Type 2 Diabetes And The Diagnosis of Prediabetes!

In the world of diabetes, there are many different terms that are commonly thrown around in normal conversation amongst health professionals.



Type 1 diabetes, Type 2 diabetes, and prediabetes are the labels used for different types of conditions related to blood sugar.



1. Type 1 diabetes is a term reserved for those whose pancreas stops making insulin at levels needed for their body. Those with Type 1 Diabetes are given insulin to try to correct the imbalance in the body.



2. Type 2 diabetes is a type of diabetes whereby blood sugar levels are higher than normal levels; insulin just doesn't get the job done. If extra measures are not taken at this point through diet, exercise or oral medication, the diabetes will continue to worsen, making that person susceptible to diabetes complications of all sorts.



3. Prediabetes is a term that refers to the situation where blood sugar levels are higher than normal but not as high as in Type 2 diabetics.



Rates of people being diagnosed with diabetes are increasing worldwide. In fact, there are 57 million people in the U.S. who have been diagnosed with prediabetes... and at least half that many are walking around without the knowledge they are on their way to this condition. Epidemic is not too strong a word to apply to this growing medical crisis



The problem with high blood sugar levels is that the extra sugar in the blood circulates throughout the body and causes damage everywhere it goes. When it gets to the skin, it causes the proteins to clump. Every time a protein clumps, then that protein essentially is disabled. It can't work any more and is really just a skeleton of a protein that just sits there and does nothing at all. In the skin, the more protein clumps you have, the more you look aged.



This happens with every organ in the body when the blood sugar levels are high. And that's why prediabetes is definitely a health issue that needs to be solved.



You would think either you have Type 2 diabetes, or you don't. But it's not quite that simple. Like many health problems, this condition develops slowly over many years. You probably don't notice anything different, the symptoms creep up on you one at a time. But inside your body, changes in how your body produces and uses insulin and sugar are occurring. And it is these changes that are setting you up for problems in the future. This phase is what is referred to as prediabetes.



The amount of sugar in your bloodstream varies throughout the day. Levels are lower prior to eating (fasting) and higher after you have eaten. For people who have prediabetes or Type 2 diabetes, daily blood sugar levels look something like this:



Prediabetes... 100 to 125mg/dL (5.5 to 6.9mmol/L)



Type 2 diabetes... 126mg/dL (7mmol/L) or higher



The fasting blood sugar test is usually the preferred test for diagnosing whether or not you have diabetes. A Glucose Challenge Test will be the next step if your levels are in the above range. Levels in the following range confirm a diagnosis of prediabetes or Type 2:



Prediabetes... 140 to 199mg/dL /L (7.8 to 11mmol/L)



Type 2 diabetes... 200mg/dL (11.1mmol/L) or higher



Many people don't take prediabetes seriously but this is the best time for you to take action to reverse the condition and prevent the development of full-blown 2 diabetes.

Dealing With Diabetes - Detecting Prediabetes

Despite what many think, diabetes doesn't just show up without previous warning signs appearing. Full blown Diabetes can take up to ten years to manifest itself. While you may not qualify for a diagnosis of diabetes, you aren't operating in normal state either. You have what's know as prediabetes.



The good news here is that people with prediabetes normally don't have any type of eye disease, kidney disease or any type of nerve damage that you could end up with full blown diabetes. Don't think you are off the hook if you "only" have prediabetes because you are not. You are far more likely to have heart disease and brain issues than someone else that has completely normal blood glucose levels.



Before you start thinking that this is some type of unknown disease, know that well over 50 million people in the United States have prediabetes. But most have no clue that they in fact have it.



So, how do you know if you should be tested for prediabetes? Well, as a general rule, you should be tested once you reach 45. You should also be tested if you are under 45 and are overweight and have one or more of these risk factors:



1. You belong to a to a higher risk ethnic group such as African American, Hispanic, Asian or Native American.



2. If you have high blood pressure, or it runs in your family.



3. If you have low HDL or what is referred to as "good" cholesterol.



4. If you have high triglycerides



5. If there is a family history of diabetes



6. If you have diabetes during pregnancy or if your newborn baby weighed more than 9 pounds



A study conducted by Diabetes Care back in 2007 indicated that folks who are overweight or obese over age 45 should be tested for prediabetes without delay as it can be extremely cost effective to do so - especially if they begin an immediate lifestyle change and begin taking any prescribed medication.



