Prediabetes
“It’s a condition where your blood glucose levels are above normal, but not high enough for you to be diagnosed with diabetes.”
Prediabetes is considered to be the first stage of type 2 diabetes. Prediabetic people are said to have occult, potential or suspected diabetes. These people have a strong genetic predisposition towards diabetes but they are unaware as they don’t show any abnormality of carbohydrate metabolism (may be due to the hypertrophy of islet tissue which produces more than normal Hormones, as a result delays the onset of diabetes.) It is a condition where your blood glucose levels are higher than normal, but not yet high enough for you to be diagnosed with diabetes. It may be referred to as impaired fasting glucose (IFT), if you have higher than normal sugar levels after a period of fasting, or as impaired glucose tolerance (IGT), if you have higher than normal sugar levels following eating.
However, Prediabetes is a critical stage in the development of diabetes as Prediabetic persons have the potential to develop diabetes if they don’t adopt proper diet pattern and lifestyle. Studies show that 15 to 30 percent of people with prediabetes will develop diabetes within five years without intervention like weight loss or increased physical activity. In fact, most people who get type 2 diabetes had prediabetes first. Prediabetes is serious in and of itself as people with prediabetic condition have a greater risk of developing cardiovascular disease than those without it. Therefore, early decisive action like good diet pattern and lifestyle choices can slow down or even halt and turn around the progression towards type 2 diabetes.
Symptoms of prediabetes
Many people have prediabetes but are completely unaware of it. This is because the condition often develops gradually without any warning signs or symptoms. In many cases, the sufferer becomes aware of their borderline diabetic state once the symptoms of type 2 diabetes start to appear. Thus, it is essential to know the risk factors.
Risk factors for prediabetes
You should be tested for prediabetes if you:
- Are overweight or obese
- Have a close relative (parent or sibling) who currently has or has had diabetes
- Have high blood pressure, low HDL ('good' cholesterol) or high triglycerides
- Are over the age of 40
- Have given birth to a baby who weighed over 9 pounds
Either a fasting plasma glucose test or an HbA1c test may be used to diagnose type 2 diabetes or prediabetes.
Diagnosis of prediabetes
There are three tests that doctors can do in order to determine whether you have high blood sugar.
HbA1C
This blood test, which is also called hemoglobin A1c, glycated hemoglobin or glycosylated hemoglobin, measures the percentage of sugar that is attached to your hemoglobin. Hemoglobin is a protein in your red blood cells. The higher the A1C, the higher your average blood sugar levels have been running over the past two or three months.
A normal A1C is below 5.7 percent. An A1C between 5.7 percent and 6.4 percent suggests prediabetes. An A1C of 6.5 or more indicates type 2 diabetes if the test is confirmed. If your results are questionable, your doctor will retest your A1C on another day to confirm the diagnosis.
Normal A1C results below 5.7%
Prediabetes A1C results 5.7 to 6.4%
Diabetes A1C results above 6.4%
Fasting blood sugar or Fasting plasma glucose
The fasting blood sugar (FBS) or fasting plasma glucose (FPG) test is a blood test that’s done after you’ve been fasting overnight. It measures the sugar in your blood. A normal fasting glucose test is lower than 100 milligrams per deciliter (mg/dL). A result between 100 and 125 mg/dL is diagnostic for prediabetes. One that is 126 mg/dL or above is indicative of diabetes. It’s recommended to retest this another day to confirm the diagnosis.
Normal FPG results below 100 mg/dL
Prediabetes FPG results 100 to 125 mg/dL
Diabetes FPG results above 125 mg/dL
Random blood sugar or Random plasma glucose
A random blood sugar (RBS) or Random plasma glucose (RPG) test is a blood test that is done any time of day that you aren’t fasting. It measures the sugar level in your blood at that moment in time. An RPG result that’s over 200 mg/dL is indicative of diabetes, especially if you are having symptoms of diabetes such as excessive thirst, hunger, or urination. If your level is higher, your doctor will use one of the other tests listed to confirm the diagnosis.
Oral glucose tolerance test
The oral glucose tolerance test (OGTT) takes a little more time than the other two glucose tests for diabetes. In this test, your blood is taken after an overnight fast, and then again two hours after you drink a sugary drink. It’s normal for blood sugar to rise after the drink. Normal blood sugar falls to below 140 mg/dL within two hours, however. If your blood sugar is between 140 and 199 mg/dL, your doctor will diagnose prediabetes. Anything 200 mg/dL or above is diagnostic for type 2 diabetes.
