Chapter One
The Origins and Dangers of Prediabetes
In This Chapter
* Crossing the line from health to prediabetes to diabetes
* Noting the recent origin of prediabetes
* Figuring out who is affected
* Calculating the costs
About 60 million people in the United States have prediabetes. That means if you are in a room with three other adult U.S. citizens, one of you will probably have prediabetes, and chances are that person won''t know it. The purpose of this book is to radically change that situation. Anyone who reads this book will know whether he or she has prediabetes. Anyone who follows the recommendations in this book will not proceed to diabetes and will probably return to normal health.
REMEMBER
This book will not make you younger, but it will help you continue to get older.
Diagnosing prediabetes is crucial because prediabetes is the critical step before developing diabetes. As you find out in this book, diabetes is associated with complications that may cause considerable physical and mental discomfort at best and be life-threatening at worst. So you don''t want to go there.
Even if you go on to develop diabetes, all is not lost. You can use the suggestions found here to avoid further complications. You can''t get rid of the diagnosis, but you can get rid of the problems.
In this chapter, you discover how to differentiate among three physical states: normal health, prediabetes, and diabetes. I explain that prediabetes is a recent phenomenon, which parallels the epidemic of obesity and lack of exercise in the United States and around the world.
Next, you discover who is affected by prediabetes and which groups of people are at the highest risk. I also touch on special considerations for children and the elderly at risk for prediabetes.
Finally, I focus on the costs of prediabetes, which are not only monetary. I explain that even though prediabetes is often considered a benign condition and not a disease, changes occur in the body of a person with prediabetes that may not be benign after all.
Distinguishing Prediabetes from Diabetes
ANECDOTE
Jane Johnson is a 48-year-old woman. She is postmenopausal and has gained about 15 pounds since her twenties, when her weight was normal. She complains of some fatigue. She goes to Dr. Sugarfeld, who discovers that Jane has family members with diabetes. Jane mentions that she used to be physically active but doesn''t have the time to do much exercise these days. A physical examination reveals only that Jane is overweight and has mild high blood pressure, so Dr. Sugarfeld sends her for blood tests. One of the blood tests the doctor orders is called a fasting blood glucose, and it discovers the level of sugar in someone''s blood in the morning after that person has fasted through the night.
When Jane returns a week later, Dr. Sugarfeld informs her that her fasting blood glucose was 114 mg/dl (6.3 mmol/L). (In the Introduction to this book, I explain what mg/dl and mmol/L stand for, in case you''re interested.) The doctor asks Jane to have one more fasting blood glucose test. This value is 108 mg/dl (6 mmol/L). Dr Sugarfeld informs Jane that she has prediabetes.
Going from normal to prediabetes
This anecdote describes one of the most common ways that prediabetes is discovered. Another common occurrence is simply the discovery that the blood glucose - the amount of sugar in the blood - is higher than it should be in a routine blood test.
The diagnosis of prediabetes is made the same way that a diagnosis of diabetes is made: by doing a blood glucose test in the laboratory. The critical values (numbers) in the test results are as follows:
A normal fasting blood glucose result is less than 100 mg/dl (5.6 mmol/L).
Prediabetes is diagnosed when the fasting blood glucose is between 100 and 125 mg/dl (5.66.9 mmol/L) on more than one occasion.
Diabetes is diagnosed when the fasting blood glucose is 126 mg/dl (7 mmol/L) or greater on more than one occasion.
A normal blood glucose level two hours after eating 75 grams of glucose is less than 140 mg/dl (7.8 mmol/L).
Prediabetes is diagnosed when the glucose two hours after eating 75 grams of glucose is between 140 and 199 mg/dl (7.811.1 mmol/L) on more than one occasion.
Diabetes is diagnosed when the glucose two hours after eating 75 grams of glucose is 200 mg/dl (11.1 mmol/L) or greater on more than one occasion.
Here''s what I can hear you saying: "You mean if my blood glucose is 99 mg/dl after fasting I don''t have prediabetes, but if my blood glucose is 100 mg/dl - one measly milligram of glucose more - I do?" I''m afraid so.
REMEMBER
These definitions are arbitrary. They have changed in the past, and they may do so again depending on scientific studies. For example, a fasting glucose result of greater than 140 mg/dl (7.8 mmol/L) used to be the cutoff point for a diagnosis of diabetes. Then doctors discovered that people who had fasting glucose levels below 140 mg/dl suffered from the complications of diabetes without having a diagnosis of diabetes. So they lowered the level for the diagnosis to 126 mg/dl (7 mmol/ L). Unfortunately, even some people with fasting blood glucose levels below 126 have shown up with complications of diabetes.
