What is
pre-diabetes? |
Pre-Diabetes can result from Insulin Resistance, which
occurs when the body fails to use insulin properly or
produces insufficient quantity in the
pancreas. Insulin
is vital for the process because it opens "doorways" on
the cell's surface called insulin receptor sites, which
allow glucose, or sugar, to pass through and be
converted into energy. The number of these sites is
highly reduced by Insulin Resistance and, as a result,
levels of glucose and insulin in the blood stream raised
and become severely unbalanced, which can lead to weight
gain and obesity – underlying causes of Pre-Diabetes.
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Who should be tested for pre-diabetes? |
Adults' age greater than 18
years should undergo this test annually
Body mass index (BMI) ≥25 kg/m²
Hypertension
High density lipoprotein < 40 mg/dl in men
or < 50 mg/dl in women.
Triglyceride (TG) > 150 mg/dl.
Women with a history of gestational
diabetes.
Women with polycystic ovarian syndrome
(Hyper androgenic chronic anovulation).
A family history of type 2 diabetes.
If none of these risk factors exist, tests
should begin at the age of 35, at a minimum
every 3 years.
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How to describe a pre-diabetic patient? |
In pre-diabetes:
►Blood glucose
levels are higher than normal but not high
enough to be characterized as diabetes.
However, many people with pre-diabetes
develop type 2 diabetes within 10 years.
►Pre-diabetes
also increases the risk of heart disease and
stroke. With modest weight loss and moderate
physical activity, people with pre-diabetes
can delay or prevent type 2 diabetes.
►Insulin
Resistance and obesity are underlying causes
of Pre-Diabetes, a reversible condition that
occurs when a person's blood glucose levels
are higher than normal but not high enough
for a diagnosis of Type 2 Diabetes.
Before an individual develops Type 2
Diabetes, they are almost always
Pre-Diabetic. The good news is that having
Pre-Diabetes does not automatically mean
that one will develop the Type 2 variety,
which must be managed for the rest of a
person's life and may require daily insulin
injections.
Research has shown that some long term
damage to the body, especially the eyes,
heart and circulatory system, may already be
occurring during Pre-Diabetes.
Taking action to manage your blood glucose
levels when you have Pre-Diabetes can
prevent or delay Type 2 Diabetes from ever
developing.
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How are diabetes and pre-diabetes diagnosed? |
The following tests are used
for diagnosis:
Fasting Plasma Glucose (FPG) Test
The FPG is the preferred test for diagnosing
diabetes due to convenience and is most
reliable when done in the morning. Results
and their meaning are shown in table 1. If
the fasting glucose level is 100 to 125
mg/dl, the you have a form of pre-diabetes
called impaired fasting glucose (IFG),
meaning that you are more likely to develop
type 2 diabetes but do not have it yet. A
level of 126 mg/dL or above, confirmed by
repeating the test on another day, means
that you have diabetes.
Table 1. Fasting Plasma Glucose Test
|
Plasma Glucose Result (mg/dL) |
Diagnosis |
|
99 and below |
Normal |
| 100 to
125 |
Pre-diabetes( impaired
fasting glucose) |
| 126 and
above |
Diabetes* |
*Confirmed by repeating the test
on a different day.
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Oral Glucose Tolerance
Test (OGTT)
Research has shown that the OGTT is more
sensitive than the FPG test for diagnosing
pre-diabetes, but it is less convenient to
administer. The OGTT requires you to fast
for at least 8 hours before the test. Your
plasma glucose is measured immediately
before and 2 hours after you drink a liquid
containing 75 grams of glucose dissolved in
water. Results and what they mean are shown
in table 2. If your blood glucose level is
between 140 and 199 mg/dL 2 hours after
drinking the liquid, you have a form of
pre-diabetes called impaired glucose
tolerance or IGT, meaning that you are more
likely to develop type 2 diabetes but do not
have it yet. A 2-hour glucose level of 200
mg/dL or above, confirmed by repeating the
test on another day, means that you have
diabetes. |
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Table 2. Oral Glucose
Tolerance Test
| 2-Hour
Plasma Glucose Result (mg/dL) |
Diagnosis |
| 139 and below |
Normal |
| 140 to 199 |
Pre-diabetes (impaired
glucose tolerance) |
| 200 and above |
Diabetes* |
*Confirmed by repeating the test on a
different day.
Gestational diabetes is also diagnosed based
on plasma glucose values measured during the
OGTT. Blood glucose levels are checked four
times during the test. If your blood glucose
levels are above normal at least twice
during the test, you have gestational
diabetes. Table 3 shows the above-normal
results for the OGTT for gestational
diabetes.
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Table 3. Gestational
Diabetes: Above-Normal
Results for the Oral Glucose Tolerance Test
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When |
Plasma Glucose Result (mg/dL) |
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Fasting |
95 or higher |
|
At 1 hour |
180 or higher |
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At 2 hours |
155 or higher |
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At 3 hours |
140 or higher |
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Random
Plasma Glucose Test |
A random blood glucose level
of 200 mg/dL or more, plus presence of the
following symptoms, can mean that you have
diabetes:
increased urination
increased thirst
unexplained weight loss
Other symptoms include fatigue, blurred
vision, increased hunger, and sores that do
not heal. Your doctor will check your blood
glucose level on another day using the FPG
or the OGTT to confirm the diagnosis.
Positive test results should be confirmed by
repeating the fasting plasma glucose test or
the oral glucose tolerance test on a
different day.
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