What is considered borderline diabetic?

What is considered borderline diabetes?

When the diabetes police are in hot pursuit and you are within five miles of a state border you have borderline diabetes. (Sorry. I couldn’t resist.) In the medical world we use certain fixed blood sugar numbers to determine who has diabetes and who doesn’t. The standards are set by the American Diabetes Association and are adjusted from time to time as new research reveals new truths.

So if your blood sugar is above a set threshold, you have diabetes. If it’s below a set threshold, you don’t. If you fall between the two sets of numbers you’re not a member of either tribe. You aren’t really quite “normal,” but your sugar isn’t high enough to really be considered a person with diabetes either. You have borderline diabetes, prediabetes, or in more technical terms, impaired glucose tolerance.

But none of these labels convey the deadly seriousness of the condition. Here’s the truth, no bull, if you have borderline diabetes, full-blown diabetes is on the way. The conversion rate from prediabetes to full blown diabetes is mind numbing, and because of this I especially dislike the term “borderline” as it makes the condition sound somehow less serious than it is.

At any rate, on to the numbers. We now use a quick and simple blood test called an A1C to diagnose diabetes. If your doctor’s office is so equipped, it can even be run from a single drop of blood from your fingertip in about six minutes.

The test gives us a picture of the blood sugar environment of your body over the last three months. Diabetes is now defined as an A1C score of 6.5 percent or greater. Normal is considered to be 5.6 and below. If you are between 5.7 and 6.4, you are on the border. (Just remember that it’s more like the border between North and South Korea—filled with land mines—than the border between North and South Carolina.)

To make it easier to grasp, these percentages can be converted into estimated average glucose numbers, in plain English—meter numbers. And in meter numbers, “borderline” diabetes is defined as an average reading between 114 and 137 mg/dL.

Are you borderline diabetic?

  • Shoes that fit: Comfortable footwear is also important as diabetes causes nerve insensitivity in the feet.
  • Poorly-fitted shoes can lead to foot complications such as ulcers, blisters or corns.
  • Stick to medications: In order to ensure blood sugar targets are achieved, most people with type 2 diabetes will require oral medication and/or insulin, along with living a healthy lifestyle.
  • Keeping clinic appointments: You need to take a proactive role in the management of your healthcare in order to prevent or delay the development of diabetic complications.
  • It is very important to follow the medication dose and timing prescribed by your doctor. It is dangerous to skip medication, or adjust medication dosage and timing without checking with your doctor.
  • Self-monitor blood sugar levels: Regular monitoring of your blood glucose gives you a basic understanding of how your diet, medication and physical activity affects your body and how you can manage it.
  • In general, individuals with diabetes should have comprehensive physical examinations once a year and have their diabetes assessed at least every three to six months.
  • Too little sleep can increase the risk of diabetes, and if you already have diabetes, sleep deprivation can lead to poor blood sugar control.
  • Diet changes are also crucial.

    Dr Yong said: “You should limit your intake of sugar, sweet treats (cake, candy, jam and honey), and unhealthy fat, such as the kind found in fried food, chips and pastries. At the same time, you should increase your intake of fibre, vegetables and fruit.”

    The Diabetic Plate is commonly prescribed to control prediabetes or diabetes, Dr Yong added. This meal-planning approach involves filling half your plate with fruit and non-starchy vegetables (stir-frying, steaming, roasting and boiling are recommended).

    Another quarter of the plate should contain whole grains such as multi-grain bread, wholemeal bread or brown rice, and the final quarter of the plate should contain healthy proteins like fish, lean meat, poultry, seafood, eggs and/or low-fat dairy products. Aim for at least two servings of fish a week.

    Other recommended lifestyle changes include keeping your blood pressure and cholesterol levels under control, quitting smoking and getting between seven and eight hours of sleep every night.


    This article was first published on March 13, 2017.
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    What is a healthy blood sugar level?

    A healthy blood sugar level is between 70 and 130 milligrams per deciliter (mg/dL) before meals and less than 180 mg/dL one to two hours after the start of a meal, according to the American Diabetes Association. Three tests are commonly used to measure blood sugar levels. A random plasma glucose test is a blood test that is done at any time of day. It may indicate you have diabetes if your blood glucose level is 200 mg/dL or higher. A fasting plasma glucose (FPG) test is often done first thing in the morning, after you have not eaten for at least eight hours. You may be diagnosed with prediabetes (at risk for diabetes) if your blood glucose level is 100 to 125 mg/dL on the FPG test, and you may have diabetes if your level is 126 mg/dL or higher.

