Ask the Doctors December 2017 Issue

Ask the Doctors: December 2017

Q: At my last checkup, my doctor said I was prediabetic, but he didn’t prescribe medication. Will changing my diet and exercising be enough to bring my blood sugar levels down?


Michael Rocco, MD

Michael Rocco, MD, medical director of Cardiac Rehabilitation and Stress Testing at Cleveland Clinic

A: We say prediabetes is present when glucose levels are higher than normal, but not high enough to be considered diabetes. Prediabetes develops when the body does not make enough insulin or begins to have trouble utilizing insulin. It is defined as a fasting blood glucose level of 100-125 mg/dL, a two-hour blood glucose level of 140-199 mg/dL during a glucose tolerance test, or a hemoglobin A1c between 5.7 and 6.4.

Prediabetes increases the risk of progressing to diabetes and of developing heart disease. More than 80 million people in this country have prediabetes. Individuals who are physically inactive, overweight, have a family history of diabetes, history of gestational diabetes, elevated blood pressure, low HDL cholesterol and/or high triglyceride levels, vascular disease or polycystic ovarian syndrome are at risk and should be screened.

In 2001, a large U.S. study showed that if you are at risk of developing diabetes, that risk can be reduced by almost 60 percent by eating healthy foods, achieving and maintaining moderate weight loss and engaging regularly in moderate physical activity.

If you are overweight, your first goal should be to lose weight. A 7-10 percent reduction in weight can substantially improve how your body utilizes insulin and improve your blood sugar levels. A prudent diet would be one centered on low-fat proteins, non-starchy vegetables (such as asparagus, Brussels sprouts and carrots) and high-fiber grains, while limiting refined sugars and starchy carbohydrates, like white rice and potatoes.

Working with a dietitian may help you develop an appropriate eating plan that includes the foods you like. Work in moderate aerobic exercise, such as brisk walking, cycling or swimming for 30 minutes on five to seven days a week. Some doctors prescribe metformin (Glucophage) for treating prediabetes, particularly if there is a history of polycystic ovarian syndrome, but this should not be a substitute for a healthy lifestyle.

Q: I recently suffered what I thought was a stroke, but it turned out to be a transient ischemic attack (TIA). What can I do to prevent a full-blown stroke?

A: TIAs occur when part of the brain experiences a temporary lack of blood flow, causing stroke-like symptoms. Unlike a stroke, however, the symptoms of a TIA are generally temporary.

Studies have reported that 4 to 20 percent of patients with TIAs have a stroke within 90 days; half within 48 hours. One in three people who have a TIA will eventually have a stroke. It is not inevitable, however.

To lessen the risk of stroke, the cause of a TIA should be diagnosed as quickly as possible, and the best treatment determined. This will require a thorough medical history and physical exam to uncover any stroke risk factors and assess brain function. Testing will often include imaging brain tissue with CT or MRI, assessing blood flow with carotid artery ultrasound or cerebrovascular blood vessel CTA or MRA, performing an echocardiogram (EKG) and sometimes, heart rhythm monitoring to exclude atrial fibrillation or flutter. In a young person with a TIA, doctors will look for vasculitis, infection, carotid artery dissection or congenital heart disease, all of which may cause stroke.

Strokes can be prevented by not smoking; maintaining a healthy weight; eating a diet low in cholesterol, fat and sodium; exercising regularly; limiting alcohol intake; and treating elevated blood pressure, cholesterol and diabetes.

After a TIA, statins, antiplatelet therapy with aspirin or clopidogrel and, sometimes, anticoagulants may be recommended. Surgery or angioplasty may be advised to open a blocked artery. The good news is that with early evaluation and treatment of TIA, up to 80 percent of strokes may be prevented.

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