The test for prediabetes is a simple blood test. The test will determine what your blood glucose level, which is simply the amount of sugar in your blood. Prediabetes is diagnosed when your blood glucose level is higher than normal, but not so high that it meets the standard for regular diabetes. If it is found that a random capillary blood glucose level is hither than 100md/dl, a second test is conducted, referred to as a fasting glucose (or oral) tolerance test.



So, what are the blood glucose levels that indicate you either have or don't have prediabetes?



Here are some good guidelines:



Blood Glucose Level Before Eating - Normal = Less than 100 mg/dl



Blood Glucose Level 1 Hr. after eating - Normal = Less than 140 mg/dl



Blood Glucose Level Before Eating - Prediabetes = 100-125 mg/dl



Blood Glucose Level 1 Hr. after eating - Prediabetes = 140-199 mg/dl



Some look at a prediabetes diagnosis as bad news. Quite the contrary, actually. It could be the best thing that has ever happened to you as it can provide the wake up call that you need to make the necessary changes to your lifestyle. Changes such as eating healthier and exercising on a regular basis. Both of these are areas that can prevent the onset of diabetes in folks that have prediabetes. Why not make the changes necessary now instead of ending up with diabetes later on? If you are one of those who doesn't respond to lifestyle changes, medication may be able to do the same thing for you.



If you don't find yourself motivated enough to fend off diabetes - and you will more than likely become a diabetic if you don't make changes - perhaps the fact that you will save upwards of $10,000 in future costs associated with the treatment of diabetes. Your call. You can sit and do nothing, or take the bull by the horns and be one of the 20% of folks who have prediabetes that successfully fend of diabetes itself.

Prediabetes: Preventable Diabetes

Diabetes has grown to pandemic proportions. It is estimated that 8.3% of the US population,or 25.8 million people, have diabetes. About 95% of these have type 2 diabetes. Diabetes is the main cause of kidney failure, limb amputation, and new-onset blindness in American adults. People with diabetes are more likely than people without diabetes to develop and die from diseases of the heart and blood vessels, called cardiovascular disease. Adults with diabetes have heart disease death rates about two to four times higher than adults without diabetes. The risk for stroke is two to four times higher among people with diabetes.



Prediabetes refers to the intermediate metabolic states between normal and diabetic glucose homeostasis. This term was first introduced in 1979 to replace 'borderline' diabetes. Pre-diabetes is becoming more common and more recognized in the United States. The U.S. Department of Health and Human Services estimates that 79 million Americans had prediabetes in 2007. It is estimated that 314 million people worldwide have prediabetes, and the number is projected to grow to 418 million in 2025.



Why worry about prediabetes? It has been estimated that between 35% and 65% of adults with prediabetes will develop type 2 diabetes within six years of the prediabetes diagnosis. Even before progressing into full blown diabetes, these people have an increased rate of microvascular (retinopathy, protein in the urine, polyneuropathy) and macrovascular (heart attack and stroke) complications.



How do you diagnose Prediabetes? Prediabetes is usually diagnosed with any one or more of the following blood test readings: A fasting blood glucose level of:110 to 125 mg/dL (6.1 mM to 6.9 mM, according to the World Health Organization criteria or 100 to 125 mg/dL (5.6 mM to 6.9 mM), according to the American Diabetic Association criteria. A blood sugar level of 140 to 199 mg/dL (7.8 to 11.0 mM) at the end of two hours after ingesting a standardized 75 gm glucose solution as part of a two hour glucose tolerance test. A glycated hemoglobin (HbA1c) between 5.7 and 6.4 percent.