    The third test, called the oral glucose tolerance test, (OGTT) is also done after you have fasted for eight hours. You’ll consume a glucose-containing beverage, and your blood will be taken two hours later. If your blood glucose level measures 200 mg/dL or higher on two different OGTTs, you may be diagnosed with diabetes. If it measures 140 to 199 on an OGTT, you may have prediabetes.

    Blood sugar, or glucose, is an important source of energy and provides nutrients to your body’s organs, muscles and nervous system. The body gets glucose from the food you eat, and the absorption, storage and production of glucose is regulated constantly by complex processes involving the small intestine, liver and pancreas.

    Normal blood sugar varies from person to person, but a normal range for fasting blood sugar (the amount of glucose in your blood six to eight hours after a meal) is between 70 and 100 milligrams per deciliter. For most individuals, the level of glucose in the blood rises after meals. A normal blood-sugar range after eating is between 135 and 140 milligrams per deciliter.

    These variations in blood-sugar levels, both before and after meals, are normal and reflect the way that glucose is absorbed and stored in the body. After you eat, your body breaks down the carbohydrates in food into smaller parts, including glucose, which can be absorbed by the small intestine.

    As the small intestine absorbs glucose, the pancreas releases insulin, which stimulates body tissues and causes them to absorb this glucose and metabolize it (a process known as glycogenesis). This stored glucose (glycogen) is used to maintain healthy blood-sugar levels between meals.

    When glucose levels drop between meals, the body takes some much-needed sugar out of storage. The process is kicked off by the pancreas, which releases a hormone known as glucagon, which promotes the conversion of stored sugar (glycogen) in the liver back to glucose. The glucose is then released into the bloodstream.

    When there isn’t enough glucose stored up to maintain normal blood-sugar levels, the body will even produce its own glucose from noncarbohydrate sources (such as amino acids and glycerol). This process, known as gluconeogenesis, occurs most often during intense exercise and instances of starvation.

    While it may seem complicated (and it is), there’s a good reason for your body to keep up this never-ending dance with glucose: Too much or too little glucose in the blood can lead to serious health problems.

    Too much glucose over an extended time (hyperglycemia) can result in the destruction of nerves, lowered resistance to infection, and heart and kidney disease. On the other hand, not enough glucose in the blood over an extended period (hypoglycemia) can affect brain function, causing fatigue, fainting, irritability and, in some cases, seizures and loss of consciousness.

    Originally published on Live Science.

    The Surprising Truth About Prediabetes

    It’s real. It’s common. And most importantly, it’s reversible. You can prevent or delay prediabetes from developing into type 2 diabetes with simple, proven lifestyle changes.

    Amazing but true: approximately 84 million American adults—more than 1 out of 3—have prediabetes. What’s more, 90% of people with prediabetes don’t know they have it. Could this be you? Read on to find out the facts and what you can do to stay healthy.

    Prediabetes Is a Big Deal

    Don’t let the “pre” fool you—prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

    Type 1 and Type 2: Not the Same

    Many people don’t realize that type 1 and type 2 are different kinds of diabetes.

    • About 90%-95% of people with diabetes have type 2; about 5% have type 1.
    • Type 1 is caused by an immune reaction and can’t yet be prevented; type 2 can be prevented or delayed through lifestyle changes.
    • Type 1 often starts quickly and has severe symptoms; type 2 is a gradual disease that develops over many years.
    • Type 1 occurs most often in children, teens, and young adults; type 2 occurs most often in older people (though increasingly children, teens, and young adults are developing the disease).
    • People with type 1 must use insulin every day to survive.
    • Prediabetes can develop into type 2 diabetes, but not type 1.

    Learn more about different diabetes types and treatments.

    Prediabetes Flies Under the Radar

    You can have prediabetes for years but have no clear symptoms, so it often goes undetected until serious health problems show up. That’s why it’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include:

    • Being overweight
    • Being 45 years or older
    • Having a parent, brother, or sister with type 2 diabetes
    • Being physically active less than 3 times a week
    • Ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby that weighed more than 9 pounds

    Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

    Ready to find out your risk? Take the quiz at DoIHavePrediabetes.orgExternal and be sure to share the results with your doctor.


    Recipe for prevention: healthy eating and physical activity.

    Diabetes Is Harder to Live with Than Prediabetes

    Though people with prediabetes are already at a higher risk of heart disease and stroke, they don’t yet have to manage the serious health problems that come with diabetes.

