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WHAT IS PREDIABETES

 Prediabetes (impaired glucose tolerance), your blood sugar (glucose) is raised beyond the normal range but it is not so high that you have diabetes. However, if you have pre-diabetes you are at risk of developing diabetes

Between 1 and 3 out of every 4 people with pre-diabetes will develop diabetes within ten years.

It is also thought that having prediabetes increases your risk of developing conditions such as heart disease, peripheral arterial disease and stroke (cardiovascular diseases). Also, people who have pre-diabetes are more likely also to have other risk factors for cardiovascular disease, including high blood pressure, raised cholesterol levels, being overweight, etc.

The World Health Organization (WHO) defines someone as having pre-diabetes if they have:

  • A fasting blood glucose of less than 126 mg/dl but over 100 mg
    • or A blood glucose of over 140mg but less than 180 mg after a two-hour oral glucose tolerance test.

If you have impaired fasting glycaemia ( prediabetes), you are also significantly increased risk of developing diabetes. Your risk of developing cardiovascular disease is also increased but this seems to be lower than if you have pre-diabetes (impaired glucose tolerance).

Many people have pre-diabetes (impaired glucose tolerance) and because there are no symptoms, they do not know that they have it

Prediabetes (impaired glucose tolerance) develops for the same reasons as type 2 diabete). There are various things that can increase your risk of developing prediabetes. They are the same risk factors as those for type 2 diabetes. They include:

  • Being overweight or obese (most people with pre-diabetes are overweight or obese).
  • Having a family history of diabetes. This refers to a close family member with diabetes – a mother, father, brother or sister.
  • Doing little physical activity.
  • Having other risk factors for cardiovascular disease such as high blood pressure or high cholesterol levels.
  • If a woman has polycystic ovary syndrome and is also overweight.
  • If you developed diabetes during pregnancy (called gestational diabetes). 

People with prediabetes (impaired glucose tolerance) usually have no symptoms. You are often found to have pre-diabetes after blood tests taken for another reason show that the person has a raised blood sugar (glucose) level. Sometimes, the doctor may suggest that a screening blood test should be taken to check your blood glucose because they are worried that you may have some risk factors for pre-diabetes or diabetes. For example, if you have high cholesterol levels, are overweight or have high blood pressure, or if you have had a heart attack or stroke, your doctor may suggest that you have a blood test to check your blood glucose.

Prediabetes is now most often diagnosed using a blood test called HbA1c. See the separate leaflet called Tests for Blood Sugar (Glucose) and HbA1c for more details. An HbA1c value 6.5%or above is recommended as the blood level for diagnosing diabetes. People with an HbA1c level 5.7-6.4% are often said to have prediabetes because they are at increased risk of diabetes and cardiovascular disease. It is also called impairedglucose tolerance

Another test to diagnose prediabetes is the glucose tolerance test but this is rarely used

There is increasing evidence that if pre-diabetes (impaired glucose tolerance) is treated, the progression to diabetes can be prevented. Also, it may be possible to prevent cardiovascular disease from developing. So, it is important to know if you have prediabetes and to treat it in order to reduce your risk of developing diabetes and cardiovascular disease. Treatments that have been suggested include lifestyle changes and treatments with medicines. The commonly used medicationt is called metformin and it may be useful if your a1c is near the diabetes range but for prevention the best strategy by far in lifesstly change particularly leading to weight loss if the person is overweight

It is also very important to have a regular blood test to recheck your blood sugar (glucose) level in case you develop diabetes. The frequency of the blood test will vary but you should discuss this with your doctor. A blood glucose test at least once each year is usually recommended.

Lifestyle changes

Lifestyle changes have been found to be the most effective way to stop pre-diabetes from developing into diabetes. Losing weight if you are overweight, and increasing your levels of physical activity, can help to reduce insulin resistance and therefore make the insulin that is produced more effective at controlling your blood glucose levels.

If you have prediabetes, you should:

  • Eat a healthy balanced diet. Your practice nurse and/or a dietician will give details on how to eat a healthy diet. The diet is the same as recommended for everyone. The idea that you need special foods if you have pre-diabetes or diabetes is a myth. Basically, you should aim to eat a diet low in fat, high in fibre and with plenty of fruit and vegetables:
    • Starchy foods contain carbohydrates. Standard advice is that you should continue to eat some starchy foods, although you should focus on wholegrain and wholewheat versions – so-called ‘complex carbohydrates’. These tend to have a lower glycaemic index (GI) which means they are more slowly absorbed and do not raise your blood sugar as rapidly.
    • However, what many people don’t realise is that starchy carbs like bread, potatoes or breakfast cereals digest down into a surprisingly large amount of sugar. More and more people are discovering that by reducing the carbs (both sugary and starchy) in their diet, it is possible to lose weight and reduce blood sugar (glucose). If you do include carbs in your diet, choose complex carbs.
  • Lose weight if you are overweight. Getting to a perfect weight is unrealistic for many people. However, if you are overweight or obese then losing some weight will help to reduce your blood glucose level (and have other health benefits too). 
  • Do some physical activity regularly. If you are able, a minimum of 30 minutes of physical activity daily is advised. For example, walking, swimming, cycling, jogging, dancing – anything that makes you at least mildly out of breath and mildly sweaty. You can start slowly and build up. You can also spread the activity over the day – for example, two 15-minute spells per day. Regular physical activity also reduces your risk of having a heart attack or stroke. Always check with your doctor that it is safe to start exercising if you have been inactive for a long period. AFTER CHECKING WITH YOUR DOCTOR THIS IS GENERAL INFORMATION ONLY