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Are you pre-diabetic? How can you tell?

Important Points:

  • Prediabetes
  • Fasting sugars
  • Chronic diseases
  • Early signs
  • Exercise

Are you pre-diabetic?
How can you tell?

Of all the chronic diseases currently known to mankind, diabetes is the most common with well over 88% of patients being prediabetic without knowing it. The onset of diabetes starts years before it becomes full blown and starts affecting one’s health. How can you know if you are on the path to being a full-blown diabetic? What can you do to arrest and reverse this process?

What Is Prediabetes?

Prediabetes is a “pre-diagnosis” of diabetes—a warning sign of sorts. It happens when your blood glucose level (blood sugar level) is higher than normal but not high enough to be considered diabetic.

Prediabetes is an indication that you  could develop type 2 diabetes (T2D) if you don’t make some immediate and lasting lifestyle changes.

During the prediabetes phase, your pancreas still produces enough insulin in response to ingested carbohydrates. The insulin is less effective at removing the sugar from the bloodstream, though, so your blood sugar remains high. This condition is called insulin resistance, and during this stage, you are accumulating microvascular damage.

What are the indications that you might have it?

Diabetes develops very gradually; it could take up to several years. It follows that when you’re in the prediabetes stage, you may not have any symptoms at all. You may, however, notice that:

  • you’re hungrier than normal
  • you’re losing weight, despite eating more
  • you’re thirstier than normal
  • you have to go to the bathroom more frequently
  • you’re more tired than usual

All of these symptoms are typically associated with diabetes, so if you’re in the early stages of diabetes, you may notice them.

What are the risk factors lead to prediabetes?

It is not very clear what exactly causes the insulin process to go askew in some people. There are several risk factors, though, that make it more likely that you’ll develop pre-diabetes. These are the same risk factors related to the development of type 2 diabetes:

  • Weight: Being overweight (have a body mass index—a BMI—of higher than 25) increases your risk for developing prediabetes. This is especially true if you carry a lot of extra weight in your abdomen. The extra fat cells can cause your body to become more insulin resistant.
  • Being inactive: This often goes hand-in-hand with being overweight. If you aren’t physically active, you’re more likely to develop prediabetes.
  • Having a close family member with type 2 diabetes: Prediabetes has a hereditary factor, so if someone in your close family has (or had) it, you are more likely to develop it.
  • Race/ethnicity: Certain ethnic groups are more likely to develop prediabetes, including African-Americans, Hispanic Americans, Native Americans, and Asian Americans.
  • Age: The older you are, the more at risk you are for developing prediabetes. At age 45, your risk starts to rise, and after age 65, your risk increases exponentially.
  • Gestational diabetes: If you developed diabetes while you were pregnant, that increases your risk for developing prediabetes later on.
  • Other health problems: High blood pressure (hypertension) and high cholesterol (the “bad” LDL cholesterol) increase your risk of getting type 2 diabetes. 
  • Polycystic ovary syndrome (PCOS): It is quite likely that if you have PCOS, you have insulin resistance and are prediabetic.
  • Hypothyroidism low thyroid function (not enough circulating thyroid hormone) and prediabetes together more than doubles your risk of developing Type 2 Diabetes in comparison to individuals with normal thyroid function.

How can you know for sure?

You should visit your doctor who may want to test your blood glucose levels if you’re overweight (have a body mass index—BMI—of over 25) and if you have one or more of the risk factors listed above.

If your fasting blood test indicates that you have prediabetes, your doctor may want to do an A1C blood test. On the other hand, your doctor may skip the fasting blood sugar test and go straight to the A1C blood test, which provides information about your average blood sugar levels over a 3 month period. These results are stated as a percentage:

  • Normal = below 5.7%
  • Prediabetes = between 5.7% and 6.4%
  • Diabetes = 6.5% or higher.

 It is advisable to start testing your blood glucose levels every three years beginning when you’re 45, even if you are not overweight and do not have any of the risk factors. That will ensure you catch any anomaly at an early stage as the risk of developing prediabetes (and therefore type 2 diabetes) increases with age. 

