Wil Dubois

Happy Saturday! Welcome to Ask D'Mine, our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois.

This week, Wil is pondering what to tell (and call) a woman who seems to have beat prediabetes, for the time being anyway...

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Cathy, told she has prediabetes, writes: After being diagnosed as having prediabetes, I lost about 80 pounds in two years with lots of hard work. I am told I am no longer prediabetic because I got my A1C and BG in the normal range using diet and exercise. So I understand I am not diabetic at all, but I will have to follow the diet and exercise for the rest of my life anyway. So what would my label be at this point? Would I describe myself as high risk and/or genetically predisposed to diabetes? I have multiple deceased and living family members with diabetes, both type 1 and 2. When I told my endocrinologist about my strong family history of diabetes, he decided he would continue to see me twice a year and the PCP will see me twice a year as well.


[email protected] D’Mine answers: First, a round of applause for Cathy. Woot, woot, woot! Eighty pounds? That’s awesome! Do you realize how much weight that is? That’s the equivalent of sixteen Chihuahuas, or eight bowling balls, or four car tires, or two microwave ovens, or one sack of Quickrete concrete mix.  

So anyway you slice it, that’s a frickin' amazing amount of weight to lose!

And as you point out, it’s changed your health destiny. But that being the case, what the Sam Heck do we call you now? An ex-prediabetic? A one-time prediabetic? A formerly glucose-impaired individual? A previous prediabetic? An erstwhile prediabetic? Cathy, late of diabetes…

Or as you suggested, a person at risk for diabetes (PARFD)? A person genetically predisposed to diabetes (PGPD)?

Or just Plain Jane, a normal, ordinary person?

Hmmmmm... so many choices. And none fits as well as Cinderella’s glass slipper after the Prince’s Ball.

OK, for background, generally speaking, diabetes diagnoses are like tattoos. They never go away, no matter how much you might regret getting one. Even with an A1C deep into the “normal” range, the diabetes tattoo remains. Why is that? Well, generally speaking, being in control doesn’t mean you’ve been cured. Diabetes isn’t curable.

But prediabetes is.

Well, maybe...

Here’s the deal: There’s much press and research on what is officially called “reversing” prediabetes. Basically, it’s well known that if you have prediabetes and do nothing to improve your health but to loose weight (or have surgery to remove a bunch of it), your sugar levels will go back to normal. And they seem to stay normal, at least as long as the weight stays off.

But I think there’s a risk in talking about the normalization of elevated blood sugars as “reversing” prediabetes. Not in any way to belittle your accomplishment, but if you put that 80 pounds back on again, I’d be willing to bet that your blood sugar woes will return. So there’s no true cure here. Just a change of circumstance. You’ve changed the numbers that make up the equation—and that is wonderful—but you can’t change the underlying formula. So I’m really glad to hear that you will keep seeing the endo and your family doc to help keep tabs on your non-prediabetes.

All of that being the case, I am not in favor of saying there’s no longer an issue here. I’m uncomfortable saying that you are now a sugar-normal person. As this condition can and will likely return, we need to be careful in both our wording and our thinking when it comes to how you should define yourself, and how the medical community should define all the hard workers like you.

Simply put, I worry that if we use words like “cure” or a “reversal” it sets people up for carelessness down the road. Both words suggest that the problem won’t come back. But abnormal blood sugar is a problem that can come back.

So rather than look at the lexicon of contagious disease, which is where cures come from, maybe we need to take a page from the book of cancer. Cancer docs avoid the “cure” word, as cancers have a nasty propensity to return after they are presumed to be defeated. So cancer is never cured. Cancer, instead, goes into remission. In the diagnosis code business there are entire categories of remission that are described as: “History of ______ cancer.”

For your medical chart, I rather like “Past history of prediabetes.” It’s simple. It’s clear. This person had this once, therefore it could happen again. It’s just not an issue right now. Still, that doesn’t work so well for an internal label, something you would use to identify yourself.

People in cancer remission are sometimes called “survivors” in the common tongue. But I’m not sure that “diabetes survivor” really works. After all, we are all surviving our diabetes. Some of us better than others.

We need a label that salutes your accomplishment, while still foreshadowing possible danger. If you were making a T-shirt I’d vote for “I beat pre-diabetes” in really big letters, with “for now” in tiny letters right below. But that still doesn’t give you what you want: A simple label, for yourself and for others. And I can’t come up with a damn thing.

Readers, what do you think?

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.