Ninety Percent Of The Population Unaware That They Have Pre
This article first appeared in the medical column Ask-the-Doc in the World Journal
Pre-diabetes means that your blood sugar level is higher than normal, but not high enough to be type 2 diabetes. During this early but critical stage, people often dont display any symptoms. The good news is that progression from prediabetes to diabetes isnt inevitable. Theres still a chance to normalize blood sugar through diet and exercise or through pharmacologic assistance to prevent or delay diabetes.
The pancreas is part of our digestive system. It produces enzymes and hormones that help digest food. One of those hormones, insulin, is necessary to regulate glucose, or sugars in the body. Research shows that before diabetes fully manifests, 50-90% of beta cells in the pancreas are already damaged. Therefore, when diabetes is present, the damage is already significant. Poor glycemic control over the long run can lead to vision, cardiac, kidney, and neurologic diseases as well as increase the risk of stroke.
According to a CDC report from 2014, 9.3%, or one in eleven people has diabetes one in four is unaware that they have it. Prediabetes is even more prevalent. There are 86 million Americans with prediabetes . Even more disturbing is that nine out of ten people who have prediabetes are unaware of it.
Why Might Blood Sugar Rise And Cause Prediabetes
Many factors can contribute to insulin resistance and an eventual increase in blood sugar levels and prediabetes. Some factors are genetic and you cannot change them. They include:
- Being over age 45 years.
- Being of certain ethnic backgrounds, such as African American, Latino, Native American, or certain Asian American groups.
- Having a family history of type 2 diabetes.
- Having heart disease or a history of stroke.
Other factors are related to lifestyle, and you can modify them. They include:
- Being overweight or obese.
- Not getting enough exercise or physical activity.
- Not getting enough sleep.
Why Do I Need To Know My Blood Sugar Numbers
Your blood sugar numbers show how well your diabetes is managed. And managing your diabetes means that you have less chance of having serious health problems, such as kidney disease and vision loss.
As you check your blood sugar, you can see what makes your numbers go up and down. For example, you may see that when you are stressed or eat certain foods, your numbers go up. And, you may see that when you take your medicine and are active, your numbers go down. This information lets you know what is working for you and what needs to change.
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Whos At Risk For Prediabetes
If you have risk factors for prediabetes, talk to your healthcare provider about getting your blood sugar checked regularly. These prediabetes checks are essential because prediabetes often has no symptoms. You can have it for years and not know it.
You may also be at higher risk of prediabetes due to:
- Parent or sibling with Type 2 diabetes.
- Ethnicity. Being African-American, Hispanic, Native American, Asian-American race or a Pacific Islander.
Recommended Target Blood Glucose Level Ranges
The NICE recommended target blood glucose levels are stated below for adults with type 1 diabetes, type 2 diabetes and children with type 1 diabetes.
In addition, the International Diabetes Federations target ranges for people without diabetes is stated.
The table provides general guidance. An individual target set by your healthcare team is the one you should aim for.
|Target Levels by Type|
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Treatment To Reverse Prediabetes
Take these steps to treat prediabetes:
- Eat a healthy diet and lose weight. Losing 5% to 10% of your weight can make a huge difference.
- Exercise. Pick something you enjoy, like walking. Try to get at least 30 minutes a day, 5 days a week. You can start with less time and work your way up to a half-hour if you need to. Check with your doctor before you do more than that.
- Get your blood pressure and cholesterol under control.
- Take medication like metformin to lower your blood sugar if youâre at high risk of diabetes.
Was The Pandemic Responsible For The Rise In Prediabetes Cases
The COVID-19 pandemic pushed a lot of people who were already on the edge, says Dr. Anam. While there may have been an increase in prediabetes diagnoses anyway, doctors have been concerned about remote work and school shutdowns leading to sedentary habits and weight gain, all of which can create a foundation for the condition.
For those who had COVID, the treatment itself may have identified a problem. “In some cases, for people who may have had undiagnosed prediabetes or diabetes, the use of high-dose steroids as part of the management for COVID-19 may have sent them over the edge, unmasking persistently high glucose levels consistent with type 2 diabetes, she says.
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Question: How Do I Know Which Foods Are Best For Me To Eat
Keep a food journal to track meals and snacks as well as post meal blood sugar levels. This can be an insightful tool to learn how different foods and different quantities of foods affect your blood sugar so that adjustments can be made at future meals or snacks. For example, you may notice that when you eat a meal rich in vegetables, you see healthier blood sugar results.
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Eat A Healthy And Balanced Diet
Theres no one special diet for all people at high risk of developing type 2 diabetes. Everyone is individual, so there isnt a one size fits all way of eating for everyone. But, the food and drink we have in our overall diet is linked to our risk of developing type 2 diabetes.
For example, if your overall diet is made up of food and drinks that are in high fat, have a high GI and low fibre content, this is linked to an increased risk of type 2 diabetes. But the good news is that by changing some of your food and drink choices, you can reduce your risk of type 2 diabetes.