What to do if you are prediabetic?

Serious lifestyle changes are effective in preventing type 2 diabetes, after you’ve been diagnosed with pre-diabetes. Your doctor will give you advice on what you need to do, but here are some additional things you can do on your own:

  • Assess Your Food Choices:  Get a healthy food plan is to assure that you are controlling your blood glucose level by keeping it in a healthy, normal range. Your meal plan should be adjusted to be comfortable and satisfying to you taking into account your overall health, physical activity, and what you like to eat.
  • Exercise regularly:  During exercise, your body burns up more glucose, thus lowering your blood glucose level. Also when you exercise, your body doesn’t need as much insulin to transport the glucose; your body becomes less insulin resistant. Since your body isn’t using insulin well when you have prediabetes, lowering insulin resistance is a very good thing.
    It is recommended that you do at least 150 minutes of moderate activity a week—that’s 30 minutes five days a week. You can get that through activities such as walking, bike riding, or swimming.
  • Lose weight. If you are overweight, losing just 7 percent of your starting weight can help delay or prevent diabetes. That means if you weigh 200 pounds, losing 14 pounds can make a difference. Weight loss also helps lower your blood pressure and cholesterol levels.
  • Metformin: Medication might be recommended for people who are at very high risk of developing type 2 diabetes after being diagnosed with prediabetes. According to the American Diabetes Association, Metformin should be the only medication used to prevent Type 2 diabetes. It works by keeping the liver from making more glucose when you don’t need it allowing your blood glucose level to stay in a better range.
  • Some good news

If you have prediabetes, you should know you are definitely not alone. In 2015, it was estimated that 84.1 million Americans age 18 and older suffered from this condition. That is a whopping 1 in 3 Americans!

Being prediabetic doesn’t mean you will certainly develop diabetes, but it is however a warning of what could lie ahead. People with prediabetes have a higher risk for type 2 diabetes as opposed to someone with normal blood sugar levels. Those chances increase if you don’t make any healthy changes to your diet or activity habits.

It is not all bleak though…. It can be reversed and you can stop the progression to diabetes. You can take control of your health by making the right choices and actively monitoring your blood sugar to ensure you do not slip into a prediabetic state or develop into a full diabetic.

References:

  1. Healthline (2018): Understanding Borderline Diabetes: Signs, Symptoms, and More. Retrieved from

https://www.healthline.com/health/diabetes/borderline-diabetes-know-the-signs

https://familydoctor.org/condition/prediabetes/
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Metabolic inflammation as a cause of insulin resistance

Important Points:

Metabolic inflammation as a cause of insulin resistance

In previous articles, I have discussed the role of metabolic Inflammation in obesity and diabetes. Today, we will narrow down to the specifics of what insulin resistance is, its effects, and how metabolic inflammation increases the chances of one developing it.  

1. What is Insulin resistance?

Approximately 30% of Americans, and up to 50% in the 60 years and over bracket, have a silent blood sugar problem known as insulin resistance. It begins when cells in your muscles, body fat, and liver repel or ignore the signal sent out by the hormone insulin to take glucose from bloodstream into our cells for breakdown or storage. Glucose, commonly called blood sugar and is the body’s main source of fuel.

Insulin resistance increases the risk for prediabetes, Type 2 diabetes, and a host of other serious health problems, including heart attacks, strokes and cancer.

2. How does Insulin Resistance Develop?

Some factors that determine insulin resistance are aging and ethnicity, but the driving forces seems to be excess body weight, too much belly fat, a lack of exercise, smoking, and even sleep depravity.

As the insulin resistance develops, more insulin is produced by your body as it tries to fight back. After an accumulated period of time, several years even, the beta cells in your pancreas get worn out because of all the extra work and can no longer keep pace with the increased demand for insulin. Then – years after insulin resistance stealthily began – your blood sugar may spike and you may manifest prediabetes or type 2 diabetes. You are also at risk of developing non-alcoholic fatty liver disease (NAFLD), a condition that increases your risk for liver damage and heart disease.

