Pre-Diabetes
Pre-Diabetes
Before people develop type 2 diabetes, they almost always have "pre-diabetes" -- blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes and is formally called adult-onset diabetes or noninsulin-dependent diabetes. If you take action to manage your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing.
Identifying Pre-Diabetes
Two different tests your doctor can use to determine whether you have pre-diabetes, the fasting plasma glucose test (FPG) or the oral glucose tolerance test (OGTT). The blood glucose levels measured after these tests determine whether its a normal metabolism, or whether its pre-diabetes or diabetes. If blood glucose level is abnormal following the FPG, that means, Impaired fasting glucose (IFG); if blood glucose level is abnormal following the OGTT, then it means Impaired glucose tolerance (IGT).
- Impaired fasting glucose (IFG)
When the condition met for Fasting plasma glucose (FPG) 100–125 mg/dl after an overnight fast
- Impaired glucose tolerance (IGT)
when the condition met for 2-hr post 75g glucose challenge 140–199 mg/dl
- Diabetes
when the condition met for Random plasma glucose>200 mg/dl with symptoms (polyuria, polydypsia, and unexplained weight loss) or FPG>126 mg/dl or 2-hr plasma glucose>200 mg/dl post 75g glucose challenge
Below table explains the above
| Test |
Fasting Plasma Glucose(FPG) |
Oral Glucose Tolerance Test (OGTT) |
Random/Casual Plasma Glucose (with symptoms) |
| How Performed |
Blood glucose is measured after at least an 8 hour fast |
75-gram glucose load (drink) is ingested after at least an 8 hour fast; blood glucose is measured at 2 hours |
Blood glucose is measured at any time regardless of eating |
| Normal |
< 100 mg/dL |
< 140 mg/dL |
|
| Pre-diabetes (IFG) |
100 – 125 mg/dL |
|
|
| Pre-diabetes (IGT) |
|
140 – 199 mg/dL |
|
| Diabetes Mellitus |
≥ 126 mg/dL * |
≥ 200 mg/dL |
≥ 200 mg/dL * 1
(with symptoms) |
IFG: Impaired fasting glucose
IGT: Impaired glucose tolerance
* Test must be confirmed by repeating on a different day
1 It is not appropriate to have a person eat a meal and then draw a random glucose two hours after
Pre - diabetes is also associated with insulin resistance and metabolic syndrome
Insulin Resistance and Pre-Diabetes
Insulin resistance is a silent condition that increases the chances of developing diabetes and heart disease. If you have insulin resistance, your muscle, fat, and liver cells do not use insulin properly. The pancreas tries to keep up with the demand for insulin by producing more. Eventually, the pancreas cannot keep up with the body's need for insulin, and excess glucose builds up in the bloodstream. Many people with insulin resistance have high levels of blood glucose and high levels of insulin circulating in their blood at the same time.
Metabolic Syndrome
Metabolic syndrome represents a constellation of lipid and non-lipid risk factors of metabolic
origin. In the past, this syndrome has been called Syndrome X, Insulin Resistance, Dysmetabolic
Syndrome, and Cardiac Dysmetabolic Syndrome. Although metabolic syndrome and prediabetes
may be present at the same time, not all people with metabolic syndrome have prediabetes
and not all people with pre-diabetes have metabolic syndrome. It is estimated that
approximately 40% of people with impaired glucose tolerance (IGT) and 70% of people with
Type 2 diabetes also have metabolic syndrome. Metabolic syndrome is diagnosed when three or
more of the following risk factors are present:
- Abdominal obesity (assessed by waist circumference): men > 40 inches, women > 35 inches
- Triglycerides ≥ 150 mg/dL
- HDL-cholesterol: men < 40 mg/dL, women < 50 mg/dL
- Blood pressure ≥ 130/85 mmHg
- Fasting glucose ≥ 100 mg/dL
Polycystic Ovary Syndrome
Insulin resistance is possibly an underlying cause of polycystic ovary syndrome (PCOS), an
endocrine (hormonal) disorder affecting 5-10% of all women. For some women, symptoms first
appear during the teen years, while others do not develop symptoms until they are in their
twenties. PCOS may continue through menopause. Diagnosis is made with a combination of a
physical exam, blood tests, and the presence of several symptoms, including hirsutism (excessive
hair growth), acne, obesity, infertility, and irregular menstrual periods. The exact cause of PCOS
is unknown at this time, and there is currently no cure. The current approach is to treat
individual symptoms and focus on insulin resistance.
