Pre-Diabetes is Not a Pre-Problem

 
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Jill Weisenberger, MS, RD, CDE is here with some of the latest tips on managing diabetes. Check out her book, Diabetes Weight Loss – Week by Week.

So many patients believe that pre-diabetes indicates that a problem might be in their future. Instead, pre-diabetes is the problem. In fact, the problem probably started years before the pre-diabetes diagnosis. Both type 2 diabetes and pre-diabetes result from insulin resistance.

When fat and muscle cells first become resistant to insulin’s action, the pancreas sends out more and more insulin to allow blood glucose into the cells. Glucose levels in the blood normalize without any sign that something is awry. However, this resistance to insulin, with its high levels of insulin circulating throughout the body, silently causes damage in people who are unaware they have the condition.

Though best known for its role in glucose control, insulin has many jobs and acts on tissues throughout the body. While fat and muscle cells are resistant to insulin’s action and demand additional insulin, other tissues throughout the body retain normal insulin sensitivity or even become hypersensitive to insulin stimulation. The extra insulin circulating throughout the body wreaks havoc on these other systems. For example, since the kidneys do not become resistant to insulin, the excess insulin may cause excess retention of salt and uric acid, which may contribute to both high blood pressure and gout. Thanks to the varied role of insulin in the body, elevated levels frequently lead to low HDL cholesterol and high LDL cholesterol, as well as increased blood triglyceride concentrations and nonalcoholic liver disease. High insulin levels may also affect the brain leading to dementia, including Alzheimer’s disease. The enzyme that breaks down insulin also breaks down amyloid beta, a peptide that accumulates in the brain with Alzheimer’s disease. In theory, if insulin levels are high, this enzyme is busy degrading insulin, and amyloid beta builds up.

I struggle to help my patients with pre-diabetes take their condition seriously without overly alarming them. I find that tackling one manifestation at a time (such as hypercholesterolemia or high blood pressure) and linking it to the overall problem often eases them into the proper mindset.

Reaven GM. Insulin resistance: from bit player to center stage. Canadian Medical Association Journal. March 22, 2011, 183(5) DOI:10.1503 /cmaj.101430

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