Prediabetes

Overview

Prediabetes is a condition where a person has higher than normal blood sugar levels but not high enough to be classified as type 2 diabetes. It indicates an increased risk of developing type 2 diabetes without proper lifestyle changes. Prediabetes usually has no symptoms, and it's important to address it through healthy eating habits, regular physical activity, and maintaining a healthy weight to prevent or delay the onset of type 2 diabetes.

Understanding the disease

Symptoms

Symptoms of prediabetes don't usually show any clear signs or symptoms. However, one possible sign is darkened skin on certain parts of the body, such as the neck, armpits, and groin. If you transition from prediabetes to type 2 diabetes, you may experience increased thirst, frequent urination, increased hunger, fatigue, blurred vision, numbness or tingling in the feet or hands, frequent infections, slow-healing sores, unintended weight loss, and other symptoms. It's essential to consult your healthcare provider if you're concerned about diabetes or notice any type 2 diabetes symptoms.

Risk Factors

The risk factors for developing prediabetes include being overweight or obese, having a large waist size, consuming a diet high in red and processed meats and sugar-sweetened beverages, being physically inactive, being over 35 years old, having a family history of type 2 diabetes, being of certain races or ethnicities (e.g., Black, Hispanic, American Indian, and Asian American), having had gestational diabetes, having polycystic ovary syndrome, and suffering from obstructive sleep apnea. Other conditions associated with an increased risk of prediabetes include high blood pressure, low HDL cholesterol, high triglycerides, metabolic syndrome, and high blood sugar levels.

Development

Prediabetes develops when the body's natural mechanisms for regulating blood sugar levels become impaired. Specifically, prediabetes is characterized by insulin resistance, which means the body's cells do not respond well to insulin, and/or the pancreas does not produce enough insulin to keep up with the body's needs. This results in a build-up of glucose in the bloodstream instead of being efficiently used for energy by the cells. Risk factors for developing prediabetes include age, family history, race or ethnicity, gestational diabetes, polycystic ovary syndrome, sleep disorders, weight, waist size, diet, inactivity, and certain medical conditions. It's important to note that prediabetes often has no symptoms, so it's crucial to get regular check-ups and monitor blood sugar levels to detect it early.

Assessment and Diagnosis

Triage

You should see a doctor if prediabetes is suspected, especially if you have any risk factors for developing type 2 diabetes. Risk factors include being overweight, having a family history of diabetes, being over the age of 45, or having a history of gestational diabetes. Additionally, it's important to see a doctor if you notice any classic signs and symptoms of type 2 diabetes, such as increased thirst, frequent urination, increased hunger, fatigue, blurred vision, slow-healing sores, or unintended weight loss. If you have any concerns about diabetes or your blood sugar levels, it's always a good idea to consult with a healthcare provider.

Diagnosis

To diagnose prediabetes, healthcare providers typically use one or more of the following blood tests:

1. Glycated hemoglobin (A1C) test: This test measures your average blood sugar level over the past 2 to 3 months. Results below 5.7%, between 5.7% and 6.4%, and 6.5% or higher on two separate tests indicate normal, prediabetes, and diabetes, respectively.
2. Fasting blood sugar test: A blood sample is taken after an overnight fast. Results of less than 100 mg/dL (5.6 mmol/L), 100 to 125 mg/dL (5.6 to 6.9 mmol/L), and 126 mg/dL (7 mmol/L) or higher on two separate tests indicate healthy, prediabetes, and diabetes, respectively.
3. Oral glucose tolerance test (OGTT): This test is not commonly used, except during pregnancy. After a period of fasting, you drink a sugary liquid, and blood sugar levels are tested periodically for two hours. Results of less than 140 mg/dL (7.8 mmol/L) and 140 to 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) after two hours indicate healthy and prediabetes, respectively, while 200 mg/dL (11.1 mmol/L) or higher suggests diabetes. Screening for prediabetes is recommended for people younger than 35 who are overweight or obese and have one or more risk factors associated with diabetes, women who have had gestational diabetes, and those who have been diagnosed with prediabetes.

