First comes “pre,” then comes what?

Remember that game we all played as children: first comes love, then comes marriage, then comes so-and-so with the baby carriage etc? Even as kids playing a game, we know there is a progression to things(even though sometimes the order may be changed, but that is another story…). The same goes for diseases like pre-diabetes, which as the name suggests, PREceeds diabetes. However many people treat this like it is one spot in time, without any future, and then they can land in some trouble.{{more}}

I have had several patients on whom I consulted in the hospitals, who now have diabetes based on their blood tests. There is no question – these folks have diabetes. Their A1Cs are high, so their blood sugars have been elevated for some time, not just a few days, because they are sick. A number of them told me: yes, at one time I was told I had pre-diabetes. At which point I asked, so what happened after that? And, invariably, they all said they same thing: well nothing happened. Did you change your diet/lose weight/start any medications? I asked. Most of them said “no.”

They then were terribly surprised to find out that they had developed diabetes since that time. Why the surprise? I can only assume that at the time of their diagnosis of pre-diabetes, they and their medical team did not pursue treatments or life changes to help reverse that pattern. Therefore pre-diabetes PROGRESSED, as it often does, to diabetes. How long that progression takes will vary from person to person. Some people never progress, but many do.

Please remember that diabetes is not a sudden spot in time for most people, especially with Type 2 diabetes. It is a progression of disease, starting with normal and going all the way to “brittle” diabetes (where blood sugars are extremely difficult to control). Pre-diabetes is a period before developing diabetes, and for many people, it is the phase where this can all be reversed. If it is NOT reversed, chances are quite high that it will progress towards diabetes.

So, please take pre-diabetes as a warning. This is not a diagnosis you sit on and just wait. It is a wake-up call to get something(s) changed in your life, or to start a medication that can slow the progression to diabetes. Talk to your medical team about what needs to be done in order to prevent that progression. Plus, you will need to be rechecked! If you are told you have pre-diabetes, you will need repeat blood testing, at least yearly, to ensure that any progression is caught quickly.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD

Staff Endocrinologist

Roper St. Francis Hospital

anita.ramsetty@rsfh.com