Pre-diabetes: could you have it?


Worldwide, an alarming number of people are becoming insulin-resistant, a condition also known as pre-diabetes, that can eventually lead to type 2 diabetes. However, very few of us are aware that this condition exists, and what serious impact it could have on our health.

Right now, more than 280 million people worldwide have pre-diabetes - a figure that's set to grow to 398 million by 2030 if the current rate continues. In sub-Saharan Africa, the number is at more than 32.8 million, and this is expected to rise to 63.2 million by 2030.

Unfortunately, the majority of people have no idea that they have pre-diabetes, as the condition develops gradually and without warning. The symptoms of type 2 diabetes (frequent urination, excessive thirst, increased appetite, weight loss, blurred vision and exhaustion) aren't necessarily obvious when someone becomes pre-diabetic.

Recent research, however, has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes.  

What exactly is pre-diabetes?
Pre-diabetes or insulin-resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. Glucose is a form of sugar that is the body’s main source of energy.

The body’s digestive system breaks food down into glucose, which then travels in the bloodstream to cells throughout the body. Glucose in the blood is called blood glucose, also known as blood sugar. As the blood glucose level rises after a meal, the pancreas releases insulin to help cells take in and use the glucose.

When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more.

Eventually, the pancreas fails to keep up with the body’s need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time. 

What causes pre-diabetes or insulin-resistance?
Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes.

Excess weight and lack of physical activity also contribute to insulin resistance.

Many people with insulin-resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease.

These conditions include having excess weight around the waist, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood. Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.

Who is at risk of developing pre-diabetes?
Diabetes South Africa recommends testing for pre-diabetes in adults with the following risk factors:

  • People with a family history of type 2 diabetes.
  • Women who had gestational diabetesor have had a baby weighing more than 4kg.
  • Women who have polycystic ovary syndrome (PCOS)
  • People who belong to an ethnic group that is disproportionately affected by diabetes (in South Africa, if you are of Indian descent, you're at particular risk).
  • People who are overweight or obese, especially in the mid-section.
  • People with high cholesterol, high triglycerides, low HDL/LDL ratio.
  • People who are inactive.
  • Older people - the ability to utilise insulin well gets worse as we age.

How is pre-diabetes diagnosed?
Two different tests are used to find out whether you have pre-diabetes.

The first one is the fasting plasma glucose test and the other the oral glucose tolerance test. The blood glucose levels revealed in these tests show whether your metabolism is fuctioning normally, or whether you have diabetes or pre-diabetes.

A person with pre-diabetes has a fasting blood glucose level between 5.5 mmol/L and 7 mmol/L. Anything over this indicates the onset of diabetes.

The oral glucose tolerance test measures a person’s blood glucose level after a fast and 2 hours after drinking a glucose-rich beverage. If you are prediabetic, your blood glucose level will be between 8 mmol/L and 11 mmol/L. Anything over this indicates the onset of diabetes. 

Can pre-diabetes be reversed?
The good news is that physical activity and weight loss can help the body respond better to insulin. By losing weight, making wise food choices,reducing stress and being more physically active, people with insulin-resistance or pre-diabetes may avoid developing type 2 diabetes altogether. Physical activity also helps muscle cells use blood glucose for energy by making the cells more sensitive to insulin.

(Sources: International Diabetes Federation, Global Diabetes Atlas; Diabetes South Africa; National Institutes of Health; American Diabetes Association)

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