1
00:00:05,050 --> 00:00:08,470
Jen: Welcome to the So That's
Why podcast, where we unpack the

2
00:00:08,470 --> 00:00:10,400
science behind everyday questions.

3
00:00:10,430 --> 00:00:11,050
I'm Jen.

4
00:00:11,340 --> 00:00:12,220
Jamie: I'm Chris.

5
00:00:12,320 --> 00:00:12,980
And I'm Jamie.

6
00:00:13,790 --> 00:00:14,160
Jen: Okay.

7
00:00:14,420 --> 00:00:14,800
Right.

8
00:00:15,080 --> 00:00:18,780
Here's a question with a
strange twist built into it.

9
00:00:18,939 --> 00:00:21,750
Why do we develop pre-diabetes?

10
00:00:22,059 --> 00:00:27,629
So the twist being, it might be the only
common diagnosis where experts can't

11
00:00:27,639 --> 00:00:34,059
reliably agree on who has it, and where
a good chunk of people have, you know,

12
00:00:34,059 --> 00:00:37,919
they get told that they've got it, but
they quietly get better on their own.

13
00:00:38,589 --> 00:00:39,780
Jamie: That is strange.

14
00:00:39,960 --> 00:00:43,019
Most diagnoses are at least
confident about being bad news.

15
00:00:43,030 --> 00:00:43,650
Yeah.

16
00:00:43,710 --> 00:00:47,209
This one turns up, has a look
around, and goes, "Well, maybe."

17
00:00:48,170 --> 00:00:48,230
Chris: Yeah.

18
00:00:48,710 --> 00:00:50,729
It really does sit in a,
an odd spot, doesn't it?

19
00:00:50,729 --> 00:00:56,009
Because the short version here is that
pre-diabetes is a stage, not a disease.

20
00:00:56,889 --> 00:01:01,320
Um, so it's where the system that keeps
your blood sugar steady starts slipping,

21
00:01:01,760 --> 00:01:04,019
and the surprising part is how early.

22
00:01:04,019 --> 00:01:07,920
So for a lot of people, it's
about 10 years or more before

23
00:01:08,240 --> 00:01:09,330
anyone measures a thing.

24
00:01:09,849 --> 00:01:12,010
Jen: Which is the bit
for us to think about.

25
00:01:12,020 --> 00:01:17,980
So you feel completely fine, you get
on with your life, but the groundwork's

26
00:01:18,010 --> 00:01:20,510
been quietly laid for about a decade.

27
00:01:20,980 --> 00:01:23,899
Jamie: So by the time the letter
lands- Mm … you're not still at

28
00:01:23,899 --> 00:01:27,699
the start of the story, you've been
handed a book already at chapter nine.

29
00:01:28,120 --> 00:01:29,670
Chris: Yeah, that's a
really good way to put it.

30
00:01:29,910 --> 00:01:34,080
And the hopeful flip side, which we'll
come back to, is that chapter nine still

31
00:01:34,080 --> 00:01:36,340
leaves a lot of chapters you can change.

32
00:01:37,150 --> 00:01:41,730
Jen: So by the end of this episode,
you'll hopefully know why fat in the

33
00:01:41,730 --> 00:01:46,759
wrong place is at the heart of this,
and why the cells that make insulin

34
00:01:46,759 --> 00:01:52,650
can go quiet without dying off, and
why even experts argue about whether

35
00:01:52,650 --> 00:01:55,890
pre-diabetes is a helpful word at all.

36
00:01:56,570 --> 00:01:58,079
Jamie: And that's a lot for us to unpack.

37
00:01:58,350 --> 00:01:58,830
Jen: It is.

38
00:01:59,380 --> 00:02:03,330
But before we get into the
biology, let's chat about the

39
00:02:03,330 --> 00:02:07,560
scale of it, which we always like
to do, because this is not niche.

40
00:02:07,739 --> 00:02:09,900
So worldwide, something like 541

41
00:02:12,059 --> 00:02:17,820
million adults have one of the main
forms of diabetes, and in the UK, the

42
00:02:17,820 --> 00:02:20,790
NHS has found around 3.6 million people.

