Almost 40 percent of Americans are walking on a treacherous health tightrope right now: They have prediabetes, blood sugar levels that are higher than normal, increasing their chances of developing full-blown diabetes. Many of them have no clue about the threat they may face and feel perfectly fine. This condition has no outward symptoms, so you wouldn't run to the doctor to see what's up. And even if you do get tested, you might not think a condition that starts with "pre-" is anything to worry about, especially if your doctor doesn't sound concerned. "People can be at risk for diabetes without being told this directly," says Stuart Weiss, MD, an endocrinologist at NYU Langone Medical Center. Instead, a doctor may say you have "a touch of sugar" or "impaired glucose tolerance" or that you're in "the gray area."
But prediabetes should be taken as a wake-up call to tackle healthy changes that can make all the difference. Sooner is better than later: The condition gives you a 15 percent to 30 percent chance of developing type 2 diabetes within the next five years. If that happens, suddenly you're at higher risk for heart disease, stroke, blindness, kidney failure, and even amputation. This "almost" stage is worrisome for other reasons: Prediabetes could push up your risk of Alzheimer's and certain cancers — breast, liver, stomach, pancreas — by 15 percent. You can do something about it, though. "Blood sugar is a continuous variable that goes from totally normal to totally diabetic with many stops along the way," says Alan Garber, MD, PhD, a professor of medicine at Baylor College of Medicine in Houston and president of the American College of Endocrinology. "The earlier you make lifestyle changes, the sooner you can slow — even reverse — the progression."
Swear you're so healthy that prediabetes couldn't happen to you? That's what the women in this story thought too. Discover the sneaky factors that can put you at risk — and find out how to ratchet the threat level down a notch, or take it all the way back to normal.
Stealth Risk #1: You work out a couple of times a week, but that's it for exercise
A weekly yoga class and weekend hike may keep your outside looking good, but you could be fooling yourself about what's going on inside. "Most people are in denial about how sedentary they are," Garber says, and exercising fewer than three times a week puts you at risk for prediabetes, according to the American Diabetes Association (ADA). The reason: Physical activity helps combat the insulin resistance that can lead to diabetes.
Take action Get at least 30 minutes (60 if you're trying to lose weight) of moderate aerobic activity like brisk walking five days a week, the ADA recommends. Also squeeze in two sessions of resistance training a week — it can be as simple as doing a few exercises that work against gravity and/or your body weight (like planks, lunges, and squats). This can lower blood sugar and keep insulin functioning better.
Stealth Risk #2: Your periods are wonky
An erratic menstrual cycle, especially if your period goes missing for months at a time, is one important clue you could have polycystic ovary syndrome (PCOS), a hormonal endocrine disorder that's intertwined with diabetes, Garber says. Studies show that around 40 percent of women between ages 20 and 50 who have glucose intolerance or diabetes also have PCOS.
Take action Look out for the oddball group of symptoms that may signal PCOS: missed periods, hair growth on the chin or belly, hair loss from the scalp, acne, infertility, and miscarriage. If you suspect you have the hormonal disorder, tell your ob-gyn about your symptoms and ask her to test your testosterone and glucose levels. Got the diagnosis? Your doctor might prescribe oral contraceptives to help regulate the hormones that control your periods plus another type of prescription pill that acts on insulin. It's important to stay consistent with your healthy eating and exercise habits to help with PCOS and the diabetes risk that comes with it.
Stealth Risk #3: You have a belly pooch
Extra belly fat puts you at huge risk for prediabetes — even if the number on your scale reads as healthy. Fat deep in your abdomen is broken down into tiny molecules called free fatty acids. These get unleashed into your blood, clog up your liver, and cause a chain reaction that eventually prevents your tissues from being able to take in the blood sugar they need, says Sherita Hill Golden, MD, a professor of endocrinology, diabetes, and metabolism at Johns Hopkins University School of Medicine.
