[HealthyChocolat]

Hi,

I've gotten one helpful response, and just realized that it didn't answer my question.

My sister's doctor told her that pre-diabetes is reversible. Is that true, what others have been told?

Thanks

[xMenace]

What is pre-D? Many of us don't believe in the concept. IMO either you are diabetic or you are not. Higher than normal BGs means you are diabetic no matter how you control it. There is a degree component to it. For some reason we call people with a small degree of diabetes pre-D's. If you reduce the things that raise your BGs such as a poor diet, lack of exercise, and too much weight then yes, you will lower your BGs. If, however, you revert back to these things and probably even if you don't, your BGs will creep back up. If you've ever been diagnosed as D or pre-D, you should continue regular testing to monitor changes.

[HealthyChocolat]

Originally Posted by xMenace

What is pre-D? Many of us don't believe in the concept. IMO either you are diabetic or you are not. Higher than normal BGs means you are diabetic no matter how you control it. There is a degree component to it. For some reason we call people with a small degree of diabetes pre-D's. If you reduce the things that raise your BGs such as a poor diet, lack of exercise, and too much weight then yes, you will lower your BGs. If, however, you revert back to these things and probably even if you don't, your BGs will creep back up. If you've ever been diagnosed as D or pre-D, you should continue regular testing to monitor changes.

Hello,

Your response upset me. I actually called my doctor, and he answered! He's a wonderful, caring, board certified internist. I copied down what he said, which is that "pre-diabetes has been accepted by the entire medical community, and is defined by the American Diabetes Association in terms of fasting blood sugars and the response to a measured dose of sugar."

He also emphasized that pre-d IS reversible by diet and exercise..."up to the point that the insulin-producing cells in the pancreas are exhausted." And even then, he said, you can still improve your health and prevent bad complications by diet, weight loss, and excercise.

He also told me to calm down. Said I sounded very nervous, and that that wouldn't help. I guess we are lucky. They don't make many doctors like that anymore.

[MJB]

Hmmm....I have no medical training but I'll throw in my 2 cents anyway.

Type 2 diabetes does not happen overnight. Increasing insulin resistance causes increasing glucose levels which cause increasing insulin production which wears down a pancreas.

Not long ago a fasting level of 140 mg/dl was considered an indication of diabetes and now it's 126. In ten years will it be 110?

I don't have the answers but living healthy is good for you no matter what!

[LoDeSp]

Originally Posted by HealthyChocolat

Hello,
He also emphasized that pre-d IS reversible by diet and exercise..."up to the point that the insulin-producing cells in the pancreas are exhausted." And even then, he said, you can still improve your health and prevent bad complications by diet, weight loss, and excercise.

I think what he means is that the symptoms of diabetes (in particular, high blood sugar, A1C > 6.0) are reversible, but the disease itself is not. Saying "diabetes is reversible" to me implies that I can take some steps that will bring me back to the point that I can eat a plate full of pancakes smothered with apple compote and maple syrup and not worry about my blood sugar rising above 100 (as my wife can do). I don't believe that this is possible. On the other hand, I can learn what foods I can eat that will keep my blood sugars from rising too high (steak & broccoli, e.g.). I can control my diabetes by eating better and exercising more. And you can too. I think this is his point. So if you replace "reversible" by "controllable" in his statement, I agree. You can control pre-diabetes through diet and exercise alone. You may not need medication.

He also told me to calm down. Said I sounded very nervous, and that that wouldn't help. I guess we are lucky. They don't make many doctors like that anymore.

He's right about the calming down. You're in relatively good shape: you don't have full blown diabetes yet, and most importantly -- you want to improve your health and control your condition. You would be surprised to learn how many people don't want to control their (pre-) diabetes. Two people in my immediate family are this way. They simply don't want to change to improve their health. So you should be fine for many years if you make the effort to be.