You should be familiar with some other terms for these levels of blood glucose, because you will likely read or hear about them:
Impaired fasting glucose (IFG) is another name for the condition where the fasting blood glucose is between 100 and 125 mg/dl (5.66.9 mmol/L) after an overnight fast.
Impaired glucose tolerance (IGT) is another name for the condition where the blood glucose is between 140 and 199 mg/dl (7.811.1 mmol/L) two hours after eating 75 grams of glucose.
Some people have impaired fasting glucose, while others have impaired glucose tolerance. Still others have both conditions combined, so the total number of people with prediabetes is not the sum of the people with IFG plus the people with IGT.
REMEMBER
Other terms that you may hear should be disregarded because they have no clear meaning and are no longer used scientifically. These include:
Borderline diabetes
Touch of sugar
(It''s important to get your terms straight. Otherwise, you may create confusion similar to what happened when a famous pianist told his audience that he was going to play a piece by a Danish composer named Mozart: Hans Christian Mozart.)
Someday it may be possible to make a diagnosis of prediabetes and diabetes without obtaining a blood sample by way of a needle stuck into a vein. A study by Melinda Sheffield-Moore, PhD, and others published in the March 2009 issue of Diabetes Care described a novel method to accomplish a diagnosis. People were given glucose to drink in which the carbon atoms were replaced by a harmless radioisotope (a form of the carbon that is made radioactive). The researchers found that the amount of radioactivity in the breath of people with prediabetes or diabetes was significantly lower than that in the breath of people with normal glucose tolerance. This result is expected because glucose is broken down for energy fairly quickly in healthy people, more slowly in people with prediabetes, and even more slowly in diabetics.
Focusing on type 2 prediabetes
There are two major types of diabetes called type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). (If you want to find out exactly what distinguishes them, pick up my book Diabetes For Dummies, which is also published by Wiley.) Here''s a grossly oversimplified overview:
Type 1 is an autoimmune disease that usually occurs in children.
Type 2 may occur in either children or adults and is often associated with risk factors such as being overweight, having high blood pressure, and leading a sedentary lifestyle.
Prediabetes that can lead to type 1 diabetes is pretty similar to prediabetes that can lead to type 2 diabetes. However, in this book I focus on the prediabetes associated with type 2. When diabetes develops in type 1, it''s because of a lack of the key hormone that controls blood glucose: insulin (see Chapter 2).
When diabetes develops in type 2, the body still has plenty of insulin but not enough to keep the blood glucose in the normal range because the body resists the action of insulin.
REMEMBER
The word prediabetes in this book refers to the period between normal blood glucose control and type 2 diabetes.
Knowing the Recent History of Prediabetes
In this section, I discuss the reason for the development of the term prediabetes, as well as the fact that prediabetes is not an entirely benign condition.
Needing new language
The term prediabetes hasn''t been around long. In fact, it was first used in 2002. It was introduced by the American Diabetes Association (ADA) and by then-Health and Human Services Secretary Tommy G. Thompson.
There were a number of reasons for the introduction of this term:
The terms impaired fasting glucose and impaired glucose tolerance were meaningless to patients and required a lot of explaining.
Other terms, like touch of sugar and borderline diabetes, were generally meaningless.
Studies such as the Diabetes Prevention Program showed that diet and exercise resulting in a weight loss as little as 5 to 7 percent of someone''s initial weight would lower the incidence of type 2 diabetes by up to 58 percent.
A broadly understandable term was needed so that patients could know where they were and where they had to go with respect to diabetes. These people stood to benefit from lifestyle modification and other treatments.
Studies at the time showed that most people with prediabetes would go on to develop diabetes within ten years unless they made relatively modest changes in diet and exercise. Therefore, the ADA and Secretary Thompson put together an expert panel of doctors and other diabetes experts. The panel report stated that intervention in prediabetes is critical for three reasons:
Just having glucose levels in the prediabetic range puts a person at a 50 percent greater risk of a heart attack or stroke.
The development of type 2 diabetes can be delayed or prevented by modest lifestyle change.
For many people, modest changes in lifestyle can turn back the clock and return elevated blood glucose levels to normal.
Along with the new term, the ADA recommended that physicians begin to screen their patients for prediabetes at age 45. Screening was especially important for people who answered yes to these questions:
Do you have a relative with type 2 diabetes or heart disease?
