Could you have it and not even know? By Rashad J. Gober
What is prediabetes?
The simplest definition of prediabetes is that your blood sugar (glucose) levels are definitely high, but not high enough to be classified as type 2 diabetes…yet. The condition is called “pre”diabetes because having it puts you at greater risk of developing type 2 diabetes later down the line. According to the Centers for Disease Control and Prevention (CDC), without significant healthy lifestyle changes, 15 to 30% of those with prediabetes will develop type 2 diabetes within five years.
Prediabetes is actually very common among Americans – the CDC reports that as many as 86 million Americans have the condition. What is particularly scary about this is that 90% of people with prediabetes don’t actually know they have it.
How could you have such a potentially dangerous condition without knowing it? It’s because, in an unfortunate turn, prediabetes often presents no clear symptoms. The only way to know whether you have prediabetes is to have your blood sugar tested, and it’s an all-too-common mistake to bypass this simple routine.
Why is it so dangerous?
Prediabetes is dangerous because, without some kind of lifestyle or health intervention, the condition is a slow, harmful plod toward type 2 diabetes. This means that the ultimate consequences of failing to address it are the same ones associated with type 2 diabetes: frequent urination, thirst, numbness and tingling in your limbs, chronic fatigue, visual disturbances, and ultimately, kidney disease, blindness, and amputations.
Prediabetes also increases the likelihood of stroke and heart disease due to the bodily damage done by high glucose levels over time. “What’s really important to understand about prediabetes is that it heralds other serious medical conditions,” says Dr. Adrien Strickland, a board-certified internal medicine physician with CHI Memorial. “You can think of prediabetes as the tip of the iceberg. Usually, people who have prediabetes are also over their ideal body weight, pre-hypertensive, and have cholesterol levels on the cusp of abnormal. Being diagnosed with prediabetes means there are additional areas you need to focus more attention on, like your weight, diet, and level of activity.”
Prediabetes is very serious, but it’s definitely possible to stop its slippery slope from leading to even more serious health complications.
Am I at risk?
Several factors may make you more likely to have prediabetes, including age, weight, lifestyle, and family history.
Age. If you’re 45 years of age or older, ask your health care provider to check your blood glucose levels. The risk of developing prediabetes increases as you get older, especially after 45.
Weight. Apart from age, being overweight (i.e., a body mass index between 25 and 29.9) or obese (i.e., a body mass index 30 or over) is a primary risk factor in prediabetes. Dr. Strickland explains why. “Being overweight causes your peripheral tissues to not take up your glucose as well,” she says. “The more adipose or fatty tissue you have, the more resistant your cells are to the effects of the insulin your body produces.”
No matter your age, if you are overweight or obese and have one or more of these risk factors, you need to see a health care provider to get your blood sugar levels checked.
Sedentary Lifestyle. Inactivity puts you at greater risk for developing prediabetes, because physical activity uses glucose for energy and helps keep weight under control. Physical inactivity may lead you right back to the weight risk factor.
In addition to the major risk factors listed above, ethnicity plays a role. Brooke Green, a certified nurse practitioner with Hamilton Physician Group, explains that diabetes most often occurs in Hispanic/Latino Americans, African-Americans, Native Americans, Asian Americans, Pacific Islanders and Alaska natives. “Family history is another significant risk factor,” she adds. “If you have a parent or sibling who has been diagnosed with prediabetes or diabetes, you have a much higher chance of having it yourself.”
Women who developed gestational diabetes while pregnant or had a baby over 9 pounds at birth also have a higher risk.
Should I get tested?
If you have some of the risk factors listed above, it’s a good idea for you to see a doctor. “Prediabetes is something that people don’t think about, but if you have a family history or are carrying too many pounds, you should definitely get tested,” says Dr. Roland, an endocrinologist with Diabetes and Thyroid Services of Cleveland.
The good news is, it’s pretty straightforward to make the diagnosis. Screening is fairly simple, requiring only blood work that can be done at the office of your physician. “I would get screened once a year at an annual physical that you have anyway,” Dr. Roland says. Your physician will administer one of three tests to check your blood sugar levels:
Fasting glucose test. The most common diagnostic tool for prediabetes is a fasting blood glucose test, which is usually measured in the morning after an overnight fast. Fasting glucose levels of 100-125 mg/DL are indicative of prediabetes.
Glucose tolerance test. Another test is the oral glucose tolerance test, which is more sensitive than the fasting glucose test, but less convenient to administer. It tests blood glucose after an 8-hour fast and 2 hours after drinking a sweet liquid provided by the doctor.
Hemoglobin A1c Test. A last test option is the hemoglobin A1c test, which measures the amount of glucose in red blood cells (no fasting necessary!). According to the CDC, an A1c value of 5.7% to 6.4% indicates prediabetes.
If you are diagnosed with prediabetes, your health care provider should also check for signs of heart disease and blood vessel problems, as the condition often causes systemic damage.
What happens if I have it?
If you do have prediabetes, use this opportunity to take inventory of potentially unhealthy lifestyle choices and habits that may be contributing to high blood sugar levels. Prediabetes can be a good “check” for people who are willing to make changes to get back on track. The good news is, it hasn’t progressed to the diabetic level yet. Your elevated blood sugar levels can return to normal levels if interventions like regular exercise and diet changes are put in place. “Weight loss and exercise make your body more sensitive to insulin, so that you don’t have to put out as much,” says Dr. Roland.
The CDC outlines several steps someone with prediabetes can take in order to get their health back in order. For example, losing 5 to 7% of your body weight is a great start for those who are overweight. For a 200-pound person, this means losing about 10 to 14 pounds. In order to combat the inactivity risk factor, the CDC recommends getting at least 150 minutes of physical activity every week. Additionally, making certain changes to your diet, such as eating less refined sugars, is also strongly recommended.
“When we’re talking about eating right, I think it’s especially important to begin eating at home,” says Dr. Roland. “Restaurants give people too much food and too many carbs. Fast food is high in fat and carbs and calories.”
She continues. “Overall I would suggest watching portions and eating three balanced meals that are high in fiber and low in sugar. If you have a snacking habit, it could be really important to try and kick that.”
Dr. Strickland says that when working to make changes, it’s vital to set measurable goals, and then create accountibility for yourself. “It’s also really helpful to identify your reason for needing to make the change, whether that has to do with your quality of life, spouse and children, longevity, wanting to avoid the same complications family members have suffered from, etc.,” she says.
In most cases, especially if the steps above are followed, medication will not be necessary for treating prediabetes. However, if you’ve been told you have prediabetes, you should make sure to have your blood glucose levels checked every 6 months to 1 year.
Where can I find more information?
For more information about prediabetes, check out the CDC’s website on diabetes and prediabetes at cdc.gov/diabetes. Also, the National Diabetes Information Clearinghouse (diabetes.niddk.nih.gov) and the National Diabetes Education Program (ndep.nih.gov) are helpful resources on this preventable condition. Take action today!