What’s prediabetes? Reverse it with just 5 to 10 kg weight loss, diet and exercise

The conversion of prediabetes to diabetes among Indians is faster than any population and about 15.3 per cent of Indians are already in the prediabetes stage. But its reversal needs simple intervention, says Dr V Mohan, Chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai

The conversion of prediabetes to diabetes among Indians is faster than any population and about 15.3 per cent of Indians are already in the prediabetes stage. (Source: Freepik)

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Often we ignore the stage leading up to the development of diabetes, when that’s the time intervention is needed to arrest the silent but steady progression of disease. This stage between normalcy and diabetes is known as prediabetes. The good news? When diagnosed at the right time, it can be reversed, managed and controlled with simple dietary interventions and lifestyle corrections. The bad news? The conversion of prediabetes to diabetes among Indians is faster than any population and about 15.3 per cent of Indians are already in the prediabetes stage.

How do we define prediabetes?

When your fasting blood glucose is below 100, you are normal. If your fasting blood glucose levels are between 101 and 125, it means you have a form of prediabetes called impaired fasting glucose (IFG). When your fasting blood glucose level is above 126, it means you have progressed to diabetes.

Now there is another kind of prediabetes called impaired glucose tolerance (IGT). For this we do a glucose tolerance test where we ask people to drink 75 gm of glucose powder dissolved in water after their fasting glucose test. Exactly two hours or 120 minutes later, we draw the blood again. If the blood glucose level stays below 140, then the person is normal. Any reading between 140 to 199 means the person has IGT. A reading above 200 is an indicator of diabetes. Some people can be detected with only IHG, others with IGT. But it is not unusual to develop both forms of prediabetes together. Why should we know this? Because if you have even one or both of the above types of prediabetes, you will progress to full-fledged diabetes faster.

What are symptoms of prediabetes?

Unfortunately, there are no symptoms at all. In fact, most symptoms like feeling thirsty and frequent urination show up in advanced forms of diabetes, not before.

So how do we detect and whom do we screen?

In India, we should be screening all adults ideally. As part of our latest study on non-communicable diseases with ICMR, we have found that 15.3 per cent of the population or 136 million people are prediabetic and waiting to convert to diabetes. Around 30 to 50 per cent of those with prediabetes convert to diabetes; some may remain as prediabetics and a few may reverse their condition. Those who are in the early stages of prediabetes may lose a few kilos and come back to normal. But if they don’t do anything, they might put on weight and progress to diabetes. Indians have an increased tendency to develop diabetes from prediabetes as compared to Caucasians who take five to ten years more.

So how can we narrow down the at-risk population and test at least half that number in a cost-effective manner? We have now devised the Indian Diabetes Risk Score Test which is the result of 20 years of research. We ask three questions and get the patients to measure their waistline with a tailor’s tape. We first ask your age because the older you are, the risk is higher. Second, we ask you about your family history of diabetes. Even if only your father or mother is diabetic, you are still at a high risk. Our scoring is 0 for no family history, 10 when one of the parents has a history and 20 when both come from families with diabetes. Third, we score you on your physical activity. If you are not into any kind of physical activity at all, your score will go up very high. Some light activity gets you a lesser score and vigorous activity means you are in safe limits. Last, take a tailor’s measuring tape and wrap it around your waist at the umbilicus. In a woman, less than 80 cm of waistline gets you a score of 0, anything between 80 to 90 cm gets you 10 and a higher measurement gets you 20. For men, less than 90 cm is 0, 90 to 100 cm is 10 and more than 100 cm is 20.

If you add up all these individual scores, the maximum total score should be 100 and a minimum of zero. A combined score above 60 means you are at a high risk of getting diabetes. This is a very simple risk score and you can easily pick up that 12 to 15 per cent at-risk population.

What to do after diagnosis?

Quick takeaways. (Designed by Abishek Mitra)

Usually, all prediabetics have excess weight and the main goal should be to reduce it. Even if you lose anything between 5 to 10 kg, you can reverse prediabetes. The weight loss has to be consistent, and you must ensure that it does not come back.

(1) Reduce calorie intake. Instead of 2,400 calories, cut your intake by half. Since most of your weight comes from carbs, cut down your wheat and rice consumption by 50 per cent. Always go for complex carbs. Replace them with green leafy vegetables, proteins, fruits, Bengal grams, mushrooms, or plant proteins and you will lose weight over a period of time.

(2) The second is exercise. About 45 minutes of brisk walking, jogging, cycling, dancing, swimming, aerobic exercises, resistance training are all good. It is important to choose an activity that you enjoy and can stick to.

(3) Keep to regular sleep timing: Once the body’s circadian rhythm gets disturbed, it can lead to obesity. Try to sleep by 11 pm if possible.

(4) Cut down stress, practise deep breathing and relaxation exercises