Prediabetes is a borderline condition between diabetes and normal sugar absorption, characterized by a decrease in insulin production and/or a decrease in the susceptibility of the body’s cells to insulin. The main symptoms are increased thirst, frequent urge to urinate, sharp weight loss, cramps at night, insomnia, hot flashes, migraine, itchy skin. The diagnosis of prediabetes is established according to blood tests for glycohemoglobin, fasting sugar levels and after carbohydrate loading. Treatment is based on compliance with a low-carb diet and increased physical activity, additionally hypoglycemic drugs are prescribed.
ICD 10
R73 Increased blood glucose
Meaning
Diabetes mellitus is one of the most common diseases in clinical endocrinology. With its untimely diagnosis and improper treatment, there is a high risk of disability and death. A key sign of the approach of the disease is an increase in the concentration of sugar in the bloodstream above the established norms immediately after eating. In such cases, doctors diagnose prediabetes (prediabetes, latent diabetes). This condition belongs to the borderline – the pathological mechanism has not yet been fixed, diabetes can be prevented by correcting nutrition and physical activity. According to statistics from researchers from the United States, about 30-40% of people are in a state of prediabetes. Pathology is diagnosed with the same frequency in children and adults, in women and men.
Causes
The violation is caused by a combination of several factors, which are divided into unchangeable and controlled. The first group of factors is related to heredity, ethnicity, the second – with lifestyle, concomitant diseases. Persons who have two or more factors identified are at risk for the development of type 2 diabetes mellitus. Among the most studied causes of prediabetes are:
- Excess weight. Adipose tissue reduces the sensitivity of cells to insulin, which slows down the absorption of sugar. The probability of prediabetes increases in people with a BMI of more than 25.
- Physical inactivity. Lack of motor activity negatively affects the work of most body systems, including endocrine. The level of functioning of the pancreas decreases.
- Improper nutrition. The consumption of a large amount of refined sugar leads to the development of a prediabetic condition. The body does not have time to produce enough enzymes and hormones to digest carbohydrates.
- Somatic diseases. Disorders of sugar absorption occur in autoimmune diseases, pathologies of the endocrine system, chronic diseases of the heart, blood vessels, liver and kidneys. The diagnosis is often confirmed in patients with arterial hypertension, polycystic ovaries.
- Taking medications. The cause of the disorder may be the intake of diabetogenic drugs. Such medications are hormonal drugs, in particular – corticosteroids and contraceptives.
- Pregnancy. Gestational diabetes increases the likelihood of developing hyperglycemia after eating. Also at risk are women carrying a fetus weighing more than 4 kg.
- Hereditary burden. In people with impaired glucose tolerance, familial cases of diabetes are detected. Close relatives of patients are recommended preventive examinations in order to identify predisposition.
- Ethnic predisposition. Americans and Asians are more susceptible to diabetes. Prediabetes is more often found in Native Americans, African Americans, Latinos, residents of Central and Southeast Asia.
Pathogenesis
Insulin is a hormone produced by the pancreas. It provides the supply of sugar from the blood to various cells of the body, which receive energy from carbohydrates. In healthy people, the absorption of glucose from the stomach into the blood stimulates the secretion of insulin. Glucose is absorbed by tissues, its plasma level decreases a couple of hours after food enters the stomach. By this time, the indicators are up to 7.8 mmol/l. In patients with diabetes mellitus, blood sugar does not decrease to normal, but remains equal to 11.1 mmol / l and higher. The values of 7.9-11 are intermediate, indicating prediabetes. The violation of the process of glucose uptake by cells is based on two mechanisms – a reduction in insulin secretion by the gland and a decrease in sensitivity (increased resistance) of tissues to the action of the hormone. In both cases, there is a prediabetes condition that does not manifest clinically, but can be detected during laboratory diagnostics.
Symptoms of prediabetes
In most cases, this disorder is asymptomatic. It is possible to detect a violation by chance according to the results of laboratory tests. Sometimes symptoms develop that are characteristic of the early stages of diabetes, but they are less pronounced and irregular. The phenomena of furunculosis, bleeding gums, periodontal disease and loosening of teeth are possible. Skin and genital itching, dry skin, prolonged healing of wounds and abrasions, menstrual cycle failures, amenorrhea, sexual weakness are detected.
