Understanding Pre Diabetes!Dr. Nitin Gupte
The Threat Of Pre Diabetes!
Even when I started my pioneering obesity clinic in Pune four decades ago, it was clear that we were fast becoming the world capital of diabetes and heart disease!
But the threat of a condition called pre diabetes was not as commonly recognised then as it is today.
Currently the commonest fear with which young people are approaching me to help them get over their weight and health issues is the threat of going from pre diabetes to full blown diabetes!
What exactly is pre diabetes?
Pre diabetes is a condition in which the blood sugar levels are raised above normal but are still lower than the diagnostic levels of diabetes.
The HbA1c or the glycated haemoglobin levels lie between 5.7 and 6.4 per cent, just below the diagnostic levels of diabetes, 6.5 per cent and above.
Pre diabetes is a condition that is part of the metabolic syndrome, characterised by obesity, especially abdominal obesity, hypertension, raised levels of triglycerides and LDL, the bad cholesterol and lowered levels of HDL, the good cholesterol.
LDL cholesterol causes blocks in the coronary arteries which leads to heart disease and myocardial infarctions or heart attacks and HDL cholesterol cleanses the coronary arteries off these blocks and protects us from heart disease.
Pre diabetes is considered the stepping stone towards developing diabetes and some of the complications of diabetes can affect the pre diabetics too.
Pre diabetes is diagnosed by checking the the blood sugar fasting and post prandial levels, the glucose tolerance test, the HbA1c, the blood insulin levels and the lipid profile. Abdominal obesity and hypertension confirm the presence of pre diabetes.
Pre diabetes may not have any recognisable signs and symptoms, that makes it even more difficult to diagnose.
But some people may have the same symptoms as those of diabetes, like excessive thirst, increased urination and fatigue and they could indicate that you aught to rule out pre diabetes and diabetes.
If you are suffering from obesity, especially abdominal obesity, have family history of diabetes, have a sedentary lifestyle, you should check your blood pressure, blood sugars, blood insulin, HbA1c and lipid profile, to screen for pre diabetes.
The causes of developing pre diabetes could be family history of diabetes, sedentary lifestyle, stress, older age, ladies who have had history of gestational diabetes and have had high birth weight (more than 9 pound) babies.
When carbohydrates are digested, they are absorbed in blood as sugar and the blood sugar levels increase.
In response to this the pancreas releases insulin in blood and insulin helps transport the sugar to various tissues of the body and under its influence, the cells of the tissues take up sugar from the blood and utilities it for the energy that they require for their functions.
Under the influence of insulin the liver also stores more sugar for providing energy to the body later.
This lowers the blood sugar and the blood insulin levels.
But when you eat too much sweets or sugary food regularly, the pancreas is forced to produce more insulin to bring down the blood sugar to normal.
After a while the cells of the various tissues stop responding adequately to the insulin and do not absorb sugar efficiently.
This means the cells of the tissues develop insulin resistance.
This causes both, the blood sugar and the blood insulin levels to stay high.
This raised blood level of insulin is called hyperinsulinemia.
When the capacity of the liver and the muscle cells to store sugar is over, the excess blood sugar is stored in the fat cells of various fat depots in the body and our weight increases, gradually leading to obesity.
Diagnostic levels of pre diabetes:
Fasting Blood Sugar Levels: Between 110 to 125 (WHO) or 100 to 125 (American Diabetes Association)
Sugar Tolerance Test: Between 140 and 199 mg/dL two hours after taking standardised 75 gm glucose solution.
Glycated Haemoglobin or HbA1c levels between 5.7 to 6.4 per cent.
Levels above these are diagnostic of diabetes.
Reversing Pre Diabetes:
The earlier that the condition of pre diabetes is diagnosed, the greater are the chances that it can be reversed.
How to reverse Pre Diabetes:
Getting physically more active and exercising regularly, walking adequately is the safest exercise, improves the insulin sensitivity of the cells of different tissues of our body.
That is the reason why exercise is the key to not only diabetes management, but also to our overall health and well being!
Keeping your consumption of sweets low, so it helps keep your blood insulin from rising unnecessarily high.
If you have uncontrollable craving for sweets, eat ample fruits through the day. It will take away the abnormal craving for eating sweets and also add valuable nutrition to your food.
Staying away from sweets with determination for a fortnight, to allow the taste buds on your tongue to get adjusted to not eating them. Once they are retrained, you won’t be able to eat as much sweets anyway.
So, to reverse your pre diabetes, you need to develop healthy food habits, eat nutritionally balanced food, exercise regularly, reduce your weight, keep stress low and sleep well.
And don’t wait to start all these things till you catch diabetes!
If you start now, you could most likely prevent the development of insulin resistance and pre diabetes!