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Prediabetes refers to having an elevated blood sugar level that is above the normal range but not yet high enough to be classified as type 2 diabetes. Both adults and children with prediabetes face a heightened risk of developing type 2 diabetes if they do not make lifestyle changes. Typically, a healthy blood sugar (glucose) level falls between 70 to 99 milligrams per deciliter (mg/dL). If you have undiagnosed prediabetes, your levels are usually in the range of 100 to 125 mg/dL.
Individuals with prediabetes may already be experiencing the early stages of damage to their heart, blood vessels, and kidneys associated with diabetes. However, there is encouraging news: the progression from prediabetes to type 2 diabetes is not inevitable.
By adopting a healthy diet, incorporating regular physical activity into your daily routine, and maintaining a healthy weight, you can work towards returning your blood sugar levels to normal. The same lifestyle modifications that can help prevent type 2 diabetes in adults may also be effective in restoring normal blood sugar levels in children.
Symptoms
Many individuals with prediabetes may not exhibit any noticeable symptoms, underscoring the importance of regular check–ups with your primary care provider. They can perform screenings, such as a basic metabolic panel, to assess your blood sugar levels, which is the most reliable method for detecting prediabetes.
For those who do experience prediabetes symptoms, these may include:
- Darkened skin in the armpits or on the back and sides of the neck, a condition known as acanthosis nigricans.
- Presence of skin tags.
- Changes in the eyes that could potentially lead to diabetes–related retinopathy.
Classic indications that suggest a transition from prediabetes to type 2 diabetes include:
- Blurred vision.
- Heightened appetite.
- Increased thirst.
- Numbness or tingling sensations in the feet or hands.
- Delayed healing of wounds or sores.
- Frequent urination.
- Frequent infections.
- Fatigue.
- Unintentional weight loss.
If you have concerns about diabetes or notice any signs or symptoms of type 2 diabetes, it is advisable to consult your healthcare provider. Additionally, if you possess any risk factors for diabetes, consider discussing blood sugar screening with your healthcare provider to ensure timely detection and management.
Causes
Prediabetes is a condition characterized by the impaired processing of sugar (glucose) in the body, with its exact cause remaining unclear but a significant influence from family history and genetics. Typically, after consuming food, sugar enters the bloodstream, and insulin, produced by the pancreas, facilitates the entry of sugar into cells, thus regulating blood sugar levels. In prediabetes, this process is compromised, either due to insufficient insulin production by the pancreas or increased resistance of cells to insulin, leading to an accumulation of sugar in the bloodstream rather than its proper utilization by cells.
Risk factors
Prediabetes is more likely to occur due to the same factors which increase the risk of type 2 diabetes. Among these are the following:
- Age: While prediabetes increases after age 35, diabetes can occur at any age.
- Family history: If they have a parent or sibling with type 2 diabetes, their risk of developing prediabetes increases.
- Weight: The main cause of prediabetes is being overweight. Insulin resistance increases with the amount of adipose tissue in the body, particularly in the areas inside and between the abdominal muscles and skin.
- Diet: A increased risk of prediabetes is linked to eating red and processed meat as well as drinking beverages with added sugar.
- Inactivity: An individual’s risk of prediabetes increases with decreasing levels of physical activity.
- Race or ethnicity: Some people are more likely to develop prediabetes than others, including Black, Hispanic, American Indian, and Asian American individuals, while the exact cause is unknown.
- Gestational diabetes: Pregnancy–related diabetes, also known as gestational diabetes, increases the likelihood of prediabetes in the child.
- Polycystic ovary syndrome: Women who suffer from this common disease, which is marked by irregular menstrual cycles, excessive hair growth, and obesity, are at an increased risk of developing prediabetes.
- Sleep: Individuals who frequently experience sleep disruptions due to obstructive sleep apnea are at a higher risk of developing insulin resistance. Obstructive sleep apnea is more likely to develop in overweight or obese people.
