Pre-Diabetes

PRE-DIABETES

Pre-diabetes puts a patient at high risk for developing diabetes and should be treated aggressively.

What is prediabetes?

This is a condition when a person’s blood sugars are mildly elevated, an early stage of diabetes mellitus. This would be defined one of three sugar testing methods:

1. Fasting blood sugar more than 100 and less than 125 mg/dl.
2. Hemoglobin-A1c testing of 5.7% to 6.4%
3. After a 75 gram dose of glucose, a 2 hour glucose value of more than 140 and less than 200 mg/dl

What causes pre-diabetes?

Pre-diabetes is caused by multiple genes that a patient has inherited which can be activated by obesity, poor diet, certain medications, and other causes. These factors increase insulin resistance and are the same reasons that patients develop diabetes mellitus type 2. This is not a condition that occurred overnight.

What are the symptoms of prediabetes?

Just like diabetes mellitus, there are usually no symptoms. Some patients will notice weight gain or fatigue. Read more.

Who is at risk?

If you answer yes to any of these questions, you may be at increased risk

1. Do you have a relative with diabetes mellitus? Parent, Uncle, Aunt, Sibling, Grandparent
2. Are you gaining weight and is your body mass index higher than 24? 
3. Do you already have high blood pressure, high cholesterol, sleep apnea, or kidney problems?

What is the treatment for pre-diabetes?

The most important treatment for this condition is early and sustained weight loss. Initial weight loss of 7% is suggested. Because the problem is rooted in genetics and exacerbated by weight and lack of activity, the sooner this weight comes off the better. There are some off label medications that can be used. Let the endocrinologists at Inter American Diabetes and Endocrinology help you reduce your risk. The sooner you lose weight, the lower your risk for diabetes mellitus. This time-dependent early-weight-loss cannot be more emphasized. The longer you wait to lose weight the less chance you have for recovery.

As an example of the importance of this time-dependent-weight-loss: think of being overweight (a body mass index with a more than 24) activates diabetes genes which promote insulin resistance. Imagine an insulin receptor like a “door” with “hinges”. The ease at which the “hinges” work is the insulin resistance. The fat on you acts like “rust” on the “door hinges”. Weight loss has the effect of improving insulin resistance like clearing off the “rust” from the “hinges”. If you let the “rust” stay for a long period of time then hinges break and the sooner diabetes mellitus will happen. The sooner you remove the “rust” the better the function of the receptors, the longer you will be free of diabetes.

What are the consequences of pre-diabetes?

According to the DPP trial, there is a 40% chance over 4 years that a person with pre-diabetes will progress to true type 2 diabetes mellitus . Diabetes mellitus has many long-term-consequences and short-term-consequences. A review of the consequences of pre-diabetes are here.