Pre- Diabetes or Type Two
Diabetes can affect ANYONE, at any age



      In 2016, 241,463 New Zealanders were living with diabetes; 90% of these being type           two diabetes.  It is thought a further 1.15 million, 1 in 4, are at risk of 'pre diabetes' (at risk of developing diabetes) and a further 300,000 undiagnosed with type two. Sadly in the Western Bay of Plenty children as young as 9 are known to have type two diabetes. 

About 10% of those diagnosed with diabetes have the autoimmune condition type one diabetes, which is not related to type two or pre-diabetes. Most people who develop type one diabetes are children or youth but throughout the world it is now known that older people of any age can develop late onset type one diabetes - latent auto immune diabetes of adulthood (LADA).

Having 'pre- diabetes,' or being 'at risk of developing' type two diabetes does not always mean you will go on to actually develop type two diabetes . If lifestyle, exercise, diet and/or medication are managed effectively, there is evidence to show that onset of type two can be stopeed or delayed.  If it is not possible to delay the onset of T2, then evidence shows good management can help prevent or slow down complications associated with high sugar levels and type two. 


Pre-Diabetes

Pre-diabetes (also known as impaired fasting glucose or glucose intolerance) is the stage that occurs PRIOR to a diagnosis of type two diabetes. Pre-diabetes and type two diabetes are not related to type one diabetes although there may be similar symptoms and insulin may be used in type one and type two diabetes.

Many people are totally unaware they have developed pre-diabetes a condition that raises the risk of developing cardiovascular disease which can lead to a heart attack or stroke. Even more troubling is that these people do not seek help and are likely to develop type two diabetes in 5-10 years. It's essential to take steps to manage this condition because pre-diabetes is reversible, but type two diabetes is not. 

Like diabetes, pre-diabetes occurs when the bodies response to insulin is impaired, a condition called insulin resistence. Levels of blood glucose are higher than normal which indicates the body is failing to process glucose into energy properly. Despite this, levels are still not high enough to indicate type two diabetes.  

For many (but not all), type two diabetes can be prevented from developing by choosing healthy food choices, increasing physical activity/movement, stopping smoking/recreational drugs, a full cardio-vascular risk assessment and other lifestyle factors, in discussion with your regular health care professional. Testing should be repeated after 3-6 months to assess if pre-diabetes has improved. Some GP's prefer to test 12 monthly. 

How do I know if I have Pre-diabetes?

Unfortunately, pre-diabetes doesn't usually have any warning signs. Some people may experience similar symptoms to type two diabetes when pre-diabetes worsens. 

We do know that the risk factors for pre-diabetes are the same as those in type two diabetes; checking your risk factors (below) is a good way of understanding if you are likely to develop pre-diabetes. 


What is a HbA1c ?

In New Zealand, the HbA1c is a blood test usually ordered by your GP or Nurse that gives an average of all your blood glucose levels over the preceeding 8-12 weeks. As an average however, it does not calculate individual high or low readings. Self blood glucose monitoring is a good way to fill in the gaps that a HbA1c may miss. 

A HbA1c less than 40mmol/mol ( ≤40 mmol/mol, or fasting plasma glucose of <6.0mmol/mol) indicates no diabetes or pre-diabetes and normal cardiovascular risk. 

A HbA1c of 41 - 49 mmol/mol and/or fasting plasma glucose ≥7.0 mmol/L or Random plasma glucose ≥11.1 mmol/L) can indicate pre-diabetes or being at risk of developing type two diabetes

A HbA1c of 50 mmol/mol indicates a diagnosis of type two diabetes

A HbA1c of 50-55 mmol/mol would be a great place to 'sit' should you have type two diabetes and be unable to improve your control. Whilst having your HbA1c's in this range may reduce your risk of future complications, or slow down any complications you may already have developed, you are encouraged to aim for less than 50 mmol/mol where possible and where safe. 

When HbA1c (& other tests) are unclear about a diagnosis, tests should be repeated.

How often should I repeat the HbA1c? 

We encourage those with pre-diabetes and type two diabetes to discuss having regular (3-6 monthly) HbA1c's with your usual healthcare provider as a way of monitoring your condition.  As HbA1c blood tests rely on a 120 day cycle of red blood cells there is no added value in having these tests more often than 3 monthly. 

Ref: https://www.health.govt.nz/system/files/documents/publications/nz-primary-care-handbook-2012.pdf

Are you at risk of developing pre-diabetes or type two diabetes?

