For those who are diagnosed with or concerned they might be at risk for prediabetes, “the first thing to do is focus on weight loss and dietary changes,” says Dr. Anam. This isn’t always easy, and stress can interrupt lifestyle management in different ways, depending on a person’s situation and stage in life, whether it’s during adolescence, pregnancy, menopause, or even retirement.
Problems with insulin often start around puberty, says Yale Medicine endocrinologist Ania Jastreboff, MD, PhD, who treats both children and adults. But there are other factors, too, adds Dr. Anam. “The big thing I’ve seen at this age is a lot of anxiety and depression, disordered eating behaviors, sedentary behavior, and excessive interaction with social media,” says Dr. Anam.
Pregnancy can also lead to struggles with weight for many women. Gestational diabetes, which usually resolves after the baby is born, is another prediabetes trigger. And around menopause, changes in estrogen levels are associated with an increase in fat around the waist, which is considered a risk factor for diabetes.
In general, those who maintain good physical health as they age can avoid prediabetes. “But as you get older, you may develop joint pain, which can limit physical activity,” says Dr. Anam, so it’s important to pay attention to those issues.
Heart disease can also impact physical activity, as can the use of multiple medications, including medicines like glucocorticoids—steroids that, among other things, increase insulin resistance and glucose production by the liver, resulting in increased blood glucose levels. They can also make people who take them feel hungrier, which leads to increased food intake and further contributes to hyperglycemia. “All these things add up,” she says.
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