PreDiabetes is a very common medical condition which unfortunately remains undiagnosed in a majority of people. About 60 million Americans are estimated to be suffering from it and yet don’t know it.
“Do I have PreDiabetes?”
You have PreDiabetes if you have one of the following two conditions:
1. Impaired fasting Glucose (IFG)
2.Impaired Glucose Tolerance (IGT)
Impaired fasting glucose (IFG) and Impaired glucose tolerance (IGT) are precursors for diabetes and therefore, are also known as pre-diabetes.
From a medical standpoint, these conditions should be regarded as early diabetes. The development of diabetes is a long process that usually spans a period of 10-20 years. During this time, the process of insulin resistance is going on. Insulin resistance is the underlying cause for IFG and IGT.
Diagnosis of Impaired Fasting Glucose
You have impaired fasting glucose if your fasting blood glucose is more than 100 mg/dl. but less than 125 mg/dl.
Diagnosis of Impaired Glucose Tolerance
Impaired glucose tolerance is diagnosed on a 2 hours oral glucose tolerance test.
In many patients with impaired glucose tolerance, a routine fasting blood glucose test is often normal.
Therefore, this important condition can be missed if an oral glucose tolerance test is not performed.
An excellent article published in 1999 in the Archives of Internal Medicine, compared the fasting blood glucose test versus the 2 hours oral glucose tolerance test. In this landmark study, known as the Decode study, a total of 22,514 individuals were followed for a mean duration of 8.8 years. The authors looked at the number of deaths due to various stages of glucose abnormalities (impaired glucose tolerance, impaired fasting glucose, and diabetes). A large number of deaths were attributable to impaired glucose tolerance. Many of these individuals had a normal fasting blood glucose. They would not have been diagnosed if only the fasting blood glucose test was given.
Unfortunately, most physicians in the US rely only on the fasting blood glucose. They don’t take the extra step of doing an oral glucose tolerance test. Consequently, this important medical condition with serious complications remains largely undiagnosed.
Glucose Tolerance Test
2 hours Oral Glucose Tolerance Test is done in the morning after an overnight fast of about 12 hours. A blood sample is drawn for glucose measurement. The patient is then given a glucose drink, which contains 75 grams of glucose. Two hours later, another blood sample is drawn for glucose measurement. The patient does not eat or drink during this two hours period.
The test results are interpreted as follows:
Fasting blood glucose:
70 – 99 mg/dl = Normal.
100–125 mg/dl = Impaired Fasting Glucose.
More than 125 mg/dl = Diabetes.
Blood glucose at 2 hours:
Less than 140 = Normal
140 – 200 mg/dl = Impaired Glucose Tolerance
More than 200 mg/dl = Diabetes
Why is it so important to diagnose Impaired Glucose Tolerance?
Impaired Glucose Tolerance is just the tip of the iceberg. In fact, these patients are suffering from a much more complicated disease process called insulin resistance.
These patients are at high risk for heart disease, stroke, dementia, peripheral neuropathy and leg amputations.
A number of excellent scientific studies clearly show that patients with impaired glucose tolerance have a markedly increased risk for heart disease. These famous studies include the Chicago Heart Study , the Rancho Bernardo Study , the Honolulu Heart Study and the Funagata Diabetes Study. These landmark studies were published in the journal of the American Diabetes Association, Diabetes Care in 1997, 1998 and 1999 respectively.
Data from the Second National Health and Nutrition Examination Survey Mortality Study was recently analyzed by the researchers at the Johns Hopkins University School of Medicine. It was concluded that in the US population, there is 40% greater risk for cardiovascular mortality in individuals with impaired glucose tolerance. This study was published in 2001 in Diabetes Care.
In the Hoorn Study, people in the Dutch town of Hoorn with impaired glucose tolerance were found to have a higher risk for cardiovascular mortality. This study was published in 1999 in the prestigious Europian journal, Diabetologia.
Patients with impaired glucose tolerance are also at high risk for narrowing of the carotid arteries, which places them at risk for stroke, mini-stroke and dementia.
Yamasaki and his colleagues did an excellent study published in Diabetologia in 1995. Utilizing ultrasounds of carotid arteries, they demonstrated that patients with impaired glucose tolerance have narrowing of these blood vessels.
In the Hoorn Study, impaired glucose tolerance was found to be a risk factor for the narrowing of the carotid arteries.
In my clinical experience, impaired glucose tolerance is frequently found in patients with stroke and dementia.
Impaired glucose tolerance is the underlying cause for peripheral neuropathy in a number of patients who do not have any obvious cause for their peripheral neuropathy.
Symptoms of peripheral neuropathy include numbness, pain, tingling or a burning sensation, usually in the feet and at times, in the fingers as well.
In three recently published studies, investigators looked at patients with peripheral neuropathy of unknown cause and gave them an oral glucose tolerance test. In these studies, a significant number of patients had impaired glucose tolerance as the cause for their neuropathy. Authors of these studies recommend using an oral glucose tolerance test in patients with peripheral neuropathy of an unknown cause.
My own clinical experience certainly confirms these observations. I have seen a number of patients who were diagnosed with peripheral neuropathy, but no cause could be found. These patients had undergone extensive diagnostic testing, except for the oral glucose tolerance test. Once I ordered the oral glucose tolerance test, these patients were diagnosed with impaired glucose tolerance or diabetes.
Patients with Impaired Glucose Tolerance are at high risk for the development of diabetes. About 10% of patients with impaired glucose tolerance become diabetic every year. Therefore, within ten years, almost all patients with this condition will become diabetic.
