Is Cutting Sugar Alone Enough for Pre-Diabetes? TCM on Blood Sugar, Constitution and Lifestyle

Is Cutting Sugar Alone Enough for Pre-Diabetes? TCM on Blood Sugar, Constitution and Lifestyle

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Medical review: Dr Chan Wing-kiu (CMCHK 009463 | Middle-aged and elderly gynaecology, internal medicine).

"The check-up says I am pre-diabetic. The doctor told me to cut sugar and come back for another blood test in six months — is that enough?"

This is the first question many Hong Kong adults over 40 ask after their annual check-up. Research from the CUHK Faculty of Medicine indicates that around 90% of people with pre-diabetes are at risk of progressing to diabetes, with the disease potentially lasting 33 years. "Cutting sugar" is only part of the answer. This article directly addresses what else to track, how Traditional Chinese Medicine (TCM) can help, and what it cannot replace.

What else should you look at beyond sugar?

The real issue in pre-diabetes is that the whole metabolic state is drifting off course, not just a sugar problem. Waist circumference, blood pressure, lipids, activity level, sleep and stress all influence whether you progress to diabetes.

The Department of Health uses the following criteria for pre-diabetes:

Category	Fasting glucose (mmol/L)	2-hour post-meal (mmol/L)	HbA1c (%)
Normal	< 6.1	< 7.8	< 5.7
Pre-diabetes (impaired fasting glucose)	6.1 – 6.9	< 7.8	5.7 – 6.4
Pre-diabetes (impaired glucose tolerance)	< 7.0	7.8 – 11.0	5.7 – 6.4
Diabetes	≥ 7.0	≥ 11.1	≥ 6.5

Four metrics matter:

Metric	Why it matters	Frequency
Fasting glucose	Baseline morning blood sugar	Every 6–12 months
HbA1c	Average blood sugar over the past 2–3 months — more stable than a single reading	Every 6 months
2-hour post-meal glucose	Ability to handle the post-meal sugar peak	As advised by your doctor
Waist circumference	Central obesity's effect on insulin resistance	Monthly self-measurement

Waist circumference is the most frequently overlooked but important figure. A male waist of ≥ 90 cm or a female waist of ≥ 80 cm, even with normal body weight, already implies a higher insulin-resistance risk.

How Western medicine manages pre-diabetes

Family doctors typically focus on three directions at this stage:

• Diet. Low-sugar, low-salt, low-fat, high-fibre; cut refined starches and sugary drinks; add vegetables, quality protein, wholegrains.
• Exercise. Five sessions a week of at least 30 minutes of moderate-intensity aerobic activity (brisk walking, swimming, cycling, dance, ball sports) plus two resistance sessions a week.
• Weight and metabolic management. When BMI ≥ 23 or waist exceeds the cut-off, aim for 5–10% weight loss; monitor blood pressure and lipids.

Studies show that these lifestyle changes can reduce the risk of progressing to diabetes by 40–60%. Cutting sugar alone usually isn't enough — refined starch, sugary drinks, insufficient exercise and short sleep all continue to drive insulin resistance.

How TCM views the "spleen dan" stage

TCM classifies pre-diabetes under "spleen dan" (脾癉) — literally "stagnation in the spleen and stomach causing sweet residues to linger in the body". Dr Lau Chiu-king of the CUHK Hong Kong Institute of Integrative Medicine notes that 6 patterns are typically seen at this stage:

TCM pattern	Common signs
Spleen-stomach stagnation	Heavy build, abdominal fullness, frequent belching or flatulence, incomplete bowel movements
Damp-heat accumulation	Sticky mouth, dry mouth without thirst, restlessness with bitter taste, heavy limbs, yellow urine
Spleen deficiency with phlegm-damp	Fatigue, low appetite, loose stools, heavy head, chest tightness, shortness of breath
Liver qi stagnation with stomach heat	Dry-bitter mouth, ravenous appetite, hard dry stools, irritability
Damp-turbid phlegm-stasis	Heavy build, body heaviness and aches, mental fatigue, dizziness, chest tightness
Qi-and-yin deficiency	Fatigue, dry mouth/thirst (worse at night), aching lumbar/knees, profuse or night sweats, palpitations and insomnia

In plainer terms: "spleen-stomach stagnation" describes weakened digestion with food sitting in the body; "qi-and-yin deficiency" describes a body running short on both energy and moisture, typically presenting as fatigue, dry mouth and warm palms and soles.

Many pre-diabetic patients show overlapping patterns; the TCM practitioner identifies primary and secondary patterns from the tongue, pulse and symptom mix.

