PRE – DIABETES A Reversible Path to Diabetes

PRE – DIABETES:A Reversible Path to Diabetes

Jerico B. Gutierrez, MD

Blood sugar testing is commonly done nowadays. Perhaps this is due to increasing awareness about diabetes, more accessible laboratory facilities, or as a part of pre – employment medical examination. Blood sugar can be tested in a number of ways. Blood sugar can be obtained after an overnight fast, with no food and fluid intake for at least 8 hours. This is termed as “fasting blood sugar”. Blood sugar can also be tested two hours after ingesting 75 grams of glucose that is dissolved in water or orange – flavored drink. A procedure called “75 gram oral glucose tolerance test (OGTT)” involves taking both fasting blood sugar and blood sugar 2 hours after intake of 75 grams of glucose. Blood sugar may also be tested without regard to meal intake. This is termed as “random blood sugar”.

Not all individuals whose blood sugar levels are higher than normal automatically have diabetes. A higher than normal blood sugar result may also be classified as pre-diabetes. Pre-diabetes may be referred to as “borderline” diabetes. It is a condition wherein the blood sugar level is already beyond normal but not high enough to be classified as diabetes. A person is considered to have pre-diabetes if his fasting blood sugar level is between 100 to 125mg/dl, or his blood sugar two hours after intake of 75 grams of glucose is between 140 to 199mg/dl. Most individuals with pre-diabetes do not feel anything. A person is considered to have diabetes, on the other hand, if his fasting blood sugar is more than or equal to 126mg/dl or his blood sugar two hours after intake of 75 grams of glucose is more than or equal to 200mg/dl. In a person who does not feel anything, an abnormal blood sugar result has to be repeated on another day to confirm the finding. However, in a person with symptoms such as increased thirst, frequent urination, weight loss, non-healing wound, or numbness of the hands and feet, a single random blood sugar that is more than or equal to 200mg/dl is already considered as having diabetes.

The elevation of blood sugar beyond normal occurs when insulin, the hormone in the body PRE -DIABETES A Reversible Path to Diabetes responsible for maintaining a normal blood sugar level, is starting to lose its control over the blood sugar or starts to decrease in amount.

Pre-diabetes is one of the strongest risk factors to having diabetes. It may be described as a bridge that one might travel from having a normal blood sugar level to diabetes. However, pre-diabetes may be reversible or may even be prevented from progressing to diabetes, just as a traveller crossing a bridge may decide to turn back and return to his point of origin, and not reach the other end of the bridge.

There are ways to prevent progression of pre – diabetes to diabetes. A proper diet consisting of high fiber, whole grains, vegetables, minimal consumption of simple sugars and avoidance of excess calories will help. Aerobic exercise like cycling, swimming, or brisk walking 30 minutes per day, five days a week is recommended. For those who are overweight or obese, a weight reduction of 5-10% of body weight will help prevent diabetes.

A person with pre-diabetes should be retested at least annually with either a fasting blood sugar or 75 gram OGTT to detect diabetes progression and potentially avoid the associated complications of diabetes such as blindness, kidney failure, foot amputations, and cardiovascular complications.

If pre-diabetes progresses to diabetes, one must bear in mind that it can still be controlled with proper medications, healthy diet, exercise, and regular follow up with an endocrinologist to control blood sugar and to screen or prevent complications.

TEST NORMAL PREDIABETES DIABETES
FBS (mg/dL) <100 100 – 125 >126
75g OGTT (mg/dL) <140 140 – 199 >200
HbA1c (%) <5.7 5.7 – 6.4 >6.5

 

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