Changes in glucose metabolism provoke an imbalance of most hormonal functions of the body, so there are changes in appetite, thermoregulation, sleep patterns, mood. Characterized by insomnia, frequent awakenings at night, hot flashes. Sugar thickens the blood, it passes through the vessels worse, especially through small capillary networks, so there are visual disturbances, pain in the head and limbs. The body needs more fluid to thin the blood – the feeling of thirst increases, the frequency of urination increases. At a glucose level of 5.5-6 mmol / l, this symptom disappears.
Complications
Lack of control over sugar levels leads to the formation of diabetes. According to the World Health Organization, about 2 million people die annually from this disease and its complications in the world. In the absence of proper treatment, the risk of nephropathy, retinopathy, hypoglycemia, ketoacidosis, trophic ulcers, diabetic gangrene with subsequent amputation of limbs increases. Diabetes contributes to the formation of malignant neoplasia, loss of vision, the development of stroke and myocardial infarction, the formation and aggravation of renal failure.
Diagnostics
The detection of prediabetes is difficult due to the low severity or complete absence of clinical signs. Diagnosis is performed by an endocrinologist. At the initial stage, a patient is interviewed – the specialist clarifies the features of the patient’s lifestyle, the presence of inactivity, overeating, concomitant somatic diseases, hereditary burden of diabetes. When detecting characteristic complaints, the question arises about the differentiation of the pre-diabetic state and the actual disease. The key diagnostic methods are three laboratory tests:
- Fasting glucose. The sugar of capillary or venous blood is measured after a period of hunger for at least 8 hours. For blood from a vein, the normal values (in mmol / l) are 3.5-5.5, for prediabetes – 5.6-6.9, for diabetes mellitus – from 7.0.
- Glucose tolerance test. Two blood sugar levels are measured: after 8-12 hours of hunger and 2 hours after loading with carbohydrates. The indicators of the second test normally do not exceed 7.8 mmol / l, in the borderline state – 7.9-11 mmol / l, with DM they increase to 11.1 mmol / l or more.
- Glycated hemoglobin (HbA1c). The approximate average sugar index over the past three months is being investigated. The target values are no more than 6.5%, borderline and pathological – 6.6% and higher.
Prediabetes treatment
The therapy is based on changing the lifestyle of patients. The most effective measures are the observance of proper nutrition, moderate but regular physical activity. Treatment is carried out by an endocrinologist, a nutritionist, a physical education instructor. Despite the efforts of specialists, the effectiveness of therapeutic measures is largely determined by the patient’s motivation. The therapeutic program includes:
- Diet. The rules of nutrition are discussed with the patient individually. Doctors recommend reducing the amount of portions, eating at least 4-5 times a day. Products with a high content of light carbohydrates – sweets and sugar-based drinks – are excluded from the menu. The diet is compiled taking into account data on the glycemic index of products, fat content. The daily caloric content is reduced. Preference is given to low–fat foods containing fiber and proteins – vegetables, mushrooms, fish, seafood, meat without fat, eggs, milk, cheese. Of the cooking methods, steaming and baking are the most useful. Special emphasis is placed on moderate salt intake and compliance with the drinking regime.
- Physical activity. A gradual increase in activity is shown. A system is being developed that allows to moderately increase the heart rate, increase blood flow in the vessels, stimulate the process of aerobic oxidation of fats, glycogen, glucose. Such classes improve the state of the cardiovascular system, contribute to weight loss. The type of load is selected individually, personal preferences of the patient and his state of health are taken into account. Most patients are recommended active hiking and cycling, sports walking, swimming, in the absence of contraindications – jogging, skiing, tennis, team games, gym classes.
- Medical correction. In some cases, the endocrinologist prescribes hypoglycemic drugs that reduce the amount of blood glucose by increasing the sensitivity of cells. Drug treatment is used if compliance with dietary recommendations and an increase in physical activity do not bring results. The disadvantage of this method is that the body remains passive, does not use its own resources to combat metabolic disorders. There is a risk of dependence on the intake of hypoglycemic agents.
Prognosis and prevention
Prediabetes lends itself well to correction, since this condition is dynamic, there is an opportunity to activate the body’s systems that struggle with elevated glucose levels. To prevent the development of pathology, it is necessary to pay attention to the diet: reduce the consumption of fast carbohydrates and fats, control calorie intake, take food in fractions, in small portions. It is worth introducing regular sports and daily half-hour walks into the day plan. People from risk groups need to periodically take tests to determine the level of sugar and cholesterol, monitor blood pressure, monitor body weight.