[JediSkipdogg]

Originally Posted by HealthyChocolat

Hello,

Your response upset me. I actually called my doctor, and he answered! He's a wonderful, caring, board certified internist. I copied down what he said, which is that "pre-diabetes has been accepted by the entire medical community, and is defined by the American Diabetes Association in terms of fasting blood sugars and the response to a measured dose of sugar."

So is there pre-cancer then? How about pre-kidney failure? Or....pre-amputation? The answer to all of those should be no. That is why pre-diabetes is not widely accepted. Pre-Diabetes is generally just a term given to those with early symptons of diabetes, however, they will be a diabetic no matter what. It would be like saying someone with a greater risk of breast cancer due to family genetics is pre-cancerous.

Originally Posted by HealthyChocolat

He also emphasized that pre-d IS reversible by diet and exercise..."up to the point that the insulin-producing cells in the pancreas are exhausted." And even then, he said, you can still improve your health and prevent bad complications by diet, weight loss, and excercise.

If you are using any treatment methods what-so-ever you are not reversing the disease, you are treating it. Eating less and exercising more are treatment methods. Like LoDeSp stated, reversing would mean one could eat a plateful of pancakes covered in syrup, do nothing after eating it, and their BG level wouldn't rise a bit. That's ludacrous and not possible.

If one is trying to prevent or control something by excercise, diet, or any medication, they have whatever disease that is, in this case diabetes.

[sweetblood]

yeah...i'd have to say pre-diabetes is a early diabetes imo...i have alot of the symptome od diabetes--sleepiness after any meal, fatigue, mood swings even hypos which r now a daily thing.. etc...i do NOT eat lo carb, ive tried that and i lost too much wt and felt DEPRIVED...majorly deprived

[shockme]

i also wonder about the validity of a "pre D" dx. i was dx'd pre D 9-07. in 11-07 i already had MEGA glucose in my urine. in 12-07 my fbs done at a hospital was 240. how could i have progressed that quickly? luckily,i was dx'd type 2 in jan. of this year....trish

[matingara]

this whole diabetes "classification" thing annoys me a bit. i think it is needlessly confusing.

saying that someone is "pre-diabetic" is equivalent to saying that anyone who is currently living is "pre-death".

i do not regard diabetes as a disease.

i regard it as a "trait".

it is analogous to a number of things. bear with me here.

as an example of what i mean. a very, very fair skinned person is much more sensitive to exposure to sunlight than a person with a dark/mediterranean/latin complexion. this very fair skinned person, if overexposed to mega doses of sunlight will get very, very sunburnt. they may get very sick or die of sunstroke.

the person who has a diabetic "trait" has the same problem with glucose in the blood as the fair skinned person does with sunlight.

a person's predeliction with tolerance/control of glucose is, however, not (necessarily) as outwardly recognizable as is the very fair skinned person.

in the case of people who have diabetes from a young age it is as if they are born with this fair skin. for those that develop the diabetic "trait" over time it is as if their tolerance of sunlight becomes diminished by over exposure to the sun over many years.

for the diabetic, the sun is glucose (or more correctly carbohydrates).

in my case, i have over-exposed myself to carbohydrates over the last 20 years. i am not fat or overweight. but i followed a very low fat, high carb diet (cos the *bleep* experts told me to). i have managed to burn out alot of my pancreatic beta cells by "soaking" them in carbohydrates (my opinion).

by reducing my carbs, i am "quiescing" my pancreas. this keeps my BGL low and with a bit of luck it will help my pancreas regain some of its potency.

therefore, please do not be scared that your sister has been tainted with the diabetic "disease" label. instead, think of it as if she has a "trait" like fair skin - or blue eyes.

the good news is that she (and you) can "avoid the sun" as the fair skinned person has been trained to do all her life. the difference is that you discovered what you need to do (and what you need to avoid) later in life than the person born with very fair skin.

hope this rant helps put things into some sort of perspective.

then again, this might just be my "crackpot" way of viewing the whole deal.

peace,

-- Joel.

[sweetblood]

great analogy, matingara!! i see your point.

