According to Joslin Diabetes Center, United States, there are 79 million people in USA who have Prediabetes.
But what is Prediabetes? Well, you can think of Prediabetes as a warning sign that the type 2 diabetes is on the way. Scary? Yes it is. I agree that Prediabetes is the sign of a scary and probably killer disease i.e. type 2 diabetes.
Prediabetes is when your blood glucose level (blood sugar level) consistently remains higher than normal, but it has not yet reached the level where it could be considered as full-blown diabetes. Most often people call Prediabetes as “Border Line Diabetes”.Prediabetes is an alert that you could develop type 2 diabetes if you don’t leave your current lifestyle and if you dont adopt a healthier lifestyle that necessarily includes weight loss and more physical activity.
If you are Prediabetic, you are not only at risk of developing type 2 diabetes but also at increased risk of developing heart and cardiovascular diseases.
But stop worrying that much – there’s a good news too. Yes, it is possible to prevent the Prediabetes from converting into diabetes type 2. Yes, you need to be physically more active, doing regular exercise, lose those extra pounds from your body and keep check on what you are eating.
Lets Explore Prediabetes More
Well, much said about definition of Prediabetes at a higher level – now this is the time to know the technicality. So technically, a person is Prediabetic if his Fasting Plasma Blood Glucose level is more than 100 mg/dL and less than or equal to 126 mg/dL. Do not just make the decision in one test but take two tests before you come to a decision. If fasting plasma blood sugar is between 100 mg/dL and 126 mg/dL in two consecutive tests (taken on two different days), you have Prediabetes.
If you are Prediabetic, it means either your Pancreas is not able to make enough insulin after eating your meal, or your body cells might not responding to insulin properly and showing resistance to insulin which is called Insulin Resistance.
A Prediabetes condition if not treated and not managed seriously, is likely going to convert into type 2 diabetes in 10 years or even less than 10 years. Does 10 years time period sounds long enough for you to think about taking Prediabetes seriously? If yes, you are wrong then.
The long term damages of Diabetes especially the damage to your heart, and circulatory system including kidney damage may already have been started while you have Prediabetes. It may be possible that when you first got diagnosed with Diabetes, most of the damages done by Diabetes have already been done. So the time to take action is now when you first got diagnosed as Prediabetic.
Take your Prediabetes as a wake-up call that you are on the path to Diabetes but you are still not too late to control the things.
If the Fasting Plasma Blood Glucose level in two tests remains higher than 126 mg/dL, this is Diabetes.
Symptoms of Prediabetes
Prediabetes often has no signs or symptoms. Diabetes doesn’t come as of a sudden (except Type 1 Diabetes in some cases when the body’s own immune system attacks and burn beta cells of Pancreas) but progresses very gradually. So at very initial stage it merely has any symptoms. When the symptoms start occurring we must have reached a long way with Prediabetes by then. You may however notice the below symptoms when your blood glucose level is higher than normal.
- Darkened skin on certain part of body such as neck, elbows, armpits, knees and knuckles.
- Increased thirst
- Feeling more hungry than normal
- Losing weight despite eating more
- Frequent urination, especially in night
- Feeling sleepy and lethargic
- Feeling tired and fatigue
- Blurred vision
Though these are the symptoms associated with full blown Diabetes but you may also feel them if you are at the early stage of Diabetes. These signs are red flag signals that you have moved or about to move from Prediabetes to Type 2 Diabetes.
Causes of Prediabetes
Body cells get energy from glucose. There is a hormone called Insulin required to get glucose from blood stream into cells and convert it into energy for the consumption by cells. This Insulin hormone is secreted by a special organ called Pancreas in your body. For some reason either the Pancreas doesn’t make enough Insulin or the body cells do not use it properly. It is called Insulin Resistance when our body cells show resistance to use insulin properly.
In any case, if blood glucose is not taken to body cells and converted into energy by Insulin, this glucose gets accumulated into the blood stream. Consequently it builds up too much of glucose in your blood causing the blood glucose level higher than normal. And this condition is called Prediabetes. If the level of glucose increased above a certain level (Fasting Blood Glucose more than 126 mg/dL) it is then called Type 2 Diabetes.
Who is at Risk – When to see a Doctor?
Consult your doctor immediately if you see any of the symptoms of Diabetes described above.
However as the Prediabetes often has no symptoms, it is recommended that you keep your blood glucose level checked regularly if you have any of the risk factors associated with Prediabetes given below.