Getting chances of diabetes
Anyone 45 years or older should consider getting tested for diabetes. If you are overweight and aged 45 or older, it is strongly recommended that you get tested. You should consider getting tested if you are younger than 45, overweight, and have one or more of the following risk factors:
- family history of diabetes
- low HDL cholesterol and high triglycerides
- high blood pressure
- history of gestational diabetes (diabetes during pregnancy) or gave birth to a baby weighing more than 9 pounds
- minority group background (African American, American Indian, Hispanic American/Latino, or Asian American/Pacific Islander)
Prevent Pre-Diabetes
Get Active
Physical activity helps your muscle cells use blood glucose, which they need for energy, by making those cells more sensitive to insulin. People who exercise for 30 minutes, five times a week have a far smaller risk of developing diabetes.
Eat Well
Eat a variety of foods that are low in fat and reduce the number of calories you eat per day.
Let fruits, vegetables and whole grains make up the bulk of your meals and snacks. Following a low-calorie, low-fat diet can help you lose weight and decrease your chances of developing diabetes.
Use the Fat and Calorie Counter to look up the number of grams of fat and the number of calories in the foods you eat. The key to losing weight and preventing diabetes is to make lifelong changes—not quick fixes—that work for you. you can prevent or delay the onset of diabetes by losing weight through a low-fat, reduced calorie eating plan, and by increasing physical activity.
Eat a Variety of Healthy Foods From Each Food Group
- Focus on fruits Eat a variety of fruits, whether fresh, frozen, canned, or dried—rather than fruit juice for most of your fruit choices. For a 2,000-calorie diet, you will need 2 cups of fruit each day (for example, 1 small banana, 1 large orange, and 1/4 cup of dried apricots or peaches).
- Vary your veggies Eat more dark green veggies, such as broccoli, kale, and other dark leafy greens; orange veggies, such as carrots, sweetpotatoes, pumpkin, and winter squash; and beans and peas, such as pinto beans, kidney beans, black beans, garbanzo beans, split peas, and lentils.
- Get your calcium-rich foods Get 3 cups of lowfat or fat-free milk or an equivalent amount of low-fat yogurt and/or low-fat cheese (11/2 ounces of cheese equals 1 cup of milk) every day. For kids aged 2 to 8, it’s 2 cups of milk. If you don’t or can’t consume milk, choose lactose-free milk products and/or calcium-fortified foods and beverages.
- Make half your grains whole Eat at least 3 ounces of whole-grain cereals, breads, crackers, rice, or pasta every day. One ounce is about 1 slice of bread, 1 cup of breakfast cereal, or 1/2 cup of cooked rice or pasta. Look to see that grains such as wheat, rice, oats, or corn are referred to as “whole” in the list of ingredients.
- Go lean with protein Choose lean meats and poultry. Bake it, broil it, or grill it. And vary your protein choices with more fish, beans, peas, nuts, and seeds.
Diet Considerations and Physical Activity for Pre-diabetes
| Goal |
Specific Recommendations |
| Increase physical activity |
Exercise for 30 minutes, five times a week |
| Maintain a healthy weight |
At least a loss of 7% of initial body weight (if BMI ≥ 25.0 kg/m2) |
| Decrease total fat and saturated fat |
Total fat not greater than 25-35% of calories; saturated fat not greater than 7% of calories |
| Emphasize monounsaturated fat |
Up to 20% of total calories |
| Decrease sugar and excess starch |
Not greater than 50-60% calories from carbohydrates, with emphasis on whole grains, fruits, and vegetables |
| Decrease sodium |
Not greater than 2400 mg/day |
| Increase fiber |
Up to 25-30 g/day |
| Increase antioxidants |
Up to nine servings of fruits and vegetables per day |
| Increase dietary Magnesium, Calcium, Potassium |
Per 2000 calories:
Magnesium(Mg) – 500 mg
Calcium(Ca) – 1200 mg
Potassium(K) – 4700 mg |
See Also