- Using tobacco: For those with prediabetes, smoking may worsen insulin resistance and raise their chance of developing type 2 diabetes. Additionally, smoking raises the possibility of diabetic complications.
- Other conditions: Blood pressure, HDL cholesterol (high–density lipoprotein), which is commonly known as the “good” cholesterol, and triglycerides (a particular kind of blood fat) are conditions associated with an increased risk of prediabetes.
- Metabolic syndrome: Certain obesity–related diseases are associated with insulin resistance and can raise the risk of diabetes, heart disease, and stroke. Metabolic syndrome refers to a group of three or more of these conditions together:
- High blood pressure
- Low HDL level
- High triglycerides
- High blood sugar levels
- Waist size is large
Diagnosis
When to begin screening: Diabetes screening for adults typically begins at age 35 but should commence earlier if you’re overweight with added diabetes risk factors. Additionally, individuals with a history of gestational diabetes should undergo screening at least once every three years.
Types of blood tests for prediabetes:
- Glycated hemoglobin (A1C) test: The glycated hemoglobin (A1C) test assesses your average blood sugar levels over a 2–3 month period. The interpretation of the results is as follows: an A1C level below 5.7% is considered normal, while a range of 5.7% to 6.4% indicates prediabetes, and an A1C measurement of 6.5% or higher on two separate tests signifies diabetes. It’s important to note that certain conditions, such as pregnancy or the presence of unusual forms of hemoglobin, can potentially affect the accuracy of the A1C test.
- Fasting blood sugar test: The fasting blood sugar test, performed following an overnight fast of at least 8 hours, provides results in either mg/dL or mmol/L units. Interpretation of the results is as follows: blood sugar levels below 100 mg/dL (5.6 mmol/L) are considered normal, readings falling between 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes, and a measurement of 126 mg/dL (7.0 mmol/L) or higher on two separate tests signifies diabetes.
- Oral glucose tolerance test: The oral glucose tolerance test, less commonly employed except during pregnancy, involves an overnight fast followed by the consumption of a sugary solution. Over the course of two hours, blood sugar levels are periodically monitored. Interpretation of the results is as follows: blood sugar levels less than 140 mg/dL (7.8 mmol/L) are considered normal, levels ranging from 140 to 199 mg/dL (7.8 to 11.0 mmol/L) indicate prediabetes, and a reading of 200 mg/dL (11.1 mmol/L) or higher after the two–hour period suggests diabetes.
Monitoring for prediabetes: If you have prediabetes, get your blood sugar levels checked at least once a year.
Prediabetes testing for children: Children are also at risk of diabetes due to increasing rates of childhood obesity. It is advisable to conduct testing for overweight or obese children who possess additional risk factors such as a family history of diabetes, specific racial backgrounds, low birth weight, or exposure to gestational diabetes during pregnancy. The blood sugar ranges for normal, prediabetes, and diabetes are consistent for both children and adults. For children with prediabetes, annual testing is recommended, or more frequent assessments if they undergo weight fluctuations or exhibit symptoms like heightened thirst, increased urination, fatigue, or blurred vision.
Treatment
To prevent prediabetes from progressing to type 2 diabetes, consider these steps:
- Eat a balanced diet rich in fruits, vegetables, nuts, whole grains, and olive oil. Choose low–fat, high–fiber foods to maintain a healthy weight.
- Get physically active with at least 150 minutes of moderate or 75 minutes of vigorous exercise per week, or a mix of both, to help control weight and improve insulin function.
- Aim to shed excess weight; even losing 5–7% of body weight can lower diabetes risk.
- Quit smoking, as it can improve insulin sensitivity and blood sugar levels.
- If necessary, your healthcare provider may prescribe medications like metformin, along with managing cholesterol and blood pressure.
For children with prediabetes:
- Encourage weight loss, reduce refined carbs and fats, control portion sizes, limit eating out, and prioritize daily physical activity.
- Medication is typically not recommended for children unless lifestyle changes aren’t effective, with metformin being the usual choice if needed.
