Ask the Pharmacist

Q: My doctor told me that I have pre-diabetes and that I need to take immediate action or I will soon be a full-fledged diabetic. What is pre-diabetes and what can I do to prevent myself from becoming a diabetic?

A: Pre-diabetes is a term you do not hear much about but probably should as it is estimated that approximately six-million Canadians have this condition, although many (experts say as many as 90 per cent) are unaware of it.
While it sounds like a pseudo-disorder (sort of like being pre-pregnant), it has, in fact, a strict diagnosis based on blood work and a protocol for treatment just like most other medical conditions.

Pre-diabetes is diagnosed when blood work, repeated a month apart, shows a fasting (i.e. empty stomach) sugar level between 6.1-6.9 or an A1C (that is the test that gives the doctor an idea of what your sugars have averaged over the last three months) of between six per cent and 6.4 per cent or a sugar level of between 7.8-11, two hours after consuming a specific quantity of sugar.

These tests are quick and inexpensive to do and vitally important as approximately half of pre-diabetics will eventually go on to become diabetics with an average of 10 per cent of them converting each year. What’s more, pre-diabetics are also at an increased risk of other significant health complications, such as heart disease and stroke, if remedial action is not undertaken.

The challenge is to identify who should be tested as these individuals will not have any symptoms that might cause them to seek medical help on their own.

Currently, the Canadian Diabetes Association recommends screening any adults over the age of 40 who are overweight and who have one or more of the following risk factors for diabetes:
 

• A lifestyle lacking in physical activity
• A first-degree relative with Type 2 diabetes
• Come from a high-risk ethnic background (African-American, Native North-American, Latino, Asian, Pacific Islander)
• Have high blood pressure
• Gave birth to a baby who weighed more than nine pounds or diagnosed with gestational diabetes during pregnancy
• Have high cholesterol
• Have been diagnosed with polycystic ovarian syndrome
• Have a history of cardiovascular disease
• Take certain drugs which can predispose an individual to diabetes, such as prednisone or the atypical antipsychotics (such as quetiapine, olanzapine).

Once identified, treatment is aimed at reducing the risk that these individuals will become diabetics with all of the attendant hassles that come with that diagnosis (more pills, higher life insurance premiums, higher travel insurance premiums, possible complications with driving for a living, higher risks for all sorts of medical conditions such as loss of eyesight, nerve pain, erectile dysfunction, heart attack).

The initial treatment usually involves lifestyle changes aimed at a modest weight reduction. This, as always, involves some combination of exercise (at least 150 minutes per week) and dieting.

A reduction in weight of between five to 10 per cent can delay or even prevent diabetes from occurring in about one out of seven pre-diabetics when it is maintained over a prolonged period (such as three years).

If lifestyle choices proves inadequate after three to six months of trying, drug therapy can be considered for those at the very highest risk. The drug of choice clearly seems to be metformin which has been a mainstay of diabetes therapy for decades.

It has a long track record of being a very safe drug with most side effects being of the bothersome type (such as gas and diarrhea) rather than the dangerous type and a cost that is extremely affordable compared to most other drugs. It is usually given twice per day with food at a dose ranging from 250-850 milligrams (mg) depending on the reduction in blood sugars required. For every 14 pre-diabetics treated, one case of diabetes is likely to be prevented.

For those whose stomachs or bowels can’t handle metformin, the drug acarbose can be trialled. This drug works in your intestines to slow the breakdown and absorption of the carbohydrates that you eat which results in lower blood sugar levels. While this drug has a slightly higher success rate than metformin, its usefulness is limited by its greater expense and the fact that as many as one-third of people who take it can’t handle the gas and diarrhea that acarbose can cause.

There are other drugs out there that can also be tried but they do come with risks of more significant side effects that make the decision to use them controversial for many doctors. The key here is to pull your head out of the sand and assess whether you are at risk or a loved one is at risk. Get tested and take action before you are told you are a diabetic and you have to deal with all the negative consequences that diagnosis will bring.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/?fref=ts