WHAT IS PREDIABETES?
Prediabetes means that you have higher-than-normal levels of blood sugar. This is not high enough to be classified as type 2 diabetes. But without lifestyle changes, adults, and children with prediabetes are at great risk to develop type 2 diabetes.
If you have prediabetes, the long-term damage of diabetes — particularly to your heart, blood vessels, and kidneys — might already be starting. There is good news, however. The progression of prediabetes to type 2 diabetes is not inevitable.
Eating healthy foods, making physical activity part of your daily routine, and staying at a healthy weight could help bring your blood sugar level back to normal. The same lifestyle changes that could help prevent type 2 diabetes in adults may also help bring children’s blood sugar levels back to normal.
SYMPTOMS
Prediabetes does not usually have any signs or symptoms.
One possible sign of prediabetes is darkened skin on specific parts of the body. Affected areas could include the neck, armpits, and groin.
Classic signs and symptoms that indicate you have moved from prediabetes to type 2 diabetes include:
- 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
WHEN SHOULD YOU SEE A DOCTOR?
Consult your health care provider if you are concerned about diabetes or if you notice any type 2 diabetes signs or symptoms. Ask your health care provider regarding blood sugar screening if you have any risk factors for diabetes.
CAUSES
The exact cause of prediabetes is not known. But family history and genetics appear to play a crucial role. What is clear is that people suffering from prediabetes do not process sugar (glucose) properly anymore.
The majority of the glucose in your body comes from the food you eat. When food is digested, sugar gets into your bloodstream. Insulin enables sugar to enter your cells — and reduces the amount of sugar in your blood.
Insulin is produced by a gland located behind the stomach known as the pancreas. Your pancreas sends insulin into your blood as you eat. When your blood sugar level begins to drop, the pancreas slows down the secretion of insulin into the blood.
When you have prediabetes, this process does not work as well. As a result, rather than fueling your cells, sugar builds up in your bloodstream. This could happen because:
- Your pancreas might not make enough insulin
- Your cells become resistant to insulin and do not allow as much sugar in
RISK FACTORS
The same factors that increase the odds of developing type 2 diabetes also increase the risk of prediabetes. These factors include:
- Weight – Being overweight is the major risk factor for prediabetes. The fattier tissue you have — particularly inside and between the muscle and skin around your abdomen — the more resistant your cells become to insulin.
- Waist size – A large waist size could indicate insulin resistance. The risk of insulin resistance goes up for men with waists larger than forty inches and for women with waists larger than 35 inches.
- Diet – Eating red meat and processed meat, and drinking sugar-sweetened beverages, are related to a higher risk of prediabetes.
- Inactivity – The less active you are, the higher your risk of developing prediabetes.
- Age – Although diabetes could develop at any age, the risk of prediabetes increases after age 45.
- Family history – Your risk of prediabetes increases if you have a parent or sibling suffering from type 2 diabetes.
- Race or ethnicity – Although it is unclear why, specific people — including Black, Hispanic, American Indian, and Asian American people — are more likely to develop prediabetes.
- Gestational diabetes – If you had diabetes while pregnant (gestational diabetes), you and your child are at greater risk of developing prediabetes.
- Polycystic ovary syndrome – Women with this common condition — characterized by irregular menstrual periods, excess hair growth, and obesity — have a greater risk of prediabetes.
- Sleep – People with obstructive sleep apnea — a condition that disturbs sleep repeatedly — have an increased risk of insulin resistance. People who are overweight or obese are at a greater risk of developing obstructive sleep apnea.
- Tobacco smoke – Smoking might increase insulin resistance and could increase the risk of type 2 diabetes in people with prediabetes. Smoking also raises your risk of complications from diabetes.
Other conditions related to an increased risk of prediabetes include:
- High blood pressure
- Low levels of high-density lipoprotein (HDL) cholesterol or the “good” cholesterol
- High levels of triglycerides — a kind of fat in your blood
METABOLIC SYNDROME
When certain conditions occur with obesity, they are associated with insulin resistance and could increase your risk for diabetes and heart disease, and stroke. A combination of three or more of these conditions is often known as a metabolic syndrome:
- High blood pressure
- Low levels of HDL
- High triglycerides
- High blood sugar levels
- Large waist size
COMPLICATIONS
Prediabetes has been connected to long-term damage, including to your heart, blood vessels, and kidneys, even if you have not progressed to type 2 diabetes. Prediabetes is also connected to unrecognized (silent) heart attacks.
