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What is prediabetes and why does it matter?

January 25, 2017

About the Author

photo of Monique Tello, MD, MPH

Monique Tello, MD, MPH, Contributor

Dr. Monique Tello is a practicing physician at Massachusetts General Hospital, director of research and academic affairs for the MGH DGM Healthy Lifestyle Program, clinical instructor at Harvard Medical School, and author of the evidence-based lifestyle … See Full Bio
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Rhonda Witwer
February 9, 2017

Low carb eliminates resistant starch, which has been shown in 9 clinical trials to significantly improve insulin sensitivity in prediabetics. It is in intact whole grains (but not refined grains), under-ripe green bananas, beans & peas. It is also available as a supplement, which was used in all of those 9 clinical studies. In December, the FDA approved a qualified health claim that resistant starch reduces the risk of type 2 diabetes based upon those clinical trials. For more information, see

I agree with you completely on eliminating refined carbohydrates, but the data is overwhelming that you should be adding resistant starch to your diet, not eliminating it.

Selma Öztürk
February 8, 2017

Prediabet should be recommended for use by phytotherapeutic antidiabetic food supplements (olive leaf, cinnamon, rooibos plant, hawthorn extract, turmeric extract, lipotropic factor etc.), probiotic supplements by doctors and dietitians instead of drugs in the treatment of insulin resistance.
And complementary medical practices, diet therapy, exercise therapy, cupping therapy, hirudotherapy, ozone therapy, acupuncture should take place in the first level health services. Respect and love
Dyt.Selma Öztürk

February 7, 2017

I am pre-diabetes. but my regular Dr is not concerned. I have a low animal fat diet with a lots of veggies and fruits, I exercise regularly more than 120 minutes a week. I am 5.4 and weight 130 pounds not over weight. Other than cholesterol, which is under control with pills, I am generally healthy. However, I am concerned about it and need to know what else I can do to control the blood sugar?

Julie Olguin Molina
February 8, 2017

Your comment about you Doctor not being concerned is fairly common.

Buy yourself a Glucometer to test your own blood sugar after meals and
start walking regularly. Insulin Resistance only responds to regular
consistent exercise for some people Be sure you have seen an Endocrinologist who can ell you that PREDIABETES IS DIABETES IN
EARLY STAGES and much can be done if you exercise consistently and
work with a Registered Dietitian to learn carbohydrate counting and you
can delay full blown diabetes for many years. Let a Hemoglobin AIC be your guide, it’s a lab test that provides you with an average blood sugar range for the last 3 months. A Registered Dietitian should also be a Certified Diabetes Educator.
(a lab test that gives you an average over the last 3 months)

February 7, 2017

The conclusion is spot on: “The consensus is that a diet rich in whole grains, vegetables, fruit, monounsaturated fat, and low in animal fat, trans fats, and simple sugars is beneficial, along with maintenance of ideal body weight and an active lifestyle.”

Very well written and helpful article!

February 6, 2017

Intermittent-FASTING as practised by our early cavemen food-gathering & animal-hunting ancestors can benefit in more ways than 1. It certainly & relatively quickly reduces diabetes-causing obesity to more beneficial levels, I have very recently myself in Malaysia found this out! (Dr. Mercola’s website for more helpful reads!) Practising Buddhist meditation withing its breathing technique can also help obesity & tends to put things in better perspective…GO FOR IT!

February 6, 2017

When my fasting blood glucose, which had been 99 for years when checked annually, was over 100 for the first time (133) I quit eating refined carbs. That got it down, but only to 117. Then I gave up nearly all carbs, which is a ketogenic diet. That was 4 years ago. My fasting glucose, without diabetic meds, is now between 75 and 100 every day, my formerly scary lipid profile looks great (despite a high fat intake) and I have lost 50 lbs and kept it off. I don’t know if this can work for everybody, but it certainly works for me. As for long-term safety, a friend of mine has been on a ketogenic diet for 15 years with no visible ill effects at all, and I know many more short-term practitioners who appear to be doing well. Of course that’s just one data point, but unfortunately there are no large bodies of data from well-designed studies out there. Nobody seems to want to finance them. But there are a books, cookbooks and support groups for ketogenic dieting. I recommend the FaceBook group called “Reversing Diabetes.” Some people report improvements in mood, energy level and blood pressure too, though those did not happen for me, but I am quite pleased to have good blood glucose, lipid and weight control without meds.

Donald Morgan
February 6, 2017

You should limit your intake of fruits that are heavy in sugar or carbs. Carbs are not for anyone who is overweight, obese, pre- diabetic or diabetic. Carbs are not a essential dietary requirement. Fats and protein are essential. Until we get this message out we will continue to have the confusion on what we should eat and we will stay sick!

Donald Morgan
February 6, 2017

Why do we continue to recommend a diet that is high in carbohydrates? Anyone that is insulin resistant, pre diabetic, type 2 diabetic should not be consuming carbohydrates! Seems like we are trying to keep people on medication. Studies show a low carb diet works well in reducing blood glucose levels as well as lowers LDL levels, raises HDL and triglyceride numbers plummet. When will we recognize this?

