Why is pre-diabetes reversible but type 2 not?

Isn't type 2 just an escalation of pre? What distinguishes the figures of 100-126 fasting glucose to 126+ to determine reversibility?

Lastly, fasting glucose in the morning is supposed to be your lowest, but I often hear of type 2 diabetics having 80-120 blood dugar at times--- like 3-4 hours after a meal, etc. Is this not supposed to be the case? Does type 2 mean your blood sugar is perpetually higher than 120?

I don't believe in 'prediabetes' just as I don't believe it's possible to be just a little bit pregnant. I don't believe either prediabetes or diabetes is reversible in the sense of curable because for most symptoms return upon discontinuation of behavioral, dietary, and exercise modifications and/or medications. Many do use these things to successfully halt the progression of the disease or even reverse complications which is not the same as a reversal or cure of the underlying disease. It's more along the lines of you notice your foot hurts more when you walk on it so you don't walk on it. Still an underlying issue, you're just not doing those normal things which aggravate it. Rather than a cure or reversal of the disease we might call those things successful treatment which lasts a lifetime and the relative absence of symptoms remission as is done with other chronic diseases.

Just one person's opinion.

Well it seems doctors look more at a1c as a the point where they actually start treating. I have a coworker who had a glucose tollerence test done. He hit a 240 after an hour and came back to below 80 after 2 hours. His a1c was 5.2. He got the prediabetes diagnosis. I am always between 120 and 130 in the morning. After testing through out the night we determine it was the dawn phenomenon. If I take too much meds then I go low at night so we went with lower drugs. My a1c is 6.5 or so. So I guess in theory a person could go below 6. Happened to me. Once I got below 6 and dropped weight I stopped insulin.

That's one of the reasons I hate A1C. According to the NIH and other sources an OGTT result > 200 = diabetes. His was 240. The doctor used something that, often inaccurately, attempts to approximate bgs instead of the bg result right in front of him. There's a study in the ADA Journal stating 60-70% of diabetics correctly diagnosed by FBG and OGTT levels have normal A1Cs. I've had a 2 hour post prandial reading recently of 280 and my A1C is 4.9. About a third of the 96 readings stored in my meter are above 140. Obviously for me A1C is major fail. Prediabetes and diabetes are meaningless terms when many doctors can't even tell us who is and who isn't. The numbers are arbitrary decisions based less upon medical truth than the fact setting them where research shows damage occurs would result in too many diagnoses and bankrupt the healthcare and insurance industries. In my opinion people should treat prediabetes the same as diabetes. For too many it is seen as a 'get out of jail free' card and excuse to do nothing until they're diagnosed diabetic and wonder how they got there.

I don't think it's "reverseable" as much as "controllable" if treated aggressively. I think that it's kind of silly for the AMA/ ADA/ T2 people to look at exercising 3x/ day with no meds as "reversed" because exercising 3x/ day is a lot of freaking work. I think too that it will likely not be entirely healthy in the long run as there's probably significant potential to "break down" if you are doing anything remotely strenuous and, if you are "reversing" (note imperfect, rather than "reversed") and get injured, you will likely have an increased chance of perhaps running into BG issues. T2 is genetic and if it's there it's there. Exercise and diet are treatments too, just like shots. They have some potential to be more fun but shots are not that big of a deal for a lot of people....