43
00:02:20,790 --> 00:02:26,049
So it had, sorry, around 3.6
million people on its books by 2023.

44
00:02:26,530 --> 00:02:29,749
Jamie: 3.6 million people, and that's
only the ones tested and counted.

45
00:02:29,769 --> 00:02:30,199
Jen: Mm.

46
00:02:30,210 --> 00:02:32,969
Jamie: The number of people actually
walking around is probably much bigger.

47
00:02:33,059 --> 00:02:33,369
Jen: Yeah.

48
00:02:33,489 --> 00:02:35,579
Chris: Yeah, not only
that, it's rising fast too.

49
00:02:35,579 --> 00:02:40,230
So that UK figure jumped by almost
a fifth in a single year, and the

50
00:02:40,380 --> 00:02:43,859
part that got me was the under
40s, which is up about a quarter.

51
00:02:44,129 --> 00:02:46,720
Jamie: Mm. So the thing people
think is a problem for later

52
00:02:46,779 --> 00:02:48,470
is quietly moving towards them.

53
00:02:48,999 --> 00:02:54,010
Jen: Yeah, and I think being in my 40s now
too, that puts, it puts it on my radar.

54
00:02:54,010 --> 00:02:59,360
So if you've been waving it off as a
someday problem, you're in good company.

55
00:02:59,650 --> 00:03:04,690
Chris: Yep, and being in my 30s, um,
or yeah, 40s, like Jen, yeah, this is

56
00:03:04,690 --> 00:03:06,000
definitely the window to think about it.

57
00:03:06,590 --> 00:03:10,890
Jen: Um, but it's worth understanding,
isn't it, rather than panicking though.

58
00:03:11,199 --> 00:03:15,099
So let's, let's see what's happening
and what's going on in the inside.

59
00:03:15,459 --> 00:03:19,730
Chris: Yeah, so the simplest way to
look at it is, um, as two things going

60
00:03:19,730 --> 00:03:23,499
on, well, going slightly wrong at
once, and they make each other worse.

61
00:03:23,510 --> 00:03:26,940
Mm. And the first is what's
known as insulin resistance.

62
00:03:27,669 --> 00:03:31,379
Jamie: And insulin is the hormone
that tells sugar where to go, right?

63
00:03:31,529 --> 00:03:32,039
Chris: That's right.

64
00:03:32,119 --> 00:03:37,029
So when you eat, your blood sugar rises
and insulin tells the cells to take

65
00:03:37,059 --> 00:03:41,109
the sugar in and to use it, and that
insulin resistance is when the cells

66
00:03:41,149 --> 00:03:43,369
stop listening as well as they used to.

67
00:03:43,609 --> 00:03:46,459
So the sugar's knocking, but
the door is slow to open.

68
00:03:46,909 --> 00:03:49,079
Jamie: So it ends up hanging
around in the bloodstream

69
00:03:49,089 --> 00:03:50,539
because nobody is letting it in.

70
00:03:50,919 --> 00:03:53,479
Jen: Yeah, and that's where it stays.

71
00:03:53,509 --> 00:03:57,639
And so the cells that go deaf
first are the ones that nobody

72
00:03:57,639 --> 00:03:59,989
suspects, which are your muscles.

73
00:03:59,999 --> 00:04:02,159
So they're the biggest
customer for blood sugar.

74
00:04:02,409 --> 00:04:05,229
They take up about three-quarters
of it after a meal.

75
00:04:05,429 --> 00:04:09,469
So when they stop listening, a lot
of the sugar has nowhere to go,

76
00:04:09,469 --> 00:04:15,789
so it builds up for 10, even 20
years before there's any diagnosis.

77
00:04:16,509 --> 00:04:19,279
Jamie: 20 years, so it's not
a breakdown, it's a drift.

78
00:04:19,289 --> 00:04:22,139
Mm. Two quiet decades, then a letter.

79
00:04:22,259 --> 00:04:22,569
Jen: Yeah.

80
00:04:22,569 --> 00:04:23,629
Chris: It really is, isn't it?

81
00:04:23,689 --> 00:04:26,649
Um, and the second thing
is in the pancreas.