3. What are the Signs and Symptoms of Insulin Resistance?

Insulin resistance does not always manifest to the naked eye but here are other possible signs that are visible:

  • A large waist. Experts say the best way to tell whether you’re at risk for insulin resistance involves a tape measure and moment of truth in front of the bathroom mirror. A waist that measures 35 inches or more for women, 40 or more for men (31.5 inches for women and 35.5 inches for men if you’re of Southeast Asian, Chinese or Japanese descent) increases the odds of insulin resistance and metabolic syndrome, which is also linked to insulin resistance.
  • Additional signs of metabolic syndrome. According to the National Institutes of Health, in addition to a large waist, if you have three or more of the following, you likely have metabolic syndrome, which creates insulin resistance.
  • High triglycerides. Levels of 150 or higher or taking medication to treat high levels of these blood fats.
  • Low HDLs. Low-density lipoprotein levels below 50 for women and 40 for men or taking medication to raise low high-density lipoprotein (HDL) levels.  
  • High blood pressure. Readings of 130/85 mmHg or higher or taking medication to control high blood pressure
  • High blood sugar. Levels of 100-125 mg/dl (the prediabetes range) or over 125 (diabetes).
  • High fasting blood sugar or you’re on medicine to treat high blood sugar. Mildly high blood sugar may be an early sign of diabetes.
  • Dark skin patches. If insulin resistance is severe, you may have visible skin changes including patches of darkened skin on the back of your neck or on your elbows, knees, knuckles or armpits. This discoloration is called acanthosis nigricans.

4. Chronic low-grade inflammation and the development of insulin resistance

As early as 1950’s, a connection between inflammation and insulin resistance seemed to present especially in the obese, but the mechanics of the link were unknown. Recently, this has become clearer. Research has shown an association between the body activating signal pathways for inflammation over and over and a decrease in insulin sensitivity which is a rise in insulin resistance. Elevated levels of many inflammation signaling molecules (cytokines) and the inflammatory marker C-reactive protein (CRP) were found in those with insulin resistance and its symptoms, especially those that were obese.

5. What Health Conditions are Related to Insulin Resistance?

An estimated 87 million American adults have prediabetes; 30-50% will go on to develop full-blown type 2 diabetes., and up to 80% of people with type 2 diabetes have NAFLD. But those aren’t the only threats posed by insulin resistance.

Thanks to years of high insulin levels followed by an onslaught of cell-damaging high blood sugar, people with insulin resistance, prediabetes, and type 2 diabetes are at high risk for cardiovascular disease. Insulin resistance doubles your risk for heart attack and stroke and triples the odds that your heart attack or ‘brain attack’ will be deadly, according to the International Diabetes Federation.

Meanwhile, insulin resistance and metabolic syndrome are also linked with higher risk for cancers of the bladder, breast, colon, cervix, pancreas, prostate and uterus. The connection: High insulin levels early in insulin resistance seem to fuel the growth of tumors and to suppress the body’s ability to protect itself by killing off malignant cells.

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk for Alzheimer’s disease

Research has also found a strong association between insulin resistance and memory function decline, increasing the risk for Alzheimer’s disease.

6. Can understanding the causes of Insulin Resistance aid in future preventive approaches?

As obesity-associated chronic low-grade inflammation is responsible for the decrease of insulin sensitivity, so obesity is a major risk factor for insulin resistance and related diseases such as type 2 diabetes mellitus and metabolic syndromes. The state of low-grade inflammation is caused by over-nutrition which leads to lipid accumulation in adipocytes and interferes with insulin signaling and action. This interference only adds to the cascade of errors (pathogenesis) that leads to insulin resistance. It has been suggested that specific factors and signaling pathways are often correlated with each other; therefore, both the accumulation and the interference mentioned should be studied further to fully understand the connection between inflammation and insulin resistance.