Prediabetes is a wake-up call, which, taken seriously, can prevent or put off diabetes.
Last Updated: May 18, 2018, 03.53 PM IST
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Considered to be a warning bell of impending diabetes, prediabetes is when your blood sugar level is higher than normal but not yet high enough to be classified as type 2 diabetes. In other words, it is an indicator of the potential to progress to type 2 diabetes.
People almost always develop prediabetes before they get type 2 diabetes. Having prediabetes does not automatically mean you will get diabetes, but it does put you at an increased risk.
In India alone, there are 72.9 million people living with diabetes and the number is expected to go up to 134.3 million by 2045, according to IDF Diabetes Atlas. However, another 80 million people are estimated to be prediabetic. Unfortunately, only 10% are aware of it.
Dr Vimal Pahuja, consulting internist and metabolic physician at Dr LH Hiranandani Hospital in Mumbai, said fasting blood sugars of 100-125 mg/dL and/or HbA1C of 5.7-6.4% are categorised as prediabetes. “If oral glucose tolerance test with 75 gm of glucose results in blood sugars of 140-199 mg/dL after two hours, it is called impaired glucose tolerance and also categorised as prediabetes.’’ Pahuja rues that many physicians don’t advise corrective measures or that it’s a casual approach on the part of health practitioners in understanding the seriousness and prescribing a corrective regimen for same. ‘‘Patients also have a lax attitude in this regard,” he added.
According to Dr Rohan Sequeira, cardiometabolic physician at Jaslok Hospital and Research Centre, Mumbai, “doctors are not taking this risk seriously and many are just asking patients to come when they have elevated sugars above the mark. This increases the risk of complication by a factor of
100. As per guidelines, medicines are not recommended for prediabetes and a very aggressive lifestyle modification and diet control are advised.”
However, this may not control, but just delay the onset of diabetes, he said.
The rise in blood sugar levels that is seen in prediabetes starts when the body begins to develop a problem called ‘insulin resistance’. If usual amounts of insulin can’t trigger the body to move glucose out of the bloodstream and into your cells, then you have insulin resistance.
Once insulin resistance begins, it can worsen over time. When you have prediabetes, you make extra insulin to keep your sugar levels near normal. Insulin resistance can worsen as you age, and it worsens with weight gain too. If your insulin resistance progresses, eventually you can’t compensate well enough by making extra insulin. When this occurs, your sugar levels will increase and you will have diabetes.
“Prediabetes may not manifest any obvious symptoms though the body becomes insulin-resistant,” said Dr Sanjay Kalra, endocrinologist at Bharti Hospital in Karnal, Haryana and vice-president of the South Asian Federation of Endocrine Societies. “The cells are unable to utilise the glucose absorbed from the food to convert it into energy and this is evident as a sense of increased hunger. While consuming more food, there may be a tendency to lose weight as the body starts using stored fat for energy instead of using glucose. This further increases the body’s resistance to insulin, leading to chronic inflammation and disorders such as type 2 diabetes, obesity, metabolic syndrome and heart disease.”
The early symptoms to watch out for are increased thirst, increased frequency of urination and a perpetual sense of fatigue, he said.
Feeling very hungry (even though you are eating enough), extreme fatigue, cuts and bruises that are slow to heal, weight loss, tingling, pain or numbness in the hands or feet are the major symptoms to look out for, said Sequeira. Women with gestational or pregnancy-related diabetes often have no symptoms, which is why it’s important for at-risk women to be tested at the proper time during pregnancy, he said.
IMPACT ON HEALTH
Among complications associated with prediabetes are cardiovascular diseases; in fact, heart attacks are seemingly more common with prediabetes than with diabetes. With prediabetes, some percentage of patients may have neuropathy (dysfunction of the peripheral nerves) or retinopathy (where the retina in the eye is affected) issues too, said Pahuja.
“If the risk factors are present and there is a strong family history, you must see your doctor for screening. Before planning for a child, women must see their physician for screening of diabetes or prediabetes. If fasting blood sugars are higher than 100 mg/dL or HbA1C is more than 5.7% or any home reading is higher than 140 mg/dL, please see a physician,” he said.
Sequeira too opined that prediabetes is a risk factor for heart disease. Like people with type 2 diabetes, those with prediabetes tend to be overweight, have high blood pressure and unhealthy cholesterol levels, he explained.
If they are not treated on time, patients will develop full-blown diabetes, which cannot be reversed. One can preserve beta cells of the pancreas (which make insulin) if the patient is treated with lifestyle therapy, and the development of diabetes can be reversed, said Pahuja.
Some risk factors are being of Asian ethnicity, being male, age more than 30 years, BMI over 25 kg/m2, family history of diabetes and sedentary lifestyle.
Doctors said lifestyle changes are the only treatment to check prediabetes. The good news is studies show that 6 out of 10 people can even reverse diabetes by lifestyle therapy more than any medicine advised for diabetes treatment.
“Initiate lifestyle changes or treatments, and potentially retard progression to diabetes or even prevent diabetes,” said Sequeira. “Becoming more active is one of the best things you can do to make diabetes less likely. If it’s been a while since you exercised, start by building more activity into your routine by taking the stairs or doing some stretching. Physical activity is an essential part of the treatment plan for prediabetes because it lowers blood glucose levels and decreases body fat. Ideally, you should exercise at least 30 minutes a day, five days a week.”
“Lower your weight, see your doctor every three to six months, load up on vegetables, especially the less-starchy food such as spinach and leafy greens, broccoli, carrots and green beans. Aim for at least three servings a day. Add more high-fibre foods to your diet. Enjoy fruits in moderation — one to three servings per day. Choose wholegrain foods instead of processed grains. Also, keep out high-calorie foods. Drink skim milk rather than whole milk, diet drinks rather than regular soft drinks. Choose lower-fat versions of cheese, yogurt and salad dressings. Instead of snacking on high-fat, high-calorie chips and desserts, choose fresh fruit or whole wheat crackers with peanut butter or low-fat cheese. The mantra should be a high-protein, low-carb diet,” advised Sequeira.
Kalra said lifestyle changes are the primary way to reverse diabetes. “Eat a diet rich in fruits, vegetables, nuts and whole grains, complex carbohydrates and high-density nutrients such as proteins and healthy fats. Have a fresh meal everyday as you can benefit from the nutrients better. Increase the fibre content in your diet, limit red meat and increase fish and skinless poultry, increase your physical activity — walk more, climb more stairs, do outdoor activities such as hiking and gardening. Just 30 minutes of moderate activity at least five days a week is important.”