work on those risk factors that they can control a little bit more, like the modifiable risk factors, like I said, physical activity, kind of what you’re eating.

6:48
There’s also medical interventions.

This includes things like medications and regular monitoring.

And sometimes we just need medications to help support us.

And there’s no shame in that whatsoever.

And oftentimes, people might do a combination of medications along with diet and lifestyle changes.

7:08
Yeah, exactly.

And if you’re wondering like, well, should there be symptoms that I should look out for?

I will say that for pre diabetes, usually there are no symptoms.

And that is why it’s so important that you do your annual visits to the doctor to get all of your testing done because that is the most accurate way to know if you have pre diabetes.

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However, if maybe you’re borderline like Jess said, well, I would say borderline diabetic where you’re in the pre diabetes range, but sometimes your blood sugars are going into the diabetes range.

You might get symptoms of high blood sugar and some of those might be that you’re urinating often because your body’s trying to get rid of the excess glucose.

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You might be really tired because when your blood sugar levels are fluctuating, it can cause fatigue.

So that might be a symptom.

Your vision might get blurry because when you have high blood sugar, it can damage the lenses of your eyes, it can cause them to swell.

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And so that might lead to blurred vision temporarily.

And if it’s chronic, it could lead to long term damage.

And also if you are urinating a lot, you might become dehydrated.

So you might notice that you’re really thirsty because of the dehydration.

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So that’s another symptom that you might want to look out for.

But again, for most people with pre diabetes, you’re probably not going to have any of these symptoms.

Now we want to talk about symptoms specific to women and conditions specific to women that may increase your risk of pre diabetes.

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Number one is PCOS.

That’s why we work with people who have PCOS because there is a strong link between PCOS and insulin resistance in pre diabetes.

So symptoms of PCOS include irregular menstrual cycles, excess hair growth, even acne.

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And women with PCOS are at a higher risk of developing pre diabetes and type 2 diabetes.

So that’s why, again, a big chunk of our patients are women with PCOS.

There’s a higher risk.

The second thing that many people don’t really consider, and I didn’t even consider this happened to me, is irregular menstrual cycles, which are caused by hormonal imbalances.

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And by hormonal imbalances, I mean things like menopause or perimenopause.

There’s other hormonal imbalances as well that can affect our menstrual cycles, but those are two that are very powerful and associated with pre diabetes and an increased risk of diabetes.

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So if you are experiencing more frequent or less frequent periods and you’re also noticing that your A1C is creeping up and we’re going to talk about the levels next, then you might want to get your hormone levels checked and just make sure you’re not in that perimenopause, menopause phase.

10:04
Because if you are, then you definitely want to get treatment for that because that might help to improve your blood glucose levels.

Yeah, and with the levels, so let’s say you go to your doctor and they do the blood work and you’re like OK, what does all of this mean?

So with the A1C test, a level below 5.7% is considered normal.

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If your A1C is between 5.7 and 6.4 then that indicates pre diabetes and anything over 6.5 is a diagnosis for diabetes.

Typically an A1C over 7 would be classified as uncontrolled or unmanaged diabetes.

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So the goal for people that have diabetes usually is less than 7%.

It does vary as you get older, like those goals are a little more flexible, but for people less than 65, generally it’s less than 7% that is the goal.

Yeah.

11:01
Additionally, there’s another test that we often look at and that is fasting glucose.

And when people have a high fasting glucose, we would call that impaired fasting glucose.

And so specifically when we’re talking about the ranges, we want our fasting glucose to be under 100 milligrams per deciliter.

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So under 100 is considered normal and for people who have pre diabetes, our fasting glucose is 100 to 125 S Again, it’s a little bit elevated, but not quite elevated enough to be considered diabetes.

Diabetes is an fasting glucose of 126 or higher.

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So if you have either an elevated fasting or an elevated A1C, your doctor might do even more testing to kind of get a sense of what’s going on.

They might repeat the fasting that’s happened to me before where it was a little elevated and then I did it again and it was normal.