[REDLAN]

I think the confusion arises because of diagnostic criteria, and the principle of the radar operator curve.

this may sound complicated but essentially when you are tested for a disease they actually measure a symptom of that disease and not the disease itself.

So for diabetes you go in and they measure your fasting blood sugar, or the rate at which your blood sugar returns to normal after a sugary drink - high blood sugar is only a symptom of the underlying disease.

Now if you went out and measured the fasting blood sugar of a healthy population, what you would find is a fairly wide range of blood sugars, and all these blood sugars would be normal for the people tested. Some of these people's blood sugars would reach the cut off considered abnormal, and so would be diagnosed with the condition.

they would in the nomenclature be known as a False Positive - that is they have been falsely diagnosed with the disease, in this case diabetes.

and here's the crux....

the closer we set the cut off to the average BG level, then the more False Positives our test will catch.

the reason why WHO set the fasting Blood sugar at 7.1 mmol or greater is because it has a low false positive rate (yes you did read this right - some people with fasting BG's above 7.0 mmol do not have diabetes). Set at this level it's very useful as a screening tool for diabetes - nearly everyone it identifies will have diabetes, and only a few won't.

the problem comes when we set the threshold lower - say choose what is known as impaired fasting Blood glucose, which is set by WHO at 6.0 mmol - and from this we can make a diagnosis of pre-diabetes.

we are going to catch more people in the net, but we are also going to catch many more false positives...

so in answer to your question, it's not that pre-diabetes is reversible - the metabolic condition that eventually leads to diabetes - it's more likely that a proportion of the people picked up by the test do not have diabetes at all. What they have is a high normal blood sugar - these people will never go on to develop diabetes.

this reasoning applies especially to the oral glucose tolerance tests - which has a much higher false positive rate than FBG.

[sbuff28@charter]

the way i see it.

Type 2 is dependent on your diet, health choices, and other things. yes it is reversable to some degree.

Type 1 not dependent on environment and health, therefore juvenile diabetes is not reverseable to any degree.

everyone has a measurable degree of insulin resistance. Most people simply have enough insulin production to cover the resistance and don't have hypoglycemia problems.

Look at type 1s. They have NO Insulin production and they vary in insulin needs dramatically. it ranges from 30 units per day for some people to over 100 units for others. The people who need 100 units a day have more insulin resistance, while the people who only need 30 units are fit, healthy, and run like crazy.

Its a simple function for type 2 diabetes. Insulin production must be more than insulin resistance, and yes you can do things to lower your resistance to insulin. If you are under 20 years old and have Type one, your screwed. period, it isn't reversible because you have ZERO production of insulin.

[shiftzor]

Originally Posted by matingara

this whole diabetes "classification" thing annoys me a bit. i think it is needlessly confusing.

saying that someone is "pre-diabetic" is equivalent to saying that anyone who is currently living is "pre-death".

i do not regard diabetes as a disease.

i regard it as a "trait".

it is analogous to a number of things. bear with me here.

as an example of what i mean. a very, very fair skinned person is much more sensitive to exposure to sunlight than a person with a dark/mediterranean/latin complexion. this very fair skinned person, if overexposed to mega doses of sunlight will get very, very sunburnt. they may get very sick or die of sunstroke.

the person who has a diabetic "trait" has the same problem with glucose in the blood as the fair skinned person does with sunlight.

a person's predeliction with tolerance/control of glucose is, however, not (necessarily) as outwardly recognizable as is the very fair skinned person.

in the case of people who have diabetes from a young age it is as if they are born with this fair skin. for those that develop the diabetic "trait" over time it is as if their tolerance of sunlight becomes diminished by over exposure to the sun over many years.

for the diabetic, the sun is glucose (or more correctly carbohydrates).

in my case, i have over-exposed myself to carbohydrates over the last 20 years. i am not fat or overweight. but i followed a very low fat, high carb diet (cos the *bleep* experts told me to). i have managed to burn out alot of my pancreatic beta cells by "soaking" them in carbohydrates (my opinion).