But what is a healthy and balanced diet anyway? All of these ways of eating have been linked with a decreased risk of type 2 diabetes:
- the Nordic diet
- moderately cutting down on carbohydrates.
This is because they are made up of healthy foods like fruits, vegetables, wholegrains and lean proteins and its the overall balance of our diet that is important in keeping us healthy.
So, to reduce your risk, aim to eat more of the foods linked with a decreased risk. Research has shown us that the following foods and drinks can be associated with a decreased risk
- total fruit and veg intake
- yogurt and cheese
- unsweetened tea and coffee
Additionally, there are some foods we recommend reducing your intake of, as these have been associated with an increased risk. These foods include:
- sugar sweetened drinks
- refined carbohydrates
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A Standard Blood Glucose Test
This requires you to fast before a blood test, so your PCP or endocrinologist can check the level of glucose in your bloodstream at any given time.
Ideally, fasting glucose levels should be 99 mg/dL or lower. If your fasting blood glucose levels are between 100 and 125mg/dL, it could be considered prediabetes, says Martha McKittrick RD.
I like to have people get a second test done, to make sure its accurate, she says.
A reading higher than 126 mg/dL indicates diabetes.
What Is The Normal Blood Sugar Level For Adults
As we age, our bodies become less able to regulate blood sugar levels as well as they used to. Thatâs why the ADA recommends that older adults aim for a fasting blood sugar level of less than 100 mg/dL. After eating, itâs ideal that your blood sugar level is below 180 mg/dL.
The ADA recommends that most adults with diabetes aim for the following blood sugar goals:
- Fasting: Less than 100 mg/dL
- Preprandial : 70-130 mg/dL
- Postprandial : Less than 180 mg/dL
- Bedtime: 100-140 mg/dL
If you experience high blood sugar levels or low blood glucose levels compared to this range you should speak to your doctor.
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High Blood Sugar Levels
Different targets have been set by various health organizations, but the American Diabetes Association has stated that fasting blood sugar should be between 80-130mg/dL, and two hours after a meal it should be less than 180mg/dL.
Some people experience high blood sugar in the mornings for several common reasons, like the Dawn Phenomenon. Fasting blood sugar is important to note, as it can give an idea of where your blood sugar naturally settles after a period without intervention.
Blood sugar rises after a meal, and then comes back down . Postprandial blood sugar is where it lands at the end of the trend line, which is generally two hours after the meal. If blood sugar is 180 mg/dL two hours after a meal, it could mean mis-calculating carb intake. Knowing the range your doctor has identified as a healthy rise is important in being aware of your bodys processes. Any number above your specific ranges is considered to be high.
Glucose is needed by your body, but when it rises too high over an extended period of time, it can have lasting detrimental effects. Its important that you regularly monitor your blood sugar levels so that youre aware of how your body is responding to your diabetes care plan.
Whats The Outlook For People With Prediabetes
Prediabetes increases your risk of having diabetes, heart disease and stroke. But you can take steps to lower your risk.
Talk to your healthcare provider about how you can stay healthy, including:
- Getting regular blood sugar tests and other screening tests you may need.
- Working toward a healthy weight.
- Getting regular exercise.
- Taking medications you may need.
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Oral Glucose Tolerance Test
The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.
- Diabetes is diagnosed at two-hour blood glucose of greater than or equal to 200 mg/dl
Oral Glucose Tolerance Test
|200 mg/dl or higher|
Is It Really Possible To Reverse Prediabetes
Whats important to remember is that prediabetes may be reversed, explains Dr. Anam. Ive had patients achieve tremendous things, she says, adding that starting early helps.
Parents may need to talk to a pediatrician when their children are in adolescenceor even before thatand adults should assess their lifestyles while they are still in their 20s or 30s, she adds. “Glucose tolerance worsens with age, so problems that arent controlled early may be more difficult later on,” she says.
Anyone who is concerned should understand their glucose numbers and check them routinely. You should know your weight, your blood pressure, and your A1C, Dr. Anam says. Keep tabs on your health and take action if you need to.
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How Is Prediabetes Diagnosed
To test for prediabetes, your healthcare provider will use a blood test. You may have:
- Fasting plasma glucose test, which tests your blood after you have fasted for eight hours .
- A1C test, which provides your average blood glucose level over the past two to three months.
You would be diagnosed with prediabetes if:
- Your fasting plasma glucose test is 100 to 125 mg/dL .
- Your A1c test is 5.7% to 6.4% mg/dL diabetes is 6.5% or higher).
Who Should Get An A1c Test And When
Testing for diabetes or prediabetes:Get a baseline A1C test if youre an adult over age 45or if youre under 45, are overweight, and have one or more risk factors for prediabetes or type 2 diabetes:
- If your result is normal but youre over 45, have risk factors, or have ever had gestational diabetes, repeat the A1C test every 3 years.