Prediabetes could progress to type 2 diabetes, which could lead to:
- High blood pressure
- High cholesterol
- Heart disease
- Stroke
- Kidney disease
- Nerve damage
- Fatty liver disease
- Eye damage, including loss of vision
- Amputations
PREVENTION
Healthy lifestyle choices could help you prevent prediabetes and its progression to type 2 diabetes — even if diabetes runs in your family. These include:
- Eating healthy foods
- Getting active
- Losing excess weight
- Controlling your blood pressure and cholesterol
- Not smoking
DIAGNOSIS
The American Diabetes Association (ADA) recommends that diabetes screening for most adults start at age 45. The ADA advises diabetes screening before age 45 if you are overweight and have additional risk factors for prediabetes or type 2 diabetes.
If you have had gestational diabetes, your health care provider will likely check your blood sugar levels at least once every three years.
There are various blood tests for prediabetes.
GLYCATED HEMOGLOBIN (A1C) TEST
This test suggests your average blood sugar level for the past two to three months.
In general:
- Below 5.7 percent is normal
- Between 5.7 percent and 6.4 percent is diagnosed as prediabetes
- 6.5 percent or higher on two separate tests suggests diabetes
Certain conditions could make the A1C test inaccurate — such as if you are pregnant or have an uncommon form of hemoglobin.
Fasting blood sugar test
A blood sample is taken after you have not eaten for at least eight hours or overnight (fast). Blood sugar values are expressed in milligrams of sugar per deciliter (mg/dL) and millimoles of sugar per liter (mmol/L) of blood.
In general:
- Less than 100 mg/dL (5.6 mmol/L) is regular
- 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are diagnosed as prediabetes
- 126 mg/dL (7.0 mmol/L) or greater on two separate tests is diagnosed as diabetes
Oral glucose tolerance test
This test is less frequently used than the others, except during pregnancy. You will need to fast overnight and then drink a sugary liquid at the primary care provider’s office or laboratory testing site. Blood sugar levels are tested regularly for the next 2 hours.
In general:
- Less than 140 mg/dL (7.8 mmol/L) is regular
- 140 to 199 mg/dL (7.8 to 11.0 mmol/L) is compatible with prediabetes
- 200 mg/dL (11.1 mmol/L) or greater after two hours indicates diabetes
If you have prediabetes, your health care provider will generally check your blood sugar levels at least once a year.
CHILDREN AND PREDIABETES TESTING
Type 2 diabetes is becoming more common in children and adolescents, likely because of the rise in childhood obesity.
The ADA recommends prediabetes testing for children who are overweight or obese and who have one or more other risk factors for type 2 diabetes, like:
- Family history of type 2 diabetes
- Being of a race or ethnicity related to an increased risk
- Low birth weight
- Being born to a mother who had gestational diabetes
The ranges of blood sugar levels considered common, prediabetes and diabetes are the same for children and adults.
Children who have prediabetes should be tested annually for type 2 diabetes — or more frequently if the child experiences a change in weight or develops signs or symptoms of diabetes, like increased thirst, increased urination, fatigue, or blurred vision.
TREATMENT
Healthy lifestyle choices could help you bring your blood sugar level back to normal, or at least keep it from rising toward the levels seen in type 2 diabetes.
To prevent prediabetes from progressing to type 2 diabetes, try to do the following:
- Eat healthy foods – A diet high in fruits, vegetables, nuts, whole grains, and olive oil is related to a lower risk of prediabetes. Opt for foods low in fat and calories and high in fiber. Eat a variety of foods to help you achieve your aims without compromising taste or nutrition.
- Be more active – Physical activity helps you control your weight, uses up sugar for energy, and helps the body to use insulin more effectively. Aim for a minimum of 150 minutes of moderate or 75 minutes of vigorous aerobic activity a week or a combination of moderate and vigorous exercise.
- Lose excess weight – If you are overweight, losing just 5 percent to 7 percent of your body weight — about 14 pounds (6.4 kilograms) if you weigh 200 pounds (91 kilograms) — could significantly reduce the risk of type 2 diabetes. To keep your weight in a healthy range, concentrate on permanent changes to your eating and exercise habits.
- Stop smoking – Stopping smoking could improve the way insulin works, improving your blood sugar level.
- Take medications as needed – If you are at high risk of diabetes, your health care provider may recommend metformin (Glumetza). Medicines to control cholesterol and high blood pressure may also be prescribed.
Children and prediabetes treatment
Children suffering from prediabetes should follow the lifestyle changes recommended for adults with type 2 diabetes, including:
- Losing weight
- Eating less refined carbohydrates and fats, and more fiber
- Reducing portion sizes
- Eating out less often
- Spending at least one hour daily in physical activity
Medication generally is not recommended for children with prediabetes unless lifestyle changes are not improving blood sugar levels. If medication is needed, metformin is generally the recommended drug.
If you or anyone you know is suffering from prediabetes, our expert providers at Specialty Care Clinics will take care of your health and help you recover.
Call 469-545-9983 to book a telehealth appointment for an at-home check-up.