Are you overweight or obese?
Do you have high blood pressure?
Do you have a sedentary lifestyle?
Do you have high levels of triglycerides and/or low levels of HDL cholesterol (both being types of fats measured in a blood test)?
Do you belong to a higher-risk ethnic group, such as African American, Latino, or Asian American/Pacific Islander?
Do you have apple-shaped rather than pear-shaped weight distribution? This means your excess weight is around your stomach rather than your hips.
For women who have had children, did you develop diabetes during the pregnancy or have a baby who weighed more than 9 pounds at birth?
For women, is there a history of polycystic ovarian syndrome, a condition that may include lack of periods, infertility, and increased hair on the body?
These days, if you can answer no to all these questions, you may be from outer space. So most doctors just screen all people over age 45.
ANECDOTE
Maria Sanchez was a 48-year-old woman whose mother had type 2 diabetes. Maria had a body mass index (BMI) of 31, which put her in the category of obese. (As I explain in Chapter 2, BMI shows how your weight relates to your height.) Her blood pressure was high at 150/94. She was from Nicaragua. Her body shape had the appearance of an apple, not a pear. She had had a baby who was 9 pounds, 4 ounces at birth. When she was tested for prediabetes, guess what? She didn''t have it. Fooled you! But seriously, you can''t make assumptions. That''s why we have to test.
Understanding the risks
Prediabetes may not be associated with most of the problems of diabetes (which I discuss in Part IV), but your body is developing some reversible damage if you have this condition. I discuss the most important issues here.
Heart attacks and strokes
Numerous studies, including one in the journal Circulation in July 2007 and another in the American Heart Journal in August 2003, have shown that increased risks of heart disease and stroke exist even when blood glucose levels are significantly below the current glucose levels necessary for a diagnosis of diabetes. These risks even extend into the levels considered normal (less than 100 mg/dl of glucose). The risk has been found to be as much as doubled for people with prediabetes compared to people in the normal range for glucose. When prediabetes becomes diabetes, the risk doubles again.
When prediabetes is reversed and you get back to normal glucose levels, your risk of heart disease and stroke is significantly reduced. So you should make every effort to achieve normal blood glucose levels.
Retinopathy
Retinopathy is an abnormality within the eyeball that is specifically associated with diabetes; I describe it fully in Chapter 13. A study in the journal Lancet in March 2008 showed that retinopathy occurs even in the prediabetic state. As glucose levels increase, the prevalence of retinopathy increases dramatically. Although there is no definite threshold below which you don''t have to worry about retinopathy, the more normal the blood glucose, the lower the risk for this complication.
Alzheimer''s disease
Strong evidence exists that links diabetes to Alzheimer''s disease. In fact, being diabetic doubles the odds of developing Alzheimer''s disease. And even people with prediabetes show evidence of memory loss and dementia (loss of intellectual capacity).
A study in Neurology in August 2004 found that women with the highest levels of glucose (in the diabetes range) did worst on tests of mental capacity. Women in the prediabetic range did better, while women in the normal range did best.
I''m reminded of the story of the musician who told his wife at the airport that he wished he had brought his piano. "Why would you bring your piano to the airport?" inquired his wife. "Because I left the airline tickets on the piano," he replied.
Quality of life
At a conference in Uruguay in 2008, Consumer Health Sciences, an international provider of consumer information, presented data concerning the quality of life for the person with prediabetes. The data showed that a prediabetic''s health-related quality of life is significantly lower than that of a healthy person. For example, someone with prediabetes loses an average of 5.6 weeks of work productivity per year compared to a healthy person.
REMEMBER
Even though prediabetes is not as serious as diabetes, it does involve medical deterioration. The longer you allow yourself to have prediabetes, the greater the damage. Start to reverse it now!
Realizing Who Is Affected
Some groups of people are affected by prediabetes more than others, and they may even be affected when their blood glucose levels are lower than the levels that currently define prediabetes. (In the earlier section "Going from normal to prediabetes," I spell out those levels.)
As I write these words, studies are taking place to try to understand who may need to worry about prediabetes more than others. In addition, unfortunately, type 2 diabetes has begun to be found in children to a much greater extent than ever before, so many children are obviously going through a stage of prediabetes. And the largest group with prediabetes is the elderly. These age groups have special considerations that I introduce here and address in much more detail in Chapter 11.
(Continues...)
Excerpted from Prediabetes For Dummiesby Alan L. Rubin Copyright © 2010 by John Wiley & Sons, Ltd. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
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