Take action: Don't stress: "If you're prone to gaining weight around your middle, that's the same place you're going to lose it," says David Katz, MD, director of the Yale-Griffin Prevention Research Center. To blast belly fat, ramp up your exercise as mentioned above and clean up your diet: Cut back on foods that are absorbed into your bloodstream rapidly — think refined carbs and foods with added sugars (that includes cookies, doughnuts, and white-flour crackers and breads); get more fiber, especially the soluble kind found in berries, apples, and whole grains like barley and oats; and for fat, rely on the healthy, monounsaturated kind (nuts, seeds, walnuts, almonds, avocado, and olive oil). "These foods, especially monounsaturated fats, are associated with better insulin levels and less deposition of fat around your middle," Katz says.
Stealth Risk #4: Your baby weighed more than 9 pounds
Big babies are a telltale sign of gestational diabetes (GD), in which a mother has high blood sugar during pregnancy. "When a pregnant woman becomes insulin resistant, the fetus makes more insulin in its pancreas to try to keep its own glucose normal," Golden says. "Since insulin is a growth factor hormone, it makes the baby grow bigger." Doctors used to think that GD was temporary, just a reaction to a hormone produced by the placenta, but they now know that about half of women who have had GD will develop type 2 diabetes in the next five to 10 years and continue to be at higher risk decades after pregnancy.
Take action: If you've been diagnosed with GD or given birth to a big baby, it's important to get your glucose levels checked annually — and commit to losing the baby weight and keeping it off.
Stealth Risk #5: You have a sweeter tooth than you realize
You may think you've cleaned the empty calories out of your diet — maybe you've scratched your morning muffin and afternoon candy habits. But you still might be getting more sugar in your diet than you think, because it's not just in obviously sweet treats.
While eating too much sugar in and of itself doesn't cause prediabetes, it gets in the way of a healthy diet that keeps you lean and fit and minimizes your risk, Katz says. And if you already have prediabetes, dumping mounds of sugar into your system makes your pancreas go into overdrive in an effort to produce enough insulin to get it all into your cells. Eventually, the pancreas becomes exhausted from the persistent fire drills, and it can't produce enough to keep you healthy. So it's a smart move on many levels to curb the sweet stuff.
Take action: Check that you're not getting more sugar than you bargained for: Even a healthy diet could harbor more quick- digesting, empty calories than you think. "People don't know that they need to be as careful in the marinara sauce aisle as in the cookie aisle," Katz says. "Pasta sauces can have more added sugar than ice cream toppings, and some salad dressings are essentially liquid candy you're pouring over your lettuce."
Stealth Risk #6: You focus on one cholesterol number and forget about the others
Just because your "bad" cholesterol number — LDL — is healthy (lower than 100 mg/dL), don't ignore the rest of the numbers from your blood work. Watch out for low levels of "good" HDL cholesterol (35 mg/dL or lower) and high levels of fats called triglycerides (250 mg/dL or higher). Both numbers are associated with prediabetes.
Take action: Using the diet and exercise strategies recommended by the experts in this story can improve blood fats and slash diabetes risk by 58 percent, according to a large study by the Centers for Disease Control. They should also help control blood pressure, essential since high levels can elevate diabetes risk.
Stealth Risk #7: Your sleep is messed up
Regularly sleeping too little (fewer than five hours) or too much (more than nine hours) increases the risk for diabetes, research shows. "When your sleep pattern is impaired, your circadian rhythms and natural patterns of hormones are disrupted," Katz explains. "The levels of the stress hormone cortisol go up. This makes your body rebuff insulin, and you have to compensate by making more." Plus, when you're tired, you tend to be less thoughtful about food choices and it can be harder to get motivated to exercise.
Take action: Shut-eye matters! In order to get your seven to eight hours, be careful with slumber-busters like alcohol and late-in- the-day coffee, and turn off any electronics an hour before bedtime; the light they emit prevents your body from making its usual, healthy hormonal sleep preparations.
If you have any of these sneaky risk factors, check in with your doctor to see if you should get your blood sugar tested, especially if you haven't had it done in a while (or ever). And don't brush off results that show you're "a little on the high side." Small changes now can set you up for big benefits later.