In this rather lengthy post about Pre diabetes, I will cover the following aspects. Feel free to jump to the section of interest, or browse sequentially if you wish to be thorough like me
- Help, I have prediabetes
- What is pre diabetes?
- What are some statistics about Pre-diabetes?
- Does your ethnicity play a role in you getting pre-diabetic?
- How about gender? Do women or men have a higher chance of being pre diabetic?
- Can children also acquire prediabetes?
- What are the complications of prediabetes?
- What is the mechanism of blood sugar increase in prediabetes?
- What are the signs of prediabetes?
- Why me? Why did I get pre-diabetes?
- Who should get tested for pre-diabetes? What are some high-risk categories for diabetes and pre diabetes?
- How do you diagnose pre-diabetes? What tests are available for detecting borderline diabetes?
- How do you make sense of the pre-diabetes test results?
I have prediabetes
I am one amongst you. I have prediabetes. I recently went to my primary care physician for an annual checkup and she said I am prediabetic. I never thought I will be diagnosed with prediabetes. I did not even know there was such a thing as prediabetes. My weight at diagnosis was 148 lbs, with a height of 5 feet 8 inches. That gives a Body Mass Index (BMI) of 22.5. So, I am completely normal with respect to BMI. Since the normal range of BMI is 18 to 25, I am almost in the sweet spot. Pre diabetes not overweight? I am skinny but borderline diabetic? A BMI of 25+ would make me overweight and for my height of 5.8, I need to weigh over 160 pounds to be overweight. How could I have pre diabetes then? I was stumped and started to survey the latest in medical literature on diabetes. What I found has helped me a lot in dealing with this diagnosis and I wanted to share it with you. If you have pre diabetes, please do share this article with your loved ones and friends so that they know what you are dealing with and how they can best support you for a suitable lifestyle.
My quest started with first understanding prediabetes mellitus. I wanted to know the answer to what was really happening to my body, what to expect and how to manage it. I wanted to gather all pre diabetes information that is based on sound research, not just conventional wisdom. I wanted to understand why it happened to me and how do I prevent diabetes type 2. How do I stop prediabetes mellitus progression? Is there such as thing as pre diabetes type 2? Or pre diabetes mellitus? Or is it just an intermediate stage for any form of diabetes? How likely I am to get diabetes in the future? How soon? What could be the pre diabetes complications? I had many questions running through my head and so being a research scientist, I started my literature survey to find eveything about pre diabetes.
What is prediabetes?
Put simply, if you have pre-diabetes, you are at high risk of developing diabetes type 2, or diabetes mellitus. You also have an increased risk of developing heart diseases. Pre diabetes is a condition in which the blood sugar level is above its normal range, but still not high enough to be classified as diabetes. The normal range of fasting blood sugar level is supposed to be under 100 mg/dl. For diabetes, we are talking a fasting plasma glucose level of about 125 mg/dl. So, if you have fasting blood sugar level is between 100 mg/dl and 125 mg/dl, then you are considered prediabetic. I have listed additional pre diabetes tests later in this article. For a quick summary, here’s the infographic released by CDC in its 2014 report on diabetes and pre diabetes.
But there are two specific categories of pre diabetes that you might fall into. If your fasting glucose level is between 100-125 mg/dl, then you have “Impaired Fasting Glucose (IFG)”. If on the other hand, a two-hour oral glucose tolerance test shows that you have a sugar level of 140-199 mg/dl then you have “Impaired Glucose Tolerance (IGT)”. So, if your doctor has said you have pre diabetes, then make sure you understand which one it is and what your specific number range was.
Pre diabetes to diabetes: How long does it take?