    Diabetes affects every major organ in the body. People with diabetes often develop major complications, such as kidney failure, blindness, and nerve damage (nerve damage can lead to amputation of a toe, foot, or leg). Some studies suggest that diabetes doubles the risk of depression, and that risk increases as more diabetes-related health problems develop. All can sharply reduce quality of life.

    Prediabetes = Preventdiabetes

    Think of prediabetes as a fork in the road: Ignore it, and your risk for type 2 diabetes goes up. Lose a modest amount of weight and get regular physical activity, and your risk goes down. Modest weight loss means 5% to 7% of body weight, just 10 to 14 pounds for a 200-pound person. Regular physical activity means getting at least 150 minutes a week of brisk walking or similar activity. That’s just 30 minutes a day, five days a week.

    The CDC-led National Diabetes Prevention Program has been proven to help people make the lifestyle changes needed to prevent or delay type 2 diabetes. Through the program, participants:

    • Work with a trained coach to make lasting lifestyle changes.
    • Discover how to eat healthy and add more physical activity into their day.
    • Find out how to manage stress, stay motivated, and solve problems that can slow progress.

    If you’re told you have prediabetes, ask your doctor or nurse if there is a National Diabetes Prevention Program offered in your community. The best time to prevent type 2 diabetes is now.

    Borderline sugar alert!

    Those with prediabetes are not only in danger of developing diabetes, but also, at risk of dying early.

    WE KNOW that people with diabetes are prone to serious, and sometimes, fatal complications.

    As was said in my previous article (Sugar in the blood, Star2, Dec 5), prediabetes is just a condition where blood glucose (sugar) levels are higher than normal, but not as high as in people with untreated diabetes. So, we need not be worried about having prediabetes then, true?

    Not true, unfortunately! Even though people with prediabetes have lower blood sugar levels than diabetics, they are also prone to developing complications that occur in people with (uncontrolled) diabetes; for example, kidney disease (nephropathy), eye disease (retinopathy) and nerve damage (neuropathy), especially to the legs.

    But, diabetes-related complications are not the only conditions prediabetics need to be concerned about.

    · Progression to frank diabetes

    This is the most common consequence of prediabetes.

    People with prediabetes are said to be about four to 10 times more likely to develop type 2 diabetes mellitus, compared to those without the condition.

    Studies have also suggested that every year, about 10% of those with borderline high blood glucose levels – that is, one in every 10 prediabetics – will progress to become diabetics.

    So, it follows that if you do not take steps to address your prediabetes, you could become a diabetic within 10 years!

    The more overweight you are, and the higher your blood glucose levels are above normal, the more likely it is that you will develop diabetes.

    It is also worth noting that type 2 diabetics almost invariably go through the prediabetic stage that lasts, on average, about 10 years before diabetes is diagnosed.

    Clearly, there is plenty of time to improve our health and prevent the progression to diabetes!

    Being diagnosed with prediabetes is a warning that your health is in danger, so start exercising and eating right to improve your wellbeing. — Filepic

    · Increased risk of heart disease and stroke

    People with prediabetes are prone to developing cardiovascular disease (diseases of the heart and blood vessels), including suffering from heart attacks and stroke.

    It is estimated that prediabetics are at least twice as likely to have a heart attack, compared to those with normal blood glucose levels.

    And it would appear that having high blood glucose levels in the prediabetic range after meals is just as dangerous as for a diabetic, even when the fasting blood sugar level is still normal.

    · Increased risk of dying from any cause

    Studies have shown that the higher the blood glucose level, the higher is the risk of early death from any cause, including of course, stroke, heart attack, cancers and kidney failure.

    The relationship is more obvious with sugar levels after food (measured by the oral glucose tolerance test, OGTT), as shown by landmark studies such as the DECODE (Diabetes Epidemiology Collaborative Analysis of Diagnostic Criteria in Europe) study involving more than 22,000 subjects.

    Why the increased risk?

    The exact cause of why people with prediabetes are more prone to heart disease or increased risk of dying (from any cause) is still not clear. Experts believe that the cause may be multifactorial, including the presence of:

    · High blood pressure

    People with diabetes (and prediabetes) are more prone to developing hypertension or high blood pressure (i.e. blood pressure 140/90 mmHg or higher).

    If you have high blood pressure, your heart must work harder to pump blood around your body. Thus, uncontrolled high blood pressure will put a strain on your heart and damage your blood vessels, promoting fatty deposition.

    By itself and in combination with other risk factors, high blood pressure increases your risk of cardiovascular disease (CVD), such as heart attack, stroke and kidney failure.

