Abstract:
Prediabetes represents an intermediate state of hyperglycemia that signals a high risk for developing type 2 diabetes and cardiovascular disease. Often asymptomatic, it can be detected through screening tests. It is important to get alert with the prediabetic state and prevent disease progression by appropriate management.
Key word: pre diabetes, diabetes, HbA1c, OGTT
Introduction:
Diabetes???? Means life long medication??? Life long diet control??? Considering it as co-morbidity??? As we know Diabetes is emerging as a lifestyle disorder found in every home in India nowadays.
But in today’s era people have become quite aware of diabetes, hypertension and hyperlipidemia. Many people are preferring routine health check-ups nowadays. But as a doctor what do we suggest to the person coming with the prediabetic state. What to do next??
Starting medication? Or suggest some other reports?? Advice for lifestyle modification or just saying that your sugar is borderline???
Now is the time for all of us to make ourselves as well as our patients aware of their pre- diabetic state.
Diagnosis of diabetes:(1)
There are several ways to diagnose diabetes. Each way usually needs to be repeated on a second day to diagnose diabetes.
Testing should be carried out in a health care setting (such as your doctor’s office or a lab). If your doctor determines that your blood glucose (blood sugar) level is very high, or if you have classic symptoms of high blood glucose in addition to one positive test, your doctor may not require a second test to diagnose diabetes.
A1C
The A1C test measures your average blood glucose for the past two to three months. The advantages of being diagnosed this way are that you don’t have to fast or drink anything.
Diabetes is diagnosed at an A1C of greater than or equal to 6.5%
| Result | A1C |
| Normal | less than 5.7% |
| Prediabetes | 5.7% to 6.4% |
| Diabetes | 6.5% or higher |
Fasting Plasma Glucose (FPG)
This test checks your fasting blood glucose levels. Fasting means not having anything to eat or drink (except water) for at least 8 hours before the test. This test is usually done first thing in the morning, before breakfast.
Diabetes is diagnosed at fasting blood glucose of greater than or equal to 126 mg/dl
| Result | Fasting Plasma Glucose (FPG) |
| Normal | less than 100 mg/dL |
| Prediabetes | 100 mg/dl to 125 mg/dL |
| Diabetes | 126 mg/dL or higher |
Oral Glucose Tolerance Test (OGTT)
The OGTT is a two-hour test that checks your blood glucose levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar.
Diabetes is diagnosed at two-hour blood glucose of greater than or equal to 200 mg/dl
| Result | Oral Glucose Tolerance Test (OGTT) |
| Normal | less than 140 mg/dL |
| Prediabetes | 140 to 199 mg/dL |
| Diabetes | 200 mg/dL or higher |
Random (also called Casual) Plasma Glucose Test
This test is a blood check at any time of the day when you have severe diabetes symptoms.
Diabetes is diagnosed at blood glucose of greater than or equal to 200 mg/dl
What is Prediabetes?(1)
Before people develop type 2 diabetes, they almost always have prediabetes—blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.
Doctors sometimes refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), depending on what test was used when it was detected. This condition puts you at a higher risk for developing type 2 diabetes and cardiovascular disease.
Symptoms(1)
There are no clear symptoms of prediabetes, so you may have it and not know it.
Some people with prediabetes may have some symptoms of diabetes or even problems from diabetes already. You usually find out that you have prediabetes when being tested for diabetes.
If you have prediabetes, you should be checked for type 2 diabetes every one to two years.
Results indicating prediabetes are:
- An A1C of 5.7–6.4%
- Fasting blood glucose of 100–125 mg/dL
- An OGTT two-hour blood glucose of 140–199 mg/dL
Preventing Type 2 Diabetes(1)
You will not develop type 2 diabetes automatically if you have prediabetes. For some people with prediabetes, early treatment can actually return blood glucose levels to the normal range.
Research shows that you can lower your risk for type 2 diabetes by 58% by:
- Losing 7% of your body weight (or 15 pounds if you weigh 200 pounds)
- Exercising moderately (such as brisk walking) 30 minutes a day, five days a week
Do not worry if you cannot get to your ideal body weight, as losing even 10 to 15 pounds can make a huge difference.
Site: https://diabetes.org/about-diabetes/diagnosis
Etiology (2)
The following factors put the patient at greater risk:
- Overweight or obesity (especially a body mass index (BMI) greater than 25 kg/m^2)
- Family history of diabetes mellitus (parent or sibling)
- Diabetes during pregnancy (gestational diabetes)
- High-risk ethnic groups: African American, Latin America, Native American, or Asian/Pacific Islander
- Hypertension
- Physical inactivity
- Dyslipidemia with levels of HDL cholesterol less than 40 mg/dL (men) or less than 50 mg/dL (women) or triglycerides more than 250 mg/dL
- Polycystic Ovarian Syndrome
Pathophysiology (2)
Since prediabetes is the precursor for diabetes mellitus, the pathophysiology is relatable. Hyperglycemia will cause production and release of insulin by the pancreatic beta cells. Excess insulin exposure for long periods of time diminishes the response of the insulin receptors the function of which is to open glucose channels leading to entry of glucose into the cells. Decreased function of the insulin receptors leads to further hyperglycemia further perpetuating the metabolic disturbance and leading to the development of not only diabetes type 2 but also metabolic syndrome. In prediabetes, this process is not to the extent of diabetes mellitus but is a first step in a metabolic cascade which has potentially dangerous consequences if not adequately addressed. Hence its imperative to start treatment at the earliest. [7] If treatment is not started or if the treatment is not adequate, adverse effects on large and small blood vessels (e.g. arteries of the cardiovascular system or retina, kidney, and nerves) may occur.
