The pre-diabetic state: What does it do to you?

By The Low Carb Clinic, 16 July 2019 - 697 words (4 minutes)

Type 2 diabetes is just the tip of the iceberg.

A person can have silent, ‘pre-diabetes’ for many years before type 2 diabetes is diagnosed – with no obvious signs or symptoms. That means that well before a diagnosis of type II diabetes, there is damage occurring inside the body – hidden from sight. Pre-diabetes (also called ‘insulin resistance’) is incredibly common – affecting at least two million Australians[1]. By some estimates, up to 90% of people with pre-diabetes don’t know they have it[2].

While pre-diabetes or insulin resistance is mostly ‘silent’, that doesn’t mean it is not life-threatening. Pre-diabetes puts a person at increased risk of poor health outcomes – including cardiovascular disease, heart attacks, kidney disease, and early death. And because pre-diabetes can be harder to spot, people with pre-diabetes will often have no idea that so much damage is going on inside their body. This makes it even more important to prevent pre-diabetes and insulin resistance, or reverse it - if you have it. Sooner, rather than later – because every day a person lives with pre-diabetes is another day the body is damaged.

So, what is the best way to prevent or reverse pre-diabetes? With a low-carbohydrate diet.

The body in pre-diabetes.

‘Pre-diabetes’ is when the body is having to work harder than it should to process carbohydrates (found in foods like sugar, bread, pasta and cereal). We all know that in diabetes, blood sugar levels rise. In pre-diabetes, the blood sugar level may be a little higher than normal, but not quite high enough to be diagnosed with type 2 diabetes. When we eat carbohydrates, the body breaks them down into glucose (glucose is another name for sugar). This glucose moves from our digestive system, and into our bloodstream.

In response, the body releases a hormone called insulin. Insulin’s job is to move glucose (sugar) from the bloodstream and into the body’s cells. It is like a ‘key’ that ‘unlocks’ cells, allowing glucose to enter. Insulin’s job is very important because high levels of glucose in the blood can damage blood vessels all over the body – causing disease. Of all the food groups, carbohydrates create the largest insulin response - because all carbohydrates are broken down into glucose.

Pre-diabetes is a state of insulin resistance.

Over time, a high-carbohydrate diet fills our cells with glucose, and so our cells stop responding as well to insulin. When the cells no longer respond very well to insulin, the person is said to be ‘insulin resistant’. To overcome this ‘resistance’, the body releases more and more insulin – higher levels of insulin, to try to move more glucose from the blood, and into the cells. It’s a vicious cycle, though – more and more insulin simply causes more and more insulin resistance. Being insulin resistant is not a healthy way to be.

Insulin resistance alone is linked to many chronic health conditions and poor health outcomes (it’s not just how high your blood sugar is that makes you sick). Insulin resistance is linked to high blood pressure[3], infertility (especially polycystic ovarian syndrome[4]), heart disease[5], and fatty liver disease[6]. High insulin fuels tumour growth and can contribute to cancer[7]. Insulin resistance is linked to Alzheimer’s dementia and cognitive decline[8]. And more generally, insulin resistance can cause fatigue, inflammation, weight gain[9], and difficulty concentrating – being insulin resistant is a state of chronic stress for the body. And, of course, without making changes to reverse insulin resistance, pre-diabetes will soon develop into diabetes.

Detecting pre-diabetes.

Pre-diabetes can be hard to detect because the high insulin levels keep blood sugar levels relatively stable. So, testing your blood sugar on a finger-prick test may not be enough to pick up on pre-diabetes. Pre-diabetes is mostly silent, and so goes unnoticed. The best way to diagnose it is with an HbA1c blood test: less than 5.7 is normal; greater than 6.5 is full-blown Diabetes. Between 5.6 and 6.5 is Prediabetes. There are also some symptoms you can look for (although they are vague and so easy to ignore).

Some signs of pre-diabetes can be:

High blood pressure
Difficulty losing weight
Extra fat around the tummy (even if you are slim in other places)
Thick, dark skin (called ‘acanthosis nigricans’) in the armpits, elbows, knuckles, groin or lips
Fatigue and difficulty concentrating
Constant hunger and thirst
High triglycerides and low HDL cholesterol

Unfortunately, being slim or active doesn’t mean you aren’t at risk of pre-diabetes. Pre-diabetes is a dietary disease – anybody eating a high-carbohydrate diet (especially if it’s high in sugar) is at risk. Pre-diabetes can be silent, but deadly. Luckily, pre-diabetes can be prevented, managed and reversed: all by reducing the body’s constant exposure to insulin.

And the best way to do this? A low-carbohydrate diet.

References

Diabetes Australia. (2015). Pre-diabetes. Retrieved from Diabetes Australia: https://www.diabetesaustralia.com.au/pre-diabetes
Centres for Disease Control and Prevention. (2018, January 12). The surprising truth about prediabetes. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/features/diabetesprevention/index.html
Wang, F., Han, L., & Hu, D. (2017). Fasting insulin, insulin resistance and risk of hypertension in the general population: a meta-analysis. International Journal of Clinical Chemistry, 464, 57-63. doi:10.1016/j.cca.2016.11.009
Gower, B., Chandler-Laney, P., Ovalle, F., Goree, L., Azziz, R., Desmond, R., . . . Bates, G. (2013). Favourable metabolic effects of a eucaloric lower-carbohydrate diet in women with PCOS. Clinical Endocrinology, 79(4), 550-557. doi:doi:10.1111/cen.12175
Volek, J., Fernandez, M., Feinman, R., & Phinney, S. (2008). Dietary carbohydrate restriction induces a unique metabolic state positively affecting atherogenic dyslipidemia, fatty acid partitioning, and metabolic syndrome. Progress in lipid research, 47, 307-318.
Urzschneider, K., & Kahn, S. (2006). The Role of Insulin Resistance in Nonalcoholic Fatty Liver Disease. The Journal of Clinical Endocrinology & Metabolism, 91(12), 4753-4761. Retrieved from https://doi.org/10.1210/jc.2006-0587
Fine, E., Champ, C., Feinman, R., Marquez, S., & Klement, R. (2016). An evolutionary and mechanistic perspective on dietary carbohydrate restriction in cancer prevention. Journal of evolution and health, 1(1). doi:https://doi.org/10.15310/2334-3591.1036
Neth, B., & Craft, S. (2017). Insulin resistance and Alzheimer's disease: bioenergetic linkages. Frontiers in aging neuroscience, 9(345). doi:10.3389/fnagi.2017.00345
Templeman, N., Skovso, S., Page, M., Lim, G., & Johnson, J. (2017). A causal role for hyperinsulinemia in obesity. Journal of Endocrinology, 232, R172-R183. doi:10.1530/JOE-16-0449