    · Abnormal blood fat levels

    In people with prediabetes, this is due to high levels of triglycerides (a type of fat), low levels of HDL (“good”) cholesterol, and sometimes, high LDL (“bad”) cholesterol, which may present singly or in combination.

    Cholesterol can build up inside your blood vessels, especially when these are already damaged by intermittently-raised blood glucose levels (as may occur in people with prediabetes) and uncontrolled high blood pressure.

    As a result, your arteries become hardened and narrow, restricting blood flow and increasing your risk for diseases of the heart and blood vessels (CVD).

    · Overweight or obesity

    If you are an Asian, you are deemed to be overweight if your body mass index (BMI) is between 23.0–24.9 kg/m², or obese if your BMI is 25.0 kg/m² or more.

    Central obesity, i.e. having excess weight around your waist (as opposed to the hips), puts you at higher risk of heart disease because abdominal fat can increase production of LDL-cholesterol.

    For Asians, a waist circumference of more than 90cm for men or more than 80cm for women means you have central obesity.

    Overweight or obesity increases the risk for CVD.

    In some studies, even mild to moderate overweight is associated with a substantial elevation in coronary artery disease risk, causing heart attack or heart failure.

    · Metabolic syndrome

    Raised blood glucose levels (such as in people with prediabetes), high blood pressure and abnormal blood fat levels (low HDL-cholesterol and/or high triglycerides) usually tend to be present together, especially in obese individuals (or those with central obesity).

    According to the International Diabetes Federation, you are said to have metabolic syndrome if you have central obesity and two or more of the above conditions.

    It is estimated that people with metabolic syndrome have a five-fold greater risk of developing type 2 diabetes, compared to those without.

    And as expected, people with this syndrome – if not properly managed – are at higher risk of developing CVD, compared to those who have prediabetes alone.

    They are three times as likely to have (and twice as likely to die from) a heart attack or stroke, compared with people without the syndrome.

    These people are also more prone to kidney failure and early death.

    From the above, it is clear that having prediabetes is not as innocuous as it seems.

    Indeed, prediabetes puts one in danger of not only developing diabetes, but also heart disease, stroke, kidney failure and other serious complications, including early death.

    So, it makes great sense for us to pay serious attention to our prediabetes, and to start taking good care of our health, so that we will not be burdened by its potentially serious (and sometimes fatal) complications.

    In the next article on Jan 2, we will learn how to best look after ourselves if we have prediabetes.

    Emeritus Professor Datuk Dr Mustaffa Embong is a consultant diabetologist and (honorary) executive chairman of the National Diabetes Institute (NADI) of Malaysia. This article is provided by NADI under the “Prevention of Diabetes and Heart Disease” Programme, which is fully funded by the Health Ministry’s Health Promotion Board.

    What is prediabetes or borderline diabetes and does it matter?

    Does prediabetes develop and progress into type 2 diabetes?

    Unfortunately for many people with borderline diabetes they are likely to progress to developing type 2 diabetes. If left untreated, 37% of people with prediabetes will go on to develop type 2 diabetes mellitus in 4 years (Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease).

    How often should I be tested for type 2 diabetes?

    If you have been diagnosed with prediabetes, you should be tested every 12 months for type 2 diabetes.

    Is prediabetes dangerous and can it cause problems?

    Diabetes is a very serious condition. People with borderline diabetes are at an increased risk of heart attacks and strokes, as well as some cancers. Even though blood glucose levels are only mildly elevated, people can still have abnormalities with their cholesterol levels and high blood pressure (hypertension). These factors also contribute to the high rates of heart disease seen in people with diabetes.

    People with diabetes who have ongoing high blood glucose levels, are at an increased risk of having poor health outcomes compared to people who do not have diabetes. Here are some important facts that you need to know that relate to people with diabetes:

    • People with diabetes are up to four time more likely to suffer heart attacks or strokes
    • Diabetes is the leading cause of vision-loss globally and is the fifth most common cause of preventable blindness and fifth more common cause of moderate to severe visual impairment
    • Kidney failure is three times more common in people with diabetes
    • Amputations are 15 times more common in people with diabetes
    • More than 30 percent of people with diabetes experience depression, anxiety, and distress
    • Early diagnosis, optimal treatment, and effective ongoing support and management reduce risk of diabetes-related complications dramatically.

    What are complications of prediabetes?

    If left untreated, prediabetes can become type 2 diabetes. Type 2 diabetes is associated with a number of complications affecting the blood vessels in our body. Complications in type 2 diabetes can be described as microvascular (small blood vessels) or macrovascular (large blood vessels) complications (Microvascular and Macrovascular Complications of Diabetes). Diabetes-related complications occur over time due to persistent high blood glucose levels, high blood pressure, and abnormal cholesterol levels. These complications are serious and can be life-threatening.

