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Last year, when I visited my GP for a series of blood tests, the last thing I expected to hear when I called up for the results was “oh! and we’ve booked you in for a chat with the diabetes nurse”. It turned out the tests had uncovered not only anaemia but a prediabetes diagnosis (sometimes referred to as borderline diabetes).
At the time I was 30 years old, of a healthy weight and a regular gym-goer. I’d always figured that if I ever were to develop diabetes it wouldn’t be until well into old age. But, it turns out, the number of people hearing the same news as me is on the up – recent ONS stats say prediabetes impacts 1 in 9 adults in England (12%), which is about 5.1 million adults.
Why is that? Well, some studies have also found links between our diets (which increasingly contain a high amount of ultra-processed foods) and developing type 2 diabetes, but there’s a lot more to it than that. There are many risk factors outside of our control, such as age, genetics, ethnicity and family history too.
“Type 2 diabetes is high blood sugar levels caused by a lack of a hormone called insulin,” says Diabetes UK. “Either your body isn’t making enough or the insulin it does make doesn’t work properly. This is sometimes called insulin resistance […] Lack of insulin causes glucose from what you eat or drink to build up in your blood.
“If you do not have enough insulin – or the insulin your body produces is not working properly – the glucose in your blood cannot enter your cells and give you energy. And your blood sugar levels keep rising.”
My GP explained that many people don’t realise they’re borderline diabetic until their high sugar levels are picked up in a blood test for something else, much like me. (He then also said “Imagine all your favourite foods… ice cream, cake, chocolate. Now put them in the bin!” #banter).
Naturally, after hearing this news I… a) panicked and b) had a lot of questions, ranging from how do I reverse prediabetes to how much sugar should a woman aim to eat a day? And does the sugar found in fruit and vegetables count towards that total?
I asked two experts, Elaine Allerton RD, a British Dietetic Association spokesperson and registered dietitian specialising in diabetes, and Natasha Marsland, Senior Clinical Advisor for Diabetes UK for the intel…
What is prediabetes?
Much like it sounds, ‘prediabetes’ or ‘borderline diabetes’ is an indicator that you’re at risk of developing type 2 diabetes and means that your blood glucose (sugar) levels are higher than usual (but still not high enough to warrant a diabetes diagnosis). Think of it more as a warning sign that you’re more at risk of developing type 2 diabetes – which is definitely something I wanted to avoid, given it increases the risk of heart disease and stroke, nerve damage, foot problems and vision loss, amongst other things.
“You are unlikely to be experiencing any symptoms with prediabetes,” Marsland adds. “If you start to have any of the symptoms of type 2 diabetes it means you have probably already developed it.”
As for risk factors, 13.6 million people are at increased risk of type 2 diabetes in the UK and characteristics such as age and race (white people over 40 and African Caribbean, Black African or South Asian people over 25), carrying excess weight (especially around your waist) and family history can all have an impact on your personal likelihood of developing type 2 diabetes.
In terms of what type 2 diabetes actually is, Marsland explains that it “happens because insulin can’t work properly, or the insulin it makes is not working properly — known as insulin resistance – so your blood sugar levels keep rising. This means more insulin is released. For some people with type 2 diabetes this can eventually tire the pancreas out, meaning their body makes less and less insulin. This can lead to even higher blood sugar levels.”
You can use the Diabetes UK ‘Know Your Risk’ calculator to find out your personal risk level. If you score highly, book in for a chat with your GP and request a HbA1c blood test.
What blood test results indicate that you have prediabetes?
Allerton adds a little more on how blood tests for borderline diabetes works, explaining it takes into account your average blood sugar levels over the span of three months: “Blood glucose levels are measured with a HbA1c (glycated haemoglobin) blood test. Glucose is carried around our bodies, attached to the red blood cells (haemoglobin), which have a lifespan of around 120 days, hence being able to calculate the average blood glucose level over the previous 3 months – and possibly being able to see a change after 3 months.”
She says the following measurements indicate a different diagnosis. For context, I was 42mmol/l – so right on the cusp of borderline, but still enough to get a major wake up call.
Diagnostic HbA1c Results
Normal: Below 42mmol/mol (below 6%)
Prediabetes: 42-47mmol/l (6% to 6.4%)
Diabetes: 48mmol/mol or above (6.5% or above)
Does borderline diabetes definitely mean you’ll develop diabetes?
It does not, says Allerton. “A diagnosis of prediabetes doesn’t mean that you will 100% go on to develop type 2 diabetes, but it is an early warning – a heads up.” She adds that depending on how high your sugar levels are at the time of diagnosis, reversing it could be achieved in 3 months. “If someone makes lifestyle changes and has a repeat HbA1c in 3 months time, the results can swing back into the normal range.”
Marsland agrees, “With the right support, and making changes to diet, increasing physical activity and losing weight if you need to, up to 50% of cases of type 2 diabetes can be prevented or delayed.”
We’ll get on to those lifestyle changes in just a mo…
How much sugar should a woman eat per day?
So the simple answer here is no more than 30g of sugar per day. But I found it quite confusing to know what counted within this bracket, for instance does the naturally occurring sugar found in fruits and veg count… or is it just my fetish for mini Magnums I need to keep an eye on?
Allerton says, “The food focus should be on the quality and quantity of carbohydrates, rather than sugar. There are 3 types of carbohydrate: sugars, starches and fibre. [You should] have less than 30g of free sugar per day, choose low glycemic index whole grain options (there are no recommended daily amounts here) and aim for at least 30g of fibre per day.”
