Is the main risk of being diagnosed with pre-diabetes the increased likelihood of developing diabetes, or is the A1C level in a pre-diabetic high enough to to increase mortality even if the A1C level remains stable? Said another way, should a person with pre-diabetes try to lower their sugar levels with medication, or simply maintain a healthy lifestyle to keep their sugar levels stable?
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Prediabetes, as diagnosed by modest increases in blood sugar levels or A1c, is indicative of underlying insulin resistance.
While high blood sugar itself is harmful to various organs, underlying insulin resistance is a significant independent risk factor for numerous diseases on its own, even if blood sugar levels are kept stable.
In other words, the health consequences of prediabetes would not be fully mitigated by simply keeping blood sugar levels stable. One would ideally need to address the underlying insulin resistance in order to minimize longer-term health risks.
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Thanks Austin, and I think I’ve heard you say that drugs like Metformin not only lower blood sugar, they also improve insulin resistance, whereas aggressively reducing carbohydrate intake may lower blood sugar, but might not improve insulin resistance……do I have that right?
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This discussion assumes we are talking about “common” insulin resistance, due to excess body fat (particularly visceral body fat), and not other/less common causes of IR.
In that context, carbohydrate restriction can help to control blood sugar (i.e., the symptom of insulin resistance), however in the absence of fat loss does not resolve the underlying insulin resistance. In this scenario, reintroduction of carbohydrates would lead to recurrent blood sugar problems.
In contrast, if the underlying insulin resistance is addressed & put into remission, then the person would have restored carbohydrate tolerance.
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Thanks again Dr Baraki, really appreciate you taking the time to respond. I think there’s a lot of us who fall into the pre-diabetes category, but don’t meet the stereotypical definition of a person with that diagnosis (sedentary, obese, poor diet, etc). My father received a type two diabetes diagnosis in his seventies. He was 5’10” and about 165 pounds, and very active. He spent the last decade of his life trying to (unsuccessfully) control his sugar levels through both medications and diet. I’ve got a very similar build as my dad (not quite as lightweight, he never strength trained), but I guess I’ve got his genetics. Would love to hear more discussion from BBM regarding pre-diabetes among populations who appear otherwise healthy. Thanks again!
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