What is Prediabetes

Prediabetes is a syndrome in which you have high blood glucose levels but they are not high enough to have the diagnosis of type 2 diabetes.  If prediabetes is left untreated, you have an increased likeliness of having type 2 diabetes at a later day.  Unfortunately, some of the complications of diabetes, such as kidney, nerve, and eye damage, can already be occurring when you have prediabetes.

Symptoms of Prediabetes

Most of the time, people with prediabetes have no symptoms.  If the prediabetes progresses to full blown diabetes, you can develop the following symptoms:

• Blurry vision
• Tiredness
• Increase in urination
• Elevated thirst
• Skin changes, including acanthosis nigricans, which is a darkening of the skin in certain areas

If you have any of these symptoms or a strong family history of diabetes type 2, you should have your doctor screen you for the disease.  Risk factors for prediabetes include the following:

• Having hypertension (high blood pressure)
• Having polycystic ovarian syndrome (in women)
• Having gestational diabetes (in women)
• Having a baby weighing over 9 pounds (in women)
• Having an African American, Pacific Islander, Asian-American, Hispanic, or American Indian heritage
• Having a family history of diabetes
• Being older than 45 years of age
• Lacking in exercise
• Having a body mass index of greater than 25 (which means you are overweight)
• You have cholesterol levels that are too high
• You have triglyceride levels that are too high

Causes of Prediabetes

No one knows exactly why a person would develop prediabetes, although it is believed to be related to heredity and family history.   There have been some genes identified that seem to increase the risk of developing type 2 diabetes.  Other causes of prediabetes include having excess fat around the waist and being physically inactive.  These things cause increased insulin resistance, which raises the blood glucose levels and results in prediabetes and ultimately, type 2 diabetes.

When you develop prediabetes, the process of having insulin released from the pancreas and lowering the blood sugar levels goes awry. The cells become resistant to the insulin levels in the bloodstream and glucose cannot enter the cells to make cellular fuel. Blood glucose levels rise and you develop prediabetes.

Risk Factors for Prediabetes

The risk factors for prediabetes are the same ones that can result in type 2 diabetes.  They include the following:

• Certain races, such as Hispanic, African-American, Pacific Islander, Asian-American, or American Indian can cause high blood sugar levels.
• Family history. If you have a first degree relative with prediabetes, your risk for the disease is high as well.
• Diabetes and prediabetes can happen in someone of any age; however, being older than 45 years of age is a risk factor for prediabetes.
• Physical inactivity. If you do not exercise, you will have an increased risk of prediabetes.
• Waist circumference. In men, if the waist size is greater than 40 inches, there is an increased risk of prediabetes. In women, a waist size of 35 inches or more predisposes them to prediabetes.
• The major risk factor for prediabetes is being overweight.  It is especially true if the weight is the result of fat around your abdomen or fat between the muscles.
• Sleep issues. If you have sleep apnea, you have a greater risk of having prediabetes from insulin resistance.  People who must work the night shift have a greater chance of developing prediabetes as well.
• Polycystic ovarian syndrome. This is a condition of women in which there are many cysts on the ovaries and the woman is often overweight, with an increase in hair growth.  Insulin resistance seems to go along with this as well.
• Gestational diabetes. Women who had gestational diabetes during pregnancy have an increased risk for developing prediabetes later in life.
• High blood pressure. Having elevated blood pressure levels seems to be associated with having prediabetes.
• Low HDL levels. HDL cholesterol is the “good” kind of cholesterol and it seems to be related to developing prediabetes.
• Elevated triglyceride levels. People with elevated triglyceride levels have a greater risk of developing prediabetes.

Complications of Prediabetes

The major complication of prediabetes is the development of type 2 diabetes.  When prediabetes becomes diabetes, you are at a greater risk of having complications, such as kidney failure, stroke, heart disease, elevated cholesterol levels, hypertension, amputations, and visual disturbances.

Testing for Prediabetes

Testing for prediabetes should start around 45 years of age.  A fasting blood sugar level should be checked at that time and every 3 years thereafter.  Screening should be done earlier among those people who have risk factors for prediabetes as listed above.

Testing for prediabetes can include the following:

• Having a fasting blood glucose level. This is when the blood sugar level is checked in the morning after you have fasted overnight. If the blood sugar level is between 100 mg/dL and 125 mg/dL, you are said to have prediabetes.
• Hemoglobin A1c Test.This is a blood test that tells how “sugar coated” the red blood cells are. Normal hemoglobin A1c levels are about 5.7 percent or less.  People with prediabetes will have a hemoglobin A1c level of between 5.7 and 6.4 percent.  If the level reaches numbers greater than 6.5 percent, it means that the prediabetes has progressed to become type 2 diabetes.
• Glucose tolerance test. This is a test in which you drink a sugary beverage after having a fasting blood sugar checked.  After drinking the beverage, the blood glucose levels are checked every hour for 3 total hours. If any number is elevated, you have prediabetes or diabetes.
• Spot blood sugar level. If you have any blood sugar level of greater than 200 mg/dL, regardless of diet, you are said to have diabetes.  If the blood sugar is close to that, it means you have prediabetes.

Treatment of Prediabetes

You can prevent prediabetes from turning into full blown diabetes type 2 by making healthy choices regarding your lifestyle.  This includes the following lifestyle factors:

• Exercising regularly. If you get at least 150 minutes of exercise per week, you are getting enough exercise to lower your blood sugar levels and lower your chances of having prediabetes turn into type 2 diabetes.
• Eating a healthy diet. This means eating a low calorie diet that is also low in sugar and fats.  Eating high fiber foods can also prevent prediabetes from becoming type 2 diabetes. Some people choose the Mediterranean diet in order to stave off type 2 diabetes.
• Taking medications. In some cases, Glucophage (metformin) can be used in prediabetes. Metformin improves insulin sensitivity and can prevent prediabetes from becoming type 2 diabetes.
• Losing weight. It is believed that a weight reduction of just 5-10 percent of the total body weight can decrease the chances of having type 2 diabetes.

References:

Prediabetes. http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/definition/con-20024420.