- If your result shows you have prediabetes, talk to your doctor about taking steps now to improve your health and lower your risk for type 2 diabetes. Repeat the A1C test as often as your doctor recommends, usually every 1 to 2 years.
- If you dont have symptoms but your result shows you have prediabetes or diabetes, get a second test on a different day to confirm the result.
- If your test shows you have diabetes, ask your doctor to refer you to diabetes self-management education and support services so you can have the best start in managing your diabetes.
Managing diabetes:If you have diabetes, get an A1C test at least twice a year, more often if your medicine changes or if you have other health conditions. Talk to your doctor about how often is right for you.
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What Is High Blood Sugar
If your blood sugar levels are chronically higher than normal, then this is referred to as hyperglycaemia. This is a common issue for those suffering from diabetes. The condition can also affect pregnant women who have gestational diabetes and occasionally those who are severely ill .
Some of the symptoms of hyperglycaemia include:
- Increased thirst
- Issues with concentration and/or thinking
If severe hyperglycaemia is left untreated the condition can lead to organ and tissue damage as the excess glucose present in the body can make it difficult for the organs and cells to function correctly. The disorder can also impair the immune system response in the healing of wounds and cuts.
Who Is More Likely To Develop Insulin Resistance Or Prediabetes
People who have genetic or lifestyle risk factors are more likely to develop insulin resistance or prediabetes. Risk factors include
- age 45 or older
- a parent, brother, or sister with diabetes
- African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American ethnicity
- physical inactivity
- polycystic ovary syndrome, also called PCOS
People who have metabolic syndromea combination of high blood pressure, abnormal cholesterol levels, and large waist sizeare more likely to have prediabetes.
Along with these risk factors, other things that may contribute to insulin resistance include
- certain medicines, such as glucocorticoids, some antipsychotics, and some medicines for HIV
- sleep problems, especially sleep apnea
Although you cant change risk factors such as family history, age, or ethnicity, you can change lifestyle risk factors around eating, physical activity, and weight. These lifestyle changes can lower your chances of developing insulin resistance or prediabetes.
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Can Children Get Prediabetes
Yes. The CDC reports that 18% of adolescents have prediabetes, and its on the rise in that group.
All children experience metabolic and hormonal changes during puberty, along with a decrease in insulin sensitivity problems tend to develop when an adolescent also has obesity, explains Dr. Jastreboff. Children who have obesity are much more likely to grow up to be adults who have obesity, and then they are likely to develop weight-related diseases like type 2 diabetes, kidney problems, and heart problems, she says.
Lifestyle changes are critical to prevention in kids, because there are no effective medications for reversing prediabetes in that age group, says Michelle Van Name, MD, a Yale Medicine pediatric endocrinologist. And we know that prediabetes and type 2 diabetes are more aggressive in kids than they are in adults.
Dr. Jastreboff also points out that in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study, a major clinical trial funded by the National Institutes of Health , youth who developed type 2 diabetes at a young age had more severe cases than adults with the disease.
How Much Weight Do You Need To Lose To Reverse Prediabetes
There are many people with prediabetes who need to take action nowif they dont, they could develop type 2 diabetes within five years, according to the CDC.
And although weight loss is a key strategy, its important to know that not everyone needs to lose a massive amount of weight, doctors say. Often only minor changes in dietary intake and minimal weight loss, together with more physical activity, will help chase diabetes away, says Sonia Caprio, MD, a Yale Medicine pediatric endocrinologist.
The CDCs national Diabetes Prevention Program , which includes an ongoing Outcomes Study, has shown that people with prediabetes who lost a modest amount of weight5 to 7% with the help of a structured lifestyle-change program cut their risk of developing type 2 diabetes by 58%.
Dr. Van Name also recommends starting with simple interventions at home and expanding on them over time, especially when working with children. With kids, we dont expect a total 180, she says. A family can help by figuring out what will motivate a child.
They might start by exploring ways as a family to get more physical activity or try different-colored foods on the dinner plate, she adds. If much of the food on your plate is green, that’s great. But if its all a beige color, it’s often a less-healthy meal,” Dr. Van Name says. Managing stress, which can be a roadblock, is also important.
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Insulin Blood Sugar And Prediabetes
Prediabetes can develop when the system goes awry and your blood sugar levels increase. This happens due to resistance to a hormone called insulin, which is produced by an organ called the pancreas. Your pancreas release insulin when your blood sugar levels rise after a meal. Insulin helps sugar get out of your blood and into your fat, muscle, and some other cells so that they can use the sugar for fuel, and so that the extra sugar leaves your bloodstream.
Prediabetes happens when your cells become less sensitive, or more resistant, to the effects of insulin. You progressively need more insulin to get the sugar out of your blood and into your cells. Eventually, possibly after years or decades, your body cannot produce enough insulin to keep up with demand.
This is when blood sugar rises to the levels that are seen in prediabetes. At this point, your doctor might diagnose you with prediabetes after taking a blood glucose test. Even higher levels, which can happen if you do not treat prediabetes, indicate diabetes.