82
00:04:26,659 --> 00:04:31,579
So there's a cell in the pancreas, which
is the beta cell, and the beta cell's

83
00:04:31,579 --> 00:04:36,919
one job is making insulin, and over those
same years, it gradually stops keeping up.

84
00:04:37,449 --> 00:04:40,799
Jen: And this is, this is a part that
I find genuinely hopeful, because

85
00:04:40,799 --> 00:04:45,269
the, the old assumption was that
those cells were simply dying off,

86
00:04:45,319 --> 00:04:47,849
and once gone, like, they're gone

87
00:04:49,041 --> 00:04:49,651
Jamie: And they're not?

88
00:04:50,211 --> 00:04:52,701
Chris: So increasingly, it
looks like they're not, no,

89
00:04:52,871 --> 00:04:54,061
at least not early anyway.

90
00:04:54,221 --> 00:04:58,221
So some great, uh, research work
has found that under that pressure,

91
00:04:58,501 --> 00:05:00,081
beta cells largely don't die.

92
00:05:00,131 --> 00:05:04,921
They do something which is more like,
um, changing job, maybe slipping back

93
00:05:04,921 --> 00:05:09,231
from being a specialist insulin maker
into more of a basic generic state.

94
00:05:09,631 --> 00:05:10,781
Jamie: So they haven't quit.

95
00:05:10,851 --> 00:05:11,891
They've downed tools.

96
00:05:11,891 --> 00:05:14,461
They're still in the building- … they're
just not doing the skilled bit.

97
00:05:14,771 --> 00:05:15,221
Chris: That's it.

98
00:05:15,251 --> 00:05:19,091
And, and it matters because if they've
gone quiet rather than gone for good,

99
00:05:19,251 --> 00:05:20,171
there's a route back, isn't there?

100
00:05:20,591 --> 00:05:25,351
And, um, a study of people at this
stage backs that up, whereby the

101
00:05:25,351 --> 00:05:29,811
number of beta cells is about the same,
it's their performance that drops.

102
00:05:29,981 --> 00:05:35,261
Jen: Which is what reframes it, so less
damage, more dormancy, so muscles not

103
00:05:35,271 --> 00:05:38,711
listening, insulin makers downing tools.

104
00:05:38,741 --> 00:05:40,801
But what is actually causing this?

105
00:05:41,401 --> 00:05:45,511
Chris: Yeah, so this is the idea that
pulls it together, and it's very domestic.

106
00:05:45,661 --> 00:05:50,461
So if you, um, if you picture your body's
fat as something that you would store in a

107
00:05:50,461 --> 00:05:52,021
cupboard, sounds a bit gross, doesn't it?

108
00:05:52,561 --> 00:05:56,891
Um, most of that fat is meant to
live there under the skin safely, but

109
00:05:57,041 --> 00:06:00,521
every cupboard has a size, doesn't
it- Mm … like a person capacity,

110
00:06:00,521 --> 00:06:01,571
and it's different for everyone.

111
00:06:02,491 --> 00:06:04,901
Jamie: So it's not about how much
fat you've got, it's about it

112
00:06:04,901 --> 00:06:06,411
spilling into the wrong places.

113
00:06:07,001 --> 00:06:12,221
Jen: Yeah, and that explains something
that confuses people, doesn't it?

114
00:06:12,231 --> 00:06:17,501
So you can be fairly slim and still
develop this because your personal fat

115
00:06:17,501 --> 00:06:19,871
storage cupboard, it might be a small one.

116
00:06:19,881 --> 00:06:26,111
Um, it's why people of like South Asian
heritage, they can develop these problems

117
00:06:26,111 --> 00:06:31,251
at lower body weights and why screening
thresholds are set lower for some groups.

118
00:06:31,651 --> 00:06:35,311
Jamie: So the bathroom scales are never
really telling the interesting story.

119
00:06:35,501 --> 00:06:39,271
Same weight, completely different
amount of fat in the places that matter.

120
00:06:39,541 --> 00:06:41,831
So we basically can't
judge purely on a number.

121
00:06:42,221 --> 00:06:43,601
Chris: No, that's absolutely true.

