Prediabetes & Diabetes: The Link to Metabolic Health

We did a deep dive on the connection between diabetes, prediabetes, and metabolic health with Calibrate clinician, Lisa Kisling Thompson, DO, MPH. 

Dr. Thompson is a board-certified preventive and lifestyle medicine specialist. She received her medical degree from Kansas City University of Medicine and Biosciences, and completed a fellowship in Obesity Medicine at the University of Colorado. Her clinical and research work focus on leveraging evidence-based approaches to sustainably prevent and reverse chronic disease.

Read on to learn more about diabetes, metabolism, and how Calibrate can help improve your metabolic health, with Dr. Thompson. 

What is diabetes? 

Diabetes is a group of diseases in which the body can’t adequately control blood sugar. There are two types of diabetes, called Type 1 and Type 2. Type 2 diabetes is the most common form, while Type 1 is a rarer autoimmune disorder usually diagnosed in childhood or early adulthood. 

What is the connection between diabetes and blood sugar metabolism?

When we eat food, our bodies break it down into a form of sugar called glucose, which circulates in our blood. Our cells use glucose as fuel. For glucose to enter cells, it needs the help of a hormone called insulin. You can think of insulin as the key that unlocks the door on our cells to let glucose enter.

In patients with Type 1 diabetes, their bodies essentially can’t make insulin. In patients with Type 2 diabetes, their cells have changed the locks, so insulin doesn’t work as a key to allow glucose in anymore. This is called “insulin resistance.” Prediabetes is a precursor to Type 2 diabetes, when a patient’s cells start showing insulin resistance. 

Both types of diabetes cause elevated glucose, or sugar, in the bloodstream. If not controlled, high blood sugar levels can cause damage to our eyes, kidneys, nerves, and more. In fact, people with Type 2 diabetes are twice as likely to die due to cardiovascular disease (heart attack or stroke) than people without diabetes. This makes early detection and good management of diabetes critical. 

Who has diabetes? 

Nearly half of all Americans struggle with some form of diabetes, according to 2020 data from the Centers for Disease Control and Prevention. 10.5% of Americans live with Type 2 diabetes, while an additional 35% have prediabetes. In the U.S., people of color are more likely to have diabetes than white people, with a 77% higher risk among Black Americans, a 66% higher risk for Latinos/Hispanics, and an 18% higher risk among Asian Americans.

Globally, 422 million people had been diagnosed with Type 2 diabetes by 2014, an increase of 300 million since 1980 according to the World Health Organization. 

How is diabetes diagnosed? 

In its early stages, diabetes may have no symptoms, so regular screenings are essential for prompt detection. Simple blood tests can reveal blood sugar levels. The most commonly used test looks at hemoglobin a1c, but fasting blood sugar levels and oral glucose tolerance tests can also be used for diagnosis. 

Checking insulin levels can help evaluate your risk for developing diabetes or prediabetes. Fasting blood insulin levels can be used to diagnose insulin resistance, a common sign that you could be on the way to developing diabetes or prediabetes.

The American Diabetes Association recommends all adults receive diabetes screenings regularly starting at age 45. For people who are overweight or obese with a Body Mass Index above 25, the United States Preventive Services Taskforce advises screenings starting at age 35.

What are typical diabetes symptoms?

Again, it’s possible to live with diabetes and prediabetes for a long time without ever noticing symptoms. For those who do experience diabetes symptoms, they can include: 

• Thirst
• Frequent need to urinate
• Increased appetite
• Low energy
• Blurry vision
• Unintentional weight changes
• Slower healing of wounds and bruises
• Tingling, pain or loss of feeling in hands and feet (neuropathy)
• Skin darkening in armpits and neck
• Increased susceptibility to infections, such as in the gums, urinary tract or skin
• Dry mouth
• Dry or itchy skin
• Erectile dysfunction in men

Diabetic ketoacidosis, or DKA, is a medical emergency that can be caused by uncontrolled diabetes. Its signs include sweet, fruity breath odor, sweating, labored breathing and vomiting. DKA can be fatal, so it requires immediate treatment. 

What do a1c levels mean? 

A hemoglobin a1c blood test gives an average measure of blood sugar levels over the past three or so months. This offers a better indication of how our bodies are managing blood sugar than a fasting glucose level, which captures just one point in time. A normal a1c level is 5.6 or below. A1c levels from 5.7 to 6.4 indicate prediabetes, while diabetes is diagnosed for an a1c level of 6.5 or above.

If you have diabetes, you and your physician will determine a “goal a1c” which can vary from person to person. Typically the goal a1c will be about 7.

What causes diabetes and why is it so widespread? 

Like many diseases, diabetes is caused by a mix of factors, some controllable and others less so. Genes and family history play a role, as well as our environment. That includes both the environment we live in now, and the ones we were born and raised in. Age is a factor, with diabetes risk increasing as we get older. So is overall health. Women who have had gestational diabetes during pregnancy and people with hypertension (high blood pressure) are more likely to develop diabetes. Lifestyle factors like diet and physical activity levels also play a role. In fact, studies show that 7% of diabetes cases worldwide (that’s almost 30 million) could be avoided just by increasing physical activity levels. 

