How dangerous is pre-diabetes? | Health Care India

Shagun Bindlish, Diabetologist/Internal Medicine, One Medical Group, asks whether a journey of prediabetes to Type 2 diabetes can be reversed

“I am going to save money on my monthly pedicures,” said Jenny (name changed) with a smile on her face. She is a 40-year-old Caucasian woman who had to go through amputation of her left forefoot.

Why tell a story about Jenny and her recent amputation? Her story has similarities with many of my other patients who have diabetes related complications. Jenny, being the sole breadwinner for the family, had been working long hours and put her health on the back burner. Her sedentary lifestyle led to her weight gain over time.

At age 32, she was diagnosed with prediabetes, based on a Haemoglobin A1C level of 6.1% and Body Mass Index (BMI) of 35 (Obesity class III). Her physician confirmed her diagnosis as borderline normal (normal below 5.7%). Due to lack of any signs or symptoms, Jenny did not take her diagnosis of prediabetes or weight gain seriously. Furthermore, she did not follow up with her doctor for the next few years.

Later, Jenny started feeling some important signs of diabetes that she should not have ignored. One of those symptoms was a feeling of numbness and tingling in her feet, along with bluish discolouration that was ongoing for almost six months. This course of illness led to gangrene and finally the amputation of her left forefoot to save her life. Her progression of diabetes was so brutal that she had to face a life-altering complication.

Interestingly, a few years ago, people, including healthcare professionals, used to talk about having “borderline diabetes”. This made diabetes seem like a less serious condition than it is, and the diagnosis was often missed due to lack of symptoms. For patients, diabetes means high sugar. Minimising the importance of blood sugar control by saying it is borderline, sends the wrong message to the patients, as was the case with Jenny.

Prediabetes

What is prediabetes, and why is it so important?

Prediabetes is also called impaired glucose tolerance. It is considered a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. As per the Centre of Disease Control (CDC) guidelines, approximately 88 million American adults – almost one in three adults – have prediabetes. Of those with prediabetes, more than 80% do not even know they have it.

Understanding prediabetes is more complicated than fighting the disease itself. Prediabetes means a step before T2DM or a warning sign or signal to act. There are several risk factors that may cause prediabetes including weight gain, heart disease, high blood pressure, high cholesterol, history of gestational diabetes and other factors that are linked to environmental factors and genetic predisposition.

Our body’s defence mechanism plays a vital role in our health. Normally, after a meal, the pancreas senses the availability of the added sugar in our blood and releases the hormone called insulin. Insulin acts like a truck to deliver the blood sugar to different organs of our body to be used as the source of energy. In case of prediabetes or impaired glucose tolerance, the cells in the body don’t respond normally to insulin. The pancreas overworks to produce more insulin than needed and eventually gives up resulting in the rise of blood sugar levels, setting the stage for prediabetes and Type 2 diabetes (T2DM) down the road.

Even in people who do not progress to T2DM, persistent prediabetes is a toxic state that is associated with increased risks for the initiation and progression to several microvascular (affecting small blood vessels in the body) and macrovascular (affecting major organs of the body like kidney, eyes, heart, liver) complications.

Prediabetes in the face of the COVID-19 pandemic and our “new normal”

With the COVID pandemic, we all are facing a global crisis on a scale that is hard to fathom. There is uncertainty, agony, fear and stress while people are adapting to the new normal of staying home, and that has had a huge impact on everyone’s health. In this scenario, there is more likelihood of getting prediabetes due to lack of physical activity, more intake of processed food or lack of motivation for self-care, while working long hours in work-from-home conditions. That is why it is imperative to understand the heightened risk of prediabetes.

The good news is that prediabetes is reversible if you take it seriously and be proactive in modifying your lifestyle. It is important for people and healthcare professionals to take extra precautions, work as a team, and be mindful of the following recommendations:

1. If you notice weight gain, reach out and talk to your doctor.
2. If you have a family history of chronic diseases such as heart disease, high blood pressure, cholesterol, gestational diabetes, follow up with your doctor every three months and discuss with them the appropriate steps to make changes to your lifestyle at the right time.
3. For those who are following a healthy lifestyle, make all efforts to maintain the same schedule even when normalcy returns to our lives.

Self-care and self-awareness are the strongest pillars of life that will support the foundation of your health. In the daily hustle and bustle of life, it is extremely important to not go off track and continue to maintain the healthy habits. Small steps can avoid the irreversible complications of Type 2 diabetes. Managing prediabetes might seem complicated, but with effort, planning and the right education, you can reverse this disease.

There are several risk factors that may cause prediabetes including weight gain, heart disease, high blood pressure, high cholesterol, history of gestational diabetes and other factors that are linked to environmental factors and genetic predisposition

Persistent prediabetes is a toxic state that is associated with increased risks for the initiation and progression to several microvascular (affecting small blood vessels in the body) and macrovascular (affecting major organs of the body like kidney, eyes, heart, liver) complications