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Does Pre-Diabetes Have a Preceding Stage?

Patrick Traynor

According to the Centers for Disease Control and Prevention (CDC), 38% of US adults have prediabetes. Prediabetes occurs before type II diabetes which is the most common cause of kidney failure, lower limb amputations, and night blindness and is the eighth leading cause of death.

If no corrective efforts are made, prediabetes generally exists between three to five years before developing into type 2 diabetes. Reversing pre-diabetes is far easier than reversing type 2 diabetes. But preventing prediabetes before it is even detected is much better.

Prediabetes



Prediabetes is a condition that results in higher than normal blood glucose levels but lower glucose levels than diabetes. It is directly measured with various values such as an HbA1C level between 5.7 and 6.4%, two consecutive fasting blood glucose levels between 100 and 125 mg/dL on different days, an oral glucose tolerance test (OGTT) between 140 and 199 mg/dL, or a blood glucose level above 200 mg/dL at any time.

Stage before Prediabetes



Prior to developing pre-diabetes, the pancreas still produces ample quantities of a hormone called insulin. Insulin helps glucose, a carbohydrate molecule derived from food, enter the cells that need it for energy. Insulin also helps glucose enter the muscle and liver cells for storage as a complex carbohydrate, glycogen.

In the stage prior to prediabetes, the body’s cells that need glucose for energy and the liver and muscle cells are still sufficiently sensitive to insulin to allow glucose’s entry. But their sensitivity is decreasing.

With this reduced sensitivity to insulin, or, conversely, increased insulin resistance, blood glucose levels would rise. But the pancreas produces even more insulin to overcome it. So, this overproduction of insulin counteracts the insulin resistance make blood glucose levels normal.

It is interesting to note that in type 2 diabetes, with this initial overproduction of compensatory insulin, the pancreatic cells eventually become compromised and do not produce sufficient insulin.

Fasting Blood Insulin

That is why some savvy providers order tests for fasting blood insulin levels for those with diabetes risk factors. Some risk factors include being overweight, having a family history of diabetes, having non-alcoholic fatty liver disease (NAFLD), having a high blood pressure, smoking including e-cigarettes, sleeping poorly, and taking antipsychotic medications.

Prevention

The Dietary Guidelines for Americans (DGAs) recommend that less than 10% of overall calories come from saturated fat and the American Heart Association (AHA) recommends less than 6%. Saturated fat increases cells’ insulin resistance.

The DGAs also recommend that less than 10% of foods come from added sugars. Refined grains and sugars increase blood glucose.

Conclusion

If you believe you are at risk for developing type 2 diabetes, ask your provider for an insulin blood test. If it is higher than normal, you probably have the stage prior to pre-diabetes and could benefit from seeing a registered dietitian. Preventative medical care is usually fully covered with no copay and no charge to the deductible.

Patrick Traynor, PHD, MPH, RD, CPT is a registered dietitian with an insurance-based practice, MNT Scientific in South Lake Tahoe, CA, Minden, NV, and Ashland, OR. He does telehealth as well. Appointments can be requested online at MNTScientific.com. Inquiries and mailing list requests can be directed to info@mntscientific.com


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