Ask Your Doctor: PREDIABETES

The content originally appeared on: The Anguillian Newspaper

While many of us are familiar with the medical term diabetes or diabetes mellitus, the term prediabetes is not well known and some are confused over the use of this term. If you have prediabetes you have a higher than normal blood sugar level. It is not high enough to be considered type 2 diabetes yet, but without lifestyle changes, adults and children with prediabetes are more likely to develop type 2 diabetes. It should be noted that progression from prediabetes to type 2 diabetes is not inevitable.

What is prediabetes?
Prediabetes is a health condition in which you have higher than normal blood sugar levels. Unmanaged prediabetes can lead to Type 2 diabetes. Prediabetes does not always have symptoms so it is important to get blood sugar levels tested, especially if you are at high risk. Losing weight, exercising regularly and eating healthy can reverse prediabetes and prevent Type 2 diabetes. People with prediabetes have up to a 50% chance of developing diabetes over the next five to 10 years if they do not take the necessary steps to reverse this disorder. You would be diagnosed with prediabetes if:
• Your fasting plasma glucose test is 100 to 125 mg/dL (normal is <100; diabetes is 126 or higher).
• Your HbA1c level is between 42mmol/mol (6%) – 47mmol/mol (6.4%). A normal HbA1c is less than 5.7%, diabetes is 6.5 or higher. HbA1c levels are your average blood glucose (sugar) levels for the last two to three months.

What causes prediabetes?
The exact cause of prediabetes is unknown. Many experts believe that family history and genetics appear to play an important role. A lack of regular physical activity and being overweight with excess fat around your abdomen also seem to be important factors.
What is clear is that people with prediabetes do not process sugar (glucose) properly anymore. As a result, sugar builds up in the blood instead of doing its normal job of giving energy to the cells that make up muscles and other tissues. In prediabetes, your cells do not respond to insulin as they should. Cells become insulin resistant resulting in prediabtes.

How do you get prediabetes?
There are three main things that contribute to developing prediabetes, and the progression to diabetes:
1. What you eat: Being overweight affects the body’s ability to process sugar in the blood.
2. What you do: Long periods of inactivity (e.g. watching television all evening) reduce the ability of insulin to deal with sugar in the blood. By the same token, being physically active increases the efficiency of the insulin.
3. The genes you inherit also contribute to the development of prediabetes.
You cannot change your genes, but you can do something about your eating habits and your physical activity. It is important to realise that dealing with prediabetes or diabetes is not simply about eating less sugar.
Who are at risk of getting 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:
• Age (being 45 or older).
• Parent or sibling with Type 2 diabetes.
• Ethnicity. Being black or Hispanic.
• Previous gestational diabetes.
• Polycystic ovary syndrome (PCOS).
• Certain medications, such as steroids, certain antipsychotics and some HIV medications.
• Hormonal conditions, including Cushing’s syndrome and acromegaly.
• Sleep disorders, such as sleep apnea.
Some risk factors for prediabetes can be modified, meaning you can change them. These include:
• Obesity or carrying extra weight.
• Exercising less than three times a week.
• High blood pressure or high cholesterol levels.
• Metabolic syndrome, a combination of high blood pressure, high cholesterol level and large waist measurement.
• Smoking.

Symptoms
Individuals with prediabetes do not usually have any signs or symptoms.
One possible sign of prediabetes is darkened skin on certain parts of the body. Affected areas can include the neck, armpits, elbows, knees and knuckles.
Classic signs and symptoms that suggest you have moved from prediabetes to type 2 diabetes include:
• Increased thirst
• Frequent urination
• Excess hunger
• Fatigue
• Blurred vision

How is prediabetes diagnosed?
To test for prediabetes, your healthcare provider will arrange for a number of tests.

Treatment for prediabetes
The best way to treat prediabetes is through healthy lifestyle changes. Eating a nutritious diet and getting regular exercise can help prevent or delay Type 2 diabetes. Even small changes can significantly lower your risk for developing Type 2 diabetes. Your healthcare provider may prescribe metformin, a diabetes medication. It may help delay diabetes in people with prediabetes.

What are some complications of prediabetes?
Having prediabetes means you are more likely to develop Type 2 diabetes, but it also puts you at increased risk of heart disease and stroke. Prediabetes is a serious problem especially if you do not take steps to address the condition. For many people with prediabetes, diabetes can be delayed or prevented by increasing your physical activity, making changes to what you eat and by losing weight. Keeping these changes going over time improves your overall health and reduces your heart disease risk too. Out of 100 people with prediabetes who make ‘healthy lifestyle’ changes, only 13 will develop diabetes (compare this with 33 out of 100 if no action is taken).

Conclusion
Prediabetes is a common condition. It means your blood sugar levels are high but not high enough to be considered to have diabetes. You may not have any symptoms. It is important to talk to your healthcare provider about getting regular blood tests, including an HbA1c test, especially if you are high risk. The good news is that you can reverse prediabetes. Losing weight and exercising, along with other lifestyle changes, can bring your blood sugar levels back to a healthy range. Talk to your doctor today about how you can prevent or delay Type 2 diabetes.

Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).