Pre Diabetes

Pre diabetes, though subtle, may be noticeable before full-blown type 2 diabetes. It may not be well-known term in the wider population. It is the first step towards diabetes. For patients, pre diabetes is important because if it is diagnosed early its progression to diabetes can be stopped. Other names for this are impaired glucose tolerance or impaired fasting glucose.

The exact cause of this beginning part of the disease is yet not completely understood yet, but genetics is one important factor in developing symptoms of pre diabetes. Scientists have found genes which are responsible for glucose intolerance. Another important factor is excessive abdominal fat.

In patients with diabetes precursor, management of glucose levels is not working properly. Their body releases smaller amounts of insulin or cells in different body parts do not take glucose from the blood. Either way, the result is increased blood glucose level.

Pre Diabetes Signs and Risks

Risk Factors for Pre Diabetes

There is a number of risk factors for developing glucose intolerance. They are the same as risk factors for type 2 diabetes.  The most important ones are body mass – overweight people are at higher risk of development of impaired glucose tolerance. Fat tissue is the reason for insulin resistance, especially fat tissue around the abdomen. The more fat you have the higher the risk of prediabetes and type 2 diabetes. Activity – any activity will cause spending glucose and burning fat. On the other hand, inactivity will cause accumulation of fat and higher levels of glucose. You are at higher risk the older you are. Waist size is another risk factor on which you have influence. But on family history and race you don't have any influence.   African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders are at higher risk of glucose intolerance. Hyperlipidemia is also linked with the development of glucose intolerance, because it seems to make the body less sensitive to insulin.

Symptoms and Signs of Pre Diabetes

In most cases, you will not feel any symptoms of glucose intolerance. Acanthosis nigricans is a common sign of early diabetes. It represents the appearance of darkened skin on some body parts such as the neck, armpits, elbows. You should be worried if you start developing symptoms of type 2 diabetes ( excessive thirst, frequent urination, blurred vision, feeling tired.

The most common complication of impaired glucose tolerance is a progression to diabetes. It can lead to further diabetes complications. In some cases, it can lead to heart attack, stroke, nerve, eye, feet, kidney damage.

Diagnosis  of Impaired Glucose Tolerance

You should start checking serum glucose levels at the age of 45. In case you have other risk factors, you should start with monitoring of glucose levels earlier.

The first step in the diagnosis of impaired glucose tolerance is an A1c test which will show the level of glucose for the period of  last three months. To be positively diagnosed, the level of A1c should be between 5.7 and 6.4. If the level of A1c is above 6.4 then it is diabetes. The normal range is under 5.7.

There are also other diagnostic tests which can be used. Fasting blood sugar test is one of them. Glucose level will be measured after fasting for eight hours. In this case, impaired glucose tolerance is diagnosed if glucose level is between 5.6 and 6.9mmol/L.

Oral glucose tolerance test is rarely used but it can measure glucose level after you intake glucose solution after a period of eight hours of fasting.  Pre diabetes range is 7.8 to 11.0 mmol/L.

Random plasma glucose (RPG) test will use a blood sample to determine glucose level. That sample can be taken at any time of day. If the glucose level is between 140 and 199 mg/dL then we can say it is prediabetes.

These test should be repeated at least once in a period of three years.

Treatment for Pre Diabetes

It is important to know that prediabetes is a reversible condition. If you follow strict instructions you have a chance to avoid progress to type 2 diabetes.

The most important steps in prediabetes treatment are diet, activity, weight loss, drugs.

Diet is very important in prediabetes treatment. You should avoid all the food which is rich in calories and carbohydrates. Ingest more fruit and vegetables. Avoid candies at all cost.  A strict diet will help you loose some pounds. It is even more effective if you increase your activity. You can start walking or jogging. This will help you burn calories and body fat. For people with an extreme risk of progression of prediabetes, medicines can be prescribed. Most often it will be metformin.


Prevention of Pre Diabetes


You should think about your health even before you develop prediabetes. If you strictly follow diabetes prevention diet, activity, and body weight you are on a good track to avoid prediabetes development. Ingest enough quantities of fruit, vegetables, omega 3-fatty acids which can be found in fish. Avoid salt, fat rich food, sugar, alcohol.

References

American diabetes association, "Diagnosing Diabetes and Learning About Prediabetes“, 2015, retrived from http://www.diabetes.org/diabetes-basics/diagnosis/?referrer=https://www.google.ba/ 

Brett Huffman and Valencia Higuera, "What Is Prediabetes?“, 2016, retrieved from http://www.healthline.com/health/type-2-diabetes/what-is-prediabetes#Prevention8

Mayo Clinic , "Prediabetes“, 2014, retrieved from http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/definition/con-20024420

Michael Dansinger,  "What Is Prediabetes?“, 2014, retrieved from http://www.webmd.com/diabetes/type-2-diabetes-guide/what-is-prediabetes-or-borderline-diabetes


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