122
00:06:43,611 --> 00:06:47,261
And of course, the modern angle here
is that our bodies haven't changed,

123
00:06:47,501 --> 00:06:48,881
it's the world around them that has.

124
00:06:48,951 --> 00:06:53,471
So we now have food at all hours- Mm
… far less movement built into the day.

125
00:06:53,811 --> 00:06:56,651
So that fat storage cupboard
might be the same size.

126
00:06:56,671 --> 00:06:59,571
We're just filling it faster and
emptying it less than we would've

127
00:06:59,571 --> 00:07:00,641
done a few generations ago.

128
00:07:01,341 --> 00:07:01,891
Jamie: Okay.

129
00:07:02,031 --> 00:07:05,321
Fat in the wrong place is useful to
know, but what everyone r- is really

130
00:07:05,351 --> 00:07:07,611
asking is, does this apply to them?

131
00:07:07,901 --> 00:07:11,182
And the answer, the honest answer
is, it depends on who you are.

132
00:07:11,231 --> 00:07:12,242
Jen: Yeah, it does.

133
00:07:12,242 --> 00:07:13,781
So take age.

134
00:07:13,811 --> 00:07:19,441
In the US, more than half the
over 65s fit the criteria, yet the

135
00:07:19,441 --> 00:07:21,801
fastest growth is in younger people.

136
00:07:21,841 --> 00:07:24,611
It's expanding at both ends at once.

137
00:07:24,831 --> 00:07:28,212
Chris: It is, and something to
point out here i- is it's not even.

138
00:07:30,651 --> 00:07:34,567
So, um, UK data put it- At around twice
the rate in Black and Asian groups

139
00:07:34,607 --> 00:07:39,317
compared to white groups, with South Asian
heritage, as Jen mentioned, carrying a

140
00:07:39,317 --> 00:07:41,377
particularly high risk, and younger- Mm

141
00:07:41,387 --> 00:07:41,887
which is worrying.

142
00:07:41,997 --> 00:07:46,117
Jamie: And here it gets awkward,
because my understanding is one

143
00:07:46,117 --> 00:07:49,357
of the main tests we lean on
isn't even-handed across everyone.

144
00:07:49,797 --> 00:07:52,817
Chris: That's right, and, um,
the most common test here is

145
00:07:52,947 --> 00:07:55,807
what's known as the HbA1c test.

146
00:07:55,847 --> 00:07:56,917
Rolls off the tongue, of course.

147
00:07:57,167 --> 00:08:01,347
Mm. And this partly depends on your red
blood cells, but on average, it reads a

148
00:08:01,347 --> 00:08:05,087
touch higher in Black patients for the
very same blood sugar as white patients.

149
00:08:05,347 --> 00:08:08,577
So it might be small on paper, but
it's big enough to tip some people

150
00:08:08,577 --> 00:08:11,017
over the line that they're not
actually necessarily really over.

151
00:08:11,437 --> 00:08:16,697
Jen: Which is, it's at the heart of why a
pre-diabetic diagnosis gets argued over.

152
00:08:17,097 --> 00:08:18,907
The tests don't even agree.

153
00:08:19,387 --> 00:08:24,267
So there are three ways to diagnose
it, and depending on which you use, the

154
00:08:24,267 --> 00:08:27,207
share of people who count swings wildly.

155
00:08:27,467 --> 00:08:33,237
So one analysis found it ranged
from about 4% of a group to over 40.

156
00:08:33,437 --> 00:08:35,967
Same people, different test.

157
00:08:35,977 --> 00:08:36,127
Jamie: Wow.

158
00:08:36,127 --> 00:08:39,687
A tenfold swing depending on
which test you happen to get.

159
00:08:40,047 --> 00:08:43,977
If three referees watched the same
match and one said nil-nil, and another

160
00:08:43,987 --> 00:08:47,507
4-3, dunno about the third, you'd,
you'd stop trusting the referees.

161
00:08:47,867 --> 00:08:48,317
Jen: I never- You would, absolutely

162
00:08:48,317 --> 00:08:49,037
never trust referees

163
00:08:49,087 --> 00:08:49,257
Chris: anyway.

