There's a diabetes epidemic in America: 17 million cases of Type 2 (adult onset) diabetes diagnosed, an estimated 6% of the U.S. population. And there are another 8 million undiagnosed. According to U.S. health authorities, the epidemic is growing...which means that there are millions of Americans in the condition of pre-diabetes who are at risk of becoming diabetic. The bad news is there is no cure yet for diabetes. This is the good news: pre-diabetes can be treated and stopped before it develops into full blown diabetes.
Simply defined, diabetes is the absence or the inability of insulin to support the metabolism of sugar/ glucose into energy. As a result, sugar builds up in the blood and when it is measured in an oral glucose tolerance test, a level of 200 mg/dl (milligrams per demiliter) is a diagnosis of diabetes mellitus. When the glucose is at the level between 140 and 200, the American Diabetes Association defines it as pre-diabetes. I wrote about this condition a decade ago when it was called insulin resistance (Understanding Insulin Resistance, Healthfair 1998).
Currently there is confusion in diagnosing and recognizing pre-diabetes—and even diabetes—by many physicians. The confusion arose because in the past, blood sugar measured at levels between 80 and 120 in the eight-hour fasting test were considered normal. Now blood sugar levels between 100 and 125 in the fasting test must be diagnosed as pre-diabetes (see graphs of tests below). In my practice, I consider a blood-glucose level of 90 mg/dl as risky. At this point, I want my patients to undertake therapeutic measures that will prevent them from becoming diabetics.
Other factors play a role in diagnosing pre-diabetes. The first step is physical observation. There is an 80% chance that persons seen with visceral adiposity (belly fat)—a waist measurement above 40 inches in a man and above 35 inches in a female—are at high risk for pre-diabetes and its dangerous consequence. Furthermore, recent studies have shown that persons with visceral adiposity, elevated triglycerides, and a family history, have 10 times the risk of developing full blown diabetes. There is scientific evidence that a significant percentage of persons with pre-diabetes will develop diabetes within 10 years.
There are solid reasons for preventing diabetes. Among its devastating complications is the fact that it predisposes a person for heart and other cardiovascular problems. Heart disease strikes persons with diabetes twice as often as persons without diabetes. In persons with diabetes, cardiovascular complications occur at an earlier age. Persons with diabetes are four times more likely to suffer strokes.
54 Million Pre-Diabetics!
The American Diabetes Association believes there are 54 million American pre-diabetics—unbeknownst to most of them, of course. And there is evidence that even at this inchoate stage the disease is causing damage to vital organs. Here is where we can make preventative progress, because there are proven therapies for heading off full-blown diabetes that work. The ADA outlines these steps for the "prevention or delay of type 2 pre-diabetes." While the outline discussed medications for insulin reduction, it most emphatically endorses (1) therapeutic lifestyle changes and (2) weight-loss dieting. Therapies like these might be familiar because the symptoms of pre-diabetes and the metabolic syndrome are quite similar—as are their treatments.
The Tests
Fasting Plasma Glucose (FPG). After an eight-hour fast, a blood test (see diagram at left) that shows a level of 100-125 mg/dl (yellow) signals pre-diabetes. In my practice, if I see a level of 90, I begin treatment. A level over 125 (red) in this test indicates diabetes.
Oral glucose tolerance test (OGTT). In this test (see diagram at left), the patient has fasted for 8-12 hours; blood is drawn and tested to establish a "baseline" blood glucose level. Then the patient drinks a sugary glucose drink-like an ultra-sweet cola, and after an hour the blood is checked. The process is repeated after three hours. If the body is unable to metabolize the glucose efficiently, it will remain and show up at high levels. In this test, a level between 140 and 200 mg/dl is pre-diabetes; a diagnosis of diabetes is when a level of 200 is reached at the second hour.
Hemoglobin A1C. For ongoing monitoring of diabetes there is the hemoglobin A1C test which uses a blood hemoglobin marker to determine the average level of glucose in the blood over a three-month period. An A1C level below 5 and from 5 to 5.7 is normal; 5.8 and 5.9 may indicate pre-diabetes. Levels above 6 indicate diabetes.
Urine Sample. An annual physical examination may include a urine sample. The sample can be tested for various conditions or infections. It may also be tested for diabetes. By itself, the urine test is indicative but not conclusive. If the results suggest diabetes, the doctor will order an OTGG.
The Symptoms
Lists of symptoms are always broad and all-encompassing and might point to any number of conditions threatening or benign. The standard symptoms of diabetes are unusual thirst, a frequent desire to urinate, blurred vision, and/or a feeling of being tired most of the time for no apparent reason. It is up to a physician to interpret the symptoms patients complain of within the context of his/her knowledge of each patient. For this reason it is a good practice to keep in touch with one's physician when there is a suspicion of pre-diabetes or any awareness of symptoms.
This blog is the first installment in a three-part series on managing pre-diabetes. In the second part, [0] Dr. V sits down for a Q&A, examining the topic of "The Ticking Clock."
About Dr. Vagnini
Dr. Vagnini is ELDR's chief medical advisor. He is the coauthor, along with ELDR Editor-in-Chief Dave Bunnell, of the book Count Down Your Age [1] (McGraw-Hill). To learn more about Dr. Vagnini, visit his website » [2]