    Macrovascular complications – Problems with large blood vessels

    Macrovascular disease affects the larger blood vessels in our body that supply blood to the heart, brain, and legs. Macrovascular complications include:

    • Coronary artery disease which can lead to a heart attack
    • Cerebrovascular disease which can lead to a stroke
    • Peripheral artery disease which can lead to pain deep in the leg muscles (calves, thigh, or buttocks) during activity as well as amputations.

    Microvascular complications – problems with small blood vessels

    Like macrovascular disease, ongoing high blood glucose levels are an important risk factor for the development of microvascular disease in patients with type 2 diabetes. Microvascular complications include:

    • Retinopathy – Disease of the eye which can lead to blindness
    • Neuropathy – Disease of the nerves which can lead to foot ulcers requiring amputation
    • Nephropathy – Disease of the kidneys which can lead to kidney failure and the need for dialysis

    How can I prevent prediabetes from progressing to type 2 diabetes?

    There are changes you can make to improve your health and prevent type 2 diabetes. For people with prediabetes, lifestyle modification can lead to a 40-70% reduction in risk of developing type 2 diabetes (Prediabetes: A high-risk state for developing diabetes). You can prevent type 2 diabetes through:

    • Eating well
    • Moving your body more
    • Being a healthy weight
    • Setting realistic goals
    • Getting support
    • Make changes part of your everyday

    There is also some evidence that suggests quitting smoking can help to reduce your risk of developing diabetes. While there still needs to be more research done in this by scientists, there are plenty of other great reasons to quit smoking. For example, quitting smoking can help to lower your risk of having a stroke or heart attack.

    Making these changes can also help to reduce your risk of developing diabetes comorbidities; hypertension and dyslipidemia.

    If you have prediabetes, the personalised 12-week prediabetes program can be tailored to your needs. It can provide you with the best advice to help you get back on track and prevent prediabetes from becoming type 2 diabetes.

    Metformin and prediabetes

    Metformin is often prescribed to people with prediabetes who are at a high risk of developing type 2 diabetes. Metformin works to keep lower blood glucose levels by preventing the liver from making more glucose when you don’t need anymore.

    For more information about metformin, you can read about the benefits of metformin and starting on metformin – what you need to know.

    Can prediabetes be reversed?

    Yes yes yes!! Prediabetes can be reversed. The greatest chance of reversing prediabetes and avoiding type 2 diabetes, is by tacking action now. Many studies have demonstrated a 5% reduction in body weight (for most people this is 5kg) can reduce the chance of developing diabetes by 40%. The sooner you start, the greater pancreatic function remains, the better your chances. Whether it is reversible or not does not change that fact improving your diet and exercise and using the right medication all lead to dramatic improvements. Fundamentally, it is not diabetes that damages the body but high blood sugars.

    What should a person with prediabetes do?

    The first thing to do once diagnosed with prediabetes is to improve your knowledge. This is a disease that is not solved in the doctors’ office but rather by making the right choices most of the time. Our understanding of diabetes and how to control it has improved dramatically, and yet still most people with diabetes have not been given the tools or understanding to be involved in the management of their condition.

    You can improve your knowledge by joining our 12-week personalised diabetes program. The program will provide you with all of the information that you need, while motivating you to stay on track. When you sign up, you receive the first week free!

    Do I Have Prediabetes or Diabetes? Guide to Diagnosis and Management

    If you’ve been diagnosed with prediabetes, there are steps you can take to help reduce your risk for developing diabetes and return your blood glucose to a normal range.

    Eat a healthy diet

    Maintaining a healthy, balanced diet can help reduce your risk for diabetes. Changing your diet can be challenging, so start by making small changes. Track everything you’re eating for a few days so you can understand what food groups you may be over- or undereating.

    You should be eating foods every day from each of the five food groups:

    • vegetables
    • fruits
    • grains
    • protein
    • dairy

    You should have healthy fats each day as well.

    Using the information from your food log, you can begin to make small changes. The goal is to choose less processed, whole foods, instead of highly processed foods that contain added sugar, little fiber, and unhealthy fats.

    For example, if you aren’t eating the recommended servings of vegetables, try adding one serving of vegetables a day to your diet.

    You can do this by having a salad with lunch or dinner, or snacking on carrot sticks. Just be careful about add-ons such as salad dressing or dips. They can sneak in unhealthy fats or extra calories. Check out these 10 healthy salad dressing recipes.