She also advises that free sugars include “all sugars (whether it be sugar, syrup, honey or nectar) added to products by a manufacturer or home cook”. Lactose added to whey powders, sugars naturally present in fruit juices, concentrates, smoothies, purees and powders, and sugars naturally present in dairy alternative drinks (e.g. soy, rice, oat or nut-based drinks) all count too. However, sugars that are naturally occurring in the whole fruits, vegetables and dairy products do not.
Marsland notes that due to added sugar being ‘hidden’ in many foods, it can quickly mount up. “The maximum recommended daily amount of free sugar is 30g for adults – which works out at just seven teaspoons a day. Given that a tablespoon of ketchup contains around one teaspoon of sugar, a chocolate biscuit has up to two, and a small serving of baked beans almost three, you can see how quickly the teaspoons can add up.”
Does the sugar in fruits and vegetables count as ‘free sugar’?
As mentioned above, this is something I found complex – and Allerton says I’m not the only one.
“In short, avoid added sugars (limit intake to less than 30g day) but enjoy naturally occurring sugars in whole fruits, vegetables and milk/dairy,” she notes. “Aim to have at least 5 portions fruit and vegetables each day, a portion is what will fit in your hand. For each portion of fruit, have two portions of vegetable across that day, as vegetables will contain less carbohydrates/sugar than fruit.
“The lower carbohydrate fruits are berries: raspberries, strawberries, blueberries, blackberries, whilst the fruits grown in warmer climates will be higher in carbohydrates: banana, pineapple, melon.”
It is confusing though, Allerton sympathises, noting that “flavoured yoghurt would be considered added sugar and part of your 30g limit, however a plain yoghurt with a small handful of added berries is not – and those berries will also contribute to your daily 30g fibre intake. It’s really about limiting the added (or free) sugars.”
She also notes that it’s important not to demonise any foods, or label them as ‘good’ or ‘bad’.
How to reverse prediabetes
Luckily, six months after hearing the news that I was borderline diabetic and seeing it as a kick up the bum to take better care of my diet (you’ll be pleased to know I’m no longer eating tablespoons of Biscoff simply because it’s there), I was able to reverse my diagnosis.
Here’s some tips on how I managed it:
Get into cooking and meal prep
It sounds obvious but I massively stripped back the amount of processed foods I eat and now opt for home cooking whenever possible, as that way I know exactly what’s in my food (including the sugar content). I also try to ‘eat a rainbow’ of fruit and veggies, as different coloured foods bring about different benefits.
Take a good look at your diet
“There is no special diet for someone with prediabetes or type 2 diabetes, just the same recommendations that we all should be following [of eating a healthy balanced diet],” says Allerton. “There’s still room for higher sugar foods occasionally.”
As for how your plate should look, Allerton recommends a quick spot of meal maths, “Use healthy portion plate principals: on a 20cm diameter plate, half should be filled with vegetables, a quarter with lean protein and a quarter starchy carbohydrate.”
She adds, “There is no recommendation as to how much carbohydrate to have each day, it is dependent on your individual energy requirements. A low carbohydrate diet would be less than 130g of carbohydrate per day.”
To work out your required daily carbohydrates number, you could assess your total daily calories and half that figure; this is how many calories should come from carbs. If you divide that number by four, you’ll be able to ascertain the total number of carbs to aim for in grams.
Find new sweet treats
I’ve also swapped to dark chocolate rice cakes or greek yoghurt with strawberries when I’m craving a sweet treat – but of course still allow myself the odd mini tub of Ben & Jerry’s or a Cadbury Caramel bar from time to time… I’m still human after all.
Track what you eat
I use MyFitnessPal to record what I eat and it has a handy function that shows how much sugar in total I’ve consumed each day. It helps seeing everything in black and white; many of the results were eye-opening (for instance I learned my former daily oat milk latte contained more than 10g of sugar!). Allerton says even just tracking for three days can give a good snapshot of your diet.
Exercise
I’ve been a gym lover for a few years now so this wasn’t totally new for me per se, but I noticed that on the days I exercise in the mornings, I’m naturally inclined to eat more healthily. If you set yourself up on a good path in the AM, that feeling can carry right through until the PM.
“Increasing daily activity [simply means] being less sedentary,” Allerton adds, reminding that exercise doesn’t have to mean a brutal HIIT class if that’s not your thing. “Take phone calls standing up, use the stairs instead of a lift, go for a walk during your lunch break, park at the furtherest corner of the supermarket carpark.” The little things can add up to make a big change.
Ask for support
Although I didn’t personally feel the need to attend it (and thought it’d be better for my place to be given to another person), my GP offered for me to take part in an NHS Diabetes Prevention Programme – a course about how to manage your diet and implement positive lifestyle changes in light of a prediabetes diagnosis.
Manage your weight
By cutting out sugary treats and eating as whole foods-focussed as possible, I naturally lost a few pounds – and felt happier and healthier for that, even though I was already in a healthy weight bracket for my age and height.
If you are struggling with your weight in the sense you’re overweight or obese, Allerton says it’s very important to manage this. “If you’re living with being overweight or obesity and are at high risk of type 2 diabetes, losing just 5% of your body weight can help to reduce your risk,” she says. “For instance, if you weigh 80kg, then a 4kg loss can be beneficial in reducing your insulin resistance.”
Weight loss is such a personal topic though and is much about your mental health as it is physical, so working with a professional who takes a personalised approach is always best. Chat to your GP, seek the help of a nutritionist or dietician, and consider if talking therapy might assist on your journey.
This article is not intended to be a substitute for professional medical advice or diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
