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Prediabetes And The Gift Of Time

In 2012, a doctor advised Ramesh, 37, a Chennai marketing executive, to take a blood test during his annual check-up. Ramesh expected to have elevated cholesterol levels, like many in his family. His doctor, however, took him by surprise when he announced that Ramesh had pre-diabetes.

“The term confused me,” Ramesh says. “I wasn’t sure if I was diabetic or not. My doctor said I wasn’t diabetic yet, but soon would be if I wasn’t careful.”

After his diagnosis, Ramesh did try to exercise regularly, but because of frequent travel wasn’t always able. He deliberately chose to disregard his doctor’s advice about following a diabetic-friendly diet.

“I thought that if I wasn’t diabetic, there was no need to be so restrictive,” he says.

Three years later, Ramesh is now on insulin to manage full-fledged diabetes and says he wishes he had taken his doctor’s warning more seriously.

Diabetes, a condition of high blood sugar resulting from the body’s failure either to produce enough insulin or to respond properly to the hormone, is a silent disease that medical professionals say has all the hallmarks of an epidemic: The World Health Organization has reported it as a leading cause of death and disability worldwide. In South Asia, the International Diabetic Federation reported recently that more than 50 percent of people with diabetes in are completely unaware of their condition.

Prediabetes, however, means blood sugar levels are higher than normal, but not high enough to be classified as diabetes. Without major lifestyle changes, people with prediabetes are likely to develop type 2 diabetes in 10 years or less.

“It’s important to understand that your pancreas [the organ that produces insulin] doesn’t shut down overnight. The degenerative process occurs slowly, over a period of many years,” says Dr. Richa Chaturvedi, an endocrinologist at PSRI Hospital in New Delhi.

So a diagnosis of prediabetes isn’t a sentence of chronic disease, she adds; if anything, it’s a gift of time.

“Prediabetes is a small window of opportunity, a wake-up call years before the onset of the actual disease,” says Dr. Chaturvedi. “It can give you the potential to change your lifestyle and possibly reverse or delay the condition.”

Five in ten prediabetics in India go on to develop type 2 diabetes, or insulin-resistant diabetes, says Dr. Chaturvedi, regardless of the changes they make to their diet and lifestyle. For the other 50 percent, however, it’s possible to stave off diabetes and to kick-start insulin efficiency.

The first step toward this is knowing if you’re at risk. Medical guidelines have recently been revised to screen for diabetes starting at an earlier age. If you’re in a high-risk group, doctors advise getting your blood sugar level tested once a year after the age of 30. A person is considered high-risk if his or her parents, maternal or paternal grandparents have had diabetes, says Dr. Chaturvedi. Other risk factors include being overweight or obese, leading a very sedentary lifestyle, delivering a large baby (more than 4 kg at birth) or being afflicted with PCOS (polycystic ovarian syndrome) or gestational diabetes.

The three tests used to diagnose diabetes are also used to diagnose prediabetes. Since it’s normal for the body’s glucose levels to fluctuate hour by hour, all three are important. They include:

  • The HbA1c Test: The American Diabetes Association recommends that this be used as the primary diagnostic test to track how your body responds to glucose. The hemoglobin found in our blood binds to the glucose that we consume, in a process called glycation. In a healthy person, glucose is readily absorbed by the body’s cells and doesn’t stay in the blood stream for long. However, if your glucose tolerance is impaired, a blood test will show a higher rate of glycation. If you’re diabetic, your reading will be above 6.5 percent; if you’re prediabetic, your reading will be between 5.7 to 6.5 percent. Once diagnosed with prediabetes, experts recommend repeating this test every three months in order to monitor if lifestyle changes (see below) are influencing the way your body processes blood sugar.
  • The Fasting Blood Sugar (FBS) Test: This blood test is administered after eight hours of fasting, preferably after a good night’s sleep. A healthy FSB level is no more than 99 milligrams/deciliter of blood. The pre-diabetic range is 100 to 125 mg/dL; it’s diabetes at 126 mg/dL and above. Dr. Chaturvedi says the simple mistake of not fasting for the proper time can throw off the whole test. “You must fast for eight hours [immediately prior] for the test to be accurate,” she says.
  • The Random Blood Sugar (RBS) Test: As the name suggests, a random blood sugar blood test is administered at any point in the day. This involves a quick pin prick on your finger from which a drop of blood is extracted, and the result is available in seconds: If your levels are between 140-200 mg/dL, you’re prediabetic; If they’re more than 200 mg/dL, you have diabetes.

The biggest challenge lies in detecting prediabetes early enough to take action. Once diagnosed by these tests, though, there’s a clear path of action that helps reduce your chances of developing diabetes.

Following a diabetic diet, losing weight, and getting plenty of exercise and sleep are the four lifestyle changes doctors agree best stave off the progression of prediabetes. But don’t be overwhelmed: The good news is that you don’t need to lose a lot of weight in order to gain control over your blood sugar. Studies have shown that shedding even 5 to 7 percent of body weight can have a positive effect for prediabetics. Once weight is under control, the WHO recommends at least 30 minutes of moderate-to-intense physical activity five to six days a week. A healthy diet low in fat and sugar, broken into small, frequent meals can also help keep your blood sugar steady and delay progression.

If lifestyle changes aren’t having the desired effect, medication may also be an option. Research published by the National Institutes of Health in the United States indicated that a drug called Metformin could significantly reduce the progression of diabetes when taken in the prediabetic stage. If you are prediabetic, as always, talk to your physician about your options to find the best course of action for you.

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