I agree with using more than the A1c to diagnose. I am type one. I had a close friend, diagnosed as "pre-diabetic" about a year ago, tell me just this week that her cjrrent, as of Monday, A1C was 7.5. She said that the doctor told her it correlated to a blood sugar of 157, and she was told to keep doing what she is doing and 'wait and see' .
My friend has lost weight and is eating more healthy ( less carbs, more leafy veggies) She also , exercises more exercise. She feels encouraged because she is not a diabetic "yet".
She also did not understand the diffrence between andA1c and a single blood glucose test. She said, " Well this test is better.. I was at 159 when they did the fingerstick ( blood glucose witht the glocometer, I do not think it was fasting.) and now I am at 157( the A1c).. so that is an improvement, right?".
She is not on any meds as of yet. She has a meter and strips ,as her sister is a diabetic who had extras. I suggested she compare pre-meal testings to 2 hour post meal testings to see if BG is raised , lowered ,or the same. She said the doctor did not tell her to do that, does' not tell her to test AT ALL. She says that she may try what I suggested; as diabetes runs in her family. She really does not want the diabetes diagnosis, and will do anything to keep it as "pre-diabetes', though the recent A1c of 7.5, with her inreased efforts does not seem to indicate that to me.
But 'I am NOT a doctor".. I just play one with my friends and online (lol)

God Bless,

Well said gphx.

I wish I could wave a magic wand and make the term pre-diabetes disappear. IMHO, it's nothing but denial, especially if it's determined using one FS or an A1C. Our resistance, as a culture, to treating things when they first show up, rather than waiting for someone to reach a random criteria like FS reading or A1C, does more damage than good. Encouraging people to make adjustments to diet, etc. to control BG before they are high enough to need meds should be standard practice. ' Pre-diabetes' is too easy to ignore.

Most people, including medical professionals, don't take recommendations for lifestyle changes seriously. Prescribe a medication, though, and suddenly the condition is more 'real'.

Rant over ;)

I belong to a Music forum and there was a thread about Prediabetes, and after reading about all the people who either had been "diagnosed" with prediabetes or knew people with prediabetes and telling short stories about them, I replied simply "There's no such thing as prediabetes. My doctor told me it's like being a little pregnant."

That stopped the thread dead in its tracks. I just don't believe that prediabetes exists. Type 2 can be managed but not "go away".

I only exercise once/day, maybe 20 min. elliptical or a 25-min. walk & no meds. Occasionally, I'll add a few minutes of weightlifting twice/week. I'm not mildly diabetic; at diagnosis in the ER my BG was 491 & even though I objected because I didn't feel bad, they insisted on seeing me ahead of at least 30 other patients.

At least in my experience, it's more about food than exercise.

I consider myself "controlled," not "cured." "Reversed?" Well, maybe "Reversed for now" would be more accurate. I hear people loud & clear when they say "I'd have high BG if I went back to my previous eating habits," but WHY would I want to do that when that (+ genetics) may have contributed to diabetes......& also weighing 405 lbs.??

Pre--diabetes. The term really doesn't bother me. I think it's a little silly but not that harmful. Pre-diabetes is just the doctors trying to lower the bar even lower. When I was diagnosed 20+ years ago I was told that as long as my fasting BS was below 140 then everything was fine, then it was 120 and then they lowered the bar to 100. Pre-diabetes is them lowering the bar again.

I see nothing wrong with a warning. Some people will heed the warning and do what is necessary and some will proceed to cross that inaginary threshold, whatever it is at the time, to T2 diabetes. The same people that will ignore a pre-diabetes diagnosis are the same ones that will ignore an early T2 diagnosis. It just seems like word games that make little difference.

Gary S

Oddly in recent years 65% of newly diagnosed lung cancer patients are nonsmokers or those who quit smoking long ago. Smoking is to lung cancer perhaps as carbs are to Type 2 diabetes. Some can intake them with no issues. Others partake and get lung cancer/diabetes. Some don't and still get the disease. You're right, a lot like diabetes.

I feel sorry for your friend. With an A1c of 7.5, she's NOT pre-diabetic, she's full blown, and if she doesn't get some help fast, she's facing the risk of complications, and soon. The new guidelines of the AACE say that any A1c over 6.5 is diabetic, so what's her doctor doing, futzing around? She needs a new doctor, she needs to be testing, she needs diabetes education, and she may need more treatment than just diet and exercise.

