Prediabetes - Strike it when it’s hot

We have all heard and read about the management of full-blown diabetes type 2, but now we are increasingly being made aware of the condition called prediabetes and the need to treat it to prevent getting diabetes. Diabetes is becoming a big health problem in Sri Lanka. Those who are diabetic are happy to take the medication prescribed by their doctor, and to visit him every few months for a check up. Patient education on diabetes is poor, and the patient assumes that his or her condition will improve with the prescribed medication. This is far from the truth.

You can be a prediabetic for the rest of your life and be healthy, as long as you make some changes in your lifestyle. If however, you don't take prediabetes seriously and don't restrict high glycaemic foods and exercise more frequently, you risk becoming a full-blown diabetic in due course.

If you come from a diabetic family, and you are overweight or obese, beware - you could be a candidate for prediabetes. There are no signs or symptoms at this stage. But it's important to watch for the classic red flags of type 2 diabetes- excessive thirsts and frequent night urination.

This is a stage when the blood sugar levels begin to rise more than normal but not high enough to be diagnosed as diabetes. It's also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). You quite often hear from people, that the doctor said, "You are a borderline case and should control with diet alone". In future, your family doctor may not express such opinions, as it's appearing to be clear that prediabetes more often seems to double the risk of death due to heart attack. With lifestyle changes this could be slowed, stopped, and even reversed.

Prediabetes is a relatively new clinical diagnosis. One reason for renaming prediabetes from its former clinical name of impaired glucose tolerance was to highlight the seriousness of the condition and to motivate people to get appropriate treatment.

The blood sugar level fluctuates during the course of the day and night. In non-diabetics the fasting level in the morning before breakfast varies from 80 - 100 mg (4.5 mmol-5.5mmols). After a meal when checked two hours later, the normal blood sugar level rises to about 140mg (7.5mmols), The preferred way to test for prediabetes is to check the fasting level. Fasting levels between the ranges of 100mg-125mg/dl is considered as prediabetes.

Full-blown diabetics need not worry about these ranges, because they are expected to bring down the fasting level to about 100-126mg/dl (5.5mmol-7mmols) with medication.

This is done in a lab where you will be given to drink about 8 ounces of a sugar drink. Blood sugar level is measured before the test and then one-hour and two hours after. If the blood sugar reaches 140-199mg/dl after two hours, you have an impaired glucose tolerance. This is another way of detecting a prediabetic state.

Family history: If you have a blood relative with diabetes, your risk of developing it is significantly increased.

If you suffer from any of the above symptoms, you should see a doctor and undergo the required tests. Postponing will lead to full-blown diabetes needing more care.

If you are diabetic, a daily check of your fasting glucose level is essential. This level should be brought down to about 100mg (5.5mmols) daily. Glucometers and the test strips don't come cheap, and the average wage earner will find it difficult to set aside money for the equipment, and medication. Those who are on insulin therapy are in a worse situation.

In developed countries the government subsidises the diabetic drugs, including insulin, through diabetic associations, and management is quite effortless. The solution is to nip the condition in the bud at the pre-diabetic state. This needs mass awareness and education by the health authorities and vigilance and care by the patient himself.

To understand prediabetes, first you must understand how sugar (glucose) is normally processed in the body. Glucose is a main source of energy for the cells that make up your muscles and other tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The hormone insulin comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

Your liver acts as a glucose storage and manufacturing centre. When your insulin levels are low - when you haven't eaten in a while, for example - your liver releases the stored glucose to keep your glucose level within a normal range.

When you have prediabetes, this process begins to work improperly. Instead of moving into your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin. Exactly why this happens is uncertain, although excess fat - especially abdominal fat - and inactivity seem to be important factors. (Mayo Clinic)