To put bluntly, unless you make lifestyle changes, it will take 5-10 years to progress from pre diabetes to diabetes. Diabetes has many deadly complications and consequences, as I will list in this article. With lifestyle changes, we are primarily talking about weight loss, physical activity to burn that excess blood sugar, controlled nutrition and diet plan. If you do not heed to the pre diabetes warning, you could end up having diabetes and then there is no turning back. You can reverse pre diabetes. You cannot reverse diabetes. Take the warning seriously and learn more about pre-diabetes in this article. Also, keep watching this blog. My fight is yours and yours is mine. I will add more articles about the perfect workout routine for preventing pre-diabetes from turning into diabetes. I will also be including posts on nutrition guidelines for prediabetes that will help you achieve your objectives, without boring you to death before you get diabetes.
How many people have pre-diabetes?
As you will see in these statistics released by the American Diabetes Association, a lot of people have diabetes and its warning sign, pre diabetes. Unfortunately, most of them do not even know they have pre diabetes. Here are some numbers
- 9.3% of Americans have diabetes. That is about 29.1 million people! Roughly 1 in 10 individuals has diabetes
- Most importantly, 21 million of the 29.1 million do not even know they have diabetes. That means about 72% of diabetics do not even know they have diabetes! That is only 1 in 4 diabetics knows they have diabetes.
- The percentage of diabetics increases significantly among seniors. About 25.9% of seniors have diabetes. That is 11.8 million people above the age of 65 have diabetes
- Every year 1.4 million Americans will be diagnosed with diabetes. With out previous figure of 72% underreported diabetics, it means that nearly 3.6 million Americans get affected with diabetes every year.
- Since every pre-diabetic does not become a diabetic, the number for pre-diabetes is even higher. About 86 million of adults (age 20 and above) had pre diabetes in 2012. This number is increasing rapidly, as it was 79 million in 2010. Increasingly sedentary lifestyles are to blame. I am one of these 86 million Americans. You are possibly too.
Now that is only people with diabetes in the United States. Diabetes is an epidemic of global proportions. Here are some excerpts from the World Health Organization bulletin on Diabetes.
- World Health Organization reports that 422 Million people had diabetes globally in 2014. That is up from 108 Million in 1980. So, the prevalence of diabetes has increased from about 4.7% in 1980 to about 8.5% in 2014.
- Globally, diabetes resulted in 1.5 million deaths and high blood glucose had to be blamed for 2.2 million deaths
- World Health Organization predicts that diabetes will be the 7th leading cause of death in the world in 2030. It is already at number 7 in the US.
How does your ethnicity make you prone to pre diabetes
As we have seen before, certain ethnic groups have higher prevalence of pre diabetes and diabetes. While the science still does not fully understand the reasons behind such selectivity, some people are just more susceptible to pre diabetes. It could be genetics, geography or cuisine. We do not know, but here are the statistics of diabetes by ethnicity.
- 7.6% of non-hispanic Whites
- 9.0% of Asian americans. Among asian americans, the breakdown is as follows
- 4.4% for Chinese
- 11.3% for Filipinos
- 13.0% for Asian Indians
- 8.8% for other Asian Americans
- 12.8% of Hispanics. Among Hispanics, the breakdown is as follows:
- 8.5% for Central and South Americans
- 9.3% for Cubans
- 13.9% for Mexican Americans
- 14.8% for Puerto Ricans
- 13.2% of non-hispanic Blacks
- 15.9% of American Indians/Native Americans or Alaskan Natives
While these statistics are primarily from the United States and might have been affected by the relative proportions of ethnicities there-in, it is still important to understand what your chances are. If you are an Asian Indian, Mexican American, African American, Puerto Rican or Native american, you are at very high risk for getting pre diabetes and consequently, diabetes. This world map shows clearly where most of the world’s diabetics are and that will give you some insights about the issue.
Pre diabetes and gender
They say women have it worse, and it might be true in the case of pre-diabetes and diabetes. A 2007 study found that the reduction in lifespans of women with diabetes is about 8.2 years, while that for men is 7.5 years. Moreover, the death rates among men with diabetes are lower than those among women. This in interesting because it has been found that without diabetes, women usually live longer than men. That is mostly attributable to the lower incidence of heart disease among women than men. However, females with diabetes are 6 times more likely to get heart disease. A 2007 study published in the European Heart Journal found that the association between diabetes and death by heart failure is higher in women than in men.