Being overweight or obese is another important diabetes risk factor, especially if we carry our excess weight primarily in our abdomen (this is called “visceral fat”). Studies show that up to half of Type 2 diabetes diagnoses are likely attributable to obesity, and people with obesity are 7-12 times as likely to develop diabetes than people with a normal weight. 

The Centers for Disease Control and Prevention offers guidelines for assessing whether excess weight around your abdomen may indicate a higher risk of illness, including diabetes: 

• For men, if your waist circumference is more than 40 inches
• For women, if your waist circumference is more than 35 inches (assuming you’re not pregnant) 

Research has suggested that more specific guidelines may be needed to account for differences by ethnicity. According to these standards, the threshold waist circumference for potentially elevated diabetes risk in white men is 39 inches. For Asian men and white women, it is 33.5 inches and for Asian women it is 31.5 inches. 

To accurately measure your waist circumference, stand up straight and use a tape measure. Place it just above your hip bones and keep it horizontal all the way around you. Hold it snug but don’t squeeze the skin. Take the measurement right after you exhale. 

Keep in mind that waist circumference alone doesn’t mean you will develop diabetes. These guidelines offer a signal that it’s worth checking with a healthcare provider to discuss your diabetes risk and get any needed screenings. 

How can weight loss improve outcomes for people with diabetes or at risk for it? 

Weight loss can go a long way toward improving outcomes for people with diabetes and prediabetes, and it can reduce the likelihood of developing these conditions. Losing weight can reduce a1c levels, improve our bodies’ glucose control capability and for some people may reverse a diabetes diagnosis completely. 

Research shows that moderate weight loss can make a big difference. Reducing body weight by 5-7% through diet and exercise has been shown to reduce diabetes risk by 58-71%, according to data from the National Diabetes Prevention Program. 

For people already diagnosed with diabetes, healthy weight management is essential to help manage blood sugar levels and reduce long-term injury to important organs such as the kidneys, eyes, and heart. In many cases, weight-loss related improvements in blood sugar control can reduce the number and dosages of medications needed to manage diabetes. Some people can come off medications entirely or may see their diabetes diagnosis reversed. 

What healthy lifestyle habits do you recommend?  

Whether you are trying to reduce your risk for diabetes or manage or reverse a diagnosis, these tips can help:  

• Get regular medical checkups. Whether you have diabetes or not, regular health screenings can catch problems earlier, making health conditions more manageable.
• Exercise regularly. Get at least 150 minutes, or 2.5 hours, of exercise per week (within the Calibrate program we help you work toward this). That can be broken up into shorter periods. For example, five minutes of walking after two meals each day adds up to 30 minutes each weekday. Dancing, mowing the lawn, hiking, and many other activities all count as exercise.
• Center your diet on whole foods. This means those closer to their natural state (for example a whole apple, rather than applesauce or apple juice). Reduce how much processed food you eat. Try to consume a variety of whole grains, legumes, nuts, fruits, and vegetables. 
• Limit refined carbohydrates in your diet. At Calibrate, we call these “fast digesting carbohydrates” and they include foods like  white rice, white flour, white sugar, and potatoes. Reducing the amount of fast digesting carbohydrates you eat will help stabilize your blood glucose and insulin levels. 

For more information on nutrition for diabetes prevention, the American Diabetes Association’s Recipes & Nutrition page is a great resource. 

What are some common myths about diabetes?

Every health condition is accompanied by myths and misunderstanding, and this is certainly the case with diabetes. One widespread myth is that you have to be overweight to develop Type 2 diabetes. While excess weight is a strong risk factor, a study found that about 12% of Americans with Type 2 diabetes have a normal weight, likely due to a stronger genetic risk for diabetes. 

How can Calibrate help with diabetes prevention and treatment? 

Calibrate uses a year-long intensive lifestyle modification curriculum and 1:1 accountability coaching combined with medications to treat the chronic disease of obesity, a major contributor to diabetes risk. Calibrate’s Four Pillars of metabolic health help  you build lasting healthier habits, including reducing refined carbs and added sugar in your diet and getting regular exercise, two science-based elements of diabetes prevention and management. 

Behavior change can be challenging, but it’s crucial for treating metabolic conditions like diabetes and prediabetes. Calibrate can ensure you have the information and support you need to maintain a healthier lifestyle for the long term. 

Along with guiding and supporting you through these lifestyle changes, Calibrate uses medications that promote weight loss and improve blood sugar control. The medications in Calibrate’s program are from a class called glucagon-like-peptide 1 receptor agonists. Unlike other commonly used medications for diabetes treatment, GLP-1 agonists improve the body’s glycemic (blood sugar) control while carrying a very low risk of causing hypoglycemia (too-low blood sugar) which makes them relatively safe for patients with and without diabetes, as research has supported.

On average, Calibrate members lose 10% or more of their total body weight, effectively reducing the risk of developing diabetes and improving diabetes management. In fact, many members have improved their glucose control enough to come off of diabetes medications and even reverse pre-diabetes. 

Have more questions? Reach out to hello@joincalibrate.com or our support team in our app.