Treat prediabetes with diet, exercise

Dear Dr. Roach: I have some questions about my lab results. My doctor’s office called to say all results were good. However, when I received the printout from the lab, I read several readings that alarmed me, including a hemoglobin A1C of 5.9% (flagged as high) and glucose 114 (again flagged as high). Should my doctor have given me any suggestions to get these results under control through change of diet, etc.?

Anon.

Answer: These results show you have prediabetes, which means you are at risk for developing diabetes in the future. Prediabetes itself carries additional risk for developing heart disease in the future. The standard of care now is to treat prediabetes, both to reduce cardiovascular risk as well as to prevent progression to overt diabetes. Unfortunately, I think your doctor missed an opportunity to make an intervention that could help your overall health.

As you suggest, diet is a major component of treatment. A visit with a dietitian nutritionist and a diabetes health educator would be the ideal way of giving you personalized recommendations about diet. I can only scratch the surface by saying that you will want to consume very small amounts of simple sugars, such as fruit juices, sugarsweetened soft drinks, sweet baked goods and candies. You also want to have no more than modest consumption of processed starches, such as bread, pasta and white rice. When you do consume them, it should be as part of a mixed meal with protein and fat, which slows absorption of the starches that would otherwise be converted rapidly to sugar by the body.

Exercise is just as important as diet. Regular, moderate-intensity exercise helps the body use dietary carbohydrates better, reducing the risk of progression to diabetes. Your exercise goal should be to eventually reach 20-30 minutes a day of moderate exercise. Some people are already way above that, while others may take weeks to safely get to that level of intensity. Neither exercise nor a proper diet are guarantees against developing diabetes, but the two together are powerful.