    You’ll also want to work on reducing the number of empty-calorie foods and beverages you’re consuming, as well as switching out simple carbohydrate foods for complex carbohydrates. Examples of substitutions you can try to include:

    Get active

    Exercise is also important for managing your blood glucose. Aim for 30 minutes of exercise five days a week.

    As with dietary changes, you should also start slow and work your way up.

    If you aren’t very active, you can start by parking farther away from a building’s entrance or taking a flight of stairs instead of an escalator or elevator. Taking a walk around the block with your family or a neighbor after dinner is another great way to add in some exercise.

    Once you get more comfortable with increasing your activity level, you can start doing more vigorous activities, such as jogging or attending a workout class.

    Remember to always get your doctor’s approval before beginning a new workout routine. They can let you know if there are activities you should avoid or things you should monitor, such as your heart rate.

    Maintain a healthy weight

    Eating a balanced diet and exercising can help you lose or maintain weight. Ask your doctor what a healthy weight is for you.

    Work with them to determine how many calories you should be eating. If you need to lose weight, ask them how much weight you should be losing per week to stay healthy.

    Crash diets and extreme workout plans may make for entertaining television, but they aren’t realistic for long-term maintenance. They’re often unhealthy as well.

    Your blood sugar levels are a critical part of your overall health and your body’s ability to function properly on a daily basis. For those of us with diabetes, striving to achieve “normal” blood sugar levels is a constant, hour-by-hour pursuit. And it isn’t easy.

    In this article, we’ll look at “normal” blood sugar levels and goal ranges for a non-diabetic’s body, and realistic blood sugar goals for people with prediabetes, type 1, and type 2 diabetes.

    Table of Contents

    Normal blood sugar ranges in healthy non-diabetics

    For a person without any type of diabetes, blood sugar levels are generally between 70 to 130 mg/dL depending on the time of day and the last time they ate a meal. Newer theories about non-diabetic blood sugar levels have included post-meal blood sugar levels as high as 140 mg/dL.

    (If you live outside the US and are used to measures in mmol/L, just divide all numbers by 18)

    Here are the normal blood sugar ranges for a person without diabetes according to the American Diabetes Association:

    • Fasting blood sugar (in the morning, before eating): under 100 mg/dL
    • 1 hour after a meal: 90 to 130 mg/dL
    • 2 hours after a meal: 90 to 110 mg/dL
    • 5 or more hours after eating: 70 to 90 mg/dL

    Diagnosing prediabetes, type 2, and type 1 diabetes

    Depending on which country or medical organization you ask, the qualifying numbers for “normal” versus “prediabetes” versus diagnosed type 1 or type 2 diabetes can vary slightly. The following blood sugar and A1c the general results are used to diagnosed prediabetes and diabetes according to sources including the American Diabetes Association and Diabetes UK:

    Prediabetes

    • HbA1c: 5.7 to 6.4 percent
    • Fasting: 100 to 125 mg/dL
    • 2 hours after a meal: 140 mg/dL to 199 mg/dL

    Type 1 or 2 diabetes

    • HbA1c: 6.5 percent or higher
    • Fasting: 126 mg/dL or higher
    • 2 hours after a meal: 200 mg/dL or higher

    Please note: Type 1 diabetes tends to develop very quickly which means that by the time symptoms are felt, blood sugar levels are generally well above 200 mg/dL all the time. For many, symptoms come on so quickly they are dismissed as the lingering flu or another seemingly ordinary virus.

    By the time blood sugar levels are tested, many newly diagnosed type 1 patients will see levels above 400 mg/dL or higher. If you do suspect that you or a loved-one has type 1 diabetes, visit your primary care or urgent care immediately and ask for a urine test to measure ketones in addition to testing blood sugar levels and A1c.

    Read more about ketones at diagnosis in Diabetes Strong’s Diabetic Ketoacidosis Guide.

    Your A1c and blood sugar goals

    Managing any type of diabetes is far more complicated than giving a patient some insulin and telling them to keep their blood sugars within X and X. If you’ve lived with diabetes for more than a few days, you probably already know this.

    What is A1c?

    “A1c, hemoglobin A1c, HbA1c or glycohemoglobin test (all different names for the same thing) is a blood test that measures your average blood sugar over the last 2-3 months,” explains Christel Oerum in DiabetesStrong’s guide to lowering your A1c.

