Prediabetes means that you have a higher than normal blood sugar level but it is not high enough to be classified as type 2 diabetes.
“Prediabetes is becoming an increasingly alarming condition given its high prevalence in India and its asymptomatic nature,” says Dr. Kartikeya Kohli, Associate Consultant, Internal Medicine at Sitaram Bhartia Institute of Science and Research.
According to a recent study, in cities like Delhi and Chennai, 48% and 38% of the population respectively had prediabetes.
Why is it Important to Take Note Early?
With prediabetes, it is likely that multi-system damage may have already begun.
If not managed in time, prediabetes could convert into type 2 diabetes putting you at risk of cardiovascular diseases and other complications.
You may not even know that you have prediabetes, which is why if you have a family history of diabetes, it may be better to speak to a physician early.
How Would You Know if You Have Prediabetes?
There are no symptoms of prediabetes.
You may be at a higher risk of developing prediabetes if you
- have either a parent or sibling who has type 2 diabetes
- are overweight and lead a sedentary lifestyle
- are older than 45
- have had gestational diabetes which increases the risk in your baby and you
- suffer from Polycystic ovarian syndrome (PCOS)
- have a habit of smoking
- have trouble breathing while sleeping or are diagnosed with obstructive sleep apnea
“If you’re older than 45 and have one or more of these risk factors, you should come in for a diabetes screening.”
Fatima Sheikh, 48, moved from Udaipur to Delhi for a new role as Professor of Literature in a leading university. Before she began, she was asked to get a pre-employment medical evaluation done.
During the consultation, when Dr. Kartikeya Kohli asked about her medical and family history and lifestyle, she informed him that she had PCOS and her mother had diabetes.
“There were multiple signs that indicated Fatima may have pre-diabetes. We asked her to get tested to confirm our suspicions,” says Dr Kartikeya.
How is Prediabetes Diagnosed?
If your doctor thinks you are at risk of developing prediabetes, you will be asked to get one of these tests done:
Hemoglobin A1c test (HbA1c) which is a blood test done to assess blood glucose levels. The HbA1c levels indicate your blood glucose levels for the past 3 months.
You will be diagnosed according to the criteria below:
- HbA1c less than 5.7%: Normal
- HbA1c between 5.7-6.4%: Prediabetes
- HbA1c 6.5% or higher: Type 2 diabetes
Fasting Plasma Glucose Test (FPG Test): You will not be allowed to eat anything for 8 hours before the test, meaning you will have to fast the night before the blood sample is taken.
Your results will be based on the criteria below:
- Below 100 mg/dL: Normal
- Between 100-125 mg/dL: Prediabetes
- Above 125 mg/dL : Diabetes
Oral Glucose Tolerance Test (OGTT): You will have to fast overnight and your blood test will be taken in the morning. You will be given a sugary drink after the sample is drawn. Another blood sample is taken about two hours later.
Blood sugar levels usually rise after the drink is consumed. Your condition will be assessed according to this criteria:
- Below 140 mg/dL: Normal
- 140-199 mg/dL: Prediabetes
- Above 199 mg/dL: Type 2 diabetes
Fatima opted for an HbA1c test since she would not have to fast and got it done on the day of her consultation itself.
Upon the confirmation of her diagnosis, she asked why Prediabetes occurs.
What Causes Prediabetes?
Put simply, prediabetes means that the insulin hormone which normally helps regulate the blood sugar levels does not work effectively, causing the blood sugar levels to rise.
“The pancreas, which is an organ behind the stomach, releases the insulin hormone which helps the body extract energy from the sugar in the foods we eat.
If your body becomes “insulin resistant” your pancreas has to secrete more and more insulin to try and keep your blood glucose levels in control. Despite the higher levels of insulin, blood sugar may not remain in the normal limits because the insulin is ineffective.”
Fatima nodded in understanding, but also asked “Is it true that prediabetes need not always turn into Type 2 diabetes?”
Prediabetes can be reversed naturally through modifications in your lifestyle that cover your diet, sleeping patterns and physical activity.
How Can Prediabetes be Reversed?
You can use these tips to reverse prediabetes naturally:
Become conscious about carbohydrates:
Your meals should contain foods that have a low glycemic index (GI) and low glycemic load (which is a product of the GI and the amount of carbohydrates in a particular food). The glycemic index is based on the pace at which the food is digested and converted into glucose.
Foods like rice, idli, potato, toast and dates for instance have a high carbohydrate content, are digested faster and consequently have a high GI and a high glycemic load. These foods should be avoided.
“You should try incorporating fibre-rich whole grains such as Ragi. Red rice may also be a good substitute for white rice. Get your proteins from tofu and pulses and healthy fats from nuts, which are a nutritious alternative to biscuits and chips. These curtail spikes in blood sugar.”
Ramp up physical activity:
The American Diabetes Association recommends breaking up long periods of inactivity or being desk-bound by indulging in a few minutes of light exercise every half an hour. You can walk around or do a few side lunges or desk-chair swivel exercises.
Fatima perked up when she heard about the exercises she could do during office hours, in the staff room or between her classes, without making too much of an effort.
“These exercises should be done in addition to 2-3 hours per week of walking, swimming, jogging, cycling or yoga,” emphasized the doctor.
Extra physical activity uses up energy from the glucose in the blood, which lowers blood sugar levels, helps you lose weight and improves insulin sensitivity.
Sleep it out:
There is mounting research that sleep is linked to metabolism. According to a study, “Changes due to sleep disturbances such as low amounts of slow-wave sleep may adversely affect glucose tolerance.”
In this way, poor sleep may be associated with a higher chance of developing diabetes.
You can use an app or a fitness tracker to track your sleeping patterns and take steps to improve your sleep.
Clear your head:
Stress levels adversely impact people with prediabetes. When you are stressed out about work, marriage, an unexpected situation or are frightened, your body secretes cortisol and adrenaline hormones which cause more glucose to be released into the blood. If you have prediabetes, the insulin in the body will not be able to regulate the increased glucose levels, causing these to rise.
“At times that you feel stressed out and not in control of a particular situation, get some fresh air and step out for a stroll if you can. Just being amidst nature can have a calming effect. If you’re not accustomed to meditating, close your eyes and sit in silence. Try not to think of all the stressors. This may soothe you.”
In case none of these changes help, your doctor may prescribe metformin to prevent or delay the onset of diabetes.
Fatima was relieved with the detailed explanations on how to reverse prediabetes. She promised herself to act on each of these measures.
The doctor also put her in touch with the Diabetes Centre so she could meet an endocrinologist and take personalized sessions with a Diabetes Educator if required in the future.
What Happens if Prediabetes is not Treated?
Prediabetes could progress to type 2 diabetes. With diabetes you may be at risk of high blood pressure, high cholesterol, heart disease, stroke, kidney disease, nerve damage, impaired vision and amputations.
“Make it a point to get your sugar levels checked once in three months to assess the impact of your lifestyle modifications.”
When Should You See a Doctor?
Speak to your doctor if you notice that you’re thirstier, visit the washroom more often (especially at night), have vision problems or feel excessively tired.
These symptoms may indicate the onset of type 2 diabetes, which can be confirmed through tests.
“Try not to get discouraged! Prediabetes may be an opportunity to reverse the condition and prevent diabetes, provided you make the necessary changes well in time,” wraps up Dr Kartikeya.
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