People with prediabetes have glucose levels that are higher than normal but not high enough yet to indicate diabetes. The condition used to be called borderline diabetes. Most people with prediabetes don’t have symptoms, but they are considered to be at high risk of developing heart disease.
Normally, your body produces a hormone called insulin to help your cells use the energy (glucose) found in food. With diabetes, either your body doesn’t make enough insulin or doesn’t efficiently use the insulin it does produce. When glucose builds up in the blood, it can damage the tiny blood vessels in the kidneys, heart, eyes, and nervous system.
With prediabetes, the subtle balance between glucose and insulin has been thrown off. The pancreas may not be able to produce enough insulin after a meal to “clear” the incoming glucose from the blood. Or cells may be insulin resistant. When cells are insulin resistant, they won’t allow the insulin to escort glucose from the bloodstream into them. Too much glucose in the blood is also called high blood sugar or hyperglycemia. A low blood sugar level is called hypoglycemia.
If you have prediabetes, you’re at high risk of developing type 2 diabetes as well as the serious medical problems associated with diabetes, including heart disease and stroke. With prediabetes, you are at a 50% higher risk of heart disease and stroke than someone who does not have prediabetes.
How is prediabetes diagnosed?
To determine if you have prediabetes, your doctor can perform one of three different blood tests – the fasting plasma glucose (FPG) test, the oral glucose tolerance test (OGTT) or the Hemoglobin A1C (or average blood sugar) test.
How is the fasting plasma glucose test (FPG) done?
The fasting plasma glucose test can be done after an overnight fast or after an eight-hour fast during the day. It is a relatively easy, inexpensive test. After the fast, a simple blood test measures glucose levels before you eat again. The test results indicate whether your blood glucose level is normal or whether you have prediabetes or diabetes:
- Normal: Normal blood sugar levels measure less than 100 mg/dl (milligrams per deciliter) after the fasting glucose test.
- Prediabetes: Blood glucose levels of 100-125 mg/dl after an overnight or eight-hour fast may indicate prediabetes. People with these results are considered to have impaired fasting glucose (IFG).
- Diabetes: Diabetes is diagnosed when the blood glucose is 126 mg/dl or above.
In most cases, your doctor will repeat any abnormal test before confirming the diagnosis.
How is the oral glucose tolerance test (OGTT) done?
The OGTT usually requires that you have the fasting glucose test first. Then you take a dose of high-sugar (glucose) solution to challenge your body to clear the glucose from your blood. After two hours, another blood glucose test is done. The final test results indicate whether you have a normal level of blood glucose or may have prediabetes or diabetes:
- Normal: Normal blood sugar levels measure less than 140 mg/dl after the oral glucose tolerance test.
- Prediabetes: Blood glucose levels of 140-199 mg/dl after the OGTT is diagnosed as prediabetes. People with these results are considered to have impaired glucose tolerance (IGT).
- Diabetes: Diabetes is diagnosed with blood glucose of 200 mg/dl or above.What is the hemoglobin A1C Test?
The hemoglobin A1C test is a simple blood test that reflects the average blood sugar for the past 3 to 4 months. It can be used to diagnose prediabetes or diabetes. It can also be used to check if your diabetes is under control:
- Normal: 5.6% or less
- Prediabetes: 5.7 to 6.4%
- Diabetes: 6.5 % or above
How common is prediabetes?
The CDC estimates that bout 79 million people in the U.S. over age 20 have prediabetes.
Prediabetes should not be ignored. It signals the likely onset of a more serious condition, and it can begin the process of doing damage to your heart and possibly other organs such as the kidneys, eyes, and nervous system.
Are there lifestyle changes recommended for prediabetes?
Lifestyle changes can help many people with prediabetes to delay — or even prevent — the onset of full-blown diabetes. Changes that can help prevent diabetes include losing weight to bring total weight to a near-normal range, exercising daily, and eating balanced meals.
In a large research study called the Diabetes Prevention Program, the following lifestyle changes reduced the development of diabetes over three years by 58%. For people aged 60 or older, the reduction was an even greater 71%.
- Weight control.Obese and overweight people are at high risk of having prediabetes turn into diabetes. Losing some excess weight can reduce your risk of type 2 diabetes. Even losing 5% to 10% of excess body weight can help.
- Exercise. Studies have shown that moderate exercise for 30 minutes a day, such as cycling, swimming, or brisk walking, helps prevent — and manage — diabetes. Aerobic exercise, the kind that gets your heart rate up to your target heart rate, is ideal for losing weight and preventing prediabetes from turning into type 2 diabetes. Check with your doctor before starting an exercise plan or increasing your activity level.
- Nutrition. Healthy meals that mix a balance of low-fat protein, vegetables, and whole grains can help prevent prediabetes from becoming diabetes. Calorie control, portion sizes (no super-sizing), and low-sugar, low-carbohydrate choices are key. Eating adequate fiber every day also helps.
Following these steps will also help reduce other risk factors for heart disease and stroke, including high blood pressure. High blood pressure is often present in people with diabetes and prediabetes.
You can control your prediabetes by creating a healthier lifestyle. If prediabetes does become type 2 diabetes, these lifestyle changes — weight control, exercise, nutrition, and blood pressure control — build the platform for managing diabetes for life. A healthy lifestyle may also help you prevent or delay the need to begin using medications such as insulin to control blood sugar levels.
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