    The prior two weeks of blood sugar levels before your blood is tested for your A1c have the largest impact on your results, but the amount of glucose attached to hemoglobin (the protein in your red blood cells) in your body from the prior 3 months. The more glucose there is in your bloodstream from high blood sugar levels, the more glucose there is to attach to hemoglobin.

    Translating your A1c to a blood sugar level

    Using this easy calculator from the ADA, you can translate your most recent A1C result to an “eAG” or “estimate average glucose level.”

    You can also use this translation when working to improve your A1c and achieving closer to normal blood sugar levels. If you know an A1c of 6.5 is an average blood sugar level of 126 mg/dL or a range of 100 to 152 mg/dL, then you can look at your current blood sugar results on your CGM and meter and pinpoint which time of day you’re frequently higher than this range.
    12% = 298 mg/dL or range of 240 – 347
    11% = 269 mg/dL or range of 217 – 314
    10% = 240 mg/dL or range of 193 – 282
    9% = 212 mg/dL or range of 170 –249
    8% = 183 mg/dL or range of 147 – 217
    7% = 154 mg/dL or range of 123 – 185
    6% = 126 mg/dL or range of 100 – 152
    5% = 97 mg/dL or range of 76 – 120

    “Normal blood sugar levels” in a person without diabetes can result in an A1c as low as 4.6 or 4.7 percent and as high as 5.6 percent.

    Just a decade or two ago, it was rare for a person with type 1 diabetes to achieve an A1c result below 6 percent. Thanks to new and improved insulin and better technology like continuous glucose monitors and smarter insulin pumps, more people with diabetes are able to safely achieve A1c levels in the higher 5 percent range.

    Why your A1c matters

    In a nutshell: your A1c is one of the clearest indicators of your risk for developing diabetes complications like neuropathy (nerve damage in your hands and feet), retinopathy (nerve damage in your eyes, risking blindness), nephropathy (nerve damage in your kidneys), and severe infection in any part of your body that requires healing.

    For instance, a small cut on your toe could become infected due to high blood sugars, struggle to heal, and become severe enough that the infection could lead to an amputation.

    The general guidelines from the American Diabetes Association recommend an A1c at or below 7.0 percent for the best prevention of diabetes complications. Your risk of developing a diabetes complication continues to drop as your A1c drops closer to 6 percent.

    Some people with diabetes aim for A1c levels in the 5s and lower — especially those who follow strict low-carb diets like the ketogenic diet and the Bernstein diet. However, this hasn’t been proven in research as especially necessary, nor is it reasonably achievable for the larger population of people with diabetes.

    It’s also important to remember that your blood sugar levels and your A1c are just information that tells you whether your body needs more or less of factors like insulin, other diabetes medications, changes in your nutrition, and changes in your exercise.

    If you don’t like the number you’re seeing on your glucose meter or your A1c results, use that number as motivation to make changes (with the support of your diabetes healthcare team) in how you safely manage your diabetes in order to get different results.

    Determining the right A1c goal for you

    Just because a normal blood sugar range of 70 to 130 mg/dL is considered the healthiest doesn’t necessarily mean that’s the appropriate goal range for you — especially if you have type 1 diabetes, or take insulin as a person with type 2 diabetes.

    The reason this may not be the right goal for you is that extremely tight blood sugar management in people taking insulin can potentially lead to frequent low blood sugars — which can be dangerous.

    Achieving extremely tight blood sugar management, like a range of 70 to 130 mg/dL, also often requires a strict nutrition plan, more frequent than usual blood sugar monitoring, precise medication management, and most importantly, years of experience studying your own blood sugar levels.

    A1c goals should be individualized

    “A1c goals should be individualized based on the individual capabilities, risks, and prior experiences,” explains Gary Scheiner, MS, CDE, founder of Integrated Diabetes, and author of Think Like a Pancreas.

    “For example, we generally aim for very tight A1c levels during pregnancy and more conservative targets in young children and the elderly.”

    However, Scheiner highlights important factors that could justify aiming for a higher A1c, like “hypoglycemia unawareness,” which is described as when a person with diabetes no longer feels the oncoming warning signs of low blood sugar. This can put you at significant risk for severe low blood sugars resulting seizures or death. To reduce that risk, you would aim for higher target blood sugar ranges.

    “Someone with significant hypoglycemia unawareness and a history of severe lows should target higher blood glucose levels than someone who can detect and manage their lows more effectively,” adds Scheiner. “And certainly, someone who has been running A1c’s in double digits for quite some time should not be targeting an A1c of 6%… better to set modest, realistic, achievable goals.”

    Learn how to lower your A1c in DiabetesStrong’s A1C Guide.

