The Lie That's Killing Us: Pre-Diabetes

The Lie That's Killing Us: Pre-Diabetes

by Riva GreenbergDiabetes advocate, author, speaker and coach, and TuDiabetes member

Pre-diabetes is a lie. Pre-diabetes is Stage 1 diabetes. And I'm taking a stand now advocating that we call it what it is.

Pre-diabetes doesn't exist. And the lie we tell that it does does incredible harm. It stops the nearly 80 million Americans we say have it from making the lifestyle changes necessary to prevent advanced Type 2 diabetes. Pre-diabetes is in truth the first stage of diabetes.



A well written truthful article about T2. The ADA should adopt these recommendations wholesale, thanks Riva.

Very well said, this is one of those things that makes me nuts! Thanks, Riva!

I believe that the CDA should adopt this as well. I agree with the article and that there is no such thing as prediabebetes and I don’t get how they’re can be a clear cut “number” between prediabebetes and diabetes. You can’t be a little bit diabetic just like you can’t be a little bit pregnant. Thanks for Sharing :slight_smile:

Pre-Diabetes is what years ago was referred to as borderline Diabetes which was a way of avoiding the truth and the same is happening today. I believe it's a way of avoiding the truth and it just delays the truth and lulls people into a false sense of security. It keeps people from facing the truth. It's like when I at times offer advice to other about Diabetes and they say oh my doctor is taking care of that. They don't realize that it's not their doctors Diabetes but theirs and that they have to manage it.

Beautifully said Betty, thanks ;)

Amen!!!!! Inasmuch as there is NO pre-cancer....the same applies to diabetes.

For another take on this subject, see this.

Oy, one link to another link - does anyone just post their opinions anymore?? What is up with all this energy in defining terms? Semantics are good up to a point; beyond that it's just mental masturbation.

Personally I've seen pre-diabetes diagnosis do exactly what it should: Give someone a heads up that action is required to prevent further progress of the disease

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And I've seen it used as an excuse to disregard the whole thing and walk away because it's "not really diabetes." Direct quote.

I have to say, I agree with Riva that pre-diabetes is just diabetes and we should stop beating around the bush. But I also am alarmed by her misunderstanding of T2 diabetes. We have a "huge" program called the Diabetes Prevention Program (DPP), which is now "the total solution." If you accept the premise that pre-diabetes is diabetes and carefully read the DPP study, you will realize that the study was fundamentally "rigged." It measured a false outcome. It didn't measure how many people still had diabetes, it simply measured whether their diabetes had progressed. In fact, in hindsight, one has to wonder whether the failure to report whether patients were still pre-diabetic even after following the low fat calorie restricted exercise regime was a "cover-up." And a recent study of the long-term effects of the DPP found "Overall, intensive lifestyle intervention achieved, with less medication, a comparable long-term effect on cardiovascular disease risk factors, to that seen in the metformin and placebo groups." Whoop-de-doo.

So does the DPP really help? I don't think we have any evidence. Does it "prevent?" I don't think so.

I think it is a house built on a cracked foundation and I am not happy with the vast sums of money being spent on this "final solution." Years from now, we may look back at this fiasco and feel ashamed of the harm done to millions of people worldwide.

Brian (bsc):

Thank you for commenting. Your comments are most interesting. Very good questions .

My wife is not overweight but was diagnosed as pre-diabetic using the FBS and OGTT. Her A1c was in the normal range. But when I performed a series of blood sugar tests on her after some high-carb meals, I was able to demonstrate to her that she is clearly a full-blown diabetic. Currently she is able to maintain an A1c of 5.6% with just diet and exercise.

My points are that
1. Pre-diabetic is in fact T2 diabetes, Stage 1
2. Current health system screening is missing a lot of bona fide diabetics.

Amen. Twice.

Am I correct in thinking, then, that if you are told you are pre-diabetic, there is no way diet and exercise will return you to a non diabetic state? T2 that is.

What has been shown is that if you diet and exercise, you can delay the onset of "overt" diabetes. I've not seen any evidence that you can return to a non-diabetic state.

Dr Bernstein defines 4 stages

1. diet
2. diet and exercise,
3. diet, exercise and oral
4. diet, exercise, oral and insulin

How many stages you can reverse is an open question

Ultimately you can probably never return to being a McDonalds Rat

I have to admit I hadn't really thought it out, but it seems to me we are told, or it is implied, that if we eat and exercise whilst pre-diabetic we can cure ourselves. Obviously this is untrue if you change the base line.
But you try and tell someone who the dr. has described as pre-diabetic that they are diabetic, they absolutely refuse to accept this.

I just actually posted a review of a book put out with the help of CDA (Canadian Diabetes Association) along with other American diabetic "experts" - that's entitled The Diabetes Prevention & Management Cookbook. Nel Peach had told me that this book had been published - and a discussion was occurring.
I often don't post here because of the controversy that arises over everyone arguing over what is diabetes and what isn't. I just think if we can all be better informed - hopefully the right way (what is the right way???) - and go with what we feel is best. I feel we're all in the same boat - whatever type we have - whatever name we give it. If I was diagnosed as being prediabetic - you bet my sweet you know what - that a book like this - could hopefully help me.
Just saying - and like I've been saying on my posts as I sent this blog to many groups on FB - don't get your knickers into a twist - we're all here to learn - and perhaps what Riva is saying (I can't know for sure - I don't have her book) - is true. I know from a fact - I've seen a few friends misdiagnosed from day one - as being Type 2 - when they should have gone onto insulin right away - and sadly - they suffer the consequences today (basically unable to work due to complications). Hopefully potential prediabetics have the ability to have good sources of info - that they have a medical team that knows what to do.
Here's the link for my review of this book - don't shoot the messenger ....


I couldn't agree more that the label matters less than getting your BG under control, using whatever it takes to achieve that.

That said, I agree with Riva that there is no such thing as "pre" diabetic. Either your body can control your BG automatically, without assistance -- or it can't. Like being "a little bit pregnant", there is no in-between. Black or white. Yes or no.

And there is a school of thought (with which I happen to agree) that the earlier you intervene with insulin, the more damage you can prevent and the more beta cell function you can save. It's a position that comes in for its share of controversy, but it has some heavyweights behind it. Joslin, for instance, now puts each newly diagnosed T2 on insulin right away.