Monday, August 20, 2012

What I have learned about Prediabetes


Over the past week I have been reading numerous websites like Diabetes Australia and the equivalent US and UK sites, World Health Organization (WHO), National Diabetes Information Clearinghouse (NDIC), various other health sites, books borrowed from the library, and the handouts I was given when I had gestational diabetes. I've got information from the sheet that had my blood test results and even from an obesity special of "Embarassing Bodies". What follows is my summary of all that information. I'm afraid it isn't referenced, and as figures varied slightly from source to source they might not always be what your favourite source gives. Also, most of the world measures blood sugar in mmol/L, any Americans reading will have to multiply by 18 to get mg/dl. Sorry if I've made any mistakes, but this is what I have learned about prediabetes.

What is Prediabetes?
Blood glucose (sugar) is managed by the pancreas. The human body likes a level of 4--6 mmol/L (millimoles per liter), and to achieve this the pancreas secretes several different hormones. When you haven't eaten for a while it secretes glucagon to increase your blood glucose level, when you eat it releases insulin which opens the cells of the body to let glucose in so you can use it. If you have type 2 diabetes, or to a lesser extent prediabetes; your muscles, fat, and liver don't respond properly to the insulin (insulin resistance). The pancreas releases more but eventually can't keep up, and excess glucose builds up in the blood and can do a lot of damage. The thirst and frequent urination that go with diabetes are caused by the kidneys trying to flush out all that extra glucose. (Type 1 diabetes is quite different, it occurs when the pancreas makes little or no insulin at all.)

A normal fasting level of glucose is less than 5.6 mmol/L. A reading of 5.6--6.9 is considered impaired fasting glucose. A reading of 7.0 of over is considered diabetes.

Two hours after drinking 75 grams of glucose, a normal reading is less than 7.8 mmol/L. A reading of 7.8--11.1 shows impaired glucose tolerance, a reading of over 11.1 is diabetes.

Both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are now called prediabetes. IGT carries a worse risk of developing into full-blown diabetes. People with prediabetes are ten times more likely to get diabetes, generally within ten years. One site suggested the average was three years. Prediabetes is almost completely preventable and reversable.

Who gets Prediabetes?
The risk assessment factors include:
# Age -- older people have a higher risk
# Gender -- men are more likely to get it
# BMI (body mass index) -- fatter people have a higher risk, in particular visceral fat* is a major contributor.
# Family history -- it has a genetic factor
# Heart rate -- high is bad
# Blood pressure -- high is bad
# A history of gestational diabetes or having given birth to a large baby
# A history of polycystic ovary syndrome

Obviously not all of these are preventable, but a lifestyle that includes a healthy diet and exercise can have a huge effect of BMI, heart rate, and blood pressure.

Visceral fat
Visceral fat is the fat that surrounds the abdominal organs, as opposed to subcutaneous fat which sits under the skin all over the body. An apple-shaped body is a good indicator of too much visceral fat. Visceral fat is associated with a much higher risk of prediabetes, diabetes, heart disease, metabolic syndrome, breast cancer, high blood pressure, gall bladder disease, and cancer of the colon and rectum. It causes a decrease in blood flow, and releases hormones into the blood that contribute to insulin resistance. Visceral fat is very, very bad; but fortunately it is the first to go when you lose weight. Even exercise without a restricted diet will reduce visceral fat.

What is so bad about Prediabetes?
Not only does it quickly lead to diabetes, if not treated, but risk factors for various problems are already increasing.
# Heart attack and stroke -- risk is double for prediabetic, double that again for a diabetic
# Damage to the blood vessels in the eyes can lead to blindness
# Alzheimer's risk doubles with diabetes
# Diabetes leads to kidney disease and possible kidney failure
# Nerve disease can lead to foot amputation
# A diabetic can expect a lot more sick days
# Sexual disfunction is common
# I have seen mentions of links to shoulder problems and periodontal disease as well

How do you prevent/reverse Prediabetes?
A weight reduction of only 5-7% can cause a 60% reduction in the incidence of diabetes. Compare this to a 31% reduced risk given by the diabetes drug metformin. A healthy weight, or even a healthier weight, is extremely important.

Exercise is vital, not only because it helps you to lose weight, but because exercise makes your cells more sensitive to insulin -- opposing insulin resistance. It also helps reduce some of the other diabetic risk factors like high blood pressure.

Frequent high glucose levels are doing damage to your pancreas and your vascular (blood) system, which is very dangerous. Damage to blood vessels in the brain can lead to a stroke, damage to blood vessels in the eyes can lead to blindness etc. Limit your intake of sugar and highly processed carbohydrates, and check your blood glucose levels to make sure they are within acceptable limits.

The Glucose Index is a way of measuring how quickly carbohydrates in food are converted to glucose in the blood. For diabetics and prediabetics, low GI foods are better because their blood glucose level rises more slowly and over a longer period rather than a quick spike.

# Lose weight
# Exercise
# Manage your carbohydrate intake, spreading them throughout the day. Aim for low GI foods.

Other issues
I have discussed topics that have seemed important to me in my particular circumstances. I haven't talked about medication or bariatric surgery for instance. So you might want to do some more research if you think you needhelp getting your prediabetes under control.

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