1. Lack of Physical Activity
You are living an inactive life style with no exercise.
2. Being Overweight
You are overweight and having body mass index above 25. Especially if you carry a lot of extra weight in your abdominal area near Pancreas, you are more likely to develop Prediabetes. Extra fat increases Insulin Resistance in cells.
3. Growing Age
If your age is 40 or above. The risk of being Prediabetic increases with the age.
4. Diabetic Family History
If you have somebody in your family with type 2 diabetes, you may also have Prediabetes as a hereditary factor.
5. Gestational diabetes
If you are a women and developed Gestational Diabetes when you were pregnant.
6. Poly cystic Ovary Syndrome
It is a condition characterized by disturbed menstrual periods, obesity and excessive hair growth. It also raises the risk of Prediabetes being associated with Insulin Resistance.
7. High Blood Pressure
If your blood pressure remains high, you are at risk of being Prediabetic. See what is blood pressure.
8. High Cholesterol Level
If your HDL (High Density Lipoprotein) Cholesterol or also called Good Cholesterol is below 35 mg/dl
9. High Triglycerides Level
Your Triglyceride level is above 250 mg/dL. Triglyceride is a type of fat in your blood.
People with some certain ethnic groups including Hispanic, Indians, African-Americans, Americans, Native Americans, and Asian Americans are more likely to develop Prediabetes
Complications of Prediabetes
The most serious and damaging complication of Prediabetes is it’s progression to type 2 diabetes. Thus it has all the complications of Diabetes indirectly associated. You are also at increased risk of heart and other cardiovascular diseases if your are Prediabetic and do not change your life style. The life style change majorly include losing weight, doing exercise, cutting down Omega 6 from your meal and increasing your physical activity level.
If you do not get your diabetes diagnosed in early stage, then your diagnosis can start even from the occurrence of complications of Diabetes. And there is no doubt that it is too late then to manage the damage. It is highly recommended that you get your blood sugar level checked regularly if you are at risk. See the above section “Who is at Risk” to ensure if you are in that category.
Not all but most possible complications include
- High blood pressure
- High Cholesterol level
- Damage to the Kidneys
- Cardiovascular disease
- Heart disease
- Nerve damage (Neuropathy)
- Alzheimer’s disease.
- Foot problems
- Loss of muscles and weakness.
- Blurred vision and blindness
- AmputationsRead more about Diabetes and complications of Diabetes in my other blog “Diabetes Mellitus (DM), The Silent Killer”.
Diagnosis of Prediabetes
There are three tests available to check if you have Prediabetes or Diabetes. Normally any one test out of these three is enough to check Prediabetes or Diabetes but sometimes your doctor may suggest any other test depending on test results. The most recommended test is Fasting Plasma Glucose(FPG) test.
Here are the three available tests for blood sugar level:
1. Fasting Plasma Glucose Test (FPGT)
This is the most recommended test to check Prediabetes and Diabetes. In most of the cases this single test is enough to check for Prediabetes and Diabetes.
FPGT is performed with an empty stomach while you haven’t eaten anything since last 8-9 hours. That’s why most often the Fasting Plasma Glucose Test is performed in the morning. A small blood sample is collected and tested either with Glucometer or in lab. This test can be performed either in lab or at home. You can easily perform FPGT at home if you have a Glucometer.
There are many diabetes test tool kits available in market. You should be very careful while choosing one and ensure that it has the highest accuracy level. I personally would recommend you could go with any of these below:
If you are very specific to price and looking something in less price, you could be with any of these below. These too are not bad and will solve the purpose.
Normal – If blood glucose level is between 70 mg/dL and 100 mg/dL
Prediabetes – If blood glucose level is between 100 mg/dL and 126 mg/dL
Diabetes – If blood glucose level is more than 126 mg/dL
Impaired Fasting Glucose (IFG) – This is another term for Prediabetes when the Prediabetes is diagnosed with FPGT (Fasting Plasma Glucose Test).
2. Oral Glucose Tolerance Test (OGTT)
Another test that is used to diagnose Prediabetes is OGGT (Oral Glucose Tolerance Test). This is also done with empty stomach for 8-9 hours. This test determines your body’s glucose tolerance level.
The doctor will test your blood glucose level at the beginning. This involves the same FPGT process as described above.