Renee kristol
February 6, 2017

Specifically, what ar examples of a low carb diet. I am trying to regain weight that I lost when I was diagnosed.

Thomas Braun RPh
February 6, 2017

Great summary of pre-diabetes. Why is there no mention of low Vitamin D blood value also being a predictor of Type II?
The correlation is there. Boosting vitamin D above 40 ng’s and eliminating excess sugar would go a long way in stopping the epidemic.

February 6, 2017

A doctor also recommended I try alpha lipoid acid as many patients had had good results with it. My other, regular doctor has been pleased that my blood sugar has not gotten worse over a couple of years. I generally use common sense in what I eat and have walked daily for years but I don’t eat as many vegetables as I should and I do like butter!

February 6, 2017

A low carb high (quality) fat diet combined with fasting works wonders. This is because the problem is one of insulin resistance and good quality fats such a avocado, coconut oil and olive oil don’t spark an insulin response to the extent of carbohydrates. Fasting also serves to improve insulin resistance – people have effectively reversed type 2 diabetes using these strategies – just google Dr Jason FUNG – he is the MAN…

February 6, 2017

Good advice, I have gave up any food that has sugar on it, the result is amazing. It is the new me now. I have more energy, no pain, I’m more awake and alert.

February 6, 2017

Disease creep sometimes called disease mongering is a real problem and it all starts with the belief that everyone needs a pill ;l just a matter of time.What really matters to the patient is what benefit will he accrue and at what no hard endpoint benefit is shown so exactly how many less C]] heart attacks; strokes and numerous other bad events happened in each group. How many deaths where prevented…..handing out a pill should be reserved for those who you can actually show a real benefit for eexactly where do you draw the line for prediabetes; you know many ‘good ideas’ simply where not. In these patients what where the A1c levels and how low where they reduced to.

J Tatnall
February 6, 2017

With dietetic counseling, continued exercise, and real life style food changes, I have lost nearly 100 lbs, and have across the board normal levels now. I am a believer in Michael Pollan’s advice, ” Eat food, mostly plants, not too much.” Real food, cook it yourself. Know what you’re eating.

February 6, 2017

I mix 2 table spoons of apple cider vinegar with water and drink it every night, walk for two hours(10000 steps) at least, no sugar, very low carbs to keep my blood sugar levels under 120. Simple but it works very well. Trying to keep my BMI close to 25.
George from

February 6, 2017

I’d be very interested in hearing Dr. Tello expand on what she means by “greatly limit our intake of sugar and carbs.” I know many prediabetics and Type 2 diabetics who follow very low-carb diets in order to keep their blood sugar numbers down. As a borderline prediabetic myself, I’ve found that even whole grains and fruit may cause significant blood glucose spikes, depending on how much and how they are eaten, so for me they do not necessarily get a free pass. I’d be interested to know if Dr. Tello has an opinion on how low it is safe/appropriate to go in setting how much carb (of any kind) to eat as a percentage of daily calories.

Azhar jamil
February 6, 2017

I also have a family history of diabetes. But I think prediabetes can be prevented successfully just changing one’s lifestyle, and everyone, at risk can do it easly.
After fourty’s a restricted diet, regular walk and limited sexual relationship with your life partener(if family is completed there might be no need) to live a healthy remaining life.
Diabetes is a very potent disease, it’s a change in human body just due to an age factor. We made it worst with our attitude.

March 12, 2017

What do you mean by “limited sexual relationship with your Life partner”? How can THAT help reducing one ‘s risk of developing type 2 diabetes??? By the way, physical intimacy with one’ s partner is not simply to” complete family “. There are actually many health benefits – physical and mental – of safe love making with one ‘s life partner.

January 30, 2017

I think every third person is suffering with diabetes these days due to our unhealthy lifestyle and lack off proper knowledge. Prediabetes is one of the best method to keep ourselves safe. Thanks for this wonderful resource.

Donald Morgan
February 6, 2017

They just need to drop the low fat diet. That’s what got us into trouble in the first place. To be healthy and avoid these chronic illnesses, lower the carbohydrate intake and increase physical activity. This is not a mystery, there are humans today that do not get the western diseases we do. The eat more fat, low carb and exercise more!

January 26, 2017

Very well said. I have a family history of diabetes and try to follow the lifestyle changes you recommend, but also use the dietary supplement alpha lipoic acid. It has been shown in many studies the lipoic acid improves insulin sensitivity and protects the peripheral and optic nerves from diabetes related degeneration. To get the maximum effect I use a solubilized high bioavailability product (thiogel). I’ve been taking 200 mg/day for almost 20 yrs and at 81 yrs, I don’t show any signs of Type 2 diabetes.

January 25, 2017

“And that’s why my husband and I greatly limit our intake of sugar and carbs…”

I would emphasize limiting intake of “refined carbs,” not carbs in general. Of course, some of the best foods for prediabetes, which you listed, are carbs (whole grains, vegetables, fruit).

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