Women are less muscular. They have a natural tendency to store higher amounts of body fat and excess weight. That means females are unable to lose their weight as fast as males can, with equal amount of effort. Thus, the high levels of blood glucose in women are more difficult to manage. Moreover, the triglyceride (blood fats) levels rise faster in women and drive down the levels of the good cholesterol, the so called HDL. Also, it is known that women with PCOS (poly cystic ovarian syndrome) and gestational diabetes are more likely to have diabetes than other women. More aggressive monitoring is needed for women with such a history. As a double whammy, women with diabetes may also experience lack of libido, which coupled with PCOS can lead to fertility issues. When they do get pregnant, they face higher risk of urinary and vaginal infections. Another 2010 study of women in the Archives of Internal medicine suggested that diabetes increases the risk of depression and vice versa. Related research in this area has shown that women with both conditions — diabetes and depression — are likely to die earlier than women who have neither diabetes nor depression.
Prediabetes in Children and Youth
The moment I found out that genetics and ethnicity are a major factor in prediabetes, I was curious. Is there such as thing as Pre diabetes in kids? What are pre diabetes symptoms in children? I found that about 208,000 children and youth, americans under the age of 20, are estimated to have diabetes. That is approximately 0.25% of the population. That is a large number. Moreover, every year, about 18000 new cases of pediatric diabetes are discovered. Of these, rougly 5000 are diabetes type 2. That is scary.
Signs of pre-diabetes in kids
Although ethnicity is a risk factor for pre diabetes in children, the most important factor is being overweight. Since kids may not be able to complain about all the right symptoms, it is even more important that you keep a closer watch on their condition. Here are some early warning signs of pre diabetes in children
- The child feels thirsty frequently. The child’s body is trying to trying to get rid of the blood sugar by dissolving it into the higher amount of water the child drinks
- Frequent or nighttime urination. The child visits the loo often of frequently wets the bed. Related to the above, the body is trying really hard to remove high levels of blood sugar through urination
- The child has blurry vision. This is serious and should be attended to immediately.
- Since the child’s body, particularly muscles is unable to efficiently utilize glucose in the blood, the body gets tired. There is unusual fatigue without much activity.
Managing pre-diabetes in kids
The approach for managing pre diabetes in children is the same as that in adults. Lose excess weight and belly fat. Adopt a physically active lifestyle. Have plenty of active play time, and limited screen time. However, as you will agree, it is harder for kids to adopt such a lifestyle, if they have not already been introduced to it. Therefore, even if you kid does not have pre diabetes, it is extremely important for you to guide them towards an active and healthy lifestyle to prevent pre-diabetes.
Pre diabetes complications: Why is prediabetes so dangerous?
High blood glucose is extremely dangerous for you and you will agree once you know what it can do to you. Over time, blood glucose damages nerves and blood vessels. This leads to complications such as heart disease, stroke, blindness, kidney failure, and lower limb amputations. Every year, diabetes affects millions. Below, we list some major statistics about diabetes related complications. You will know why you have to keep pre diabetes from turning into diabetes. I have gathered this summarized list from notable and trustworthy resources for diabetics, such as the International Diabetes Federation, American Diabetes Association, and the Mayo Clinic. Feel free to browse them for further details.
- Hypoglycemia related emergency room visits in 2011: 282000
- 71% of diabetics had high blood pressure or Hypertension
- 65% of diabetics had higher levels of bad cholesterol or LDL, a condition also known as Dyslipidemia
- Diabetics had a 1.7 times higher risk of cardio vascular disease, 1.5 times higher risk of stroke, and 1.8 times the risk of heart attack than people without diabetes
- 28.5% of people with diabetes, or 4.2 Million individuals had diabetic retinopathy, or damage to small blood vessels in the retina, causing blindness or other eye problems
- Diabetes is the primary cause in 44% of kidney failure cases. About 228,924 individuals were living with chronic dialysis or a kidney transplant in 2011.