Are you at risk? There are certain indications that you have or may be at an increased risk of developing prediabetes. These include increasing age, inactivity, sleeping less than 6 hours per day and being overweight or obese. Certain races are at an increased risk, namely Asian Americans, Hispanics/Latinos and non-hispanic blacks. Other risk factors include abnormal lipids, especially high triglycerides and low HDL (the good cholesterol) and diagnosed cardiovascular disease. If you had gestational diabetes (high blood sugar during pregnancy), or gave birth to a child weighing more than 9 lbs, you are also at risk. Two other rather uncommon conditions, namely polycystic ovarian syndrome and acanthosis nigrans also indicate increased insulin resistance and predisposition to prediabetes and diabetes. And finally, patients with psychiatric disorders, especially schizophrenia, on multiple psychotropic drugs, also have a high incidence of prediabetes.



Symptoms: Prediabetes is often asymptomatic and suspicion often rests solely on risk factors mentioned above. If present, the symptoms of prediabetes, are the same as those of diabetes: constant hunger, increased thirst and urination, unexplained weight loss, weight gain, generalized malaise, blurred vision, slow healing from minor wounds like cuts and bruises, tingling or loss of sensation in the hands or feet, frequent or recurring gum, skin, vaginal or bladder infections.



How do you treat? The call for early treatment of prediabetes is gaining momentum. Several recent studies have evaluated the role of life-style changes and medications for the treatment of this malady:



1. Exercise: Regular physical activity prevents progression into diabetes. In the Da Qing IGT and Diabetes Study of 110,660 men and women in China( Diabetes Care 1997;20:537-44.), progression to diabetes decreased from 67.7% to 41.1%, when comparing an uncontrolled group to a controlled exercise group over a period of 6 years.



2. Diet: In a Finnish study (N Engl J Med 2001;344:1343-50), there was an incidence of 23% of progression into diabetes in a control group compared to only 11% in an intervention group over a period of 4 years. Interventions were aimed at reducing weight 5% or more, reducing dietary fat to less than 30% of the total caloric intake and increasing dietary fiber to at least 15g per 1000 calories ingested.



3. In al large study involving 27 clinical centers around the US(N Eng J Med, February 7, 2002),3234 prediabetic overweight participants were divided into two groups. One group received intensive training in diet, physical activity, and behavior modification. The aim was to reduce body weight by 7% and maintain the loss, and exercise 150 minutes a week. The second group received metformin 850 mg twice a day. At the end of the study, the lifestyle intervention group reduced diabetes progression by 58% compared to 31% in the metformin group.



4. A prediabetes task force (American Association of Clinical Endocrinologists 18th Annual Meeting, Houston,Tx. 2009) suggested a more aggressive therapeutic approach to these patients, recommending treating high-risk individuals with diabetic medications such as metformin, acarbose, glucagon-like peptide 1 agonists and thiazolidinediones. These treatments are not yet FDA approved for prediabetes, but are backed by strong scientific data indicating that battling insulin resistance early protects the pancreas and prevents progression into diabetes.



The health and monetary costs of prediabetes are not known. But diabetes is an expensive disease, costing about $174 b billion annually in the US alone. Direct medical costs account for about $116 billion and indirect costs such as disability payments, time lost from work, and premature death account for the remaining $58 billion.



Millions of lives and billions of dollars can be saved by aggressive life-style and therapeutic intervention in patients suffering from prediabetes.



Remember: Prediabetes means preceding diabetes. But it also means preventable diabetes.

The Key Differences Between Prediabetes & Diabetes

The most common way for prediabetes to be diagnosed is via a normal blood test during a routine doctors visit. It's recommended that everyone of the age of 45 be tested for prediabetes during an annual physical.



A normal "fasting" blood glucose is less than 100 mg/dl.



Prediabetes is diagnosed whenever the fasting blood glucose level falls in between 100 and 125 mg/dl on more than one occasion.



Diabetes, on the other hand, is diagnosed when the fasting blood sugar level is 126 mg/dl or higher on more than one occasion.



* fasting refers to a period of 8 hours or more without eating.



A normal blood glucose level two hours after eating is 75 grams of sugar is less than 140 mg/dl



Prediabetes is diagnosed when the glucose level two hours after eating 75 grams of sugar is between 140 and 199 mg/dl on more than one occasion.



