Dr. Sri Prakash Mokshagundam

If you’ve got pre-diabetes — meaning that you’re on a path leading to becoming a diabetic — you may not know it.

According to the Centers for Disease Control, more than 1 in 3 Americans have pre-diabetes, and 90 percent of them aren’t aware of it.

Pre-diabetes is identified when blood sugar levels, or hemoglobin level (A1C), are higher than normal but not in the range of having diabetes. A reading of between 100 and 125 for blood sugar, or an A1C measure between 5.7 and 6.4, indicates that a person is likely to progress to diabetes.

Dr. Sri Prakash Mokshagundam, an associate professor at the University of Louisville specializing in metabolism and diabetes, said that for those who learn they have pre-diabetes, the progression of the disease can be slowed.

“For those with pre-diabetes, the general recommendation is lifestyle change,” he said. “People at high risk can benefit from using medication, but diet and lifestyle changes are more effective than medication. A lot of people have difficulty making those changes. It requires time and commitment. It’s really not that difficult, but you have to be committed.”

Diet and exercise tips

The American Diabetes Association publishes numerous tips to help patients make adjustments in their diet and exercise habits, including setting very specific goals. One might be committing to eating a fruit or vegetable at every meal. Or getting a minimum of 150 minutes of physical activity each week.

Many organizations offer advice on diet for pre-diabetes patients that include vegetables, fish and shellfish, and plant-based proteins, such as beans, peas, lentils, tofu, and nuts. Also suggested are whole grains and whole-grain products, healthy fats such as olive oil and avocado, fresh fruit and spices and herbs.

For a person who has pre-diabetes and commits to and follows through with a planned lifestyle change, the progression to diabetes can be slowed dramatically. Dr. Mokshagundam said that while it is a certainty that the progression of the disease will continue, it can take several years before patients will become diabetic and require medication.

Dr. Mokshagundam cited a study of diabetes prevention in which the results of diet and lifestyle change were compared to the results using medication. It showed the rate of progression for those incorporating lifestyle changes slowed by 68 percent, compared with 31 percent using medication.

The cost of diabetes

He said diabetes affects millions of Americans, and it’s expensive. He said more than $300 million per year is spent on treating diabetes. In Kentucky, more than a million people are at risk, with 340,000 at “very high risk,” according to the Kentucky Diabetes Network.

Most doctors recommend treating pre-diabetes patients by changing their lifestyle, which by itself can reduce blood sugar levels.

When the body is unable to handle glucose properly, diabetes is the result. It can cause specific damage to the eye, kidneys, nerves, blood vessels and increase the chance of suffering a heart attack or stroke.

Insulin is the hormone made by the pancreas that helps glucose in your blood enter cells in your muscle, fat and liver. If a person develops diabetes, the patient may require insulin injections to regulate glucose.

Risk factors and testing

Dr. Mokshagundam said that since there are no symptoms for pre-diabetes, and that individuals should have their blood sugar tested, especially if there are risk factors. Those include age (anyone over 45 should be tested), obesity, a family history of diabetes, or if you have high blood pressure or abnormal cholesterol.

In addition, these ethnic groups have a higher risk — African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American.

“You should go to your family care doctor to get screenings. There are web sites, from the CDC or KyDiabetes.net, that have tests you can use to score yourself for your risk, using factors such as age, gender, physical activity, and weight.”

Making a change to your lifestyle is challenging, especially with the ready availability of unhealthy foods, Dr. Mokshagundam said.

“Today we don’t have to be physically active to get work done,” he said. “I can sit at my office and order pizza or get anything I want. It’s a major contributor to the problem we have.”

You can find additional information about pre-diabetes, including advice on making lifestyle changes, at the Kentucky Diabetes Network.