Prediabetes:
Causes/Symptoms/Complications/Diagnosis
For patients diagnosed with prediabetes, the thought of living with a chronic illness for the rest of their lives is understandably upsetting. However, it is possible to see the condition in a positive light, says Sally Brozek, a registered dietitian and certified diabetes educator at Piedmont’s Diabetes Resource Center. “Prediabetes is a wake-up call and a real opportunity to get healthy and prevent a chronic disease you have for the rest of your life,” she says. “It’s time to take action.”
What causes prediabetes?
The cause of prediabetes is the same as the cause of Type 2 diabetes — mainly, insulin resistance.
Insulin resistance happens when cells in your muscles, fat and liver don’t respond as they should to insulin. Insulin is a hormone your pancreas makes that’s essential for life and regulating blood sugar levels. When you don’t have enough insulin or your body doesn’t respond properly to it, you experience elevated blood sugar levels.
Several factors can contribute to insulin resistance, including:
- Genetics.
- Excess body fat, especially in your belly and around your organs (visceral fat).
- Physical inactivity.
- Eating highly processed, high-carbohydrate foods and saturated fats frequently.
- Certain medications, like long-term steroid use.
- Hormonal disorders, like hypothyroidism and Cushing syndrome.
- Chronic stress and a lack of quality sleep.
What are the risk factors for prediabetes?
Risk factors for prediabetes include:
- Family history of Type 2 diabetes (parent or sibling).
- Having overweight or obesity (a BMI greater than 25).
- Being physically active fewer than three times a week.
- Being 45 or older.
- Smoking.
- Obstructive sleep apnea.
- Having had gestational diabetes.
- Polycystic ovarian syndrome (PCOS).
Race and ethnicity are also factors. You’re at increased risk if you are:
- Black.
- Hispanic/Latino American.
- Native American.
- Pacific Islander.
- Asian American.
Some of these risk factors you can’t change, like your age and family history (genetics). But others, like physical inactivity and smoking, you can help improve. The more of these risk factors you have, the more likely prediabetes is around the corner — or you already have it.
It’s important to talk to your primary care provider about screening for prediabetes. While it might be mentally easier to avoid finding out, knowing and taking action are very valuable to your long-term health.
How diabetes is related to obesity
Having obesity makes you more likely to develop diabetes, the condition of having too much glucose (sugar) circulating in your bloodstream. Obesity also causes diabetes to worsen faster.
Here’s what happens: Managing the level of glucose in your blood is the job of the pancreas. The pancreas creates insulin, which is a hormone that moves glucose out of your blood. Normally, insulin transports glucose to your muscles to use right away for energy or to the liver, where it’s stored for later. But when you have diabesity, your cells resist letting insulin move glucose into them. To make matters worse, the area of your liver where excess glucose is usually stored is filled with fat. It’s like trying to put furniture in a room that’s already packed. “There’s no space for anything else,” Dr. Waddadar explains.
With nowhere to be stored, the glucose remains in the bloodstream. “So your pancreas creates even more insulin trying to accomplish the job of moving glucose out of the blood,” says Dr. Waddadar. “It’s trying to push against the resistance created by the fat. Your pancreas becomes overworked, and as a result, it wears out. It starts producing less insulin. Diabetes develops and then quickly worsens if the fat resistance remains.”
What are the symptoms of prediabetes?
Most people with prediabetes don’t have any symptoms. This is why it’s important to see your primary care provider regularly so they can do screenings, like a basic metabolic panel, to check on your blood sugar levels. This is the only way to know if you have prediabetes.
For the few people who do experience symptoms of prediabetes, they may include:
- Darkened skin in your armpit or back and sides of your neck (acanthosis nigricans).
- Skin tags.
- Eye changes that can lead to diabetes-related retinopathy.
What are the possible complications of prediabetes?
The main complication of prediabetes is it developing into Type 2 diabetes. Undiagnosed or undermanaged Type 2 diabetes increases your risk of several complications, like:
- Heart attack and stroke.
- Eye issues (diabetes-related retinopathy).
- Kidney issues (diabetes-related nephropathy).
- Nerve damage (diabetes-related neuropathy).
While it’s possible to reverse prediabetes, it’s typically not possible to reverse diabetes complications. This is why prevention and/or proper management are key.
How is prediabetes diagnosed?
Healthcare providers rely on routine blood test screenings to check for prediabetes. If you have risk factors for prediabetes, your provider may recommend these screenings more often. Prediabetes happens when you have elevated blood sugar levels, but they’re not high enough to be considered Type 2 diabetes.
Healthy blood sugar (glucose) levels are 70 to 99 milligrams per deciliter (mg/dL). If you have undiagnosed prediabetes, your levels are typically 100 to 125 mg/dL.
The following tests can check for prediabetes:
- Fasting plasma glucose test: This tests your blood after you haven’t had anything to eat or drink except water for at least eight hours beforehand (fasted). Basic metabolic panels and comprehensive metabolic panels include a glucose test. Providers routinely order these to get an overall look at your health.
- A1C test: This test provides your average blood glucose level over the past two to three months.
Your provider would diagnose you with prediabetes if your:
- Fasting plasma glucose test result is 100 to 125 mg/dL (normal is less than 100; diabetes is 126 or higher).
- A1C result is 5.7% to 6.4% (normal is less than 5.7%; diabetes is 6.5% or higher).
Knowledge is power, especially when it comes to understanding your health. The more you can learn, the better. Seek information from reputable sources like medical journals, healthcare websites, support groups, or your provider. I'll be sharing some of the resources I use at the bottom of each post. Your newfound knowledge can provide comfort, reduce confusion, and empower you to make informed decisions about your treatment and potential lifestyle changes.
Deep Dive resources:
Join me tomorrow as we look at the management and tools we can use to combat this disease!
Much Love,
Katie
RN, CPT. Wellness Coach
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