by reducing my carbs, i am "quiescing" my pancreas. this keeps my BGL low and with a bit of luck it will help my pancreas regain some of its potency.

therefore, please do not be scared that your sister has been tainted with the diabetic "disease" label. instead, think of it as if she has a "trait" like fair skin - or blue eyes.

the good news is that she (and you) can "avoid the sun" as the fair skinned person has been trained to do all her life. the difference is that you discovered what you need to do (and what you need to avoid) later in life than the person born with very fair skin.

hope this rant helps put things into some sort of perspective.

then again, this might just be my "crackpot" way of viewing the whole deal.

peace,

-- Joel.

I agree with some of what you are saying, however i totally disagree that diabetes is not a disease. What you are missing is that fair skin is a reaction to UV, your skin keeps working and recovers after being burnt, yes it is more susceptible to burning but that doesn’t mean it can’t recover. Diabetes you cannot recover from, the causes are genetic "traits" and yes life style can have a big impact on types 2.

I think no matter how you put it, it’s very easy to not accept diabetes and refuse to deal with it. i understand your upset, you have every right to be upset and when everyone on this forum found out they where diabetic they were very upset as well. It just takes time to come to terms with it and its not all bad, if it makes you change your life style eg eat healthier and live for the minute then in my opinion that can be a positive side effect.

[Ronin]

Hi HealthyChocolat!

I see that you are not the person with the diagnosis, but you share the concern about the "D-Word." The advice to "calm down" is well placed. It is too easy to panic. It is also easy to get confused over the whole Pre-Diabetic diagnosis.

There is a lot of controversy in the diabetic community and amongst physicians and other medical professionals about this diagnosis. My personal research says that this particular diagnosis was adpoted with the hope to catch potential Type-2 people before they sucumbed to full-blown diabetes. To that extent the condition is "reversable" but reversable only in the way that alcoholism is "reversible" only if you stop drinking alcohol forever.

A diagnosis of Pre-Diabetes is the warning that something is going wrong with the control of glucose in the blood stream. That being said a high FBG (Fasting Blood Gulcose) level is the first step in the diagnosis. A second high FBG to confirm the first should then be followed by an HbA1c test to determine the weighted average BG levels for the past 90 days. If this is over 6 then it is likely that the person is developing diabetes and an OGTT (Oral Glucose Tolerance Test) with C-Peptide readings should be done to validate the HbA1c test. The C-Peptide test as part of the OGTT is essential to avoid mis-diagnosing a person who is actually developing Type-1.5 (a failing pancreas) as a Type-2 because the treatment regimine is totally differnt. A person who has a low C-Peptide reading (heading towards Type-1.5) will respond well to insulin therapy while a person with a high C-Peptide reading (Insuling resistant heading towards Type-2) will not and needs a different course of treatment.

Yes, this is all a bit confusing and overwhelming. To put it simply, your sisters doctor is taking the appropriate course of action with modifications to diet and exercise (which have to be translated into a permanent lifestyle change) along with on-going monitoring. As I said before the ability to reverse Pre-Diabetes is like an alcoholic reversing alcoholism -- they can never go back to being "social drinkers" only recovering alcoholics. That is the good, and the bad news. The diagnosis is a wake-up-call that you need to heed.

FWIW: I have already determined that my Pre-D diagnosis, because of my low C-Peptide reading, says that my Pancreas is headed towards self destruction. However, with diet and exercise I hope to keep it working for a very long time.

[irishrncde]

I have pre-diabetes. I am also an RN/CDE. What I teach is that pre-diabetes is when your fasting sugars are in the 100-125 range. 10 years ago we would said that people with pre-diabetes will develop diabetes The (Diabetes Prevention Program) DPP showed us that with just moderate exercise and weight loss, a person can delay and possibly avoid developing diabetes. We just keep learning. The problem with the Pre-DM range is that they are already seeing some complications,specifically neuropathy and retinopathy in that range, so I'm sure we will keep seeing the numbers go down.
Sheila