Sunday, May 22, 2016

Pre-Diabetes

People with pre-diabetes have glucose levels that are higher than normal (i.e. above 100 mg/dl) but not high enough yet to indicate diabetes (i.e. above 125 mg/dl).

If you've been diagnosed as a pre-diabetic, you can prevent the onset of full-blown diabetes, but you must heed the warning and take action to change your eating habits and lifestyle.

Begin eating more whole foods such as vegetables, fruits, legumes, and whole grains; and start exercising on a consistent basis. Try to avoid eating grain for breakfast -- instead eat a vegetable, plant-based breakfast. In addition, cut back on eating theprocessed foods, fast foods, excess animal meat and living a sedentary lifestyle. Use theDeath to Diabetes program to get you started on the right track.

If possible, try to avoid taking any diabetic medication! Diabetic medications such as metformin(Glucophage) may lower your blood sugar, but these drugs don't do anything to prevent the onset of Type 2 diabetes! So, don't start taking a diabetic pill thinking that the pill is going to stop the diabetes from developing in your body. It won't.

If you're serious about preventing the onset of diabetes, you must educate yourself about diabetes, nutrition, and drugs. So, get the Death to Diabetes book to get you started on acquiring this important knowledge. It will empower you on so many levels --physically, emotionally, intellectually, spiritually, and eventually financially.

Definition of Pre-Diabetes
Pre-diabetes is the state in which some but not all of the diagnostic criteria for diabetes are met. It is often described as the “gray area” between normal blood sugar and diabetic levels.

In general, you are pre-diabetic if your blood glucose level is between 101 mg/dl and125 mg/dl. If your fasting blood glucose is above 126 mg/dl, then, you are probably diabetic.

While in this range, patients are at risk for not only developing Type 2 diabetes, but also for cardiovascular complications.  It has been termed "America's largest healthcare epidemic," affecting more than 60 million Americans.  Pre-diabetes is also referred to as borderline diabetes, impaired glucose tolerance (IGT), or impaired fasting glucose (IFG).

Impaired fasting glycemia or impaired fasting glucose (IFG) refers to a condition in which the fasting blood glucose is elevated above what is considered normal levels but is not high enough to be classified as diabetes mellitus. It is considered a pre-diabetic state, associated with insulin resistance and increased risk of cardiovascular pathology, although of lesser risk than impaired glucose tolerance (IGT). IFG sometimes progresses to Type 2 diabetes mellitus. There is a 50% risk over 10 years of progressing to overt diabetes. A recent study cited the average time for progression as less than three years.  IFG is also a risk factor for mortality.

Blood Tests for Pre-Diabetes
Two blood tests are commonly used to determine if you have diabetes or prediabetes:
-- Fasting plasma glucose test (FPG)
-- Oral glucose tolerance test (OGTT)

These tests measure how quickly your body can "clear" glucose from your blood. 

Fasting plasma glucose test (FPG)
The fasting plasma glucose test can be done after an overnight fast or after an eight-hour fast during the day. It is a relatively easy, inexpensive test. After the fast, a simple blood test measures glucose levels before you eat again. The test results indicate whether your blood glucose level is normal or whether you have pre-diabetes or diabetes:

    * Normal:  less than 100 mg/dl
    * Pre-diabetes: 101-125 mg/dl 
    * Diabetes: greater than 125 mg/dl

 
Oral glucose tolerance test (OGTT)
The OGTT usually requires that you have the fasting glucose test first. Then you take a dose of high-sugar (glucose) solution to challenge your body to clear the glucose from your blood. After two hours, another blood glucose test is done. The final test results indicate whether you have a normal level of blood glucose or have pre-diabetes or diabetes:

    * Normal: less than 140 mg/dl 
    * Pre-diabetes: 140-199 mg/dl 
    * Diabetes: greater than 199 mg/dl


Signs and Symptoms
Pre-diabetes typically has no signs or symptoms. Patients should monitor for signs and symptoms of type 2 diabetes mellitus. These include the following:

    * Constant hunger
    * Unexplained weight loss
    * Weight gain
    * Flu-like symptoms, including weakness and fatigue
    * Blurred vision
    * Slow healing of cuts or bruises
    * Tingling or loss of feeling in hands or feet
    * Recurring gum or skin infections
    * Recurring vaginal or bladder infections

Possible Causes

    * Sleep disorders
    * Family history of diabetes
    * Impaired glucose levels and/or metabolic syndrome
    * Cardiovascular disease
    * Hypertension (high blood pressure)
    * Increased triglycerides levels
    * Low levels of good cholesterol (HDL)
    * Overweight or obese
    * Women who have had gestational diabetes, had high birth weight babies (greater than 9 lbs.), and/or has Polycystic Ovarian Syndrome (PCOS)[10]


In a way, pre-diabetes is a misnomer since it is an early stage of diabetes. It is now known that the health complications associated with type 2 diabetes often occur before the medical diagnosis of diabetes is made.