History and Physical(2)
The majority of the patients with prediabetes do not experience any symptoms and hence appropriate screening and monitoring especially in individuals with family history is needed. In the minority of patients who do experience symptoms, they can be as follows:
- Increased appetite
- Unexplained weight loss/weight gain
- High BMI
- Weakness
- Fatigue
- Sweating
- Blurred vision
- Slow healing cuts or bruises
- Recurrent skin infections/gum bleeding
The single sign of prediabetes is elevated blood glucose on a blood test that is not high enough to be classified as type 2 diabetes mellitus.
Site: https://www.ncbi.nlm.nih.gov/books/NBK459332/#:~:text=Go%20to:-,Pathophysiology,with%20family%20history%20is%20needed
Prediabetes Causes
You get prediabetes because you have insulin resistance. That’s when your body makes insulin (a hormone that helps regulate the levels of sugar in your bloodstream) but doesn’t use it correctly. This causes your blood sugar levels to be higher than they should be.
Causes of Insulin resistance
Doctors aren’t sure exactly why people develop insulin resistance. But things contributing it include:
- Your genes
- Excess body fat
- Long-term stress
- Sleep loss
- Lack of exercise
- A diet heavy in processed foods
- Some hormonal health conditions, such as Cushing’s syndrome and hypothyroidism
- Some medications, such as steroid drugs used over a long period
Prediabetes Treatment
The main treatment for prediabetes is a healthy lifestyle that includes these steps:
- Eat a healthy diet.
- Lose weight if you need to.
- Exercise regularly.
- Stop smoking.
- Get your blood pressure and cholesterol under control.
If you’re at high risk of diabetes, your doctor might also suggest you take medication such as metformin (Glucophage) to lower your blood sugar.
Exercise for prediabetes
When you exercise, your body uses the sugar in your blood to fuel your workout. Over time, regular physical activity can lower your overall glucose levels. You’ll also become more sensitive to the insulin in your body. That makes it easier for your muscles to tap into that glucose.
You should get at least 150 minutes per week of moderate exercise. Aim for 30 minutes a day, 5 days a week. You do not have to do anything too intense.
What Is the National DPP?
The National DPP is a partnership of organizations that support the delivery of an evidence-based lifestyle change program that has proven to reduce the risk of developing type 2 diabetes by 58% (71% in those who are 60 years and above) in those with prediabetes.
The six-month core program, followed by a six-month maintenance period, offers personalized support from lifestyle coaches and weekly group meetings during your journey to better health.
The program covers:
- Healthy eating: Discover the benefits of an eating plan to help you reach or maintain weight wellness.
- Increasing physical activity: Learn how regular physical activity can boost your energy, improve your mood, and help you stay on track with your health goals.
- Strategies to maintain long-term lifestyle changes: Gain effective problem-solving techniques to overcome common challenges when being active, following a meal plan, or losing weight.
- Reduce stress: Learn how to identify and address the stress in your life that may derail your journey to better health.
The program provides a flexible learning format with in-person, virtual, and distance learning options.
Homoeopathic medicine used for diabetes:
- Gymnema Sylvestre- It is indicated when in diabetes, a patient presents with profuse urine loaded with sugar, the passage of which makes the patient feel very weak. There may also be burning all over the body and diabetic carbuncle.
- Syzygium Jambolanum- It helps in the diminution of sugar in the urine. It is indicated when there is great thirst, profuse urination, weakness, emaciation and prickly heat in the upper part of the body.
- Uranium Nitricum– It is indicated when the urine is copious and acidic such that it causes burning in urethra. The patient is not able to retain this urine without pain.
- Cephalandra Indica: It was found to be more effective in reducing fasting blood sugar level. This medicine is prepared from an Indian plant.
- Insulinum: An active principle from the pancreas which affects sugar metabolism. Used for diabetes as well as for acne, carbuncle , erythema with itching eczema. Also used in the gouty, transitory glycosuria when skin manifestation is persistent.
- Natrum Sulphuricum: Used for Hydrogenoid constitution, where the complaints are due to living in damp houses, basement, cellars. Patients are worse in rainy weather or water in any form. It is used in diabetes when urine is loaded with bile and brick dust sediments when there is excessive secretion.
- Abroma Agusta: It is used for diabetes, menstrual irregularity and general weakness. It is frequently used for managing diabetes and its associated symptoms like excessive thirst, urination and weakness.
- Phosphoric acid: The common acid “debility” is very marked in this remedy, producing a nervous exhaustion. Mental debility first; later physical. A congenial soil for the action of Phosphoric acid is found in young people who grow rapidly, and who are overtaxed, mentally or physically. Whenever the system has been exposed to the ravages of acute disease, excesses, grief, loss of vital fluids, we obtain conditions calling for it. Some examples are pyrosis, flatulence, diarrheal, diabetes, rachitis and periosteal inflammation. Urine is frequent, profuse, watery, milky in Diabetes. Micturition, preceded by anxiety and followed by burning. Frequent urination at night. Phosphaturia.
Bibliography:
1. https://diabetes.org/about-diabetes/diagnosis
https://www.ncbi.nlm.nih.gov/books/NBK459332/#:~:text=Go%20to:-,Pathophysiology,with%20family%20history%20is%20needed