Management and Treatment

Complications

Prediabetes is linked to various complications, including:

• Long-term damage to the heart, blood vessels, and kidneys
• Unrecognized (silent) heart attacks
• Progression to type 2 diabetes, which can lead to further complications such as high blood pressure, high cholesterol, heart disease, stroke, kidney disease, nerve damage, fatty liver disease, eye damage (including loss of vision), and amputations. While prediabetes may not have obvious signs or symptoms, one possible sign is darkened skin on certain parts of the body, such as the neck, armpits, or groin. It is important to consult a healthcare provider if you have any concerns about prediabetes or experience any symptoms associated with type 2 diabetes.

Prevention

Prediabetes can be prevented or delayed through healthy lifestyle choices, such as eating healthy foods, getting active, losing excess weight, controlling your blood pressure and cholesterol, and not smoking. Making these changes can help you lower your risk of developing type 2 diabetes, even if you have a family history of the condition. For those with prediabetes, medications like metformin may be prescribed to reduce the risk of progression to type 2 diabetes, typically for older adults who are obese and unable to lower blood sugar levels with lifestyle changes.

Home Remedies

Home remedies for prediabetes involve making healthy lifestyle changes, such as:

1. Eating a balanced diet: Focus on consuming foods low in fat, calories, and high in fiber, such as fruits, vegetables, and whole grains.
2. Incorporating physical activity: Aim for at least 150 minutes of moderate to vigorous aerobic activity per week, like brisk walking, cycling, or swimming.
3. Losing excess weight: Even a modest weight loss of 7-10% can help reduce the risk of developing type 2 diabetes.
4. Managing stress: Engage in stress-reducing activities, such as yoga, meditation, or deep breathing exercises.
5. Getting sufficient sleep: Aim for 7-9 hours of quality sleep per night to help maintain overall health. Remember, prediabetes itself doesn't have specific signs or symptoms. However, making these lifestyle changes can help prevent or delay the progression to type 2 diabetes, as well as improve overall health and well-being. Consult with your healthcare provider for personalized advice and recommendations.

Treatment

To treat prediabetes, you can make healthy lifestyle changes, such as:

1. Exercise regularly: Aim for at least 150 minutes of moderate or 75 minutes of vigorous aerobic activity per week, or a combination of moderate and vigorous exercise.
2. Lose excess weight: If you're overweight, losing 5-7% of your body weight can significantly reduce the risk of developing type 2 diabetes.
3. Eat a healthy diet: Focus on consuming foods low in fat and calories, high in fiber, and rich in fruits, vegetables, nuts, whole grains, and olive oil.
4. Reduce portion sizes: Control your portion sizes to avoid overeating.
5. Eat out less often: Limit dining at restaurants to help you maintain a healthier diet.
6. Monitor blood sugar levels: Regularly check your blood sugar levels to track your progress and make necessary adjustments. Medications may also be prescribed by a healthcare provider to help manage blood sugar levels, such as metformin (Glumetza) for children with prediabetes. However, the primary approach to treating prediabetes is through lifestyle changes. Always consult with a healthcare professional before starting any new treatment or medication.

Preparing for medical consultation

To prepare for an appointment for prediabetes, you should:

1. List any symptoms you've been experiencing, including those that may seem unrelated to prediabetes, and for how long you've experienced them.
2. Prepare a list of your key medical information, including recent surgeries, the names of all medicines you take and the doses, and any other conditions for which you've recently been treated.
3. Write down key personal information, including any major stresses or recent life changes that may impact your prediabetes management.
4. Make a list of all the medications, vitamins, and supplements you're taking.
5. Bring records of your glucose values or your meter to your appointments.
6. Write down questions to ask your health care provider, such as:
   • What lifestyle changes can I make to manage my prediabetes?
   • Should I make any dietary modifications? Can you recommend specific dietary guidelines?
   • What is an appropriate exercise routine for me?
   • Are there any medications or supplements that can help manage my prediabetes? What are their side effects?
   • How often should I monitor my blood glucose levels?
   • What are the signs and symptoms of progression to type 2 diabetes?
   • How can I reduce my risk of developing type 2 diabetes? Remember to inform your health care provider about any dietary supplements or alternative therapies you're considering, as they may interact with your medications or affect your blood sugar levels.