Kristina Chetcuti, a registered health coach (UKIHCA) specialising in behaviour change and lifestyle medicine (ELMO), answers your lifestyle dilemmas.
Q. “My doctor has just told me I’m prediabetic. I can’t say I’m completely shocked, seeing as both my mother and grandmother have Type 2 diabetes. Does this mean I’m destined to follow the family tradition, or is there something I can do to avoid it?”
A. No! Type 2 diabetes does not have to be your fate. Yes! There is something you can do. Let’s break it down step by step.
Prediabetes means your blood sugar is higher than normal, but not yet high enough to be diagnosed as Type 2 diabetes. It’s a sign that your body is struggling to regulate blood sugar.
But first things first: where does this sugar in our blood come from? Mainly from two places: the food we eat and the liver.
When we eat carbohydrates, such as white bread, pasta, rice and potatoes, our digestive system breaks them down into glucose (sugar), which is absorbed through the small intestine and then enters our bloodstream.
However, even when we’re not eating, our liver releases glucose into the bloodstream to keep us supplied with energy between meals and overnight. And that’s important because, if our blood glucose were to fall to dangerously low levels, we could lose consciousness, suffer seizures and potentially die.
The problem arises when we have too much glucose in our blood for too long, because then it can start damaging the blood vessels, nerves and organs. Luckily, our amazing body has cleverly devised a way of getting rid of the extra glucose.
It messages the pancreas: “Can I please have some of that excellent hormone of yours to help pack away this extra sugar?”
The hormone, insulin, is dispatched immediately to help store the surplus in the liver’s "warehouse." If that’s not enough, insulin then turns to the cells in the body for additional stowing. So far, so good, but, alas, sometimes cells might become unwilling to cooperate.
Credit: Unsplash
Allow me to digress for a minute. In my home country – maybe because we’re tiny, or maybe because we’re an island, or maybe both – we are, um, very politically attuned. People are very eager to help (for free, sort of) prospective parliamentary candidates get elected.
There’s a name for these helpers – canvassers – who essentially go door to door trying to persuade people to support their man or woman in the running.
Now, I like to think of insulin as a canvasser. It turns up at the cell door and knocks: “Hello, I’ve got glucose here. Would you mind letting it in?”
If this is a one-off, the cells don’t mind and they open the door. But if it starts happening way too often, the cells keep the door shut (who wants politicians prattling away till forever?). But the pancreas is tenacious: it sends more canvassers. And more. And more.
They keep knocking, but the cells become even more reluctant to answer. Meanwhile, glucose is hanging around outside in the bloodstream, and blood sugar starts to rise. The body is frantically trying to deal with this alarming situation, but… it just can’t.
That's, in short, how insulin resistance can contribute to prediabetes and, potentially, Type 2 diabetes. Both are associated with an increased risk of cardiovascular problems, including high blood pressure, unhealthy cholesterol levels and a higher risk of dementia.
I know, it’s difficult to take action on something when there aren’t any visible, tangible symptoms. But there are external signs to watch out for.
Credit: Belga/Tom Goyvaerts
One possible outward clue of insulin resistance is skin tags: small, soft, flesh-coloured, benign growths of skin that hang off the surface of the neck, eyelids, armpits or groin area. Another possible sign is acanthosis nigricans: a dark, velvety-looking discolouration and thickening of the skin, most commonly around the back of the neck or in the armpits.
Those are tell-tale signs that show that not all is well in the state of Denmark.
Yes, age, genetics, family history and other health conditions can all play a role in prediabetes. But if we manage to reduce the insulin demand, bring blood sugar back into the healthy range and keep monitoring it, then it can be reversed.
Please start by asking your healthcare professional for an explanation of your blood sugar results: what they mean, what you can do about them and when you should be tested again.
Talk about your overall heart health, too, including your blood pressure and cholesterol. And then set about making some realistic changes to your lifestyle.
It is a blessing that you were diagnosed at this early stage. In fact, think of prediabetes as a warning sign: instead of helplessly waiting for the Type 2 diabetes sentence, this is an opportunity to start taking consistent action for a healthier you.
Here are some lifestyle actions you might want to consider:
Eating
Be mindful of the type and quantity of starchy foods you eat. Refined carbohydrates, such as white bread, white rice and regular pasta, can raise blood glucose more quickly than their higher-fibre alternatives.
Consider eating more vegetables, berries, lean proteins, fish, nuts and seeds.
Moving
Movement helps bring down blood sugar because it’s absorbed by the muscles, giving the pancreas and the insulin canvassers a break.
A brisk 15-minute walk after lunch and dinner can do wonders, but movement can take many forms. Just choose activities you enjoy and can safely do.
Lifting
Muscle helps our bodies absorb extra glucose, so they aren’t there just for looks. Walking or running are excellent, but not enough; we need to lift stuff.
This can take many forms: resistance bands, weights, Pilates, yoga… just do it. Keep in mind that we start losing muscle from the age of 30 onwards.
De-stressing
When we're stressed, our body, thinking we're in the savannah about to be attacked by a lion, releases glucose into the bloodstream to give us a burst of energy.
Stress hormones such as cortisol can also make our cells less sensitive to insulin. If stress becomes chronic, it can interfere with blood sugar regulation.
Sleep
Sleeping too little on a regular basis can make our cells less responsive to insulin, making them less likely to open the door to our canvassers.
Poor sleep can also affect our stress hormones and appetite regulation, making us more likely to crave refined carbohydrates, which in turn can cause our blood sugar to spike.
