Dear Dietitian: Prediabetes diagnosis

Leanne McCrate

Dear Dietitian,

My husband was just diagnosed with prediabetes. We were given a sheet of paper with information on this, but it left us with many questions. Does he need a special diet? Will he have full-blown diabetes in a few years? We need more information, please.


Dear Suzanne,

A new diagnosis can be overwhelming, and often leaves us with many questions. You are wise to seek information. Prediabetes is when your blood sugars are high, but not high enough to be considered type 2 diabetes. This term is phasing out the former description “borderline diabetes,” giving it a more direct connotation. According to the Centers for Disease Control (CDC), about 84 million American adults have prediabetes, and of these, 90 percent don’t know they have it.

The good news is you can prevent prediabetes from becoming type 2 diabetes by making lifestyle changes. Some estimate you can reduce the likelihood of developing type 2 diabetes by as much as 40-70 percent!

According to the American Diabetes Association, prediabetes is defined by one or more of the following criteria:

--An A1C level of 5.7 percent to 6.4 percent. Your A1C is a 3-month average of blood sugar levels.

--Fasting glucose level of 100 – 125 mg/dl. Fasting means you haven’t eaten for at least 8 hours prior to the glucose test.

--Two-hour oral glucose tolerance test of 140-199 mg/dl. This test is used to diagnose gestational diabetes.

Your risk factors for prediabetes are:

--Family history

--Being overweight

--Age 45 or older

--Being physically active less than 30 minutes per week

--Having had gestational diabetes

--Having polycystic ovary syndrome

--Ethnicity: Prediabetes rates are higher in African American, Hispanic, and Native American ethnicities.

Of these risk factors, there are two things you can change: weight and physical activity. If you need to lose weight, do it. While in clinical practice, I would encourage patients to try a new health plan for 30 days. This is the toughest time because you are making changes in behavior but might not see results yet. Once you start seeing the fruits of your labor, it motivates you to carry on.

Beware of food plans that are too restrictive, both in calories and food groups. A program that is too restrictive only makes us feel deprived, and who needs that? Furthermore, it sets you up for failure. You are more likely to say “To heck with it,” and eat everything in sight. It’s hard to get back on track after that.

So much depends on our attitudes. Just this morning, someone asked me how I had lost weight so that she could do the same. After discussing my new health plan, she listed all the reasons she couldn’t lose weight. If you think you can or can’t, you’re right. Don’t be your own worst enemy.

Exercise is as important as eating healthy when it comes to prediabetes. Physical activity moves blood sugar from your extremities to your core where it can be utilized. Again, don’t overdo it. If you haven’t been exercising, start with a half-mile walk three times a week, then increase slowly to reach a goal of 150 minutes per week. The good thing about exercise is it makes us feel better, so we keep doing it!

Remember, what you do makes a difference. Taking care of yourself is one of life’s greatest privileges. No one else can do it for you.

In good health,

Dear Dietitian

Leanne McCrate, RD, LD, CNSC, aka Dear Dietitian, is an award-winning dietitian based in Missouri. Do you have a nutrition question? Email her at