If you have returned from an annual physical and the doctor told you that your blood sugar was “just a little above normal” you are likely wondering if you have diabetes or at risk for diabetes. The most likely answer to this question is that you have “prediabetes” and, thus, are at a high risk of developing diabetes.
Overview and definition
While medicine has several technical names for prediabetes - impaired fasting glucose, hyperglycemia, and impaired glucose tolerance - they all describe a person whose blood sugar levels are higher than normal but not high enough to be classified as diabetic. It is important to diagnose and know if you have this condition so that you can take the appropriate steps to treat it and prevent the onset of diabetes.
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What causes prediabetes?
Prediabetes develops when the body begins to have trouble using the hormone insulin. Your pancreas produces insulin in order to guide glucose out of the bloodstream and into muscle cells. If your body does not respond to insulin, levels of glucose (sugar) start to rise in the bloodstream and you develop prediabetes. If not prediabetes is not treated effectively, your body will become more resistant to insulin, blood sugar levels will continue to increase, and eventually, they will reach the range of diabetes.
Who is at risk?
- Risk factors for prediabetes include anything that makes your body resistant to the effects of insulin.
- BMI above 25
- Low level of physical activity: a simple definition is less than 4,000 steps a day
- Age above 65
- Family history: if mom, dad, brother, or sister have diabetes or prediabetes you are much more likely to develop it.
- Other health conditions: polycystic ovarian syndrome, hypothyroidism, and high blood pressure, and high triglycerides
- Medications: steroids (prednisone, medrol), certain psychiatric medications, certain birth control pills, certain blood pressure medications, and certain cholesterol medications can cause prediabetes. It is important to undergo baseline testing for prediabetes before starting any of these medications.
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How is prediabetes diagnosed?
- Fasting blood glucose. This is a blood test that is part of most standard blood draws. You need to have been without any food for at least eight hours. If you fasting blood glucose (another name for sugar) is between 100 and 125 then you have prediabetes. If your fasting blood sugar is above 126, then you may have diabetes and you should clarify this with your doctor.
- Hemoglobin A1C. This is a non-fasting blood test that you need to specifically request. It corresponds to your average blood sugar during the three months prior to the test. A value of 5.7% - 6.4% means that you have prediabetes.
- Oral glucose tolerance test. This test is classically used in pregnancy to identify women at risk of gestational diabetes, but it can also be used to identify those with prediabetes.
- Obesity as a cause of prediabetes
In the traditional model of obesity, consuming more calories than you body can burn leads to
elevated blood sugar which your body then stores as fat. In this theory, “a calorie is a calorie”, and if you can simply decrease calorie intake to match what your body needs you will lose weight and decrease blood sugar. This theory has been the mainstay of prevention and treatment for obesity in the last century and led to even higher levels of obesity because it does not grasp the etiology of obesity for the majority of people with prediabetes.
- Prediabetes as a cause of obesity