Misunderstood Prediabetes

Misunderstood Prediabetes
Learn how prediabetes leads to type 2 diabetes and how fat plays a role.
Arthur Agatston, M.D., author of The South Beach Diet Print Email Most people mistakenly associate all diabetes with a lack of insulin, the hormone produced by the pancreas that clears sugar (glucose) and fat out of the bloodstream and moves it into the cells after meals. Type 1 diabetes, formerly called juvenile diabetes, is characterized by the inability of the pancreas to make enough insulin. But in prediabetes, which often leads to type 2 diabetes, the problem is not too little insulin but the resistance of cells to the hormone's effects.

In fact, in prediabetes, blood insulin levels actually remain high after a meal until the excess insulin finally opens the floodgates, allowing glucose to move from the bloodstream into the cells. This results in a rapid fall in blood sugar, which is known as reactive hypoglycemia because the reaction, or blood sugar drop (hypoglycemia), comes sooner after a meal than a normal, gradual drop would. It's why the insulin resistance associated with prediabetes only exacerbates the already exaggerated swings in blood sugar and consequent cravings caused by bad carbohydrates. And it's why prediabetics are almost always hungry again soon after a meal and tend to gulp down their food to bring up their sagging blood sugar.

Prediabetes typically occurs in individuals with a genetic predisposition to accumulating belly fat. In fact, you can recognize people with prediabetes on the street. They're the ones walking around with large bellies and relatively thin arms and legs. They also tend to have high blood pressure, low levels of good HDL (high-density lipoprotein) cholesterol, and high levels of triglycerides (a fat-storage molecule found in blood and fat cells).

But how does prediabetes lead to type 2 diabetes? Over time, your pancreas tends to burn out from the stress of producing extra insulin to overcome the insulin resistance of your tissues and clear sugar and fat from your blood in a timely manner. It is at this point that your sugar remains high for many hours after a meal and type 2 diabetes is diagnosed.

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During the prediabetes phase, most people's fasting blood sugar is borderline, normal, or even low. For this reason, many of my patients initially believe that their risk of heart attack and stroke increases only if they become diabetic. This belief is wrong! During the prediabetes phase, when fasting blood sugar is still normal, insulin resistance is present and it takes longer to clear fats and sugar from the bloodstream. It's that extra fat hanging around after a meal that often penetrates the walls of the blood vessels supplying the heart muscle, brain, and other organs. This is the origin of atherosclerotic plaque that clogs these vessels and eventually leads to a heart attack or stroke. And, yes, this can and does occur during prediabetes, well before type 2 diabetes is diagnosed.

Again, this is relatively recent information. Prediabetes was first described in 1988 by Gerald Reaven, MD, of Stanford, and we're still learning about the havoc it wreaks on our blood vessels and overall health.

Last Updated: 05/05/2008
Reprinted from: THE SOUTH BEACH DIET SUPERCHARGED by Arthur Agatston, MD with Joseph Signorile, PhD. © 2008 by Arthur Agatston, MD. Permission granted by Rodale, Inc., Emmaus, PA 18098. Available wherever books are sold or directly from the publisher by calling (800) 848-4735. To learn more, visit The South Beach Diet Online.

From	Comment
coyote	October 12, 2009 5:32 PM Very informative thank you for posting it.