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44 years
What is prediabetes?
Sep 28, 2014

Dr. Zakia Dimassi Pediatrics
Prediabetes is a condition in which blood glucose or A1C levels—which reflect average blood glucose levels—are higher than normal but not high enough for a diagnosis of diabetes. Pre-diabetes has no signs or symptoms. People with pre-diabetes have a higher risk of developing type 2 diabetes and cardiovascular (heart and circulation) disease, including heart attack and stroke.

Lifestyle changes, including healthy eating, exercise and weight adjustment, approximately one in three people with pre-diabetes will develop type 2 diabetes.

Type 2 diabetes is a condition where blood glucose levels are higher than normal. This occurs when the body cannot produce enough insulin, or the insulin produced is not fully functional, a condition known as insulin resistance. In insulin resistance, the body produces insulin but cannot use it effectively. As a result, glucose, instead of being absorbed by the cells, accumulates in blood, leading to type 2 diabetes or prediabetes.
And because in insulin resistance different body tissues fail to respond properly to insulin and thus cannot easily absorb glucose from the bloodstream, the body requires higher levels of insulin to help glucose enter cells. The beta cells in the pancreas, which are responsible for the fabrication of insulin, try to keep up with this increased demand for insulin by producing more. As long as the beta cells are able to produce enough insulin to counterbalance the insulin resistance, blood glucose levels will be maintained in the healthy range. Over time, the beta cells will start to decompensate and fail to keep up with the body’s increased need for insulin. The result is type 2 diabetes and prediabetes because, without sufficient amounts of insulin, excess glucose builds up in the bloodstream, leading to diabetes, prediabetes, and other serious health disorders.
The major factors that contribute to the development of insulin resistance are:
1- Excess Weight
Obesity, especially excess fat around the waist (known as central obesity), is a primary cause of insulin resistance. Previously believed to be a site of energy storage, belly fat has been recently shown to produce hormones and other substances that can cause serious health problems such as insulin resistance, high blood pressure, imbalanced cholesterol, and cardiovascular disease (CVD).
Belly fat is significantly involved the development of a chronic inflammatory state in the body, which produces damage over time, without overt signs or symptoms of disease. Another interesting finding is that complex interactions in fat tissue attract immune cells to the area and trigger low-level chronic inflammation. This inflammation can contribute to the development of insulin resistance, type 2 diabetes, and CVD. Weight loss has been demonstrated to reduce insulin resistance and prevent or delay type 2 diabetes.
2- Physical Inactivity
Sedentary lifestyle or physical inactivity is associated with insulin resistance, often leading to type 2 diabetes. The muscle tissue uses more glucose than other tissues. Normally, active muscles burn their stored glucose for energy and replenish their reserves with glucose taken from the bloodstream, keeping blood glucose levels in balance.
Exercising increases the muscles’ sensitivity to insulin, reversing insulin resistance and lowering blood glucose levels. Exercise also induces muscles to absorb more glucose without the need for insulin. The more muscle a body has, the more glucose it can burn to control blood glucose levels.
Other Causes
Other causes of insulin resistance may include ethnicity; certain diseases; hormones; steroid use; some medications; older age; sleep problems, especially sleep apnea; and cigarette smoking.
Untreated sleep problems, especially sleep apnea (whereby the respiration is suddenly interrupted for a few seconds during sleep), can increase the risk of obesity, insulin resistance, and type 2 diabetes.
Risk factors for pre-diabetes

The risk factors for developing pre-diabetes are the same as for type 2 diabetes. They include:
• a family history of type 2 diabetes
• being overweight
• waist measurement (in men) – Caucasians – greater than 94 cm, Asians – greater than 90 cm
• waist measurement (in women) – greater than 80 cm
• low level of physical activity
• smoking
• high blood pressure or high cholesterol (blood fats), or both
• history of heart disease or stroke
• gestational diabetes (diabetes during pregnancy)
• polycystic ovary syndrome
• some antipsychotic medications
Diagnosis of pre-diabetes

Pre-diabetes is diagnosed by a blood test that checks your blood glucose level.

Any blood glucose test that shows higher than normal blood glucose levels needs to be further investigated. This is likely to involve an oral glucose tolerance test (OGTT). The results of the OGTT will show whether your blood glucose levels are in the normal, pre-diabetes or diabetes range.

The diagnosis of pre-diabetes is based upon having one or both of:
• Impaired fasting glucose (IFG) – is when your fasting blood glucose level is higher than normal, but still below the level for a diagnosis of diabetes.
• Impaired glucose tolerance (IGT) – is when your blood glucose level two hours after an OGTT is higher than normal, but is still below the level for a diagnosis of diabetes. The fasting blood glucose level may be in the normal range.
Management of pre-diabetes

Pre diabetes, type 2 diabetes and heart disease can be prevented by making lifestyle changes, including:
• Weight loss – helps the insulin your body makes to work better and lower your blood glucose levels.
• Physical activity – regular moderate physical activity to help manage weight, and reduce blood glucose, blood pressure and cholesterol levels. Exercise also makes insulin work better.
• A healthy diet – this involves less fat, especially saturated fats, and more fruit, vegetables and high-fiber wholegrain foods.
• Quitting smoking – smoking causes insulin resistance and increases the risk of blood vessel disease.
• Blood pressure and cholesterol control – these should be kept under control and checked regularly.
In most cases, if enough lifestyle changes are made, type 2 diabetes can be prevented.
If an individual is diagnosed with pre-diabetes, lifestyle changes are most important. A repeat oral glucose tolerance test should be done in 12 months, unless symptoms of diabetes appear earlier.