OVERVIEW
Prediabetes is a condition characterised by sugar imbalance. The body uses sugar in the form of glucose as an energy source. The sugar in the blood needs to be regulated, so it does not become too much. The hormone insulin, secreted by the pancreas, regulates the blood sugar level.
Prediabetes is a clinical condition that usually precedes Type 2 diabetes. The blood sugar level in prediabetes is higher than usual but not high enough to diagnose diabetes. Prediabetes is also impaired fasting glucose or impaired glucose tolerance.
Most people with prediabetes, about 85%, are unaware that they have the condition. This is because prediabetes does not usually show symptoms. Symptoms present when complications arise or when it becomes type 2 diabetes mellitus.
Prediabetes, with proper management, can be resolved with ease. Appropriate lifestyle measures prevent it from developing complications or progressing to type 2 diabetes.
KEY POINTS
- Prediabetes occurs as a result of insulin resistance. In insulin resistance, the cells resist insulin, preventing glucose from entering the cells.
- Prediabetes, left unchecked, advances to type 2 diabetes and develops complications.
- Heart attack and stroke are significant complications of prediabetes.
- Prediabetes is reversed easily by healthy lifestyle habits and prescribed medications from a doctor.
SYMPTOMS
There are no clear-cut symptoms of prediabetes. Most people stay for years with prediabetes but do not know because symptoms do not show. When symptoms present, the symptoms are typical symptoms of Type 2 diabetes. Presentation of symptoms usually indicates that the disease has progressed almost to Type 2 diabetes. Presenting symptoms include:
- Increased frequency of urination, particularly at night
- Feeling tired
- Increased water intake without complete satisfaction
- Blurry vision
- Darkening and thickening of the skin in the armpit or side of the neck
The darkening of the skin is a condition called acanthosis nigricans. It usually presents in people with polycystic ovarian syndrome (PCOS) as a sign of insulin resistance.
DIAGNOSIS
To confirm the diagnosis of prediabetes, the doctor will order at least one of the following tests:
- Fasting blood sugar: The individual is required to stay away from food for at least 8 hours. After that, the doctor collects a blood sample to assess the fasting blood sugar level. Normal fasting blood sugar is less than 100 mg/dl. Values between 100 – 125 mg/dl are indicative of prediabetes. A person with diabetes mellitus will return values higher than 125 mg/dl.
- Oral Glucose Tolerance Test (O.G.T.T.): The O.G.T.T. will indicate if a person is normal, prediabetic or diabetic. The person must fast, after which the doctor collects the patient’s blood sample. After two hours, the person drinks a sugary drink and submits another blood sugar sample. A result of fewer than 140 milligrams per deciliter (mg/dl) indicates that the individual is normal. If the range falls between 140 – 199 mg/dl, it is prediabetes. Any value higher than 199 mg/dl is diabetes.
- Haemoglobin A1c test: Haemoglobin A1c test is also a glycosylated haemoglobin test commonly used by doctors to diagnose prediabetes. It accesses blood glucose levels over three months. A second test serves as a confirmation. A result of 5.6% or less indicates a normal glycosylated haemoglobin concentration. If the outcome falls between 5.7 – 6.4%, it is prediabetes. It is diabetes when the result is greater than 6.4%. People who are either obese or have heart disease should undergo periodic tests to detect the condition early.
CAUSES
There is no primary cause of prediabetes. It occurs when the body cannot utilise insulin appropriately. Insulin lowers blood sugar levels by increasing the rate of glucose uptake in cells.
In prediabetes, the body is resistant to the secreted insulin. As such, glucose accumulates in the blood, leading to increased blood sugar levels. If the insulin resistance continues, Type 2 diabetes mellitus could set in.
Although there are no outright causes of prediabetes, some risk factors make a person more susceptible to having prediabetes. These risk factors include:
- Being overweight
- Direct family history of type 2 diabetes mellitus
- Large waist size
- Poor physical activity
- Increased age (from 45 years above)
- Being Black, Native American or Latino
- Irregular lipid levels, like high cholesterol and triglycerides
- History of gestational diabetes
- Polycystic ovary syndrome
Anybody with the above risk factors should consult a doctor for prediabetes assessments.
PREVENTION
Lifestyle adjustments help prevent prediabetes. Losing weight is a significant way of avoiding prediabetes and type 2 diabetes. Studies have shown that when people at risk of prediabetes lose 5 to 7 per cent of their starting weight, they reduce the chances of coming down with the disease.
Prediabetes prevention includes:
- Weight loss
- Eat healthy, especially eating foods that are high in fibre content
- Keep stress levels in check
- Avoid smoking
- Limit alcohol input
TREATMENT
Doctors treat prediabetes in the following ways:
Regular exercise: Exercising at least five days a week helps maintain a healthy weight and resolve prediabetes. Individuals should start with exercises that they enjoy doing.
Maintain a healthy diet: A diet rich in fibre and less sugar will help a patient with prediabetes.
Medication: The doctor may prescribe metformin, an antidiabetic, to regulate blood sugar levels.
Controlling the blood pressure: Keeping the blood pressure within appropriate limits by using prescribed antihypertensives will relieve complications.
Avoid smoking: Quitting smoking reduces the toxic substances that could aid insulin resistance.
Complimentary and alternative medicine: Some people opt for C.A.M. as an alternative to conventional treatment. C.A.M. includes supplements and acupuncture. A patient should see a doctor before deciding whether or not to go for C.A.M.
With these treatment methods, prediabetes resolves. But if nothing is done to checkmate the disease, prediabetes will proceed to type 2 diabetes, and complications will develop. Complications of prediabetes include:
- Heart diseases
- Stroke
- Retinal retinopathy, which could result in blindness
- Peripheral neuropathy
- Hearing problems
- Foot damage as a result of necrosis usually leads to amputation of the affected foot
- Damage to the kidneys
CONCLUSION
Prediabetes is a condition that individuals should ignore. A person should seek medical attention on symptom presentation. Prediabetes is preventable and easily reversible. But can develop life-threatening complications if not managed well. Metformin is very helpful in managing prediabetes.
MOST COMMON