164
00:08:51,397 --> 00:08:55,397
Jen: But that, it feeds the, the
biggest myth, that pre-diabetes

165
00:08:55,427 --> 00:08:59,187
means diabetes is definitely
coming, and nothing can be done.

166
00:08:59,187 --> 00:09:02,277
So the pre, it makes it
sound like a countdown.

167
00:09:02,417 --> 00:09:03,117
It isn't.

168
00:09:03,337 --> 00:09:09,197
Over a few years, very roughly about
a quarter progress, half stay put, and

169
00:09:09,457 --> 00:09:11,617
the other quarter drift back to normal.

170
00:09:12,157 --> 00:09:14,167
Jamie: So a quarter
effectively get the all clear.

171
00:09:14,217 --> 00:09:14,557
Jen: Mm.

172
00:09:14,617 --> 00:09:17,587
Jamie: Sometimes doing nothing
dramatic, which is why some health

173
00:09:17,587 --> 00:09:21,157
bodies aren't keen on the word, and
would rather just describe the blood

174
00:09:21,157 --> 00:09:23,557
sugar and skip the ominous prefix.

175
00:09:23,577 --> 00:09:23,907
Jen: Mm.

176
00:09:24,007 --> 00:09:25,267
Chris: And there's a fair
case there, isn't there?

177
00:09:25,267 --> 00:09:29,387
So nobody disputes that some people
are genuinely on the road to type 2

178
00:09:29,407 --> 00:09:34,127
diabetes, but the question is, how wide
should the prediabetes category be?

179
00:09:34,647 --> 00:09:39,297
So the, the highest risk group is
usually the one identified by a glucose

180
00:09:39,297 --> 00:09:43,067
tolerance test, whereas the broader
definition's pulling millions more

181
00:09:43,067 --> 00:09:47,057
people, many of whom, as you said,
may never develop diabetes at all.

182
00:09:47,147 --> 00:09:47,467
Jen: Mm.

183
00:09:47,577 --> 00:09:50,767
Chris: And that's why this remains
an active scientific debate

184
00:09:50,767 --> 00:09:52,637
rather than a settled fact.

185
00:09:52,987 --> 00:09:56,687
Jen: But debated or argued
over isn't ignore it.

186
00:09:57,017 --> 00:10:01,857
Um, even the critics agree it's a
useful nudge for a lot of people.

187
00:10:02,127 --> 00:10:06,717
The honest position is in the
middle, a real signal, just drawn

188
00:10:06,717 --> 00:10:08,347
with a slightly blunt pencil.

189
00:10:08,667 --> 00:10:09,547
Jamie: A blunt pencil.

190
00:10:09,587 --> 00:10:10,287
I'm having that.

191
00:10:10,747 --> 00:10:11,937
Jen: You can have that one for free.

192
00:10:12,627 --> 00:10:15,727
Chris: So while you're talking about
your pencils, for whatever reason, um, I

193
00:10:15,727 --> 00:10:20,277
can take us down a, a kind of genuinely
upbeat route, because after all the

194
00:10:20,277 --> 00:10:23,997
uncertainty, this is actually one of the
most changeable situations in medicine,

195
00:10:24,327 --> 00:10:27,297
and the s- the evidence is in- unusually
deep when it comes to prediabetes.

196
00:10:28,127 --> 00:10:29,687
Jen: Yeah, it's decades deep.

197
00:10:29,697 --> 00:10:34,517
So there was a landmark prevention
trial that took a few thousand

198
00:10:34,527 --> 00:10:36,547
high-risk people and split them up.

199
00:10:36,837 --> 00:10:41,727
So the group making modest changes, you
know, a bit of weight loss and a bit

200
00:10:41,727 --> 00:10:45,907
more movement, they cut their chance
of developing diabetes by getting on

201
00:10:45,907 --> 00:10:48,727
for, like, 60% over about three years.

202
00:10:49,187 --> 00:10:52,527
Clearly better than the medication
group in the same trial.

203
00:10:52,787 --> 00:10:55,887
Jamie: Hang on, so the walking
and eating group beat the drug?

204
00:10:56,167 --> 00:10:58,047
That's not how these stories usually go.

