Last week my friend Dana mentioned that her blood sugars have been rising, but I could see she didn’t realize the significance of what she was saying. Her doctor said her Hemoglobin A1c (HgA1c) was 6.1 or maybe 6.3, but, as she reported, “he was pretty cavalier about it,” so she took her cue from her doctor and didn’t worry about it.

First some background on HgA1c. This simple blood test measures your average blood sugar for the prior 3 months. So you can’t cram. Measurements run from near 4.5 (very low) to about 12 (extremely high), though I’ve seen higher. An HgA1c of 5.6 corresponds to an average blood sugar of 114, and results of 5.6 or less are normal. An HgA1c of 6.5 corresponds to an average blood sugar of 140 and meets the diagnostic criteria for diabetes. Results between 5.7 and 6.4 are considered pre-diabetic. That’s where my friend Dana’s results put her. That’s not okay with me.

Here’s what we know about type 2 diabetes. First, it comes on very slowly, over years if not decades. So you have plenty of time to reverse course. Second, the scientific literature shows that many people have years of damage to nerves and blood vessels at the time of diagnosis.  The way I think about it, the current diagnostic criteria for diabetes make that diagnosis a solid 10 years after it starts. We’re very adept at diagnosing 10-year-old diabetes. Ouch.

What should you do if your doctor tells you that your blood sugars are in the prediabetic range? Whether or not it makes a difference to your doc, I propose that you embrace the news as a big brass ring, a gift, a lucky warning shot, and then get busy counting your blessings (and maybe your blood sugars).

Eat less processed food, and ban the words “corn syrup” and “corn starch” from anything you put into your mouth. Get a pedometer and figure out how to increase the number of steps you take daily, even if it’s by just a few hundred, say from 2000 to 2500. Every little bit helps, though more is obviously better. Watch your portion sizes, because losing even a few pounds can drop your blood sugars back into the normal range. Eat more green vegetables, beans, avocados, olive oil, cinnamon. Consider buying a glucometer to find out what your blood sugars look like 90 minutes after you eat. If your results are higher than approx. 120-130, think about what you might have eaten to cause the persistent spike. These are just a few ideas to help conserve your insulin and increase the chances that you will make it last a lifetime.

How do you know if you’re at high risk of becoming diabetic? Here are a few clues, some of which you can tell for yourself, and some of which you will need a doctor to order: 1) a fasting blood sugar above 95 concerns me, and I make a mental note to monitor more closely; 2) an HgA1c between 5.7 and 6.4, especially if trending upward; 3) a 2-hour glucose tolerance test with an abnormally high OR low 2-hour result [a high result means your insulin supply is being outstripped by the demand so excess blood sugar is still floating around 2 hours later, and a low result means there’s a disconnect between insulin supply and demand, an early sign of increased risk]; and 4) you have other related risk factors, including high blood pressure, high cholesterol (especially triglycerides), gout, and abdominal obesity. Think of each as an opportunity for more healing. Trust me — you want normal blood sugars.