What TCM can and cannot do at this stage

TCM can	TCM does not replace
Improve spleen-stomach metabolism, ease phlegm-damp	Western blood-sugar monitoring
Use acupuncture to support insulin sensitivity	Pharmacological therapy for type-2 diabetes (e.g. metformin)
Address accompanying issues (insomnia, constipation, fatigue)	Acute hyperglycaemia, ketoacidosis or other emergencies
Offer constitution-informed dietary suggestions	Individualised dietitian-led calorie planning
Help align lifestyle rhythm	Regular medical follow-up for high-risk profiles (family history, high BMI)

TCM at the pre-diabetic stage is a bridge that supports constitution and lifestyle — once diabetes is diagnosed, Western medicine remains the principal manager.

A 90-day constitutional plan

• Diet. Halve the rice portion or switch to brown or multigrain rice; stop sugary drinks; include a palm-sized portion of protein and a bowl of vegetables at each meal.
• Exercise. Five sessions of moderate aerobic activity per week (brisk walking 30 minutes or more) plus two resistance sessions.
• Sleep. 7–8 hours per night; chronic short sleep raises cortisol and worsens insulin resistance.
• Stress. Find a personal stress-release routine; chronic stress raises blood sugar.
• Follow-up. Day 0 baseline check-up; day 90 retest HbA1c, fasting glucose and waist; adjust the plan based on the trend.

When to see a Western doctor or call emergency

• A sudden jump in blood sugar (HbA1c rising from 6.0 to above 6.8) — book a follow-up immediately
• Persistent thirst, marked night-time urination, short-term weight loss — the classic triad of diabetes
• Blurred vision — poor glucose control can affect the retina
• Slow wound healing, recurrent infections — rule out uncontrolled hyperglycaemia
• Darkened, thickened skin on the back of the neck or in the armpits (acanthosis nigricans) — a marked sign of insulin resistance

How Aspira TCM Clinic assesses such cases

Dr Chan reviews the most recent check-up (please bring HbA1c, fasting glucose, lipids, blood pressure and waist measurement), family history, the full medication list, and diet and exercise habits. Pre-diabetic patients are typically supported with herbal medicine combined with acupuncture, alongside coordination of lifestyle and diet. If the patient is already on diabetes medication or other chronic-disease drugs, the herbal prescription is designed to avoid interaction.

Further reading

• Tired after meals and waking to urinate — is it pre-diabetes? →
• Blood thinners and TCM: 3 prerequisites for atrial-fibrillation patients →

FAQ | How Can TCM Support Prediabetes?

Q1: Can Chinese herbs lower blood sugar?

Some herbal constituents show insulin-sensitivity benefits in research, but TCM herbs are not a stand-alone treatment for diabetes. At the pre-diabetic stage they can support constitution; once diabetes is diagnosed, Western therapy leads and TCM supports. Walk away from any clinic that "guarantees lower blood sugar" or asks you to stop Western medication.

Q2: My parents both have diabetes — am I bound to develop it?

Family history raises risk but does not make diabetes inevitable. Studies show that lifestyle change can reduce the progression risk by 40–60% in high-risk individuals. Family history is a prompt to start monitoring earlier.

Q3: I cut sugar and rice — why is my HbA1c still going up?

Possible reasons: (a) the main starch went down but the gravy and fatty meat went up; (b) not enough exercise; (c) short sleep or high stress raises cortisol; (d) body weight has not actually fallen. Review the whole lifestyle and ask your family doctor whether further tests are warranted.

Q4: Should I be taking metformin in the pre-diabetic stage?

Whether metformin is appropriate depends on your overall risk (HbA1c, family history, age, BMI, comorbidities) and is determined by your family doctor or internist. Not every pre-diabetic patient needs medication; in most cases lifestyle change comes first. This is not within a TCM practitioner's remit to decide.

Disclaimer: Every patient's constitution and condition are different, and treatment outcomes vary accordingly. The above is for reference only. Please consult a practitioner for a treatment plan tailored to your specific situation. Prescription details are shared for TCM academic purposes only and do not constitute prescribing advice. Do not self-prescribe.

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References

• CUHK Hong Kong Institute of Integrative Medicine — "Understanding pre-diabetes: TCM stabilises blood sugar" (Dr Lau Chiu-king) https://hkiim.cuhk.edu.hk/imc/tc/press/d/認識「糖尿病前期」中醫改善穩血糖
• HKU Faculty of Medicine — "Stage-based TCM differentiation and treatment of diabetes" https://www.med.hku.hk/zh-hk/media/knowledge-exchange/newspaper-columns/2023/aug/diabetes-diagnosis-and-treatment-by-stages-in-traditional-chinese-medicine
• Department of Health — Diabetes health information https://www.chp.gov.hk/en/healthtopics/content/25/59.html
• Diabetes Hongkong — Pre-diabetes management https://diabetes-hk.org/