Then, the doctor will give you a drink of 75 gm Glucose mixture which is a very high sugary dose. Then your blood glucose level is measured again after two hours. Objective of this test is to check Glucose tolerance level of your body.
Normal – If blood glucose level is less than 140 mg/dL
Prediabetes – If blood glucose level is between 140 mg/dL and 199 mg/dL, two hours after drinking the glucose mixture
Diabetes – If blood glucose level is above 200 mg/dL in an OGTT, two hours after drinking the glucose mixture
Impaired Glucose Tolerance (IGT) – This is another term for Prediabetes when the Prediabetes is diagnosed with OGTT (Oral Glucose Tolerance Test) test.
3. Hemoglobin A1C (HA1C or Glycated hemoglobin Test)
This is also called Average Blood Sugar test. This blood test shows the average blood sugar level for past 3 months.
Dr. Dodel says – “Hemoglobin is a protein within red blood cells which carries Oxygen to these cells. As glucose enters the bloodstream, it binds to hemoglobin or we say that the sugar Glycates with Hemoglobin. The more glucose that enters the bloodstream, higher the amount of Glycated hemoglobin would be.”
In HA1C test, we measure the percentage of blood sugar attached to Hemoglobin or in other words the percentage of Glycated Hemoglobin. The higher your blood sugar levels, the more sugar you will have attached with hemoglobin.
This test is also used to diagnose Prediabetes or Diabetes. If a person is already diabetic, this test can be performed to check if the sugar level has been under control in past 3 months.
Normal – If HA1c level is less than 5.7%
Prediabetes – If HA1c level is between 5.7% and 6.4 %
Diabetes – If HA1c level is more than 6.4%
In some certain conditions such as pregnancy and some other conditions the A1C test can give inaccurate results. Your Doctor will determine if A1C is to be performed depending on your condition.
If your blood sugar level is normal, your doctor may recommend a screening test every three years.
Treatments of Prediabetes
According to the American Diabetes Association (ADA) once you are diagnosed with Prediabetes you must make some serious lifestyle changes to prevent your Prediabetes from converting into Type 2 Diabetes.
Here are the ADA’s recommendations to prevent your Prediabetes from progressing to type 2 diabetes or to completely reverse your Prediabetes to normal. This is very it very crucial for your life to stop Diabetes at it’s Prediabetes stage before it reaches to the Chronic Diabetes stage.
1. Lose weight
Losing weight and doing regular exercise are at the top of all other required to-do’s. Get started on a weight loss program as soon as you are diagnosed with Prediabetes. Losing your weight can significantly reduce your risk of developing type 2 diabetes. Take healthy food to include in your Weight Loss Diet.
2. Exercise Regularly
This is the must to be done part of your life if you are diagnosed with Prediabetes and do not want to get type 2 diabetes. While exercising, it burns the more glucose hence lowering your blood sugar level. Exercise can significantly decrease Insulin Resistance in your body.
3. Take Low Carb Diet
Leave or cut down your favorite potato dishes or any other dish which is high in carbohydrate. Your Liver converts extra carbohydrate into glucose increasing your blood glucose level.
4. Avoid Oily Food
Cut down all the oil, butter or other ingredients containing Omega-6 (also called bad fat) . Omega 6 is Inflammatory in nature and increases Insulin Resistance in body cells. This Insulin Resistance can lead to type 2 diabetes. Eat more broiled foods and cut down the fried food from your meal.
5. Eat Fish
Fish are great source of Omega 3 (also called good fat) which is Anti-Inflammatory in nature thus reducing the Insulin Resistance. Choose oily fishes such as salmon etch. Add 2-3 servings of fish in your weekly meal plan.
6. Eat White Meat
Add only white meat in your meal such as chicken breasts which does not have fat. Eat only broiled chicken which is cooked without oil.
7. Eat Green Vegetables
Eat more green and leafy vegetables which are low in carbohydrate and fruits which have less amount of sugar.
8. Taking Medications (Metformin)
Sometimes for people who are at very high risk of developing type 2 diabetes, doctor may recommend to take medicine. As per American Diabetes Association Metformin should be the only medication used to prevent type 2. People with higher weight and having higher BMI are at high risk and should be prescribed Metformin. Apart from them a women with a history of Gestational Diabetes should also be prescribed medication.
Metformin reduces production of extra glucose in Liver when it is not needed, thereby keeping your blood glucose level in a better range.