Prediabetes is the state in which some but not all of the diagnostic criteria for diabetes mellitus are met. Prediabetes is described as the “gray area” between normal blood sugar and diabetic levels.

Prediabetes is a stage between normal and diabetes mellitus stage. It is an alarming sign for upcoming diabetes mellitus or a chance to change your future. Universally, numerous terms are given like, Borderline Diabetes, Chemical Diabetes, Touch of Diabetes etc. According to the ADA statistics 17 million US citizens have diabetes mellitus and 16 millions have prediabetes. ADA defines it as a stage before the development of diabetes mellitus, with normal glucose tolerance, but with an increased risk of developing diabetes mellitus in near future.

Prediabetes is a condition when your blood sugar level triggers higher than normal, but not so high that we can justify it as type 2 diabetes mellitus. According to the Centers for Disease Control and Prevention, 41 million U.S. adults aged 40 to 74 have prediabetes. And the same reports from, The American Academy of Pediatrics show that, one of every 10 males and one of every 25 females have prediabetes aged from 12 to 19 years.

Signs and Symptoms of Prediabetes

          Prediabetes can take a long time to transform finally as diabetes mellitus. It has been generally observed that prediabetes will eventually convert to diabetes mellitus but, at the same time, there are greater possibilities to revert back to normal if taken care seriously. People suffering from prediabetes may show same symptoms as in diabetes mellitus but, they will be erupting occasionally like:

  • Excessive thirst 
  • Unexplained weight loss
  • Tingling sensations in feet and fingers
  • Excess Hunger 
  • Flu-like symptoms, including weakness and fatigue
  • Frequent Urination
  • Irritability
  • Frequent infections
  • Blurred vision
  • Skin itching

Causes of Prediabetes

          The exact cause of prediabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of prediabetes.

          What is clear is that people who have prediabetes aren't quite processing sugar (glucose) properly anymore. This causes sugar to build up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues. Most of the glucose in your body comes from the foods you eat, specifically foods that contain carbohydrates. Any food that contains carbohydrates can affect your blood sugar levels, not just sweet foods. During digestion, sugar enters your bloodstream and with the help of insulin is then absorbed into the body's cells to give them energy.

          Insulin is a hormone that comes from the pancreas, a gland located just behind the stomach. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key that unlocks microscopic doors that allow sugar to enter your cells. Insulin lowers the amount of sugar in your bloodstream. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

When you have prediabetes, this process begins to work improperly. Instead of fueling your cells, sugar builds up in your bloodstream. This occurs when your pancreas doesn't make enough insulin or your cells become resistant to the action of insulin or both.

Diagnosis of Prediabetes

          People with prediabetes will never know by their own about their high blood sugar. If they are suffering from the mentioned factors which indicates risk zone, they should periodically go for routine check up and should be cautious enough about the given signs and symptoms. Once they crossed the age of 45, they must routinely visit a doctor and ask for its diagnosis.

There are two types of blood tests to determine whether you are suffering from prediabetes or not, they are as follows:

Fasting blood glucose test : A fasting blood sugar level under 100 milligrams of glucose per deciliter of blood (mg/dl) is considered normal. If your blood sugar level is 100 to 125mg/dL, you have prediabetes - also called impaired fasting glucose (IFG). If you are suffering from prediabetes then the fasting blood sugar as well as post postprandial blood sugar will fluctuate easily.

Oral Glucose Tolerance Test (OGTT) : After fasting for at least eight hours, FBS (fasting blood sugar) is checked and then an oral dose of 8 ounce sugary syrup is administered. The blood glucose level is checked after an hour and if it reaches 144-199 mg/dl after two hours, you have impaired glucose tolerance.

Pathophysiology of prediabetes

          Diabetes mellitus is a group of metabolic diseases that are characterized by hyperglycemia and defects in insulin production in the pancreas and/or impaired tolerance to insulin effects. Diabetes Mellitus is a leading cause of morbidity and mortality. Because the disease can be insidious, the diagnosis is often delayed. Effects of the disease can be macrovascular, as seen in the cardiovascular system/arthrosclerosis, or microvascular, as seen with diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy.
Normal glucose homeostasis is controlled by three interrelated processes. There is gluconeogenesis (glucose production that occurs in the liver), uptake and utilization of glucose by the peripheral tissues of the body, and insulin secretion by the pancreatic islet cells. What triggers the production and release of insulin from the pancreas is the presence of glucose in the body. The main function of insulin is to increase the rate of transport of glucose into certain cells of the body, such as striated muscles, fibroblasts, and fat cells. It is also necessary for transport of amino acids, glycogen formation in the liver and skeletal muscles, triglyceride formation from glucose, nucleic acid synthesis, and protein synthesis.
Insulin enters cells by first binding to target insulin receptors. Diabetes mellitus and some of those with prediabetes have impaired glucose tolerance—in these individuals, blood glucose rises to abnormally high levels. This may be from a lack of pancreatic hormone release or failure of target tissues to respond to the insulin present or both.

