What is prediabetes?

When your blood sugar is higher than normal, but not high enough to be diabetic, this is called Pre-diabetes. It can also be known as Impaired Glucose Tolerance or Non-diabetic Hyperglycaemia.

If you have prediabetes you are at risk of developing diabetes, but you do not have it yet. You are also at higher risk of developing heart disease.

Most people with prediabetes do not have any symptoms. It is good that this has been detected now, as it means that you have the chance to take action to reduce the risk of developing diabetes and make a real difference to your health.

• A normal Hba1c is below 42 mmol.
• In prediabetes, the Hba1c is between 42 and 47 mmol.
• Diabetes is diagnosed when the Hba1c is 48 or higher.

What can you do?

A lot of research has been done to show that that making changes to your lifestyle can prevent you from developing diabetes.

Losing weight

If you are overweight – aim for a BMI of less than 25. We know that this can be difficult to achieve and maintain, and help is available! Ask us about referrals to Slimming World for a 12-week programme, exercise referrals, and the Healthy Lifestyles program.

Nutrition

What you eat has a huge impact not just on your blood sugars but also on your general wellbeing. Sustainable, long term changes are much more effective than short-term diets.

Have at least 5-7 portions of fruit and vegetables a day

The more variety you can eat, the better! Trying to “eat the rainbow” (consuming as many different colours as you can) gives you a plentiful supply of important phytonutrients. Berries in particular, are packed with antioxidants and are also low in carbohydrates, making them particularly valuable in prediabetes.

Increase your fibre intake

This fills you up and feeds your Gut Microbiome (the healthy bacteria in your gut which help you with many important bodily functions). Aim for at least 30g of fibre a day. Good sources of fibre are beans and pulses, whole grains, seeds and nuts.

Switch to healthy fats

Contrary to popular belief, some fats are actually good for you! Nuts, seeds, oily fish, olive oil and avocado contain lots of beneficial unsaturated fat which protect your heart by boosting your HDL (or good) cholesterol. A higher intake of Omega-3 fats, such as found in oily fish, is also recommended.

Limit sugar and refined carbohydrates

These have very little nutritional value and are known to spike your blood sugar. Refined carbohydrates include white flour, many breads, white pasta, potatoes and white rice. Wholemeal grains contain more fibre and are digested more slowly, which means that they do not affect your blood sugars as much as refined grains. It may be tempting to switch to artificial sweeteners but these, too, may have harmful effects on your metabolism and are best avoided.

Reduce your salt intake

Aiming for less than 6g a day which is the recommended upper limit for adults.
Beware of processed food and ready meals – many ready meals contain added sugar and salt, as well as a variety of emulsifiers and other added ingredients that may leave you feeling hungry again soon. Try to cook yourself where possible.

Drink plenty of water

Aiming for 6-8 glasses a day. Fruit juices contain a lot of sugar, and diet drinks, although low in sugar, are generally not helpful in weight loss as they can contribute to sugar cravings and affect your gut microbiome.

Physical activity

Physical inactivity is one of the leading causes of premature death. In contrast, being active daily reduces the risk of a wide range of diseases such as Type 2 diabetes, coronary heart disease, depression and anxiety.

• Try to do at least 150 minutes of moderate exercise (such as brisk walking or cycling), or 75 minutes of vigorous exercise (such as running) a week. This can be broken up into chunks.
• In addition, muscle strength training is important, and should be done on at least 2 days a week.
• For those with little time, HIIT (High Intensity Interval Training) has been found to be very effective.
• Try to avoid prolonged sitting which is harmful – break it up by periods of light exercises where possible.
• If you have physical limitations, remember that any exercise is better than none! Try to move more throughout the day, in whatever way you can.

Useful resources, including exercise videos and the “couch to 5k” jogging training programme.

Smoking

Smoking increases your risk of heart disease and stroke. With treatment and support, you are 4 times more likely to successfully quit smoking than if you attempt it yourself. Help is available at Painswick pharmacy, and through Healthy Lifestyles. Do not be afraid to ask for help if you would like to stop smoking, even if you have not been successful in the past or have relapsed.

Alcohol

The recommended maximum amount is 14 units of alcohol per week. A unit of alcohol is 10ml of pure alcohol, which is about:

• Half a pint of lower to normal-strength lager/beer/cider (ABV 3.6%)
• A single small shot measure (25ml) of spirits (25ml, ABV 40%)
• A small glass (125ml) of wine contains about 1.5 units of alcohol

Sleep

Lack of sleep affects your blood sugar and can cause you to feel more hungry, thus contributing to weight gain. Most people need 7-9 hours of sleep a day and it is important to schedule enough time to allow yourself adequate sleep. However, sleeping problems are common and affect up to a third of the population.

Some helpful advice on sleep hygiene is available on the NHS website, and The Sleep Council has a wealth of further information and leaflets to help you.

Relaxation

It is known that chronic stress can have an impact on many areas of your health, including your blood sugar and your blood pressure. Whilst there may not be an easy fix for this, the first step is to be aware of it and looks at potential ways of reducing your stress levels. Some suggested strategies include:

• Give yourself permission to relax and take time out for yourself
• Practice meditation, mindfulness, contemplation or prayer
• Schedule regular screen free times
• Make time to connect with others in a meaningful way

What we do

We would like to keep an eye on your blood sugar levels and will invite you for a blood test with one of our nurses at least once a year. Please get in touch if you think it has been longer since your last blood test.

Resources

Healthy Lifestyles, has coaches who offer free 1:1 support in getting healthier, losing weight, cutting down alcohol and increasing your physical activity. Their website has some useful tip and they can be contacted via phone on 0800 1223788.

www.diabetes.co.uk and www.diabetes.org.uk both have further background information on diabetes and prediabetes.

Books

• The 4 Pillar Plan written by Dr Rangan Chatterjee who starred in the BBC series “Doctor in the House” is very easy to read and contains some excellent lifestyle advice on eating, moving, sleep and stress reduction.
• The 8-Week Blood Sugar Diet by Michael Mosley, another well-known medical TV personality, suggests a tailored diet plan based on a low carb Mediterranean diet. His website www.thebloodsugardiet.com is also helpful.
• The diet Myth by Prof Tim Spector is a fascinating book looking at the impact of food on our bodies by focusing on the role of our gut microbiome and what we can do to make a difference
• The Obesity Code Dr Jason Fung discusses the important role that hormones such as insulin play. His theory remains debated, but many people have successfully applied the strategies that he suggests to reduce their weight and prevent diabetes.