So you might get more tests.

11:58
And for people who are like, what is fasting mean?

That’s just your blood glucose when you haven’t eaten.

Typically it’s taken in the morning after you’ve fasted for.

I would say typically it’s like 10 to 12 hours of no food.

You can drink water though, and that’ll give you kind of a good reading.

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And with pre diabetes and diabetes, it typically doesn’t occur on its own.

You might have other chronic conditions going on and so these are just other labs that you wanna be aware of.

The first is gonna be the lipid profile because you might be at a higher risk of having high cholesterol or high triglycerides.

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And so with your triglycerides, we want to aim for a goal of less than 150 milligrams per deciliter.

That is considered normal total cholesterol.

We want to aim for less than 200.

So there’s the LDL and the HDL.

When it comes to cholesterol, the LDL is not considered as healthy.

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The HDL is considered healthy cholesterol.

So with LDL, we want it to be less than 100.

And with the HDL, we want it to be over 60 milligrams per deciliter.

So those are just some ranges to keep in mind time, making sure you’re getting your lipid profile done and also your blood pressure because oftentimes people with pre diabetes or diabetes also have hypertension.

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So you can get a blood pressure cuff and just have that at home or make sure that you do it when you go to the doctor’s office.

And we want to aim for less than 120 / 80.

So anything over those numbers would be considered elevated.

Yes.

13:35
Also with Diabetes Digital, we will test your labs.

So we’re going to check your LDL, we’re going to check your HDL, your triglycerides, your total cholesterol, your A1C and your fasting glucose.

We checked them periodically just to see how you are improving and we’ll make adjustments accordingly.

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When it comes for nutrition for diabetes, there are 5 main factors that we look at and we try to help people with.

I mean, there’s even more than this honestly, but here’s some things to start with.

So one is increasing your fiber intake.

Foods high in fiber like vegetables, fruits, whole grains, legumes, which are beans, will help to regulate blood sugar levels because they slow the release of sugar into your bloodstream and they promote satiety, that feeling of fullness and being satiated.

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So that’s number one.

We also want to choose fats, especially healthy fats, things like avocados, nuts, seeds, olive oil.

Those are going to improve insulin sensitivity and also improve heart health because as Wendy mentioned, diabetes often goes hand in hand with different heart issues.

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The third thing is opting for lean protein.

So we always want to try, when possible, to pair those carbohydrates with lean proteins like chicken, Turkey, fish, tofu, and legumes to help stabilize blood sugar levels.

It’s also going to help you just feel more satisfied, like we mentioned throughout the day.

14:59
The fourth thing is limiting refined sugars and simple carbohydrates.

If you’re not familiar with our work, I should preface that by saying that we are all foods fit dietitians, which means all foods can fit into a balanced diet.

15:16
So we don’t say that you should eliminate carbohydrates or refined sugars.

We are just saying limiting them based on your goals because they can lead to more rapid spikes in blood sugar levels.

Now, if you’re someone who’s like, Nope, I need my treat after every single meal, we can work with you, right?

15:33
In that case, maybe things like physical activity after your meal or you know, medication in some cases that might help keep your blood sugar levels at Target while also having you eating the foods that you want to eat.

And last but not least, staying hydrated.

So important.

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Drinking enough water throughout the day is going to support overall health and hydration status.

And with all of this, it’s really important to personalize.

So we personalize hydration goals.

We personalize your goals when it comes to carbohydrates and everything else, even fiber.

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Because for some people, if they’re having some GI issues like gastro issues, they might not be able to tolerate high fiber.

So it’s all individualized based on your needs, your activity level, your cultural preferences.

Like all those things are things that we take into account when figuring out what’s gonna work best for you.

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And also understanding the impact of carbohydrates on your blood sugar levels because people react differently to different types of carbohydrates.

You might think that maybe white rice will wildly elevate your blood sugar levels, where that might not be the case, especially when paired with other foods that create that balancing effect.

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So we look into the numbers with you and really figure out what are the meals that you thrive on.