- 60% of non-traumatic lower limb amputations happen in people with diabetes. About 73000 individuals had their legs amputed for non-traumatic reasons, just because diabetes had destroyed their nerves and blood vessels leading to these lower extremities. This is called peripheral neuropathy and the risk is about 25 times more in people with diabetes than those without diabetes.
- Owing to these complications, diabetes continues to be the #7 leading cause of death in the US. In 2010, diabetes was the primary cause for nearly 70000 deaths, and one of the causes for 234000 deaths. This in spite of the fact that only 35%-40% people had reported diabetes, and only 10%-15% had it reported on their death certificate. Thus, diabetes is severely under-reported and the damage may be even more.
- Neuropathy or nerve damage is a common result of high blood glucose levels. This in turn will lead to numerous other problems such as digestive issues, kidney disease or nephropathy, eye problems or retinopathy, and erectile dysfunction. As you can imagine, damaged nerves can also lead to tingling sensations, or in extreme cases loss of feeling. Injuries can go unnoticed, leading to the need to amputate the limbs. As a diabetic, you will need to be extremely cautious about any internal injuries since they may go unnoticed.
Now that you know, let these numbers sink in a bit. If you have pre diabetes just like me, we have a very tough battle to fight. Make a pledge today that you will do anything in your capacity to prevent your prediabetes from progressing into diabetes.
Why does the blood sugar level increase in pre diabetes?
Now that we know that pre diabetes has all to do with blood sugar level, a natural question is why does the glucose level increase beyond the normal range. For that and to correctly understand the management of pre diabetes, it is crucial to understand the sugar metabolism process and the concept of insulin resistance.
The digestive system breaks down carbohydrates — sugar and starches, into glucose and releases it into the blood stream. Naturally, the body needs a mechanism to utilize some of this glucose as fuel for energy and to store the excess for later use. These tasks are accomplished by the hormone Insulin.
Insulin is produced in the Pancreas, a tiny organ, about 6 inches, that sits behind the stomach, at the back of the abdomen. Specifically, inside the pancreas, there are clusters of cells, called the islets, that contain beta cells, which produce insulin and release them into the blood. Insulin helps the various muscles, liver and fat cells in the body to absorb glucose and use it as a fuel for energy. It also stimulates liver and muscle tissue to store excess glucose in the form of glycogen, for future use. Since the role of insulin is so specific, the pancreas release insulin right after it notices an increase in the blood glucose levels.
Now, some people have a condition called “Insulin resistance”. They are making insulin alright, but their body is not using it effectively for sugar metabolism. Naturally, instead of being used or stored as glycogen, the glucose levels in the blood keep building up, leading to diabetes type 2. The muscles, fat and liver cells are unable to utilize insulin efficiently to work with the glucose available to them. So the beta cells have to work even harder to produce even more insulin to deal with increased levels of blood glucose. When this continues for a long time, the beta cells are just not able to keep up and there is not enough insulin in the blood to metabolize the glucose. In pre diabetes, the beta cells cannot produce enough insulin to metabolize sugar. First it is pre diabetes, and as it continues, it develops into full-blown diabetes type 2 or diabetes mellitus. Studies have shown that for most people, pre diabetes changes into diabetes within 10 years, unless there is a lifestyle intervention.
What are the symptoms of pre diabetes
You must be wondering, what are the symptoms of prediabetes. Unfortunately, most people will not have any signs and symptoms of pre diabetes. Even after having it for many years. Some will not have any observable symptoms till their pre diabetes has converted to the dangerous diabetes. But given the criteria I mentioned earlier, your physician can identify people at high risk by their physical characteristics.
The symptoms may vary among individuals. Nevertheless, here are some common symptoms that experts agree on, some of which may manifest in some people. I have gathered this list based on numerous trustworthy resources that you should bookmark, such as the American Diabetes Association’s page on diabetes symptoms:
- Increased thirst and increased urination: Your body is attempting to dissolve the excess, unused sugar into water and remove it from the body through urination.
