Prediabetes and its Management

Pre-diabetes and its Management

Prediabetes means you have a higher than normal blood sugar level. It's not high enough to be considered type 2 diabetes yet, but without lifestyle changes, adults and children with prediabetes are more likely to develop type 2 diabetes.

According to the National Institutes of Health (NIH), prediabetes is reversible. Treatment may include lifestyle modifications, such as diet and exercise, and medication. If you have prediabetes and don’t make lifestyle changes, you could develop type 2 diabetes within 10 years.

The first step for managing prediabetes is; understanding what a prediabetes diagnosis means.

  • What causes prediabetes?

Insulin is a hormone made by your pancreas that helps your body convert glucose into fuel. When you eat a meal, the carbohydrates in your food are converted into glucose, otherwise known as blood sugar.

That glucose stays in your bloodstream until your pancreas releases insulin. The insulin acts like a key that opens your cells to allow the glucose to enter, where it’s then used to fuel your body. Without insulin or when insulin is not working effectively, that glucose stays stuck in your bloodstream and accumulates, causing your blood sugar to rise.

During type 2 diabetes, your pancreas can still produce insulin, but that insulin gradually becomes less effective at helping the glucose into your cells.

Prediabetes is an indicator that your body is beginning to stop using insulin as efficiently as it should. In other words, your body is starting to become resistant to insulin. When your body resists insulin, the glucose levels in your blood rise, which is how you develop prediabetes and, if that process is not stopped and allowed to progress, type 2 diabetes.

  • What are prediabetes symptoms to watch out for?

Typically, adults experience either no symptoms at all, or the insulin resistance symptoms are so gradual or slight they may go unnoticed for years. Sometimes, though, there are warning signs. These include:

 

  • Increased thirst
  • Increased hunger
  • Fatigue
  • Unexplained weight loss, even if eating more
  • Frequent urination

The last symptom happens because excess sugar in your bloodstream triggers your body to make more urine in order to flush the glucose out. The more you urinate, the more likely you are to become dehydrated, which can lead to a cycle of increased hunger and thirst signals.

Diabetes symptoms men experience can also cause sexual issues such as erectile dysfunction (ED) and decreased sex drive.

 

  • How is prediabetes diagnosed?
  1. Blood Glucose level

Category

fasting

2 hrs after eating

normal

80-100

Under 140

Pre-diabetic

101-125

140-199

diabetic

126 and higher

200 and higher

(*units in mg per dL)

  1. Hemoglobin A1c test (HbA1c)

Normal

Prediabetic

Diabetes

5.6% or less

5.7 to 6.4%

6.5% or above

 

  • Children and Prediabetes Testing:

Doctors diagnose prediabetes based on the same blood sugar levels, no matter the person’s age. The American Diabetes Association says children 10 and older should be tested if they’re overweight or obese and have:

  • A family member with type 2 diabetes
  • A mother who had gestational diabetes while pregnant with the child
  • Native American, African American, Hispanic, Asian American, or Pacific Islander heritage
  • Signs of insulin resistance or conditions linked to it, such as a low birth weight, high blood pressure, or polycystic ovary syndrome.

If a child who has a high chance of getting prediabetes has normal test results, the American Diabetes Association advises testing them again at least every 3 years.

 

 

  • What are the risk factors and warning signs of prediabetes?

Your risk of developing prediabetes increases when you have any of the following:  

 

  • Unhealthy diet. Diets high in sugar and processed foods raise your blood pressure and increase your level of LDL, or “bad cholesterol” in addition to your blood glucose, putting you in danger of developing prediabetes.
  • Excess weight. If you’re medically overweight, you’re at a high risk for developing prediabetes. This is especially true if you carry a lot of extra weight in your abdomen, which is known as visceral fat and can play a role in insulin resistance.
  • A sedentary lifestyle that includes little to no physical exercise. Being very inactive contributes to insulin resistance and weight gain, both of which can then lead to prediabetes. Aim to move around at least 30 minutes per day, even it is just to go on a walk.
  • A family history of type 2 diabetes. Prediabetes has a hereditary factor. If someone in your immediate family has T2D—or has had T2D in the past — you are more likely to develop prediabetes and type 2 diabetes yourself.
  • A history of gestational diabetes. Diabetes during pregnancy can signal a higher risk for prediabetes and type 2 diabetes later on.
  • Smoking. The nicotine in cigarettes decreases the sensitivity of your cells to insulin, which raises the glucose in your blood. Other chemicals in cigarettes cause inflammation and make it harder for those cells to absorb insulin.
  • Advanced age. The older you are, the more at risk you become. At age 45, your likelihood of developing prediabetes starts to rise. By retirement age, almost 25% of seniors over 65 have prediabetes.

 

  • Is prediabetes reversible?

Absolutely! You can turn back your prediabetes by adopting lifestyle changes, including:

  • Evaluating food choices. Contrary to popular opinion, you don’t have to eliminate the foods you love. For the best chance at long-term success, work with your dietitian to create a meal plan that still includes your favorite foods with slight alternations if necessary, so you don’t feel deprived and can stick to it long-term. Some examples of this might include switching out white rice for cauliflower rice as an accompaniment to your usual dishes, or swapping “zoodles” made from squash or other vegetables for pasta so you can still enjoy your favorite recipes with less starch.
  • Exercise. Exercise is a great way to reverse prediabetes for a number of reasons. First, a fitness regimen can help you shed the pounds that increase your risk for prediabetes without restrictive dieting. Additionally, when you exercise, your body uses more glucose, which helps clear it out of your bloodstream. Finally, exercise activates a cell receptor called GLUT-4, which actually helps absorb glucose out of your bloodstream and move it into your cells. Cardio and weights both are exercises that help activate the GLUT-4 mechanism. The American Diabetes Association recommends at least 150 minutes of moderate physical activity each week, which most commonly averages out to 30 minutes, five times a week. But you can also divide it up into longer workouts on days when you have more time available if you know you will be too busy to exercise on others.
  • Losing weight. If your doctor has medically advised weight loss for prediabetes and you don’t know where to begin (or you’ve already tried every diet with no results), ask for help. Losing just 5 to 10% of your body weight can significantly reduce your risk of developing type 2 diabetes and eliminate your prediabetes, so consult a nutritionist and trainer if you have found it too challenging to lose weight in the past.
  • Medication. If you are at a very high risk of developing type 2 diabetes after being diagnosed with prediabetes because of comorbidities such as obesity, you doctor may recommend a medication such as metformin, which keeps your liver from making more glucose when you don’t need it, so your glucose levels stay within a safer range.

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REFERENCES :

  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34(suppl 1)S62-S69
  • World Health Organization (WHO), International Diabetes Foundation (IDF). Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF Consultation. Geneva, Switzerland: WHO; 2006.
  • James C, Bullard KM, Rolka DB, et al. Implications of alternative definitions of prediabetes for prevalence in U.S. adults. Diabetes Care. 2011;34:387-391
  • Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
  • Retnakaran R, Qi Y, Sermer M, et al. Glucose intolerance in pregnancy and future risk of pre-diabetes or diabetes. Diabetes Care. 2008;31:2026-2031.