205
00:10:58,147 --> 00:11:00,867
Jen: I know, and it surprised
everyone at the time, too.

206
00:11:01,187 --> 00:11:07,677
Um, and there was a clear dose, so roughly
every kilogram lost lowered the risk

207
00:11:07,717 --> 00:11:15,427
by about a sixth, and people c- who hit
all their targets cut it by nearly 90%.

208
00:11:16,047 --> 00:11:18,457
Chris: And the important thing
is, is it lasts, doesn't it?

209
00:11:18,467 --> 00:11:20,277
Mm. Which is actually quite
moving when you think about it.

210
00:11:20,277 --> 00:11:20,297
Yeah.

211
00:11:20,307 --> 00:11:24,227
So there was one big study that
followed people for 30 years after

212
00:11:24,227 --> 00:11:27,927
a six-year program, and they still
had a death rate about a quarter

213
00:11:27,927 --> 00:11:32,377
lower and had gained, on average,
like, well over a year of extra life.

214
00:11:32,567 --> 00:11:32,837
Jen: Mm.

215
00:11:33,087 --> 00:11:36,437
Jamie: Now, I can feel everyone bracing
for the part where we say- … "Overhaul

216
00:11:36,437 --> 00:11:40,247
your entire existence by Monday."
In my experience, that's usually

217
00:11:40,247 --> 00:11:42,077
exactly where these things fall down.

218
00:11:42,387 --> 00:11:47,517
Jen: It is, and the number that matters
isn't the perfect plan, it's the one

219
00:11:47,517 --> 00:11:52,707
that you'll still be doing this time
next year, because real-life results are

220
00:11:52,707 --> 00:11:57,917
always smaller than trials pres- precisely
because, well, life happens, doesn't it?

221
00:11:58,197 --> 00:12:02,207
Chris: It does, and the actual levers here
are reassuringly dull, I can promise you.

222
00:12:02,207 --> 00:12:08,237
So the trials aimed at about 7% weight
loss, which is not that high, is it?

223
00:12:08,257 --> 00:12:12,537
Mm. And roughly 150 minutes of movement
a week, which is two and a half hours.

224
00:12:12,983 --> 00:12:15,293
Which sounds a lot until you
actually cut it down and it

225
00:12:15,293 --> 00:12:19,303
becomes the equivalent of l- like
a brisk 20 to 25-minute walk daily.

226
00:12:19,493 --> 00:12:23,363
Jamie: Mm. A 20-minute walk, not
a personality transplant, not a

227
00:12:23,373 --> 00:12:25,493
wardrobe of new gym kit, a walk.

228
00:12:25,553 --> 00:12:25,883
Yeah.

229
00:12:25,883 --> 00:12:26,273
Chris: That's it.

230
00:12:26,303 --> 00:12:29,473
And the, the bit I like is that
the movement helps on its own.

231
00:12:29,473 --> 00:12:34,559
So people that miss that weight
target but- kind of kept moving,

232
00:12:34,709 --> 00:12:37,359
they still cut their risk by over
40%, which is huge, isn't it?

233
00:12:37,449 --> 00:12:37,789
Jen: Mm.

234
00:12:37,959 --> 00:12:40,039
Chris: So even if the
scales aren't budging, the

235
00:12:40,039 --> 00:12:41,329
walking's doing the real work.

236
00:12:41,959 --> 00:12:46,389
Jen: And there's good evidence for
how you eat, too, not just how much.

237
00:12:46,399 --> 00:12:51,389
So if you follow a Mediterranean-style
diet, uh, which, you know, consists

238
00:12:51,389 --> 00:12:58,349
of lots of veg, beans, whole grains,
olive oil, um, that cut new diabetes

239
00:12:58,389 --> 00:13:03,509
meaningfully in one big trial, even
when people barely lost weight.

240
00:13:03,519 --> 00:13:03,529
Mm.

241
00:13:03,969 --> 00:13:06,739
Jamie: So nobody has to live
on dry crackers and willpower.

242
00:13:06,799 --> 00:13:08,899
That's the version that
usually dies by Wednesday.

243
00:13:09,049 --> 00:13:10,109
Jen: Everyone's cheering

244
00:13:10,109 --> 00:13:10,539
Chris: now.