Normal OGTT results below 140 mg/dL
Prediabetes OGTT results 140 to 199 mg/dL
Diabetes OGTT results above 199 mg/dL
Summary with regards to investigations:-
The following results indicate the presence of prediabetes:
- Fasting plasma glucose: 5.5 mmol/L to 6.9 mmol/L or above 100 mg/dL
- HbA1c: 42 to 47 mmol/mol (6.0 to 6.4%)
- If your results are above the upper limits for prediabetes, your physician may either diagnose you with type 2 diabetes or take another test in the near future to confirm whether you have diabetes. If you have symptoms of diabetes but have an HbA1c of below 42 mmol/mol (6.0%), you may be given an oral glucose tolerance test (OGTT).
If you are diagnosed with prediabetes, your doctor should clearly set out the steps you need to take to lower your risk of developing type 2 diabetes.
How to stop prediabetes leading into type 2 diabetes? The good news is that cases of prediabetes that are identified early on can be reversed, preventing them from progressing into full-blown type 2 diabetes.
The two principle factors for consideration are:
- Making changes to your diet and
- Appropriate physical exercise to your lifestyle
By making these changes, blood sugar levels can be returned to normal.
For a comprehensive and individual plan, consult your doctor.
Managing prediabetes
If you’ve been diagnosed with prediabetes, there are steps you can take to help reduce your risk for developing diabetes and return your blood glucose to a normal range.
Eat a healthy and balanced diet
Maintaining a healthy, balanced diet can help reduce your risk for diabetes. Changing your diet can be challenging, so start by making small changes. Track everything you’re eating for a few days so you can understand what food groups you may be over- or undereating. The goal is to choose less processed, whole foods, instead of highly processed foods that contain added sugar, little fiber, and unhealthy fats.
For example, if you aren’t eating the recommended servings of vegetables, try adding one serving of vegetables a day to your diet. You can do this by having a salad with lunch or
dinner, or snacking on carrot sticks. Just be careful about add-ons like salad dressing or dips. They can convert into unhealthy fats or extra calories.
You’ll also have to work on reducing the number of empty-calorie foods and beverages you’re consuming, as well as switching out simple carbohydrate foods for complex carbohydrates. Remember to consult your dietician or Family physician for a healthy diet chart.
Get active
Exercise is also important for managing your blood glucose. Aim for 30 minutes of exercise five days a week.
As with dietary changes, you should also start slow and work your way up. If you aren’t very active, you can start by parking further away from a building’s entrance or taking a flight of stairs instead of an escalator or elevator. Taking a walk with your family after dinner is another great way to add in some exercise.
Once you get more comfortable with increasing your activity level, you can start doing more vigorous activities, like brisk walking, jogging or attending a workout class.
Remember to always get your doctor’s approval before beginning a new workout routine. They can let you know if there are activities you should avoid or things you should monitor, like your heart rate.
Maintain a healthy weight
Eating a balanced diet and exercising can help you lose or maintain weight. Ask your doctor what a healthy weight is for you. Work with them to determine how many calories you should be eating. If you need to lose weight, ask them how much weight you should be losing per week to stay healthy. Crash diets and extreme workout plans may make for entertaining television, but they aren’t realistic for long-term maintenance, and often they’re unhealthy as well.
Summary:-
Prediabetes often leads to diabetes, and most of the time there are no noticeable symptoms. That’s why it’s important to have your blood glucose levels tested, especially if you are over age 40 or have a family history of diabetes.
If you’re overweight, testing before age 40 is recommended if one of the following risk factors is present
- Sedentary lifestyle or physical inactivity,
- a family history of diabetes
- race (Asian-Americans, African-Americans, Native Americans, and Pacific Islanders being at higher risk)
- for women, birth of a baby weighing over 9 pounds
- blood pressure over 140/90 mm Hg
- HDL (good) cholesterol levels under 35 mg/dL or triglyceride levels over 250 mg/dL
- an HbA1C equal to or greater than 5.7 percent or a high fasting blood sugar over 100 mg/dL on a previous test
- other conditions associated with Hormones resistance, such as polycystic ovarian syndrome or acanthosis nigricans
- history of cardiovascular disease
If you do have prediabetes, you can reduce your risk for type 2 diabetes by exercising about 30 minutes each day and losing just five to 10 percent of your body weight. Your doctor may also start you on a suitable medication to help control your blood sugar provided if you have a family history or sedentary lifestyle.
Prediabetes doesn’t have to progress to type 2 diabetes. Early decisive action like lifestyle changes can help you get and keep your blood sugar levels within their normal range.