Prediabetes - Treatable with Lifestyle

This is the first installment of a series discussing prediabetes, and specifically how to treat and ideally reverse prediabetes. If you already have diabetes, or are just looking to lose weight, you can find useful information here too.

If you’ve recently been told you have prediabetes, you are in the right place!

No one wants to hear they have prediabetes, but the great news is that this is a condition that can be treated without medication, and you can make yourself healthier, increase your energy, and boost your productivity all at the same time. Sounds good, right? Stick with me.

First, the bad news. If you’ve been diagnosed with prediabetes, then your metabolism is not functioning at an optimal level. Prediabetes indicates a disruption in the regulation of glucose (blood sugar) and insulin in your body, and most commonly arises from a combination of genetic risk, aging, and weight gain. Prediabetes can be diagnosed by having a fasting glucose 100-125 mg/dL, a glucose 2 hours after a 75-gram glucose load of 140-199 mg/dL, or a hemoglobin A1c value of 5.7-6.4% (The hemoglobin A1c, also called HbA1c or just A1c, reflects the average glucose level over the last 2-3 months). The risk of developing diabetes within 5 years is roughly 10% for those at the low end of these scales and approximately 50% for those at the higher end.

Taking the Diagnosis Seriously

You need to take prediabetes seriously. People who develop diabetes have an increased risk of heart disease, stroke, cancer, liver disease, sleep apnea, and depression. One study showed the average health care cost for people with diabetes was $7,900 per year more than for people without diabetes. People with diabetes need more sick days and time away from work.

Whew! Enough with the bad news! Let’s have you not go there.

Now for the Good News

You can reduce your risk of developing diabetes by over 50% without taking additional medication. The best and most-quoted study for diabetes prevention was called, shockingly, the Diabetes Prevention Program, or DPP. The DPP showed that people who lost 7% of their body weight (roughly 10-15 pounds for most people) and exercised 150 minutes per week, at an intensity equal to brisk walking, reduced their risk of progressing to diabetes by 58% over an average of 2.8 years. For comparison, a group treated with the diabetes medication Metformin had a reduction in risk of 31%. Similar benefit has been shown in other similar studies. Summary – exercise and weight loss worked, and was more powerful than diabetes medication.

So you’ve got prediabetes. What should you do now?

I will expand on these concepts over the next few posts, but let’s start with a simple list for now:

  1. Get moving. Target 150 minutes per week, minimum, of activity at an intensity equivalent to brisk walking. You don’t have to get to 150 minutes by tomorrow. If you are at zero minutes per week now, try 10 minutes every other day. 30 is greater than 0. In the DPP study, 75 minutes of the 150 minute target could be strength training or resistance training. (I would be remiss if I did not mention to get clearance from your doctor if you are not sure if you are healthy enough to start exercise).
  2. Get nutrition. You want to start moving your body weight down if you are overweight. Remember, it only took 10-15 pounds to show benefit in the DPP. Any weight loss is better than nothing. Is there a “best diet” to help with weight loss? I think too many people get stuck here. I’ll explore this particular topic in greater detail in the next post, but I’m convinced there are many paths to success. Ideally you will find a nutrition program that works for you, supports the way you like to eat, and is something you can maintain for your lifetime. A few bullets to get you started:
    • If you are not sure where to start, try a high-protein/low-carb program – South Beach, Paleo, LeanMD – or Mediterranean diet. These have been associated with good success rates for most people, and most people find they can still enjoy eating like this.
    • Limit starchy carbohydrates. The white stuff like bread, pasta, rice, and potatoes.
    • Don’t drink calories. Especially sugar-sweetened beverages like soda.
    • Limit alcohol. Yes, these are calories you drink. You’ll be fine if you cut them out altogether, but if you really, really don’t want to give it up you can have one standard drink per day (no piña coladas though – check out the calorie content of alcohol here).
    • Eat more vegetables and eat more fiber. These will help to keep you full.
    • Get the junk food out of your kitchen. If it is something that will blow up your plan, get it out of your house.
    • If you’re prone to snacking at night, try these hacks. Brush your teeth by 8 pm and get out of the kitchen. Let’s tell your brain it’s time to be done eating
  3. Get sleep. This one is often overlooked but is very important. If you aren’t getting enough sleep, you’re putting yourself in “metabolic storage mode” and sabotaging your weight loss efforts. Shoot for a minimum of 7-7.5 hours each night.
  4. Get support. The more people you have who are cheering you on and offering encouragement, the better. Try to spend less time with people who are telling you you’re wasting your time.
  5. Get help. If you are not making the progress you want, get help! It’s okay to seek support to get yourself unstuck. If your car got stuck, you’d call a tow-truck, right? If your health is stuck, it’s okay to seek help. If you want to go a bit deeper on this, download this 23-page document on making better progress with your health.

Over the next few months we will dive deeper into these concepts. Think of prediabetes as your wake-up call. Time to do something. You are in control. Now get busy!

Originally published on

Christopher Fox