Vicky is a successful businessman. He is 42 years old, about six feet, and weighs 110 kg. He doesn’t sleep well. He sweats a lot and feels lethargic right from the start of the day. He knows he is overweight and needs to do something about it, but where is the time! He tried losing weight by skipping breakfast and gorged on burgers at noon, so sooner than later he found himself back to where he started and worse. On his wife’s insistence, he saw a doctor and got himself a full medical check up. The blood work revealed a blood sugar level of 6.8 mmol (122.4 mg /dL). Vicky has prediabetes.
What is prediabetes?
Prediabetes is a condition in which the blood glucose or A1c levels become higher than normal but not high enough to be labeled as diabetes. Blood glucose levels rise when the body cannot process the sugar properly leading to build up of the sugar in the bloodstream.Since heart and circulatory system diseases (cardiovascular disease) associated with type-2 diabetes may begin with prediabetes, it is important that you know if you have the condition.
Read more about causes, symptoms, diagnosis and treatment of diabetes.
How do we get prediabetes?
During digestion, sugar from the foods that we eat, and especially carbohydrate foods, enter our bloodstream in the form of glucose and with the help of insulin get absorbed into the cells to give energy for various body functions. And when the pancreas does not make enough insulin or / and our cells become resistant to the action of insulin, the glucose does not get absorbed properly and causes the build up.
How can we know if there is sugar build-up in the blood?
There are two tests to determine the blood sugar levels. One is OGTT and the other is IFG measurement.
The World Health Organization first described prediabetes as ‘impaired glucose tolerance (IGT)’ diagnosed through Oral Glucose Tolerance Test (OGTT) where the plasma glucose levels at 2 hours after consuming 75g glucose is more than 7.8 mmol /l but less than 11.1 mmol /l and the fasting plasma glucose is less than 7.0 mmol /l.
The American Diabetes Association (ADA) however found this process to be too time taking and bothersome, so they diagnosed pre-diabetes as impaired fasting glucose (IFG), which relies on one fasting measurement, that is, the fasting blood sugar levels after you haven’t eaten for at least eight hours. The fasting blood sugar level of 100 to 125 mg/dl (5.6 to 7 mmol /l) is considered prediabetes.
In short, if your OGTT shows readings of 7.8 to 11.1 mmol /l (or 140.4 – 126 mg/dl) you have prediabetes. In the same way, if your IFG measurement is 5.6 – 7.0 mmol /l (or 100 – 125 mg/dl) you have prediabetes.
‘Everyone’s blood glucose goes up after eating regardless if you have diabetes or not. Generally the blood glucose will start rising about 15-20 minutes after eating and peak in 60-90 minutes and be back at baseline in 3-4 hours. Also, it depends on the type of food you eat (carbs/protein/fat) and the amount of food you eat. Non diabetic individuals will not see the blood glucose rise more than 140 mg/dl or 7.7 mmol/l after eating. People with prediabetes will see the post meal numbers in the 140-200 range and individuals with diabetes will see numbers above 200 mg/dl for diagnosis,’ say Nancy Klobassa Davidson and Peggy Moreland, certified diabetes educators at Mayo Clinic.
What are the symptoms of prediabetes?
The signs and symptoms of prediabetes are usually imperceptible. It sort of comes up as a silent disease. Watch out for symptoms such as increased thirst, frequent urination, fatigue and blurred vision. These are all signs of type-2 diabetes. Sometimes, darkened areas may appear on the neck, armpits, elbows, knuckles and knees suggesting that you are at risk for type-2 diabetes.
But what are the warning signs that you are on the path to developing prediabetes? The most important sign is your expanding waistline, which means, a waist circumference of more than 40 inches for men and 35 inches for women. Another sign is being overweight with a BMI above 25.
Apart from these obvious signs, other risk factors for prediabetes are:
Age – more than 45 years.
Physical activity level – you are inactive or have a sedentary job.
Family history – you have a family history of type-2 diabetes.
Gynecology problems – you suffer from polycystic ovary syndrome or you had developed gestational diabetes when you were pregnant, or your baby’s birth weight was more than 4.1kg.
Blood pressure – you have high blood pressure.
Cholesterol – you have HDL ‘good’ cholesterol levels below 35 mg/dl or your triglyceride level is above 25 mg/dl.
Sleep – you sleep too little or too much.
Does prediabetes always progress to diabetes?
Although prediabetes is a big risk factor for type 2 diabetes, progression to type-2 diabetes is not inevitable.
The International Diabetes Federation reports that ‘40-50 percent of people with IGT will develop type-2 diabetes (accompanied by increased risk of cardiovascular disease) within ten years’. But they believe that about 30 percent of pre-diabetic people will return to normal glucose tolerance.
However, normal glucose tolerance will not return by just doing nothing; you have to take certain actions to slow down or prevent progression of prediabetes.
How to slow down or prevent progression of prediabetes?
A healthy diet low in fat and calories and regular physical activity are the two most important factors that can help you slow down or even reverse prediabetes.
Research studies from the National Institute of Diabetes and Digestive and Kidney Diseases (DPP) and from Finnish Diabetes Prevention Study (DPS), found that risk for diabetes could be delayed or prevented by 58 percent with lifestyle interventions involving low fat, low calorie diet and moderate intensity physical activity of at least 150 minutes per week.
The following guidelines may help you make the required lifestyle changes –
- Eat three meals a day including a nutritious breakfast. Add 2 – 3 snacks per day.
- Replace processed foods with whole grain and high fiber foods.
- Limit red meats. You are at a 20 percent greater risk of getting diabetes than those who don’t eat red meat. Choose nuts, seeds, lentils (dal), fish or poultry instead.
- Consume lots of fruits and vegetables such as greens, carrot and broccoli. Choose fresh fruits instead of fruit juices.
- Swap high calorie foods for low calorie ones. For example, choose low fat cheese instead of regular ones, or skim milk instead of whole milk.
- Lose weight if you are overweight. Losing even a moderate 5 – 7 percent of the body weight can make a big difference.
- Inactivity increases diabetes risk. Studies have shown that for every 2 hours you spend watching TV or being idle, you increase the chances of diabetes by 14 percent. ‘Working your muscles more often and making them work harder improves their ability to use insulin and absorb glucose. This puts less stress on your insulin-making cells,’ according to the Harvard School of Public Health.
- Even if you are not much into gyms, brisk walking for half an hour every day can reduce diabetes risk.
- Quit smoking. Those who smoke increase their diabetes risk by 50 percent as compared with non-smokers.
- Keep your alcohol consumption under moderation. One drink a day for women and up to 2 drinks per day for men is okay. If you don’t drink, then there is no need to start.
It is very important to monitor disease progression by getting your blood glucose levels checked as per the instructions of your healthcare provider. So, if your tests show that you have prediabetes, it is high time for you to make those diet and lifestyle changes.
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Published : March 28, 2013 8:30 am | Updated:March 30, 2015 6:20 pm