Risk factors of Prediabetes

          The same factors that increase the risk of developing type 2 diabetes mellitus increase the risk of developing prediabetes, including:

  • Extra weight. Being overweight is a primary risk factor for prediabetes. The more fatty tissue you have — especially inside and between the muscle and skin around your abdomen — the more resistant your cells become to insulin.
  • Inactivity. The less active you are, the greater your risk of prediabetes. Physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.
  • Advancing age. The risk of prediabetes increases as you get older, especially after age 45. This may be because people tend to exercise less, lose muscle mass and gain weight as they age. However, older people aren't the only ones at risk of prediabetes and type 2 diabetes mellitus. The incidence of these disorders is also rising in younger age groups.
  • Family history. The risk of prediabetes increases if a parent or sibling has type 2 diabetes mellitus.
  • Race. Although it's unclear why, people of certain races — including African-Americans, Hispanics, American Indians, Asian-Americans and Pacific Islanders — are more likely to develop prediabetes.
  • Gestational diabetes mellitus. If you developed gestational diabetes mellitus when you were pregnant, your risk of later developing diabetes mellitus increases. If you gave birth to a baby who weighed more than 9 pounds (4.1 kilograms), you're also at increased risk of diabetes mellitus.
  • Polycystic ovary syndrome. For women, having polycystic ovary syndrome — a common condition characterized by irregular menstrual periods, excess hair growth and obesity — increases the risk of diabetes mellitus.
  • Sleep. Several recent studies have linked a lack of sleep or too much sleep to an increased risk of insulin resistance. Research suggests that regularly sleeping fewer than six hours or more than nine hours a night might up your risk of prediabetes or type 2 diabetes mellitus.

Complications of Prediabetes

          Progression into type 2 diabetes mellitus is the most serious consequence of untreated prediabetes.

Type 2 diabetes mellitus complications include:

  • High blood pressure
  • High cholesterol
  • Heart disease
  • Stroke
  • Kidney disease
  • Blindness
  • Amputations

Management of Prediabetes

          Intensive weight loss and lifestyle intervention, if sustained, can substantially improve glucose tolerance and prevent progression from IGT to type 2 diabetes mellitus. The Diabetes Prevention Program (DPP) study found a 16% reduction in diabetes mellitus risk for every kilogram of weight loss. Reducing weight by 7% through a low-fat diet and performing 150 minutes of exercise a week is the goal. The ADA guidelines recommend modest weight loss (5-10% body weight), moderate-intensity exercise (30 minutes daily), and smoking cessation.
For patients with severe risk factors, prescription medication may be appropriate. This can be considered in patients for whom lifestyle therapy has failed or is not sustainable and who are at high-risk for developing type 2 diabetes mellitus. Metformin and acarbose help prevent the development of frank diabetes mellitus, and also have a good safety profile. Evidence also supports thiazolidinediones but there are safety concerns, and data on newer agents such as GLP-1 receptor agonists, DPP4 inhibitors or meglitinides are lacking.

Treatments and drugs for Prediabetes

          If you have prediabetes, healthy lifestyle choices can help you bring your blood sugar level back to normal or at least keep it from rising toward the levels seen in type 2 diabetes mellitus. Guidelines from the American College of Endocrinology suggest the following to treat prediabetes:

Eat healthy foods. Choose foods low in fat and calories and high in fiber. Focus on fruits, vegetables and whole grains. Strive for variety to help you achieve your goals without compromising taste or nutrition.

Get more physical activity. Aim for 30 to 60 minutes of moderate physical activity at least five days a week. Take a brisk daily walk. Ride your bike. Swim laps. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day.

Lose excess weight. If you're overweight, losing just 5 to 10 percent of your body weight — only 10 to 20 pounds (4.5 to 9 kilograms) if you weigh 200 pounds (91 kilograms) — can reduce the risk of developing type 2 diabetes mellitus. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Motivate yourself by remembering the benefits of losing weight, such as a healthier heart, more energy and improved self-esteem.

Take medications as needed. Sometimes medications — such as the oral diabetes mellitus drugs metformin (Glucophage) and acarbose (Precose) — also are an option if you're at high risk of diabetes mellitus. This includes if your prediabetes is worsening or you have cardiovascular disease, fatty liver disease or polycystic ovary syndrome. Some studies have indicated that pioglitazone (Actos) and similar drugs, which improve insulin sensitivity, might help reduce the risk of converting from prediabetes to diabetes mellitus, but were associated with weight gain and water retention (edema).
In other cases, medications to control cholesterol — statins, in particular — and medications to control high blood pressure are needed. Healthy lifestyle choices remain essential, however.

Because the findings from several recent studies suggest that regularly getting a good night of sleep may reduce insulin resistance, try to get at least six hours or more of sleep each night.

Prevention of Prediabetes

          Unlike diabetes mellitus, prediabetes is a reversible condition with the administration of proper medication and life style modification. Thus prediabetes can be prevented with right diet and exercise.

Healthy Choices Of Food : The selection of right type of food is extremely important at this stage. One should restrict to food with low fat and low calories, and on the other side, fresh fruits and vegetables with lots of antioxidant should be the preferred choice.

Life-style modification : The person with less physical activity and sedentary life are at the risk of falling prey to prediabetes. The best way to keep ourselves active is by, walking, using stairs as far as possible, and spending daily 30 mins for some specific exercise like yoga.

Maintain ideal body weight : The persons who are overweight may develop more complications in the maintenance of normal blood sugar level, thus it is advised to maintain ideal body weight. To reduce excess of weight they should see a registered dietitian, and by working with your doctor, follow your treatment plan. It can help you to keep your prediabetes from worsening and developing into type 2 diabetes mellitus.

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