Progression to full-blown diabetes can be prevented in these patients if this condition is properly diagnosed and aggressively treated.
Like diabetes, impaired glucose tolerance is a disease and can easily be diagnosed with an Oral Glucose Tolerance test. The importance of impaired glucose tolerance as a disease state was emphasized by an excellent article published in Diabetes Care in 1999 .
Sadly, most physicians do not order the Oral Glucose Tolerance test and therefore, this very important condition remains undiagnosed in a majority of patients.
In an excellent article published in Diabetes Care, the author reviewed extensive scientific evidence of the significance of diagnosing impaired glucose tolerance in the clinical practice .
In order to prevent devastating medical conditions such as diabetes, heart disease, stroke, peripheral neuropathy, dementia, kidney failure, blindness and leg amputation, physicians should start using the Oral Glucose Tolerance test.
Who is at risk for PreDiabetes?
Following are the risk factors that increase your likelihood of PreDiabetes:
1. Over the age of 30.
2. Overweight, especially if your waist-line is more than forty inches if you are a male or more than thirty-five inches if you are a female.
3. Sedentary lifestyle.
4. High blood pressure.
5. Triglycerides level more than 150 mg/dl.
6. HDL cholesterol level is low (less than 40 mg/dl if you are a male or less than 50 mg/dl if you are a female).
Several scientific studies have shown that the decline in glucose tolerance usually begins in the third decade and continues throughout adult life.
In a study published in July 2001 in Diabetes Care , Japanese investigators reviewed data from 13,694 individuals who underwent a 2 hours oral glucose tolerance test during a health screening in Japan between 1994 to 1999.
In this study, the fasting blood glucose level, aging, obesity, high triglycerides level and blood pressure were strongly associated with impaired glucose tolerance.
However, there were a number of individuals who had a normal fasting blood glucose, but turned out to have impaired glucose tolerance on an Oral Glucose Tolerance Test, especially in older individuals.
Aging is a strong predictor of impaired glucose tolerance. It is estimated that there is a mean increase of 9.4 mg/dl per decade in the values of 2 hours post meal blood glucose, starting at age thirty. The authors of this article stress the importance of performing an Oral Glucose Tolerance Test, especially in older individuals.
In another large study from Sweden published in 1999 in Diabetes Care 21,057 men and women aged 30-60 years underwent an oral glucose tolerance test. The risk for impaired glucose tolerance was higher among individuals with obesity, high blood pressure, high triglycerides level and a family history of diabetes. However, more than 70% of individuals did not have any family history of diabetes. Also impaired glucose tolerance was present in a number of non-obese individuals.
Who should be tested for Prediabetes-Impaired Glucose Tolerance (IGT)?
Any individual with the following conditions should have an oral glucose tolerance test to diagnose the state of impaired glucose tolerance:
1. Everybody over the age of 30.
2. Obese individuals, even under the age of 30.
3. People with high blood pressure. People with low HDL cholesterol. People with high triglycerides.
4. People with a fasting blood glucose between 100 – 125 mg/dl. (A fasting blood glucose greater than 125 mg/dl is diagnostic for diabetes and these patients do not need an oral glucose tolerance test).
5. People with coronary artery disease, including those who have had angioplasty, stent placement or heart bypass surgery.
6. People with stroke, mini-stroke, dementia or memory loss.
7. People with peripheral vascular disease, also known as poor circulation in the legs.
8. People with peripheral neuropathy, which often manifests as pain, tingling or numbness in feet, which is usually worse at night.
9. Women with Polycystic Ovary Syndrome.
10. Women with a history of gestational diabetes.
Treatment of PreDiabetes
PreDiabetes (IGT and or IFG) is a marker for Insulin Resistance Syndrome. Therefore, treatment should aim to reduce insulin resistance and prevent complications of Insulin Resistance Syndrome such as heart attack, stroke and dementia.
This treatment should also prevent the progression to frank diabetes.
Therefore, the goals of treatment of impaired glucose tolerance are:
- To prevent heart attack, stroke and dementia.
- To prevent progression to frank diabetes.
- Try to revert to normal glucose tolerance.
1. Stress Management
Stress of daily living is a major factor that causes prediabetes. Stress increases your cortisol level and adrenaline level. Both of these hormones worsen your insulin resistance. Therefore, stress management is the most important step in treating your prediabetes.
Stress comes from the busy mind. What is the basis of the busy mind and how to be free of it? Learn it from my book, “Stress Cure Now.”
A low-carbohydrate diet helps to treat PreDiabetes and prevent it from getting worse.
For diet, the key element is consistency and awareness about your eating habits.
You can break your old eating habits. Just be aware of them and don’t get taken over by them. See detailed explanation how to break your eating habits in “Stress Cure Now.”
I have formulated an Herbal combination that may help you to cope with the stress of daily living. It is called Stress Buster.
Aerobic exercise helps to treat insulin resistance. In this way, exercise is an important tool in treating PreDiabetes.
How much exercise? Just about 30 minutes a day.
For example, walking 30 minutes a day is an excellent exercise. Consistency is important.
4. Vitamins and Herbs
Certain Vitamins and herbs have been shown to reduce insulin resistance in excellent scientific studies. These vitamins/herbs are:
There are two drugs that treat insulin resistance. These are Metformin and Pioglitazone. These drugs are approved for the treatment of Type 2 diabetes. Each has potential side-effects, which you should explore and discuss with your health care professional before you embark on either of these medications.