What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes.
There are two conditions that fit into this category;

• Impaired Fasting Glucose (IFG) - When the blood glucose level is higher than normal after fasting for eight hours (between 5.5 and 7.0 mmol/L) but not high enough to diagnose diabetes.
  
•  Impaired Glucose Tolerance (IGT) Which is diagnosed using an Oral Glucose Tolerance Test and the two hour blood test is higher than normal (between 7.8 and 11.0 mmol/L) but not high enough to diagnose diabetes.
  
• It is possible to have both Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT).
  

Diabetes Australia has answered the question succintly.  The average person may be further helped by their Risk Assessment Tool Australian Type 2 Diabetes Risk Assessment ToolAll fields are required. Please complete all sections to calculate your risk.1. Your age group?
Please select your age groupUnder 35 years 0 points 35 - 44 years 2 points 45 - 54 years 4 points 55 - 64 years 6 points 65 years or over 8 points 2. Your gender?
Please select your genderFemale 0 points Male 3 points 3. Your ethnicity/country of birth:
3a. Are you Aboriginal, Torres Strait Islander, Pacific Islander or Maori descent?
Please select your ethnicityNo 0 points Yes 2 points 3b. Where were you born?
Please select your country of birthAustralia 0 points Asia (including the Indian sub-continent), Middle East, North Africa, Southern Europe 2 points Other 0 points 4. Have either of your parents, or any of your brothers or sisters been diagnosed with diabetes (type 1 or type 2)?
Please complete this section to calculate your riskNo 0 points Yes 3 points 5. Have you ever been found to have high blood glucose (sugar) (for example, in a health examination, during an illness, during pregnancy)?
Please complete this section to calculate your riskNo 0 points Yes 6 points 6. Are you currently taking medication for high blood pressure?
Please complete this section to calculate your riskNo 0 points Yes 2 points 7. Do you currently smoke cigarettes or any other tobacco products on a daily basis?
Please complete this section to calculate your riskNo 0 points Yes 2 points 8. How often do you eat vegetables or fruit?
Please complete this section to calculate your riskEveryday 0 points Not everyday 1 point 9. On average, would you say you do at least 2.5 hours of physical activity per week (for example, 30 minutes a day on 5 or more days a week)?
Please complete this section to calculate your riskYes 0 points No 2 points 10. Waist measurement
10a. Your waist measurement taken below the ribs (usually at the level of the navel, and while standing) cm. Please enter your waist measurement (between 2 and 3 characters). Waist measurement (cm)10b. Are you of Asian or Aboriginal or Torres Strait Islander descent? YesNo


How is this question calculated? 

 

There is a continuum that goes from normality to type 2 diabetes. Diabetes actually starts off by becoming less responsive to insulin.The pancreas compensates by producing more insulin, which keeps the blood glucose level controlled. However, the pancreas cannot keep on increasing it's capacity forever, so at some point, it starts to fail. The requirements for insulin then exceeds the capacity of the pancreas to produce insulin and the blood glucose levels start to rise. This is pre diabetes. After that, it is a numbers game. When blood glucose continues to rise, at a certain point, it is called diabetes. This is determined by a fasting blood glucose level of >5.5 mmol/L. This also can be diagnosed by a HbA1c of >6.5%. However, if you look when the pathology of diabetes actually starts, it is at the point of insulin resistance, which is long before pre diabetes. You normally get Impaired Glucose Tolerance (IGT) first, when your pancreas does not have the capacity to produce enough insulin when you eat, to Impaired Fasting Glucose (IFG) when the pancreas cannot mainitain the glucose level at all times. Pre Diabetes responds to lifestyle changes and it also has been shown that Metformin slows the progression to “full” diabetes.

If you have pre-diabetes, you are at high risk of developing type 2 diabetes and also are at increased risk of developing heart disease. Pre-diabetes is a condition in which blood glucose levels are higher than normal, but not high enough to be classified as full-blown diabetes. Those with pre-diabetes are at increased risk of developing type 2 diabetes within a decade unless they adopt a healthier lifestyle that includes weight loss and more physical activity.

First, let's define what "pre-diabetes" is and is not. Diabetes is defined as having a fasting plasma blood glucose level of 7mmol/L or greater on two separate occasions. If diabetes symptoms exist and you have a casual blood glucose taken at any time that is equal to or greater than 11.1 mmol/L and a second test shows the same high blood glucose level, then you have diabetes.

In general, people who have a fasting plasma blood glucose in the 5.6-6.9mmol/L range are defined as having impaired fasting glucose. If your doctor gives you an oral glucose tolerance test, and at two-hours your blood glucose is 8-11mmol/L you have "impaired glucose tolerance". Either of these is medical terminology for what your doctor is probably referring to when he says you have "pre-diabetes." Be sure to ask your doctor what your exact blood sugar test results are when he tells you that you have "pre-diabetes." Some physicians are not as familiar as they should be with the new national guidelines for diagnosing diabetes. They may be telling you that you have pre-diabetes, when in fact you have actual diabetes.

Among those who should be screened for pre-diabetes include overweight adults age 45 and older and those under age 45 who are overweight and who have one or more of the following risk factors:

are habitually physically inactive

have previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)

have a family history of diabetes

are members of certain ethnic groups have had gestational diabetes or have given birth to a child weighing more than 4 kg

have elevated blood pressure

have an high cholesterol or high triglycerides

have polycystic ovary syndrome

have a history of vascular disease

That all said, if you have pre-diabetes diabetes, what should you do?  If you are at risk for developing type 2 diabetes, you can reduce your risk by 58% through sustained modest weight loss and increased moderate-intensity physical activity, such as walking 60 minutes a day.

What Should You Eat?

It's not so much "what" you should eat, but how much. If you are overweight, your first and foremost goal should be to lose weight. This means working with an Accredited Practising Dietitian to determine the quantity and type of food you should eat at each meal. One of the key issues in losing weight is controlling portion size. Your dietitian will also direct you how to make food choices that cut down on the amount of fat you eat because each gram of fat has significantly more calories in it than a gram of carbohydrate or protein. This means:

eating more foods that are broiled and fewer foods that are fried.

cutting back on the amount of butter you use in cooking.

eating fish and chicken more, and only lean cuts of beef.

eating meals so that your dinner plate has more vegetables, , salads, lean protein, fruit and wholegrains

Your dietitian will show you how you can continue to eat all the foods you love — just probably not in the same proportions as you have in the past. Having diabetes or having "pre-diabetes" does not mean that you can't eat certain foods. The solution isn't "avoid foods with sugar in them." Rather, you need to lose weight if you are overweight, cut back on portion sizes, and plan for those occasions when you eat a small piece of cake or chocolate.

Physical Activity

Along with weight loss, your goal will be to begin program of physical activity, if you aren't getting regular exercise now. Why? Because physical activity will help you use the insulin you produce to convert the food you eat into energy. This will help keep your blood glucose lower. If you have a small piece of cake with a meal, follow it up with a brisk walk.