Diabetes is diagnosed when the blood glucose level two hours after eating 75 grams of sugar is over 199 mg/dl on more than one occasion.



Yep - it's true. If your blood glucose is 99 mg/dl after fasting, you don't have prediabetes. But if it is one lousy milligram of glucose more, you do have it. It's really that simple. The line has to be drawn somewhere.



Of course, these definitions are in fact quite arbitrary. They have been changed in the past and could very well change in the future. If it is determined that large numbers people who have lower blood sugar levels are experiencing complications from diabetes, you can be sure the thresholds will be lowered. Unfortunately, there are indeed people with blood sugar levels below 126 who show signs of complications from diabetes. But this is not the norm at this point.



In past times, it wasn't all that uncommon to hear people say that they had a "touch of sugar" or that they had "borderline diabetes." Neither of these terms are accurate today because there is no such thing as a touch of diabetes. Either you have diabetes, prediabetes or you don't. There is no in between.

Borderline diabetes-is there a difference between prediabetes and type 2 diabetes?

If you've been diagnosed with prediabetes, then this is the stage to get into action! There is no way that you could get in on the action without awareness of the problem.



The first step begins with awareness.



What is Borderline diabetes?



Borderline diabetes or prediabetes is when blood sugars are out of normal range, but not in the range for the diagnosis of type 2 diabetes.



The clinical name for this is called fasting glucose.



Borderline diabetes or prediabetes is important because it serves as a warning sign. This is the time to make major changes in lifestyle. Or increases the risk of becoming a type 2 diabetic.



How is prediabetes diagnosed?



The quickest way to diagnose prediabetes is a fasting blood sugar. I usually recommend an overnight fast for at least 8 hours and if possible up to 12 hours.



Blood glucose levels normal for diabetes are among 70-99 mg/dL. Substantially less than 100 mg/dL.



When your blood glucose is between 100-125 mg/dL, this indicates prediabetes or borderline diabetes.



If the level is above 126 mg/dl that indicates diabetes type 2.



Another test that can be used to diagnose prediabetes is called the glucose tolerance test (OGTT) oral.



This is a more detailed tests. Firstly, a fasting blood glucose level. Once a fast 8-12 hours is required.



Then you are given a very sweet liquid to drink. This is equivalent to 75 G glucose or the amount of sugar in a can of Coca Cola for example.



Two hours after taking this, I did another blood test. If this is between 140 and 199 mg/dL.



When your blood sugar is over 200 mg/dL, then this indicates type 2 diabetes.



Borderline diabetes have symptoms?



There are symptoms associated with borderline diabetes. So don't expect to have the common signs of diabetes.



What are the risks associated with prediabetes?



The main risk is the development of type 2 diabetes. However people with prediabetes are at increased risk for heart disease, stroke and hypertension.



Get more information on how diabetes and hypertension are linked.



Remember that the same risks that put you at risk for type 2 diabetes also can put you at risk of prediabetes.



What can you do to prevent prediabetes from becoming diabetes type 2?



As noted earlier in this article, diagnosed with prediabetes should serve as a warning sign to make changes in your lifestyle.



In other words does not mean that inevitably will become a type 2 diabetic.



Patients diagnosed with prediabetes should be closely monitored. This is one of the times that, with a commitment to a healthy life, progression to diabetes can be reversed.



The hallmark of success reversing prediabetes is diet and exercise. If you are overweight or obese, commit to losing weight.



Just losing 10% of your current body weight could reverse these effects.



It is important to work with your doctor during this critical phase. By monitoring your blood tests, you and your doctor are better aware of the corrective action to be taken.



Sometimes the doctor may choose to put on a drug called metformin. When this happens, many times patients may get confused because they don't understand enough because I'm on a medication for diabetes even if you don't have diabetes. But research shows that the metformin helps reduce the chances of developing full-blown diabetes.



So next time you hear someone say that they have been diagnosed with borderline diabetes or prediabetes, do a favor to them and educate them about it.



Let them know that this is the time to begin to make changes in their lifestyle.