Yeah, you may do well with a plate of pasta and oil, like we just don’t know.

And that’s why, again, it’s important to do the monitoring and the testing of blood glucose to really see how foods affect you specifically and physical activity, like I mentioned, that’s a huge factor in helping regulate your blood glucose levels.

17:11
And I just want to talk a little bit about some of the benefits of regular physical activity.

We’re going to go more into detail again in the exercise episode, but it helps to improve insulin sensitivity and it really does lower blood sugar levels.

There’s so many people who will test their blood glucose on a day where they did physical activity and they’ll test when they didn’t and they’ll have the same thing to eat, and yet they’ll notice that when they do the activity, the blood sugar levels are lower.

17:38
So in terms of goals, we want to aim for at least 150 minutes of moderate intensity aerobic activity per week and also strength training 2 times per week.

So just to break that down, moderate intensity aerobic activity can be things like walking.

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My personal favorite, the strength training can be anything from yoga to Pilates to going to the gym and lifting weights.

It’s really important though, to find things you enjoy.

You might do dancing for your aerobic activity.

You might just want to join a sports league.

18:12
There’s so many things we can do, but it has to be something that you actually enjoy and set realistic goals.

Oftentimes people get diagnosed and they want to overhaul their lifestyle overnight and I can tell you that 99% of the time that does not work.

So making those small and consistent changes and building up on your routine and again, finding things that you can stick with is going to be your best bet long term.

18:37
Something that doesn’t get talked about enough is stress and the impact that that can have on your blood sugar levels.

So it’s really important if you find yourself consistently stressed to practice and management strategies.

It could be mindfulness, like deep breathing, just to help like quiet the mind, reduce stress.

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Talking to your loved ones might help.

Sometimes I could stress you out even more.

But finding people who are supportive and who can help ease your load is going to be really helpful.

Participating in activities that you enjoy that provide you with joy, fulfillment.

19:13
It could be movement or it could be something else.

So trying to identify what those activities are.

And also you can always seek support from a mental health professional.

We really encourage it because sometimes the stress of dealing with the chronic condition can be overwhelming and having to deal with, you know, a million other things that life throws at you.

19:34
So we encourage you to seek therapy if you’re able to, if you have coverage for it, because that can be really helpful as well.

Yeah, and don’t underestimate the power of a support system.

It’s so important that support and accountability for a lot of people.

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I’m someone who does really well with external accountability when it comes to different healthcare goals.

If I know I have a meeting, it’s going to just help remind me, OK, these are the goals that I set, like someone’s checking in on me.

And that really helps me to know that especially if it’s like gentle check insurance, it can also help you celebrate wins, monitor progress.

20:14
So that’s why we really recommend meeting with a dietitian.

And of course, we have to plug Diabetes Digital, which is our platform where we will match you with a dietitian on our team.

We accept all of the major insurances and we’re in 29 States and we started a 12 week to lower your A1C program.

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So whether you have diabetes or pre diabetes or gestational diabetes or type 1 PCOS, like we’ll work with you and help to get that A1C lowered.

We’ll check your labs and really be able to monitor your progress.

So go to our website diabetesdigital.co/quiz to take our quiz and see if you are in our network and if not still complete the quiz because if we get enough people in your state with your insurance, we will get a network and we’ll let you know when we do.

21:05
All right y’all, thank you so much for tuning in.

If there’s anyone who could benefit from this information, please share this episode with them and TuneIn for the next episodes of our four part pre diabetes series.

Next episode we’re going to talk about how long does it take to reverse pre diabetes.

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So definitely tune in for that and we’ll catch you next time.

Thank you so much.

Bye.

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us at diabetesdigital.co.

21:40
Also, if you found our conversation helpful, do us a favor and rate and review this podcast on iTunes, plus share with someone who might find this helpful.

You can also connect with us on Instagram at Diabetes Digital.Co and Tune In every Wednesday for practical, inclusive and culturally humble diabetes insights.

Bye.