Prediabetes: The Younger Brother of Silent Killer Diabetes
- 17th May 2020
What is Prediabetes?
Higher than normal blood sugar is not uncommon. when you go for a routine blood test and you receive a report in which blood sugar level is more than 100 mg% and three months sugar level (Glycated hemoglobin, HbA1c) is in a range of 5.7 to 6.4. It simply means you are suffering from prediabetes.
These patients are not treated by medications but lifestyle modification may revert the condition. Most of the patients who are diagnosed as prediabetes do not take it seriously and they usually thank himself for not being diabetic.
Nowadays, in the corona era, a similar situation is seen in the hospital. If someone is not diagnosed as COVID-19 positive but diagnosed as other serious illness then also they congratulate himself for not being COVID-19.
If no intervention is taken at an appropriate time, prediabetes can lead to diabetes.
According to the National Institute of Health (NIH), prediabetes can be reversed by a good lifestyle such as diet modification and exercise but when you develop diabetes, you need to continue lifelong medications. Although lifestyle modification helps in both conditions, you cannot reverse diabetes in all patients but prediabetes is usually reversed.
Triage is a science we usually use in a natural disaster where we segregate patients in a different category according to the level of care they need. We can also segregate Prediabetes and diabetes just like disaster triage.
While diabetes is a chronic metabolic disorder characterized by high blood glucose levels, pre-diabetes or borderline diabetes is a slightly higher level of blood glucose levels which may be the blueprint of development of Type II diabetes.
Prediabetes remains unnoticed and untreated for many years as these patients usually do not have any clear symptoms. Thus, it is important to understand the importance of regular or annual health checkups if you have a strong family history of diabetes.
Prevention is always better than cure fits when you talk about any chronic illness. If blood sugar level or glycosylated hemoglobin (HbA1c) remains above the normal limit for a long period, prediabetes can turn into Type II diabetes. American Diabetes Association stressed on the fact that heart and circulatory systems are vulnerable to damage even during the early stages of diabetes or in the prediabetes stage.
Symptoms of Prediabetes:
Asymptomatic individuals are usually diagnosed with annual health checkups. About 66% of the Indian population are unaware of the disease they have. That is why we stressed on triage in the beginning.
Few patients may present with some symptoms which are denoted as red flag signs for prediabetes. These are:
- Excessive Hunger-Thirst-Urination especially at night
- Easy fatigability or low blood sugar level
- Minor cuts won't heal
- Obesity or overweight or weight gain
- Family history of pre-diabetes and/or Type II diabetes
- Polycystic Ovarian Syndrome (PCOS/PCOD) in women
- Metabolic syndrome in men and women
- Body Mass Index higher than 24.99 even less in Indians
- High blood pressure
- Acanthosis nigricans - It is the dark pigmented, thick and velvety texture of the skin, which may be found around elbow, armpits, knuckles, neck, knees,
- Low High-Density Lipid (HDL) cholesterol, high triglycerides, etc.
All adults above the age of 30 should consider getting tested for diabetes or prediabetes, especially if they having any of the red flag signs mentioned above. Annual testing is required in these individuals. In younger individuals retesting can be done every 3 years if they have normal blood glucose levels. It should be carried out every year if they fall into a category of prediabetes.
What are the causes of prediabetes?
Body cells feed on glucose for energy which is taken by food. This process is facilitated by insulin. Normally pancreas secretes insulin in the bloodstream and the body uses it but if the insulin is inefficient to send glucose inside of the cells, this condition is termed as insulin resistance.
The exact causes of insulin resistance are not clear but in most cases, it is linked to a bad lifestyle and family history of diabetes.
Risk factors for prediabetes
Most Important factors are
- Higher body mass index (BMI)
- Sedentary lifestyle
How is prediabetes diagnosed?
People suffering from this condition, also known as impaired glucose tolerance where glycosylated hemoglobin level (HbA1c) or blood glucose control in the past three months remain between 5.7-6.4 percent. Any value above 6.4 falls under the diabetic range.
Preventive Measures for Pre-Diabetics
How to treat prediabetes?
Lifestyle modification is the most essential step and it goes a long way in helping an individual to keep the condition under control and prevent prediabetes from developing into diabetes. Lifestyle modification consists of a balanced diet, optimal physical activity, and a night of quality sleep.
- A balanced diet should consist of an adequate amount of complex carbohydrates and fiber from whole grains, pulses, fresh fruits and vegetables, and healthy fats.
- Cooking oils high in MUFA and PUFA or mono or polyunsaturated fats are recommended. These fats have a positive impact on diabetes by inhibition of the development of cholesterol.
- Emphasis is given on foods having a low glycemic index or low glycemic load. Food items like oats, apples, soya beans, cucumber, broccoli, pulses with their husk, and a variety of sprouts should also be consumed.
- A regular exercise regime especially weight training in young and brisk walk in an adult is necessary to keep a check on the condition.
- Alcohol and smoking cessation also help in establishing good lifestyle measures.
- Eating habit modification:
- Control your cravings or eating addiction: The more you eat the higher is the craving. Don’t make your stomach a trash can, train your mind to adapt gradually.
- Start the day with healthy breakfast: Breakfast decides your whole day so it is the most important meal of the day. Skipping breakfast is associated with the development of diabetes. Moderate carbohydrates, high protein, and minimal fats are good alternatives in the breakfast menu.
- Take out time for cooking: - Food is a very strong medium to express our love. Many mass media advertisements are based on this fact. Cooking can give you emotional as well as optimal control over the foods you eat.
- Eat smaller portions at regular intervals: Divide 3-time meal to 5-time meal. It has a good impact on glycemic control or blood sugar control. Remember not to starve yourself which has a bad impact on overall health.
- Plan the meals: Don’t wait until you’re hungry. Shop food ingredients in advance so that cooking remains convenient
- Read the labels of readymade foods: Get in the habit of reading the labels which contain real information. Do not get in the trap by a fancy word like low fat or sugar-free, natural, herbal, organic, etc. Low fat often means high refined carbohydrates.
Complications of Prediabetes
If no intervention is taken on the appropriate time, prediabetes can lead to diabetes and other conditions, such as:
- Heart (Cardiac) disease
- Stroke or cerebrovascular accidents
- Nerve damage (Neuropathy)
- Kidney damage (Nephropathy)
- Eye damage (Retinopathy)
- Foot damage, in which poor blood flow some patient may need amputation of the affected part due to poor blood supply
- skin infections
- Hearing problem
- Alzheimer’s disease
Conclusion: Although lifestyle modification is required in both but Type 2 Diabetes is treatable but Prediabetes is reversible with long-term lifestyle modifications.