- Increased hunger, even after eating. Since your body cannot efficiently utilize what you ate, you feel hungry again. It does not make sense, no matter what you eat, you are never satiated. It is a double whammy since you want to lose weight to avoid diabetes, but your body signals you to eat more!
- Dry mouth: Since most of the fluids are getting ready to be urinated, you constantly feel a drier mouth
- Fatigue and a constant feeling of tiredness: Your muscles are unable to efficiently use the glucose in your blood, and are constantly sore, tired, and you do not feel like doing much.
- Numbness or tingling of hands or feet, blurry vision: This is related to nerve damage or neuropathy that the high levels of blood glucose are wreaking on your nerves and also blood vessels. These are dangerous signs and you should immediately arrange to meet your doctor.
- Wounds do not heal as fast as they should.
- Infections of the skin
- Patches of the skin near folds and creases turn black. For example, in people with extremely high blood glucose, the skin behind and under the neck starts showing a dark ring.
- Reduced feeling in your hands and feet due to Diabetic Neuropathy or nerve damage
- Breath that has a fruity, sweet or acetone-like odor.
Some symptoms of diabetes are specific by gender. For example, the signs of diabetes in women include the following: (lfor more details, view Healthline’s page on diabetes symptoms in women)
- vaginal and oral yeast infections and vaginal thrush
- urinary infections
- female sexual dysfunction
- polycystic ovary syndrome
The symptoms of diabetes that are unique to men include:(for more details, see Healthline’s page on diabetes symptoms in men)
- Erectile dysfunction, or the inability to maintain erection
- Urologic issues, possibly related to the internal nerve damage. These issues may result in an overactive bladder, inability to control urination, and urinary tract infections (UTIs).
- Retrograde ejaculation, or the release of semen backwards into the bladder. Consequently, lesser semen is released during ejaculation. This may cause problems with fertility or virility.
If you are a man, do not be ashamed of erectile dysfunction and talk with your doctor. Diabetes might be lurking and more dangers are ahead.
Why is prediabetes happening to me?
There are many reasons why someone might get pre diabetes, but there are some well-known culprits as to why it is happening to you now.
- Excess weight
- Physical inactivity
- Sleep apnea
- Cigarette Smoking
- Steroid use
- Hormonal imbalances
- Ethnicity of genetic lineage
- Older age
Let’s see the mechanisms of some of the major causes of pre diabetes here.
Experts believe that the excess weight, particularly the visceral (or internal) fat on your waist is the primary cause of insulin resistance. Belly fat is known to produce hormones and other substances that can lead to chronic and long-lasting inflammation inside the body, without any signs or symptoms. Such inflammation leads to development of insulin resistance, pre diabetes, diabetes type 2, and cardio vascular diseases (CVD), which can lead to heart attack or stroke.
Since glucose is an instant source of energy for muscles, having more muscles means that the body is able to burn more glucose and thereby maintain a healthy blood sugar level. Physical inactivity leads to muscular degradation and consequently a less muscular physique. Just by increasing the musculature of the body, one can fight insulin resistance and pre diabetes to keep diabetes at bay.
Bad quality of sleep can cause pre diabetes. Sleep apnea, or interrupted sleep due to breathing issues, leads to interruptions that take the body out of deep slumber and causes sleepiness or excessive tiredness during the day. But most people who have sleep apnea do not even know they have it. With the advent of latest wrist-based health monitoring devices, there is some light at the end of the tunnel.
As you can see, some of these factors are under your control, while others are not. You can attempt to manage excess weight, inactivity, smoking, sleep apnea, and steroid usage. But hormonal imbalances, your ancestry and old age are just out of your control. So, it is even more important for you to understand the reasons behind your pre diabetes, so that the appropriate strategy can be undertaken.
Prediabetes criteria: Should I get screened for prediabetes?
