Pre-Diabetes

Diabetes is a metabolic disorder that affects the regulation of glucose in the blood stream and the use of glucose in the cells for energy. Without glucose the metabolic process of providing energy changes and the body begins to burn fat and protein for which insulin, the primary hormone regulating glucose metabolism, is not required. (1)

There are two types of Diabetes – Type 1 and Type 2 – but it is only in Type 2 diabetes that there is some warning, or pre-diabetes, that the condition is imminent. In Type 2 diabetes the individual often has some pre-disposing factors and possibly some genetic factors. The process is generally gradual and occurs when the cells of the body become resistant to the insulin that is being produced. In other words, the body continues to produce insulin, in greater and greater amounts, but the cells no longer are able to utilize it.

Before developing Type 2 diabetes, most people have a condition referred to as \”pre-diabetes\” where the blood glucose is at higher than normal levels but not yet high enough to cause severe symptoms or be diagnosed as diabetes. The American Diabetes Association estimates that there are over 18 million people in the U.S. who have diabetes and 57 million who have pre-diabetes. (2) More importantly, recent research has identified specific changes in the body that begin to cause long-term damage to the heart and circulatory system. (3)

Because people with diabetes often fall into risk groups, or those individuals who have a higher probability of developing diabetes, those who have pre-diabetes have the same risk factors. Diabetes is more common among those who are overweight, have diabetes in their immediate family or belong to certain populations, such as African Americans, Latinos, Native Americans and Asian Americans.

There are two different tests that can be used to determine if high blood sugar is a problem that should be addressed. These tests should be ordered if the individual has underlying risk factors. The first test is a fasting plasma glucose test. This measures the amount of glucose or sugar in the blood stream after not having eaten for at least 12 hours. If the glucose is high after fasting then the doctor determines that you have impaired fasting glucose. (4)

The second test is an oral glucose tolerance test (gtt). This test requires a bit more cooperation from the patient since they must drink a high sugar drink that is between 8 and 16 ounces after having fasted for 12 hours. If the physician wants the oral GTT they will draw a fasting glucose prior to starting the test. Once the individual drinks the fluid a lab technician will draw blood and request urine every 30 to 60 minutes. This test measures the body\’s response to a high load of glucose and how well the pancreas can respond with insulin as well as how quickly the body can move the glucose into the cells. (5)

Doctors will evaluate the numbers that are reported back from these two tests and make a determination that an individual has pre-diabetes if their glucose in their blood is between 140 and 200 after a gtt or between 100 and 126 after a fasting glucose test. These numbers have been revised downward over the years as researchers are better able to determine the impact they have on long-term health.

Today, treatment for pre-diabetes includes dietary changes, lifestyle changes and exercise. All of these things will help the body to more fully utilize the insulin that the body is producing and possibly delay further treatment for diabetes with oral hypoglycemic agents or insulin injections.

Blood sugar values that range over 126 for fasting or 140 for oral glucose challenge represents diabetes that must be treated and monitored more closely. In a study by the American Diabetes Association researchers found that approximately 11% of patients with pre-diabetes go on to develop diabetes in one year. (6)

Usually pre-diabetes doesn\’t have symptoms. It is the high blood glucose levels that cause the classic symptoms of diabetes and in individuals who have pre-diabetes their blood glucose isn\’t high enough to cause symptoms such as excessive thirst, multiple trips to the bathroom, unexplained weight loss, blurred vision and extreme hunger.

In new research published July 2009 researchers found that the increased risk to heart disease and stroke found in individuals who smoked was most likely caused because nicotine builds an insulin resistance in the body. This resistance causes pre-diabetes which leads to a greater risk of cardiovascular disease. Their results suggested that by working to decrease the insulin resistance found in smokers they could effectively decrease the increased risk to cardiovascular disease in the same population. (7)

(1) Diabetes UK: What is Diabetes?
http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/What_is_diabetes/

(2) American Diabetes Association: Diabetes Statistics
http://www.diabetes.org/

(3) Kids Health: Long-Term Complications of Diabetes
http://kidshealth.org/teen/diabetes_center/basics/complications.html

(4) The New England Journal of Medicine: Normal Fasting Plasma Glucose Levels and Type 2 Diabetes in Young Men
http://www.nejm.org/doi/full/10.1056/NEJMoa050080

(5) MedlinePlus: Glucose Tolerance Test
http://www.nlm.nih.gov/medlineplus/ency/article/003466.htm

(6) American Diabetes Association: Prediabetes FAQ
http://www.diabetes.org/

(7) Charles Drew University of Medicine and Science: Why Smoking Increased the Risk of Heart Disease and Stroke
http://www.diabetes.org/