At Optimal Hormone Health, in addition to hormone levels, we check a variety of other labs to ensure we are getting a well-rounded picture of your overall health. One such lab value we check is your hemoglobin A1c- but we often get asked why we do that if we are hormone providers. In short- we do this because one health concern that often goes unnoticed until it reaches a critical stage is pre-diabetes. This condition, marked by higher-than-normal blood sugar levels, significantly impacts not just our metabolic health but also has far-reaching effects on hormonal balance within the body. Let's dive in a bit deeper.
What is Pre-Diabetes?
Pre-diabetes is a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. It's often considered a warning sign, urging individuals to make lifestyle changes to prevent the progression to full-blown diabetes. A hemoglobin A1c value of 5.7-6.4% indicated pre-diabetes.
What are the Risk Factors for Pre-Diabetes?
Overweight or Obesity
Excess weight, particularly around the abdomen, increases the risk of insulin resistance, a precursor to pre-diabetes.
Inactive Lifestyle
Lack of regular physical activity contributes to weight gain and decreases insulin sensitivity.
Family History and Genetics
Having a close family member (parent or sibling) with type 2 diabetes increases the risk of developing pre-diabetes due to shared genetic and lifestyle factors.
Age
The risk of pre-diabetes increases with age. Individuals over 45 years old are at higher risk, likely due to decreased physical activity and muscle mass.
Race and Ethnicity
Some ethnic groups, such as African Americans, Hispanic/Latino Americans, Native Americans, Asian Americans, and Pacific Islanders, have a higher risk of developing pre-diabetes.
Gestational Diabetes
Women who had gestational diabetes during pregnancy are at an increased risk of developing pre-diabetes and type 2 diabetes later in life.
Health Conditions
Conditions like polycystic ovary syndrome (PCOS), high blood pressure, and high cholesterol levels are associated with an increased risk of pre-diabetes.
Poor Diet and Nutrition
Diets high in processed foods, sugary beverages, and low in fiber can contribute to insulin resistance and increase the risk of pre-diabetes.
Sleep Disorders
Conditions like sleep apnea and poor sleep quality have been linked to an increased risk of insulin resistance and pre-diabetes.
Stress
Chronic stress can affect hormone levels and contribute to insulin resistance, potentially increasing the risk of pre-diabetes.
Medications and Health History
Certain medications, such as corticosteroids, antipsychotics, and some HIV medications, can increase the risk of insulin resistance. A history of cardiovascular disease or having had a heart attack can also elevate the risk of developing pre-diabetes.
The Health Ramifications
The repercussions of pre-diabetes extend far beyond the risk of developing diabetes itself. This condition is a precursor to several health complications, including cardiovascular diseases, nerve damage, kidney problems, and even hormonal imbalances.
According to the CDC, "without taking action, many people with prediabetes could develop type 2 diabetes within 5 years." Type 2 diabetes is an emotionally & financially costly, chronic disease with many health complications.
Hormonal Effects of Pre-Diabetes
Insulin Resistance
Pre-diabetes primarily arises from insulin resistance, where the body's cells become less responsive to insulin, the hormone responsible for regulating blood sugar. This resistance not only leads to elevated blood sugar levels but also triggers a cascade of hormonal disruptions.
Impact on Insulin and Glucagon
Insulin and glucagon, two critical hormones in blood sugar regulation, face imbalance in pre-diabetic conditions. Elevated insulin levels can result from the body's attempt to compensate for insulin resistance, leading to hormonal irregularities.
Effects on Sex Hormones
Pre-diabetes can also affect sex hormones like estrogen and testosterone. Elevated insulin levels can disrupt the delicate balance of these hormones, contributing to issues like polycystic ovary syndrome (PCOS) in women and reduced testosterone levels in men.
Cortisol and Stress Response
Moreover, pre-diabetes can influence the body's stress response by altering cortisol levels. Chronic elevation of cortisol, often seen in insulin-resistant individuals, can lead to increased abdominal fat deposition, further exacerbating insulin resistance.
Reversing Pre-diabetes
The good news is that pre-diabetes can be reversible with lifestyle changes.
Get Moving
Regular physical activity plays a pivotal role in reversing pre-diabetes. Engaging in exercise helps improve insulin sensitivity, making it easier for your body to regulate blood sugar levels. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, cycling, swimming, or dancing. Additionally, incorporating strength training exercises at least twice a week can further enhance insulin sensitivity and aid in managing pre-diabetes.
Lose Weight
Shedding even a small percentage of body weight can significantly improve insulin sensitivity and reduce the risk of developing type 2 diabetes. The ongoing study from the CDC's Diabetes Prevention Program has shown that people with pre-diabetes who lost a modest amount of weight—5 to 7% (10 to 14 pounds for a person weighing 200 pounds, for example)—with the help of a structured lifestyle-change program cut their risk of developing type 2 diabetes by 58%.
Dietary Changes
Adopting a balanced and nutritious diet is key in reversing pre-diabetes. Emphasize whole foods rich in fiber, such as fruits, vegetables, whole grains, and legumes. Limit the intake of processed foods, refined sugars, and saturated fats, which can contribute to insulin resistance. Opt for complex carbohydrates with a low glycemic index to help regulate blood sugar levels. Additionally, portion control and mindful eating practices can aid in managing pre-diabetes.
Get Enough Sleep
Prioritize quality sleep as it plays a significant role in hormone regulation and overall health. Inadequate sleep can disrupt insulin sensitivity and contribute to the development of pre-diabetes. Aim for 7-9 hours of uninterrupted sleep each night. Establish a bedtime routine, create a comfortable sleep environment, and limit screen time before bed to improve sleep quality and support your body's metabolic processes.
Limit Alcohol Intake & All Tobacco
Alcohol can affect blood sugar levels and contribute to weight gain if consumed excessively. Moderation is key, and if you drink, do so in limited amounts. Similarly, tobacco use, including smoking and chewing tobacco, can exacerbate insulin resistance and increase the risk of developing type 2 diabetes. Studies show people who smoke have a higher chance of pre-diabetes than nonsmokers.
Get Your Hormone Levels Checked
Testosterone replacement has been shown to reduce hemoglobin A1c and serum glucose levels in diabetic men. There are also epidemiological studies to suggest that low testosterone levels are associated with and predictive of future development of Type 2 diabetes. A 2020 study of Type 2 diabetic men found ⅓ of participants had remission of their diabetes, and most reached goal A1c levels with TRT.
Take-Away
The overall takeaway message is that pre-diabetes can be reversible, and it does not have to be a life-long problem. Staying on top of your lab values is critical, which is why we monitor this yearly, at a minimum, for all of our patients. It is important to catch and prevent pre-diabetes early to minimize your risk of Type 2 Diabetes and avoid further health complications. Pre-diabetes should be taken seriously as it can affect so many parts of your health, including your hormones. Pre-diabetes isn't necessarily a precursor to Type 2 diabetes, but it should certainly be a wake-up call to make health changes.