Doctor’s Tip: Early treatment of prediabetes is critical |

Doctor’s Tip: Early treatment of prediabetes is critical

Dr. Greg Feinsinger
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My mentor in heart attack prevention, Brad Bale, M.D., and his nurse practitioner Amy Doneen wrote an evidence-based book called “Beat the Heart Attack Gene.” In it they say that the cause of 70 percent of cardiovascular disease (heart attacks and strokes) is insulin resistance, which is also called prediabetes.

We all know about the obesity epidemic in the U.S. and the health problems it causes. To see if you might have prediabetes, measure the circumference of your waist at the point of greatest circumference (not your belt size). If you are a woman and your waist circumference is 35 inches or greater or if you are a man and the measurement is 40 inches or greater, you almost certainly have insulin resistance/prediabetes, the cutoff points being less in Asians and East Indians.

People with insulin resistance have visceral fat, meaning fat around their internal organs. Humans are not genetically meant to have this kind of fat, which is very toxic for us and prevents our tissues from using insulin as they should. The pancreas overcompensates by pumping out more insulin and eventually wears out, leading to diabetes. The problem is that over the 10 to 20 years that most people have prediabetes before they are diagnosed with diabetes, the same complications are occurring that occur in people with diabetes:

• Inflammation of blood vessels resulting in cardiovascular disease.

• Kidney damage.

• Eye damage that can lead to blindness.

• Nerve damage called neuropathy that can lead to burning pain in the lower extremities.

• Erectile dysfunction.

Only if prediabetes is caught early can it be completely reversed. Unfortunately, the diagnosis is often missed, even after people have had a heart attack or stroke. If you have cardiovascular disease, a family history of cardiovascular disease or diabetes, if you meet the above criteria for waist circumference, or even if you don’t but have a little bit of a belly when you look in the mirror sideways, insist on finding out if you have prediabetes. Here’s what to look for:

• Fasting blood sugar higher than the low 90s.

• Triglyceride/HDL ratio on a lipid panel of greater than 3.5/1 in a Caucasian, 3.0/1 if Hispanic, and 2.0/1 if African-American.

• The gold standard test is a two-hour glucose tolerance test, where you fast 12 hours, go to the lab, drink 75 grams of glucose, and if your one-hour blood sugar is 125 or greater or your two-hour 120 or greater, you clearly have insulin resistance.

• A1C is a blood test that measure the blood sugar trend over three months, and should be less than 5.7. However Bale and Doneen say that the predictive power of this test is poor compared with the above.

Meat and dairy products contribute to development of prediabetes and diabetes, unrelated to weight gain. A plant-based, whole (unprocessed) food, low-fat diet along with regular exercise can prevent and reverse these conditions. If you’re unwilling to make the necessary lifestyle changes, there are medications that help such as metformin and Actos.

Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, now has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and any other medical concerns. Call 970-379-5718 for an appointment. For questions about his columns, email him at

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