Pathophysiology
Diabetes mellitus (DM) 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. DM 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, or microvascular, as seen with retinopathy, nephropathy, and neuropathy.

Normal glucose homeostasis is controlled by three interrelated processes. There isgluconeogenesis (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. DM and some of those with pre-diabetes 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.

Prevention
The goals of prevention are to delay the onset of type 2 diabetes, preserving the function of the beta cells, and preventing or delaying the microvascular and cardiovascular complications. Obesity is an extremely important environmental influence, therefore, exercise, weight loss, and proper nutrition are critical. It has been found that lifestyle modification/intervention provides the greatest benefit in preventing the progression into type 2 diabetes.

The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) have developed lifestyle intervention guidelines for preventing the onset of type 2 diabetes:

    * Healthy meals (whole foods, limited processed/fast foods)
    * Physical exercise (30 minutes of exercise per day, five days a week)

Many studies showed that a balanced plant-based diet (such as the Death to Diabetes diet) is a very valuable prevention and treatment tool in diabetes and pre-diabetes. Previous advice focused on low-fat approaches, which haven't worked. In fact, low-fat diets have actually helped to make us fatter!

Screening
Fasting plasma glucose screening should begin at age 30-45 and be repeated at least every three years. Earlier and more frequent screening should be conducted in at-risk individuals. The risk factors for which are listed below:

    * Family history (parent or sibling)
    * Dyslipidemia (triglycerides > 200 or HDL < 35)
    * Overweight or obese (body mass index > 25)
    * History of gestational diabetes or infant born with birth weight greater than 9 lb (4 kg)
    * High risk ethnic group
    * Hypertension (systolic blood pressure >140 mm Hg or diastolic blood pressure > 90 mm Hg)
    * Prior fasting blood glucose > 99
    * Known vascular disease
    * Markers of insulin resistance (PCOS, acanthosis nigricans)

Key Point: If possible, ensure you get the hemoglobin A1C test! This may be a better indicator of blood glucose control than the fasting blood glucose test.

Diagnosis
Pre-diabetes is usually diagnosed with a blood test:

    * Fasting blood sugar (glucose) level of:
          o 110 to 125 mg/dL (6.1 mM to 6.9 mM) - WHO criteria
          o 100 to 125 mg/dL (5.6 mM to 6.9 mM) - ADA criteria
    * Two hour glucose tolerance test after ingesting the standardized 75 Gm glucose solution the blood sugar level of 140 to 199 mg/dL (7.8 to 11.0 mM).
    * Glycated hemoglobin between 5.7 and 6.4 percent

Levels above these limits would be a diagnosis for diabetes.

Management
Persons with pre-diabetes actually have the same complications as persons with diabetes, only less frequently. They run the risk of developing diabetic eye disease, nerve damage, and early diabetic kidney disease with excess protein in the urine. Patients with pre-diabetes are also thought to already have an increased risk of heart and blood vessel disease.

Intensive weight loss and lifestyle intervention, if sustained, can substantially improve glucose tolerance and prevent progression from IGT to type 2 diabetes. The Diabetes Prevention Program (DPP) study found a 16% reduction in diabetes risk for every kilogram of weight loss. Reducing weight by 7% through a balanced 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.

If at all possible, try to avoid taking any diabetic medication such as Metformin! These drugs will not prevent the onset of diabetes! In fact, they may even fuel the onset.

Prognosis
The progression to type 2 diabetes mellitus is not inevitable for those with pre-diabetes  The progression into diabetes mellitus from pre-diabetes is approximately 25% over three to five years. However, this percentage can be reduced to almost 0%  if patients followed a nutrition/lifestyle-driven program such as the Death to Diabetes Wellness Program.

Epidemiology
Studies conducted from 1988-1994 indicated that at that time, 33.8% of the US population 40–74 years of age had IFG, 15.4% had IGT, and 40.1% had pre-diabetes (IFG, IGT, or both). Eighteen million people (6.3% of the population) had type 2 diabetes in 2002. In 2008, the diabetic population has grown to 24 million, almost 7% of the population.

Note: If you want to to learn more about diabetes and if you're serious about defeating your diabetes, request a free copy of the author's research paper titled The 7 Mistakes That Diabetics  Make.

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References

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