    Your blood sugar isn’t just because of what you eat

    Mainstream media would have you believe that your blood sugar levels are impacted only by what you eat and how much you exercise, but people with type 1 and type 2 diabetes who test their blood sugars frequently could tell you otherwise.

    It’s especially important to keep this mind when looking at your own blood sugars and your goals because there are certain variables and challenges that impact blood sugar levels that you can’t always control.

    For example:

    • Menstrual cycles: raises blood sugar and insulin needs
    • Adrenaline rushes from competitive sports, heated arguments, rollercoaster rides: raises blood sugar and insulin needs
    • The common cold and other illnesses: usually raises blood sugar and insulin needs
    • Hormonal changes due to puberty and healthy growth in young adults: raises blood sugar and insulin needs
    • An injury which raises overall inflammation levels: raises blood sugar and insulin needs
    • Glucogenesis during anaerobic exercise: raises blood sugar

    While you can’t necessarily prevent these factors that affect your blood sugar from occurring, you can work with your diabetes healthcare team to adjust your insulin, other diabetes medications, nutrition and activity levels to help compensate for them when they do occur.

    For example, when engaging in anaerobic exercise — like weightlifting — many people with type 1 diabetes find it necessary to take a small bolus of insulin prior to or during their workout because anaerobic exercise can actually raise blood sugar.

    Learn more about exercising with diabetes in DiabetesStrong’s Fit with Diabetes ebook.

    Still frustrated with your blood sugar and A1c results?

    Your blood sugars and your insulin or medication needs never stay in one place. If you gain weight or lose weight, your insulin and medication needs will change. If you become more active or less active, your needs will change. If you make drastic or even small changes to your nutrition, your needs will change!

    Working with your diabetes healthcare team, and diabetes coaches who can teach you how to make changes in your overall diabetes management plan are essential. Diabetes is a lifelong learning process.

    Take a deep breath and be patient. If you don’t like what you’re seeing on your glucose meter, don’t get mad…get studying! Take good notes and work with your team to make changes to reach your goals.

    Read more about improving your A1c in DiabetesStrong’s guide, How to Lower Your A1c.

    If you liked this guide to normal blood sugar levels, please sign up for our newsletter (and get a sign-up bonus) using the form below. We send out a weekly newsletter with the latest posts and recipes from Diabetes Strong.

    Is ‘Borderline’ Diabetes Really Diabetes?

    Receiving comprehensive care that includes nutrition and exercise advice is key to successfully preventing potential complications. Unfortunately, patient education often gets short shrift in today’s hurried medical environment. Don’t hesitate to seek the information you need, whether you ask your doctor directly or search for it online.

    Q3. I am a type 2 diabetic on medication — metformin and Glucobay. If I go on an occasional sugar binge, will I suffer from any serious immediate side effects, e.g., a stroke or a heart attack? And will there be any long-term damage?

    — Gerald, Malaysia

    The seriousness of the damage depends on how frequently you go on a sugar binge, the quality and quantity of the sugar-containing foods, how much you eat, and what you do to compensate for this dietary indiscretion. If the sugar is a once-a-year affair and you exercise to burn the excess calories, check your sugar levels, and medicate appropriately, you might be able to minimize the potential complications. If you have sugar binges on a regular basis, regardless of your activity level, the high sugar levels will contribute to dangerous complications.

    Excessive levels of sugar, even transiently, are toxic to the body, including the cells that line the blood vessels and the pancreas. The dysfunction of these cells is one of the immediate effects of high sugar levels, leading to an increase in insulin resistance and worsening of your diabetes. The long-term effect, as you have guessed, includes strokes and heart attacks. This effect is accelerated by the usual culprits in sweets. As you know, most sugar products such as candy bars, cakes, cookies, and ice cream are also high in fat, the very root cause of clogged and inflamed blood vessels. They are also dense in calories. The excess calories turn into fat, and excess fat leads to obesity and furthers insulin resistance. Despite taking metformin and Glucobay, sugar binges raise the glucose and fat level in your bloodstream. This, in the short and long term, can lead to a stroke and heart attack; at a minimum it leads towards the continued formation of plaques in your blood vessels.

    Perhaps investigating the reasons for your sugar binges (such as self-imposed dietary deprivation and stress) and addressing these reasons might help you enjoy sweets in moderation. You might also try to find fruit-based sweets that use sugar substitutes, or dark chocolate containing plant sugars such as insulin that do not raise sugar levels.

    Learn more in the Everyday Health Type 2 Diabetes Center.

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