While we have all heard about the enormous rise in Americans diagnosed with Type II Diabetes, there has been little education about the early warning signs, a condition called pre-diabetes.

Affecting 56 million Americans, pre-diabetes is a major risk factor for heart attacks, kidney disease and blindness. In the United States today, one in every six health-care dollars is spent on treating diabetes or its complications. With only more health-care spending on the horizon, the American Association of Clinical Endocrinologists recently recommended aggressive action to dramatically reduce the risk of pre-diabetes progressing to full-blown, symptomatic diabetes.

Pre-diabetes is a condition in which the ability to maintain blood sugar in the normal range is impaired, but is not severe enough for a diagnosis of diabetes. The major cause of pre-diabetes is an impaired ability of insulin to transport glucose into cells. Although the exact reason is unclear, this problem is much more common in those who are overweight. To compensate for this impairment, the levels of circulating insulin in the blood increase and, as the problem worsens, blood sugar levels become abnormally elevated.

Pre-diabetes is diagnosed by identifying a random blood sugar level above 120 milligrams/deciliter. If present, a glucose-tolerance test is usually recommended. Here the blood sugar is measured before and at 30, 60 and 120 minutes after drinking 50 grams of glucose. A fasting blood sugar greater than 100 milligrams/deciliter and a blood sugar level greater than 140 milligrams/deciliter two hours after drinking the glucose is diagnostic of pre-diabetes. If the fasting level is above 126 milligrams/deciliter or the two-hour blood sugar level is above 200 milligrams/deciliter, diabetes is diagnosed.

Anyone over 45 or who has any risk factors for the disease should be screened for diabetes at least every two years. The risk of pre-diabetes increases with age, in those who are overweight, sedentary, have a family history of diabetes and in women who have had high blood sugar during pregnancy (gestational diabetes). It is also more common in blacks, Hispanics, Asians and American Indians. Women with a diagnosis of polycystic ovarian syndrome are also more prone to being pre-diabetic.

Although not everyone with risk factors develops pre-diabetes, there is no question that a combination of lifestyle changes and medications can return the blood sugar to normal and prevent the development of more serious complications.

The best way to turn the tide against diabetes is through comprehensive lifestyle changes. First, the presence of either pre-diabetes or diabetes is an absolute indication to lose weight. An impaired ability of insulin to transport sugar into cells can be substantively improved by reducing body fat, which is metabolically inert, and then increasing muscle mass, which is metabolically very active. Begin by developing a healthful diet that contains the appropriate amounts of good fats and protein while avoiding excessive consumption of starches and sugar. Combine healthy eating with a serious commitment to exercise and strength training. Build muscle. The more muscle, the easier it becomes for insulin to maintain a normal blood sugar level.

In addition to lifestyle issues, anyone with pre-diabetes should vigorously address any other health concerns. High blood pressure must be aggressively treated, aiming for a systolic or top blood pressure below 130 and the target bad, or LDL, cholesterol should be below 70. If necessary, medications could be required.

Often pre-diabetics have markedly elevated triglycerides. The best way to bring these values to the normal range is to compulsively restrict carbohydrate intake. There are medications available that specifically lower triglyceride levels, but these should be avoided if at all possible. It is also important to monitor kidney function closely by screening the urine for protein and measuring creatinine levels in the blood annually. Although not approved by the FDA, the AACE believes that using medications to control blood sugar should be considered if elevated levels persist.

Pre-diabetes, as its name suggests, is the first step to diabetes. It is vital that anyone at risk of diabetes be compulsively screened and monitored by a good physician. Wherever you are on the health spectrum, take steps today to live a healthier, happier tomorrow.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

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