Based on what we discussed so far, if you fall into certain categories, you are at a high risk of developing diabetes in the future. Prediabetes, being a warning sign for diabetes, should be a must have screening test for you. In consultation with your physician, you should periodically get screened for pre diabetes. Here are the high risk categories for pre diabetes:
- If you lead a sedentary lifestyle. If you are not physically active.
- If you have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
- If you have a family history of diabetes.
- Certain ethnic groups are more susceptible to diabetes. These include Asian American, African-American, Hispanic American, and Native American sub-populations.
- If you are a female and have borne children weighing more than 9 pounds.
- If you are a female and you have had gestational diabetes
- If you have high blood pressure
- If you have low “good” cholesterol and high “bad” cholesterol. That means HDL levels lower than 35 mg/dl and LDL levels higher than 250 mg/dl.
- If you have polycystic ovary syndrome
- If you have a history of vascular disease
- If you have a large waist size in proportion to the body. For men, a waist size of 40 or more and for women a waist size of 35 are high risk factors. If you are naturally skinny, then your waist size should be even smaller.
Diagnosing Prediabetes: How to test for pre diabetes?
Prediabetes is usually tested with a blood test. The most accurate test for insulin resistance, called the Euglycemic clamp, is significantly expensive that most physicians do not use it. Instead, they rely on research which shows that if a blood test indicates prediabetes, then insulin resistance is likely present. While a simple prick-on-the-finger test in a physicians office can be performed, it is not as accurate as a test performed in a lab. There are essentially 3 types of blood tests that can identify pre diabetes.
- the hemoglobin A1c test
- the fasting plasma glucose (FPG) test
- the oral glucose tolerance test (OGTT)
The “prediabetes A1c”, also called the “pre diabetes hemoglobin A1c”, or “prediabetes hba1c” test estimates average blood glucose levels over the past 3 months. Although the most reliable among blood tests, it is less sensitive. It may miss pre diabetes that can be caught by other tests. But if this test shows that you have prediabetes, then you do have it. If it does not, make sure you ask for more testing to confirm that you really do not have pre-diabetes. The test result may also be affected by other existing conditions such as sickle cell anemia, thalasamia, or if you come from a Mediterranean, African, or Southeast Asian ancestry. An A1c range of 5.7 to 6.4 indicates prediabetes. If its already more than 6.4, sorry to say it, but you have already entered the realm of diabetes type 2. More information about the hbA1c test can be obtained from the NIDDK page titled The A1c test and diabetes.
The FPG test measures fasting blood sugar level, or fasting glucose level. In this case, fasting means, you have not eaten for at least 8 hours prior to drawing blood for the test. If you have a blood sugar level of 100-125 mg/dl, then you have pre-diabetes. The resulting diagnosis of pre diabetes is called Impaired fasting glucose (IFG).
The OGTT test measures blood sugar after people have not eaten for 8 hours and 2 hours after they drink a loaded-with-glucose sweet drink. It tests how quickly your body can metabolize the glucose you consume. A blood sugar range of 144-199 mg/dl is considered pre-diabetes. This particular form of pre-diabetes is called Impaired glucose tolerance (IGT).
The following table summarizes these numbers:
Understanding the prediabetes test results
The higher your score is on any test, if means you have an increased likelihood of getting diabetes. If you are in the prediabetes number range, then it literally means that your beta cells are not able to produce enough insulin to deal with the glucose in your body. Your insulin resistance has progressed significantly and that you are moving closer to getting diabetes. If you have been tested positive for pre-diabetes, you should consider making immediate lifestyle changes. You should also re-appear for the test after your immediate goals have been met, such as 5-10 percent weight-loss.
Even if your test indicates otherwise, or if you have a hbA1c score of less than 5.7, it only means that today you do are not pre-diabetic. But if you match any of the high risk categories above, you should still make it a habit to periodically get yourself tested, maybe once every year.
Sometimes the results may not match across the tests and that does not mean the tests are wrong. It just means that the disease has not progressed enough to trigger each test. Even if one test shows that you have pre diabetes, please take it seriously.