There is a real problem with docs thinking they can just look at the A1c and know everything. It doesn't take into account variabillity of BGs, nor does it notice that different people glycate differently, and that a person can have a "normal" A1c and still have frank diabetes. Someone else gave the figures on that, but this stupid reliance on A1c, and the refusal of the medical community and insurance companies to help people like your friend makes me really mad! :-(

Thanks for the support Natalie.. Did not mean to "Hijack" this thread..but I feel so passionate about getting people the right diagnoses and treatment..Unfortunately, the scenario I just described is not that unusual. Delayed diagnoses of adult onset diabetes, regardless of the type; has occured quite often among people I have talked to in my community. This "wait and see" approach is to keep them from being scared too soon? Is it because they assume that persons diagnosed as adults will not be able handle the truth? That it is too much info too soon?.. I do not want to scare people when I suggest that they do further testing or change doctors..but I feel morally obligated to do so. Most will listen; as I have the "bad kind" of diabetes( lol-Type 1) for four decades, and am still living fairly healthy and definitely happy.

God bless,

Pre-diabetes is a bad term. The politically correct terminology these days is "Metabolic Syndrome". It is all semantics for the same discussion.

Hi Emmy. I agree totally with what you have said. I have managed to bring the A1C down from 10.2 to 6.3. Of course, it has consumed almost all my time. My doctor told me Thurs. that I have "a little bit of diabetes". Testing once/week should do the trick? No wonder everyone is so confused!

As a 64 year old goat fighting this type 2 crud for last 30 years and last 4 getting mess under control I would offer my opinion as follows:

Setting of the body BG level at fasting when gut produces no glucose requires waltz of three main players namely:
Liver, pancreas, and the fat/skeletal muscle cells that absorb glucose under insulin control if there is room and cells not filled to capacity and turning on Insulin resistance.

Simply stated as liver ages, it starts releasing larger and larger low level releases of glucose ( it ages); on top of that the pancreas also ages and probably reduces its basil pulse release as well. Since this is pre diabetes, I would assume the skeletal muscle/fat cells are not completely filled up and the average BG set point starts shifting up as describrd for pre-diabetes.

At this point, carbs control and hearty exercise are capable overcoming the liver small over release and thus stopping the diabetes in its tracks as the extra liver releases are not sufficient to fill completely the local storage sites of the skeletal muscle cells and fat keeping insulin resistance turned off.

As the body ages; the liver gets nastier releasing larger releases ( leaks) of glucose and the pancreas further drops its basil response resulting in the fat/skeletal muscle cells to fill riht up and enforce insulin resistance.

At this stage it takes a heroic effort to cut the glucose pressure, arrest the liver on drugs - and any other meds - possibly a insulin boost - liquid insulin. In addition carbs control and sufficient hearty exercise are still critically needed to ensure that once liver/pancreas monkey shines are arrested - corrected, the carbs control and hearty exercise keep glucose burned off and room in fat/skeletal muscle cells do not stay filled up enforcing insulin resistance.

The big problem here is that once one decides to correct this crap, the external insulin/ pills one has been on must continue till the pancreas and and the skeletal fat muscle cells decide to go back to work and use the body's own insulin as the pancreas goes back to work as well. At that point - unpredictable timing on, the body suddenly now has twice as much working insulin it had a day before.

This needs to be watched /alarmed by a CGMS and protected by patient action against lows and promptly cut back the external pills/insulin injections to correct operating point. At all times one must be under care/approval of plan by your diabetes care doctor. Do NOT TRY this on your own.

This is not puff pastry and wishefull thinking as research papers bearing the ADA label have data and conclusions suggesting this is what is going on.

I am a full blown type 2 and my bg rarely goes over 120. Through low carb diet, metformin and a very low carb diet I rarely eat the food that will spike me over 120. Although my bgs are normal they are that way because of a change in lifestyle. If I go back to eating Standard American diet I would easily go back to 200-300 bgs, again.