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Do I Have Pre Diabetes?: Impaired Fasting Glucose

Do I have Pre Diabetes?

Impaired fasting glycaemia or impaired fasting glucose (IFG) refers to a condition in which the fasting blood glucose is above normal levels but is not high enough to be classified as diabetes mellitus. It is a pre diabetic state, associated with insulin resistance , 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. Many newly identified IFG patients progress to diabetes in less than three years. Some patients with pre diabetes can also be diagnosed with impaired glucose tolerance, but many have normal responses to a glucose tolerance test.

Normal functioning of insulin Source:

World Health Organization (WHO) criteria for impaired fasting glucose differs from the (American Diabetes Association) ADA criteria, because the normal range of glucose is defined differently. Fasting plasma glucose levels 100 mg/dL (5.5 mmol/L) and higher have been shown to increase complication rates significantly.

However, WHO opted to keep its upper limit of normal at under 110 mg/dL for fear of causing too many people to be diagnosed as having impaired fasting glucose, whereas the ADA lowered the upper limit of normal to a fasting plasma glucose under 100 mg/dL.

WHO criteria: fasting plasma glucose level from 6.1 mmol/l (110 mg/dL) to 6.9 mmol/L (125 mg/dL).

ADA criteria: fasting plasma glucose level from 5.6 mmol/L (100 mg/dL) to 6.9 mmol/L (125 mg/dL).

Do I Have Pre Diabetes: Signs and symptoms

Pre diabetes typically has no distinct signs or symptoms. Patients should check 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 ofcuts or bruises

  • Tingling or loss of feeling in hands or feet

  • Recurring gum or skin infections

  • Recurring vaginal or bladder infection

  • Do I Have Pre Diabetes: Cause

  • 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 obesity

Women who have had gestational diabetes, had high birth weight babies (greater than 9 lbs.), and/or has Polycystic Ovarian Syndrome (PCOS)

These are associated with insulin resistance and are risk factors for the development of type 2 diabetes mellitus. Those in this stratum (IGT or IFG) are at increased risk of cardiovascular disease. Of the two, impaired glucose tolerance better predicts cardiovascular disease and mortality.

In a way, prediabetes 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.

Do I Have Pre Diabetes: Genetics

As the human genome is further explored, it is likely that multiple genetic anomalies at different loci will be found that confer varying degrees of predisposition to type 2 diabetes. Type 2 DM, which is the condition for which pre diabetes is a precursor, has 90-100% concordance in twins; there is no HLA association. However, genetics play a relatively small role in the widespread occurrence of type 2 diabetes. This can be logically deduced from the huge increase in the occurrence of type 2 diabetes which has correlated with the significant change in western lifestyle.

Genetics    Source: Wikipedia

Do I Have Pre Diabetes: Pathophysiology

Diabetes mellitus (DM) is a group of metabolic diseases that are characterized by hyperglycemia and defects in insulin production in the 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/atherosclerosis, or microvascular, as seen with retinopathy, nephropathy, and neuropathy.

Normal glucose homeostasis is controlled by three interrelated processes. There is gluconeogenesis (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.

Source: Wikipedia

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 prediabetes 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.

Do I Have Pre Diabetes: Prevention

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

  • Healthy meals (a diet low in saturated fat, sugars and refined carbohydrates, as well as limited sodium and total calories)

  • Physical exercise (45 minutes of exercise per day, five days a week)

  • Reducing weight by as little as 5-10 percent can have a significant impact on overall health.

Do I Have Pre Diabetes: 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 obesity (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 mmHg or diastolic blood pressure > 90 mmHg)

  • Prior fasting blood glucose > 99

  • Known vascular disease

Markers of insulin resistance (PCOS, acanthosis nigricans)

  • 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

Do I Have Pre Diabetes: Diagnosis

Pre diabetes is usually diagnosed with a blood test

  • Fasting blood sugar (glucose) level of:

  • 110 to 125 mg/dL (6.1 mM to 6.9 mM) – WHO criteria

  • 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 (A1c) between 5.7 and 6.4 percent

Levels above these limits would be a diagnosis for diabetes.

Source: Wikipedia


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