What Is Prediabetes? Prediabetes is a “pre-diagnosis” of diabetes—you can think of it as a warning sign. It’s when your blood glucose level (blood sugar level) is higher than normal, but it’s not high enough to be considered diabetes. Prediabetes is an indication that you could develop type 2 diabetes if you don’t make some lifestyle changes. But here's the good news: it is possible to prevent prediabetes from developing into type 2 diabetes. Eating healthy food, losing weight and staying at a healthy weight, and being physically active can help you bring your blood glucose level back into the normal range. Symptoms Diabetes develops very gradually, so when you’re in the prediabetes stage—when your blood glucose level is higher than it should be—you may not have any symptoms at all. You may, however, notice that: • you’re hungrier than normal • you’re losing weight, despite eating more • you’re thirstier than normal • you have to go to the bathroom more frequently • you’re more tired than usual All of those are typical symptoms associated with diabetes, so if you’re in the early stages of diabetes, you may notice them. Causes and Risk Factors Prediabetes develops when your body begins to have trouble using the hormone insulin. Insulin is necessary to transport glucose—what your body uses for energy—into the cells via the bloodstream. In pre-diabetes, your body either doesn’t make enough insulin or it doesn’t use it well (that’s called insulin resistance). If you don’t have enough insulin or if you’re insulin resistant, you can build up too much glucose in your blood, leading to a higher-than-normal blood glucose level and perhaps prediabetes. Researchers aren’t sure what exactly causes the insulin process to go awry in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are the same risk factors related to the development of type 2 diabetes: • Weight: If you’re overweight (have a body mass index—a BMI—of higher than 25), you’re at a high risk for developing prediabetes. Especially if you carry a lot of extra weight in your abdomen, you may develop prediabetes. The extra fat cells can cause your body to become more insulin resistant. • Lack of physical activity: This often goes hand-in-hand with being overweight. If you aren’t physically active, you’re more likely to develop prediabetes. • Family history: Prediabetes has a hereditary factor. If someone in your close family has (or had) it, you are more likely to develop it. • Race/ethnicity: Certain ethnic groups are more likely to develop prediabetes, including African-Americans, Hispanic Americans, Native Americans, and Asian Americans. • Age: The older you are, the more at risk you are for developing prediabetes. At age 45, your risk starts to rise, and after age 65, your risk increases exponentially. • Gestational diabetes: If you developed diabetes while you were pregnant, that increases your risk for developing prediabetes later on. • Other health problems: High blood pressure (hypertension) and high cholesterol (the “bad” LDL cholesterol) increase your risk of getting type 2 diabetes. Polycystic ovary syndrome (PCOS) also raises the risk for prediabetes because it’s related to insulin resistance. In PCOS, many cysts form in your ovaries, and one possible cause is insulin resistance. If you have PCOS, that means you may be insulin resistant and therefore at risk for developing pre- diabetes. Diagnosis Your doctor may want to test your blood glucose levels if you’re overweight (have a body mass index—BMI—of over 25) and if you have one or more of the risk factors listed above. Even if you aren’t overweight and don’t have any of the risk factors, your doctor may want to start testing your blood glucose level every three years beginning when you’re 45. That’s a smart thing to do because the risk of developing prediabetes (and therefore type 2 diabetes) increases with age. Because there are so many possible complications of diabetes (e.g., heart problems and nerve problems), it’s a good idea to be vigilant about detecting blood glucose abnormalities early. To diagnose you with prediabetes, the doctor can run one of two tests—or he or she may decide to do both. The tests are: • Fasting plasma glucose test (FPG): You can’t eat anything for eight hours leading up to a FPG test. That's why a FPG test is often done in the morning. The doctor checks your blood glucose level (blood sugar level) after drawing a small blood sample. If your blood glucose level is between 100 and 125mg/dL, you have prediabetes. You may hear the doctor use the phrase “impaired fasting glucose” or IFG, which is another term for prediabetes when it’s diagnosed with the fasting plasma glucose test. If your blood glucose level is above 126mg/DL with the FPG test, you may have diabetes. • Oral glucose tolerance test (OGTT): This is another test used to diagnose prediabetes. The doctor will give you instructions on how to prepare for the test, but you won’t be able to eat anything for eight hours before the test; you’ll be fasting. In that way, the oral glucose tolerance test, abbreviated OGTT, is similar to the fasting plasma glucose test. On the day of the test, the doctor will test your blood glucose level at the beginning of the appointment; that’s called your fasting blood glucose level. Then, you’ll drink 75g of a very sugary mixture. Two hours later, your blood glucose level will be measured. If your blood glucose level is between 140 and 199mg/dL two hours after drinking the sugary mixture, you have pre-diabetes. You may hear the doctor use the phrase “impaired glucose tolerance” or IGT, which is another term for pre-diabetes when it’s diagnosed with the OGTT. If your blood glucose level is above 200mg/DL with the oral glucose tolerance test, you may have diabetes. Treatments The American Diabetes Association says that serious lifestyle changes are effective in preventing type 2 diabetes after you’ve been diagnosed with pre-diabetes. Your doctor will walk you through what you need to change, but typical recommendations are: • Eat well: A registered dietitian (RD) or certified diabetes educator (CDE) can help you create a meal plan that’s full of good-for-you and good-for-your-blood-glucose-level food. The goal of the meal plan is to control your blood glucose level and keep it in the healthy, normal range. Your meal plan will be made just for you, taking into account your overall health, physical activity, and what you like to eat. • Exercise: When you exercise, your body uses more glucose, so exercising can lower your blood glucose level. Also when you exercise, your body doesn’t need as much insulin to transport the glucose; your body becomes less insulin resistant. Since your body isn’t using insulin well when you have prediabetes, a lower insulin resistance is a very good thing. And of course, there are all the traditional benefits of exercise: it can help you lose weight, keep your heart healthy, make you sleep better, and even improve your mood. The American Diabetes Association recommends at least 150 minutes of moderate activity a week—that’s 30 minutes five days a week. You can get that through activities such as walking, bike riding, or swimming. • Lose weight: If you’re overweight, you should get started on a weight loss program as soon as you’re diagnosed with prediabetes. Losing just 5 to 10% of your weight can significantly reduce your risk of developing type 2 diabetes. The combination of eating well and exercising more is a great way to lose weight—and then maintain your new, healthy weight. • Metformin: For people who are at a very high risk of developing type 2 diabetes after being diagnosed with prediabetes, the doctor may recommend a medication. The American Diabetes Association says that metformin should be the only medication used to prevent type 2. It works by keeping the liver from making more glucose when you don’t need it, thereby keeping your blood glucose level in a better range. Your doctor will keep a close watch on your blood glucose levels, monitoring them to make sure that your pre-diabetes doesn’t become type 2 diabetes. If needed, he or she may suggest adjustments (e.g., different diet or more exercise) to better control your blood glucose levels.
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