What is prediabetes?

Prediabetes is when your blood sugar is higher than normal, but not high enough to make you diabetic. If you have prediabetes, take this opportunity to make immediate lifestyle changes to prevent the onset of diabetes.

How is prediabetes measured?

There are three main types of tests that diagnose prediabetes. The most common test is a fasting blood sugar (FBS), which is typically measured the morning after an overnight fast (10 to 12 hours). If your FBS is less than 126 but more than 99 mg/dL, then you have prediabetes. If you want to be specific, you can say you have impaired fasting glucose or IFG, which is one type of prediabetes.

The second type of test is called the A1C or glycohemoglobin test which has been used to monitor individuals with established diabetes. The A1C test indicates your average blood sugar levels over the past 2-3 months. A level between 5.7-6.4 percent may indicate an increased future risk of diabetes. A value of 6.5% or greater would indicate diabetes. No fasting is required to have this test done. For more information on this test, go to glycohemoglobin.

The final test is called a glucose tolerance test, in which you drink a sugar-sweetened drink and then have your blood sugar checked two hours later. If your blood sugar is 140 to 199 mg/dl, then you have impaired glucose tolerance or IGT which also falls under the category of prediabetes. This test is less commonly done due to the convenience and ease of the fasting blood sugar and A1C tests.

Why is prediabetes common in South Asians?

South Asians have a very high prevalence of diabetes, so it makes sense that prediabetes is epidemic in this population. A combination of genetics, a diet that is high in refined carbohydrates(e.g.-white rice, breads, sweets, etc.) and a sedentary lifestyle are major contributing factors. Excess fat, particularly around the stomach, puts South Asians at higher risk as well.

Do all individuals who get prediabetes eventually become diabetic?

No. Not all prediabetics have the same risk of becoming diabetic. Some will never develop diabetes while others will inevitably become diabetic. The more diabetes risk factors you have, the greater your chances of becoming diabetic. Risk factors for developing diabetes include:

• Increased weight, especially around your stomach. Keep in mind that a BMI of more than 23 is abnormal for South Asians
• A first degree family history of diabetes, which means either your parents, siblings or your children have diabetes
• High triglycerides (type of cholesterol)
• Low HDL (healthy, protective cholesterol)
• High blood pressure
• Diabetes during pregnancy (gestational diabetes)

How can I prevent prediabetes from becoming diabetes?

Many of the diabetic risk factors mentioned above are preventable. South Asians can reduce their chance of becoming diabetic by taking these steps:

• Lose Weight — The BMI (body mass index) cutoff has been lowered to 23 for South Asians in comparison to 25 for the general population. Calculate your South Asian adjusted BMI.
• Exercise Regularly — Aim for aerobic exercise for a minimum of 30 minutes at least 5 times per week.
• Increase overall fiber intake.
• Reduce White Rice Intake — This is a major cause of elevated triglycerides in the South Asian diet. Healthier alternatives are brown rice, whole grain couscous, quinoa, bulgur or other healthier grains. See our short video on grains.
• Replace Starchy Vegetables — Such as potatoes, corn, peas and winter squash with less starchy vegetables such as spinach, sweet potatoes, broccoli, carrots and green beans.
• Choose Beverages Wisely — Make water your primary beverage. Soft drinks, sugar sweetened juices, lassi and even frequent cups of coffee or tea with added sugar can raise blood sugar levels.

Fiber: A South Asian's Best Friend

A high-fiber diet can reduce the risk of diabetes, high cholesterol, heart disease and cancer. It also promotes weight loss and optimizes digestive health. All South Asians should aim for at least 30 grams of fiber each day. Below are some tips for increasing fiber in your diet.

• Cereal — Choose a cereal with at least five grams of fiber per serving. Some brands have more than 10 grams per serving. Steel cut oatmeal is better than rolled oats. Beware of added sugar with many flavored instant oatmeal. Add toppings such as berries, nuts, raisins, flaxseed or wheat bran to further increase fiber content.
• Breads — Replace naans and puris with rotis or chapatis made with 100 percent whole wheat flour. Store-bought breads should list 100 percent whole wheat in the ingredients and contain at least 3-4 grams of fiber per slice
• Replace White Rice — White rice is stripped of fiber and raises blood sugar and triglycerides. Healthier high-fiber alternatives include brown rice, whole-grain couscous, quinoa, bulgur or other healthier grains. Grains such as couscous and quinoa not only have more fiber, but cook in just a few minutes and go well with South Asian cuisine.
• Fruits and Vegetables — Eat plenty of these throughout the day to boost fiber intake. Each meal should be accompanied by a fruit and vegetable, with additional servings between meals. Keep in mind that fruits such as watermelon, grapes, mangos and pineapples are high in sugar.
• Beans, peas and lentils — These are a staple of South Asian cuisine and are high in fiber and provide protein as well. Try to eat more meals that emphasize these ingredients.
• Snacks — Choose high-fiber snacks such as fruits, vegetables (carrot sticks), whole wheat crackers, nuts, seeds and low-fat popcorn. Keep track of calories when snacking, especially with nuts.
• Toppers and Mixers — Crushed bran cereal, flaxseed, unprocessed wheat bran and chopped or ground nuts can be mixed into baked products or used as toppings to increase the fiber content of your favorite foods and snacks.
• Supplements — Getting fiber from natural foods is preferred. However, supplements such as Metamucil or Citrucel are also effective ways of getting fiber into your diet.

Side Effects

Adding too much fiber too quickly to your diet can cause increased gas, abdominal bloating and cramps. Increase fiber intake gradually over a few weeks and drink plenty of water to soften your stools and prevent constipation.

Last Reviewed: 2012