245
00:13:10,589 --> 00:13:10,939
Yeah, absolutely.

246
00:13:11,829 --> 00:13:14,959
Now, two, um, honest caveats.

247
00:13:15,359 --> 00:13:18,479
So the first one, and is the
responsible one, so do forgive me.

248
00:13:18,799 --> 00:13:22,489
So if your blood sugar is in the
pre-diabetic range- Mm … and

249
00:13:22,489 --> 00:13:25,099
that's typically, um, an HbA1c

250
00:13:27,219 --> 00:13:31,829
result of 42 to 47, where anything
below 42 is considered normal, by the

251
00:13:31,829 --> 00:13:35,739
way, please don't treat a podcast as
your cue to self-diagnose- No, don't

252
00:13:35,739 --> 00:13:37,429
or start doing anything drastic.

253
00:13:37,989 --> 00:13:40,839
It's a good reason to have a
decent chat with your doctor,

254
00:13:40,859 --> 00:13:42,439
though, but just don't panic.

255
00:13:42,649 --> 00:13:43,489
Jamie: And there it is.

256
00:13:43,519 --> 00:13:46,619
Chris cannot get through a podcast
without doing a safety briefing.

257
00:13:46,939 --> 00:13:47,169
Chris: Yeah.

258
00:13:47,169 --> 00:13:49,679
Tray tables away- … seats in
the upright position, please.

259
00:13:49,939 --> 00:13:51,429
Someone's gotta do the safety
briefing, haven't they?

260
00:13:51,429 --> 00:13:51,909
Yeah.

261
00:13:52,219 --> 00:13:54,439
Um, and the second caveat is the science.

262
00:13:54,509 --> 00:13:59,019
So for most people, making the weight
and movement changes powerfully delay

263
00:13:59,019 --> 00:14:00,729
diabetes rather than cancel it forever.

264
00:14:00,779 --> 00:14:01,149
Jen: Mm.

265
00:14:01,269 --> 00:14:05,649
Chris: So with the long kind of follow-up
studies showing the gap does narrow

266
00:14:05,699 --> 00:14:10,019
over about 15 years or so, but let's be
honest, delaying something by years when

267
00:14:10,019 --> 00:14:11,629
it comes to health is a prize that- Yeah

268
00:14:11,639 --> 00:14:12,319
shouldn't be underestimated.

269
00:14:12,499 --> 00:14:13,699
Jen: Yeah, definitely.

270
00:14:14,009 --> 00:14:18,629
And there's also some genuinely powerful
medical options, too, for people with a

271
00:14:18,629 --> 00:14:23,639
lot of weight to lose, but that's, like,
doctor's office territory, not ours.

272
00:14:23,989 --> 00:14:28,379
Um, but the honest thing to know
is that several mainly work while

273
00:14:28,389 --> 00:14:33,869
you're taking them, and you stop, and
the benefits do tend to drift back.

274
00:14:33,879 --> 00:14:38,209
Jamie: So no magic wand, but a lot of
leverage, and most of it the unglamorous

275
00:14:38,219 --> 00:14:39,799
stuff you already know how to do.

276
00:14:40,359 --> 00:14:43,759
Jen: What strikes me is this
isn't really a standalone thing.

277
00:14:43,769 --> 00:14:46,569
It sits downstream of all
the ordinary stuff, isn't it?

278
00:14:46,569 --> 00:14:51,049
You know, how you sleep, how much
you move, even how stressed you are.

279
00:14:51,049 --> 00:14:52,609
They all feed the same picture.

280
00:14:53,109 --> 00:14:56,729
Chris: They do, and a rough night
nudges your blood sugar the wrong way

281
00:14:56,729 --> 00:15:00,309
the next day- Mm … and bumps up the
stress hormones, and the problems build.

282
00:15:00,549 --> 00:15:03,999
So the body doesn't fit these as
separate kind of problems the way

283
00:15:03,999 --> 00:15:05,129
our health checks try to, does it?

284
00:15:05,129 --> 00:15:05,649
Jen: Yeah.