If you agree with one or more of the following statements you have a higher risk of developing pre-diabetes; discuss your concerns with your usual healthcare provider:

  • I am Chinese, Maori, Pacific Island, Indian sub-continent or Asian
  • I am a child or young adult with a BMI ≥ 30 kgm-2 or ≥27 kg m-2 in Indo-Asian) and/or family history of early       onset type 2 diabetes in two or more first degree relatives (parents or siblings).
  • I am male over 45 years of age, or female over 55
  • I have a family history of type two diabetes
  • I am an adult on long term steroid or antipsychotic treatment
  • I have had diabetes in a previous pregnancy and/or had large babies (more than 4.5kg)  
  • I am overweight or have a waist measurement over 90cm for women or 100cm for men  
  • I have circulation problems, high blood pressure, heart disease, high cholesterol (triglycerides) or low good cholesterol
  • I am a smoker  
  • I have polycystic Ovary Syndrome (PCOS)  
  • I don't exercise regularly or do much physical activity  
  • I am overweight, particularly around my middle

If you have answered YES to any ONE OR MORE of the above risk factors,it is important to see your Doctor or nurse to have a simple blood test to screen for & detect diabetes.  If you do not have any of these risk factors then you should undertake a cardiovascular risk assessment with your GP at ages 35 (Male Maori), 45 (Other males & Maori female) or 55 (all other woman) or if you suspect you may be unwell or your risk factors may change. 



How do I reduce my pre-diabetes risk?

Whilst you cannot change certain things like your genes or your age, you can make some changes towards reducing your risk of pre-diabetes or type two diabetes. In  Finland (Finish Diabetes Prevention Study 2003) a study showed that people with pre-diabetes who made healthy lifestyle changes could lower their diabetes risk by up to 58%. The study also showed that lifestyle intervention was twice as effective as medication. If you do not have pre-diabetes but may be at risk then the same lifestyle interventions are likely to prevent you from developing the condition.

Move More Often
Exercising regularly at moderate intensity can reduce the risk of type two diabetes. Snackitivity ie small amounts of excerise repeated several times a day has also been proven to improve health. Walking briskly for at least 2.5 hours per week can lower the chance of developing diabetes by up to 30% in both male and female and independent of weight.

Sit Less Often
Find ways to get up out of your chair, or from your desk. Even standing at a desk to work has been shown to improve health. Interrupt sitting for a minute every 30 mins improving insulin sensitivity and glucose tolerance. Making small changes can make a big differnece

Quit Smoking
Smoking increases the risk of heart disease and cancer but can also increase your risk of pre-diabetes.  Smokers are more insulin resistant and 20 smokes a day can double your diabetes risk

Sleep
Several studies have shown that insufficient sleep worsens insulin resistance. Sleeping less than 5-6 hours a night can raise your risk of diabetes whereas getting 8-9 hours per night can improve health. 

Maintain a healthy body weight
Eating a balanced diet is important to reduce your risk. The kind of food you eat is also important. Fight weight gain by eating a diet that is low in total kilojoules and total fat, especially saturated fat. Match the food you eat with the amount of energy you expend. Fill up on veggies, salad, high fibre wholegrain bread, rice and pasta. Limit cakes, biscuits, chips, lollie and soft drinks

Eat like you live in the Med
Eating a diet high in veggies, omega 3 (fish, tuna, salmon), whole grains, nuts and olive oil (extra virgin, cold pressed) but low in red meat, dairy foods and processed foods is likely to reduce your risk of diabetes and pre-diabetes. Watching total carbohydrate intake has also been proved to be helpful where there are high glucose levels.

Cut the Fat
Avoid processed meats such as corned beef, bacon, salami, sausages which tend to be high in saturated fat and salt and are linked to heart disease and diabetes. Include plant proteins such as chickpeas, lentils and tofu instead of meat

Base your meals around leafy greens and veggies
Ensure they make up at least half of your plate. Eating lots of stir-frys and veggie curries is a good way to keep healthy. Make sure most of your shopping trolley is filled with fresh fruit, veggies and salad

Snack on Protein foods
Such as boiled eggs, tuna, salad, raw unsalted mixed nuts, veggie sticks and hummus or low fat unsweetened yoghurt with a dessert spoon of blueberries

Click here for more information about Living with Type 1 Diabetes

Click here for more information about Living with Type 2 Diabetes

Click here for more information about Healthy Eating

Click here for details about complications in type one diabetes and type two diabetes

Click here for details about kidney disease and diabetes

Click here for information about diabetes and burnout