What is pre-diabetes ? Simply put the body is having trouble utilizing insulin properly. Meaning, the uptake of glucose ,which depends on insulin (a peptide) binding to insulin receptors in the body, is compromised. The body becomes what is called "insulin-resistant".
As a result, glucose hangs around in the blood in higher amounts then normal. This causes changes in the metabolism, cravings, weight gain or weight loss, and fatigue. Also glucose hanging around in the blood can cross link with other tissues (ie; eyes, kidney’s, arteries) and start to cause organ decline that can lead to kidney disease, heart disease, and eye disease. Also being diabetic will also compromise one’s immune system leading them more susceptible to infection. When insulin resistance continues to persist in the body, there is a chance that diabetes will develop,which is an extreme form of inadequate use of Insulin.
Pre-diabetes is technically when the fasting blood glucose levels are above 100 mg/dl but not yet above 125 mg/dl. It is also a sign of the early stages of insulin resistance. However , more appropriately ,insulin resistance is probably better assessed using hemoglobin A1c which is an average of our glucose levels over the course of three months . When the hemoglobin A1C levels are levels between 5.7% and 6.4% means you have a higher chance of getting diabetes (ie. pre-diabetes). Levels of 6.5% or higher mean you have diabetes.Many circles still rely on the research tool called HOMA-IR score which uses fasting Insulin (mU/l)and fasting Glucose (mg/dl) as a predictor of insulin resistance.
HOMA-IR Score Breakdown
Healthy Range: 1.0 (0.5–1.4) Less than 1.0 means you are insulin-sensitive which is optimal.
Above 1.9 indicates early insulin resistance.
Above 2.9 indicates significant insulin resistance.
For my assessment; I personally like hemoglobin A1c and Homa-IR score in combination.
What is the cause of insulin resistance?
Somewhere along the line we all decided to blame excessive sugar intake. Certainly we can point blame certain components of the western diet , especially excess fructose consumption, alcohol abuse, and processed food consumption. Or perhaps the lack of fiber in the Western diet. In addition, a sedentary lifestyle can be partially to blame because muscle loss and fat gain are a key leverage point for insulin resistance (see below). And we can’t overlook the S&S combo...sleep and stress. Certainly poor sleep leads to cortisol disruption and metabolism disruption leading to insulin resistance.
The sedentary lifestyle impact is related to the amount of fat cells in the body. When the size of the number of fat cells increases in the body, they secrete a greater amount of inflammatory markers (leptin, tumor necrosis factor, resistin, free fatty acids) which end up increasing insulin resistance and also increase the production of glucose by the liver. Also important is that these fat cells will eventually decrease the secretion of adiponectin; which is a hormone that is involved in making insulin sensitive, reducing atherosclerosis, and lowering triglycerides. (Lyon, 2006)
So then what else could cause insulin resistance? There are genetic, environmental , and possible medication causes of insulin insensitivity.
Recently the microbiome and mitochondria have been implicated in the possible cause of diabetes. My recent podcast episode with Richard Sprague discussed Day Two stool testing which looks at gut microbiome testing and how through this data we can understand our unique gut microbiome's response to various carbohydrates. This was based on a landmark study that was put out by the Weizmann institute which showed how we could predict glucose response to certain foods based on our unique gut microbiome.
Also we must consider basic defects in mitochondria as part of the insulin resistance picture . The Krebs Cycle which is intimately involved with carbohydrate processing can be disrupted due to many factors including mitochondrial dysfunction and nutrient deficiency and so this must be investigated in pre-diabetes using the organic oat test. We discuss the impact of mitochondria in my recent podcast with Dr. Chris Meletis .
In addition as my mentor Dr. Joseph Pizzorno states there may be environmental
causes of insulin resistance such as arsenic , mercury, pcb's , and lead toxicity.
Many of these environmental toxins can lead to mitochondrial toxicity or simply make mitochondrial function poorly.
I suspect we will find key single nucleotide polymorphisms (snp’s) in the future that will also guide us in this question.
Insulin resistance is the stage of health that I call a "wake up call" to look at ways to reduce adiposity in the muscle cells. A good first approach is to look at the glycemic load of the diet. Which is related to the fiber, processed ingredients, and sugar content of foods. Blood sugar levels drop on a low-glycemic-load diet and on a diet with adequate protein, carbohydrate, and fat ratios. Also, it is important to initiate weight training/resistance training as this a key step in improving muscle composition in the body. Finally there are many nutrients nature offers that can help us become more resistant to insulin such as chromium, cinnamon, green tea, and alpha lipoic acid.
If that is not helping stabilize glucose levels then we look deeper as mentioned in this article. Sometimes it involves doing a lifestyle reset like a 21-28 detoxification of your metabolism You can see how well your metabolism is doing by this screening tool . A score greater than 49 indicates a significant need for metabolic detoxification and diet and lifestyle overhaul.
If your blood work “horoscope” is predicting diabetes in the future; jump on it now! It pains me that people are not seen as empowered individuals with the ability to change there future. If a Dr. tells you have prediabetes or early type 2 diabetes and doesn't discuss any of the above topics with you; ask for a referral to a licensed naturopathic medicine doctor, licensed clinical nutritionist, or licensed functional medicine provider. You certainly can have your original doctor on your team as part of the mastermind to your problem .