285
00:15:06,099 --> 00:15:07,579
Jamie: Yeah, that's the bit that gets me.

286
00:15:07,859 --> 00:15:11,369
We get a separate appointment and leaflet
for each as if the body is posting

287
00:15:11,369 --> 00:15:15,449
out individual health memos- … when
really it's all one long conversation.

288
00:15:15,459 --> 00:15:15,469
Mm.

289
00:15:15,779 --> 00:15:19,229
Jen: And I'll, I mean, I'll confess,
I do treat my own health like

290
00:15:19,229 --> 00:15:20,989
a to-do list of unrelated jobs.

291
00:15:20,989 --> 00:15:25,329
You know, if I'm not sleeping it's like,
"Sort my sleep, move my body", and then

292
00:15:25,329 --> 00:15:28,999
that you think about your foods, as
though they aren't all the same drawing.

293
00:15:29,499 --> 00:15:30,059
Chris: No, that's right.

294
00:15:30,089 --> 00:15:32,309
Uh, but they are really very much
the same drawing, aren't they?

295
00:15:32,309 --> 00:15:37,149
Mm. So wh- which is why, um,
pre-diabetes is best thought of

296
00:15:37,289 --> 00:15:41,689
less as a verdict and more as the,
the foundations of a house sh, uh,

297
00:15:42,149 --> 00:15:43,739
showing their first hairline cracks.

298
00:15:43,739 --> 00:15:44,109
Yeah.

299
00:15:44,119 --> 00:15:47,889
So it's easily enough to do something
about long before they reach the walls.

300
00:15:47,919 --> 00:15:48,249
Jen: Yeah.

301
00:15:48,699 --> 00:15:51,709
Jamie: So then why do we get pre-diabetes?

302
00:15:52,109 --> 00:15:57,459
Jen: Because two things slowly drift
out of step over years, so your cells

303
00:15:57,469 --> 00:16:02,299
stop responding to insulin as well
as they should, and the cells that

304
00:16:02,299 --> 00:16:07,829
make insulin gradually go quiet, and
underneath both very often is fat

305
00:16:07,939 --> 00:16:12,279
overflowing its normal cupboard into
organs that don't usually hold it.

306
00:16:12,699 --> 00:16:16,769
Chris: Yep, and it builds in kind of
near silence for a decade or more,

307
00:16:16,779 --> 00:16:21,119
which is why a, like, a warning that
lands while you feel perfectly fine

308
00:16:21,119 --> 00:16:22,289
is so easy to wave away, isn't it?

309
00:16:22,309 --> 00:16:22,859
Jen: Mm.

310
00:16:23,489 --> 00:16:27,609
Jamie: So that pre that spooked us at
the start turns out to be good news.

311
00:16:27,609 --> 00:16:28,019
Yeah.

312
00:16:28,079 --> 00:16:30,549
It's the chapter where the
ending isn't written yet.

313
00:16:30,829 --> 00:16:34,199
Blunt pencil and all, you're
handed the warning while you

314
00:16:34,199 --> 00:16:35,829
can still do something about it.

315
00:16:35,829 --> 00:16:36,199
Jen: Yeah.

316
00:16:36,879 --> 00:16:42,459
So that's why we develop pre-diabetes,
not a sentence, but a signpost, the

317
00:16:42,459 --> 00:16:47,159
body flagging early and quietly that
the conditions have tipped while there's

318
00:16:47,289 --> 00:16:50,059
plenty of road left to change the course.

319
00:16:50,679 --> 00:16:52,479
That's it from us this week.

320
00:16:52,509 --> 00:16:54,809
Make sure you hit that subscribe button.

321
00:16:54,989 --> 00:16:58,749
We're unpacking the science behind
everyday questions each week.

322
00:16:59,059 --> 00:17:02,569
Tell us in the comments what
you'd like us to explore next.

323
00:17:02,959 --> 00:17:06,639
Thanks for geeking out with us,
but for now, that's it from me.

324
00:17:07,229 --> 00:17:07,939
Jamie: That's it from me.

325
00:17:08,239 --> 00:17:09,189
Chris: And that's it from me.

326
00:17:09,329 --> 00:17:10,039
Jen: Bye for now.