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As high blood sugar becomes more of a national obsession–partly associated with our obesity epidemic, partly linked to our typical Western diet–the term pre-diabetes is being used more frequently. Prediabetes indicates fasting blood sugar over 100 but below 126 (or glycosylated hemoglobin above 5.7 but below 6.5), above which the diagnosis would indicate diabetes.  It is estimated that close to 80 million American adults fall into the pre-diabetic category.

One might wonder if “prediabetes” is comparable to being a little bit pregnant?  Happily, it is not, because while many people diagnosed with prediabetes go on to develop the full-blown disease, the condition is reversible with diet and physical activity. A landmark controlled trial proved that proper diet and regular exercise combined with intensive coaching beat out even the prescription drug Metformin in lowering blood sugar to normal levels.

Reversing the disease before it becomes full blown is important, because diabetes is a disease best treated before it starts or in its earliest, preliminary stage. Once blood sugar regularly rises above 126, it is much harder and often impossible to “cure” the disease  though progression can be largely halted and complications prevented with a lifetime regimen of one or more drugs.

High blood sugar is a much more complicated issue than it often appears in the media. Treating pre-diabetes immediately is important because capillary damage, which usually affects the retina in the eyes and the kidneys first, is silent and painless, and it occurs far earlier than was previously thought. So does neurological damage, which results in the tingling in the bottom of the feet, which many people with high blood sugar experience.

As an integrative practitioner, I counsel very effectively for diet and physical activity.   And I always prefer lifestyle changes over pharmaceuticals when possible. But recent studies have convinced me that this early damage to the microvascular system, which is irreversible, warrants medical treatment immediately.  Then as you work to lower your blood sugar through appropriate dietary practices and increased exercise, you can taper off and hopefully discontinue the drugs if you are successful. The two approaches work best in tandem.

Lest I sound too conservative, in my next post, I’ll discuss insulin sensitivity and a couple of natural non prescription supplements, which have proven helpful in dealing with pre-diabetes and diabetes.