The ‘normal range’ of blood glucose in humans is less than 100 mg/dl when fasting and less than 140 mg/dl after a meal. In a “diabetic” the fasting glucose is more than 126, and post-meal, more than 200. In “Pre-diabetes”, which is an intermediary but important stage, literally a forerunner of the overt ‘diabetic stage,’ the fasting blood glucose ranges “between 100-125 and post-meal between 140-199.”
To illustrate the importance of “prediabetes” let’s start with an example. Just as before an “all-out war” negotiations and interventions take place to avert the catastrophe. In the same way, a lot of effort must be expended in the “pre-diabetic stage” so that the potentially lethal “diabetic stage” is delayed or does not set in at all.
Mike Ferns was a company executive. He was told by his GP that he had “prediabetes”. “My sister was hospitalised in coma with an extremely high blood glucose reading of 557mg/dl,” remembers Michael. Though she came out of that illness, within four years she had both her legs amputated above the knee.”
So for Michael it was important to remain in the ‘pre-diabetic stage’ which he managed for over a decade through lifestyle changes alone, until over a period of time he sadly lapsed into the “diabetic stage”. His GP decided that Mike required then a small dose of an anti-diabetic drug. He was reluctant to swallow a pill at first but soon reconciled himself to the idea.
It is true that having “high blood glucose levels” over a period of time can cause damage to the small and large blood vessels and nerves. This can lead to many health complications. Any “diabetic” must get his eyes checked yearly, see the dentist and GP every six months and a “podiatrist” (a person qualified to diagnose and treat foot disorders) every eight weeks. He must also check his blood glucose levels at least three times a week.
The emphasis today is on precautionary measures even at the “pre-diabetic stage.” Those in the “pre-diabetic stage” are potential diabetics as diabetes does not emerge overnight. Physicians and various specialists reiterate the significance of intervention at this crucial phase not only to prevent or delay onset of “diabetes” but to avoid complications in the long run. Various studies have proved that cardiovascular complications including heart disease -have already set in at the time of detection of “diabetes.” Hence intervening at the “pre-diabetic stage” is important in order to reap maximum benefits.
“Pre-diabetic stage precedes diabetes by five to ten years. While “macro-vascular complications” (cardiac disease, stroke and peripheral vascular disease) set in ten years before diagnosis of diabetes, “micro-vascular conditions” like diabetic retinopathy (eye disease), diabetic nephropathy (kidney) and neuropathy (nerves) set in five years before diagnosis of “diabetes”.
Family history and genetic predisposition play an important role in developing type 2 diabetes but there are those who develop diabetes due to non-genetic factors like obesity, high stress levels, faulty diet and sedentary lifestyle. What worries doctors is the early onset of diabetes nowadays. Though age remains a risk factor, incidence of diabetes in patients below the age of 60 has been increasing.
The “pre-diabetes stage” cannot be brushed off just because blood glucose levels are not yet in the “diabetic range.” It is important to understand that blood glucose levels are kept from reaching the diabetic level only because “beta cells” (that produce insulin) work overtime to keep blood glucose levels normal. But compounded by obesity and sedentary lifestyle, they may soon lose their effectiveness in keeping blood glucose levels under check.
To sum up what is “Prediabetes?” It’s a stage when your blood glucose is higher than normal, but not high enough to be called “diabetes.” You won’t necessarily notice any symptoms — you can have it and not know it. A simple blood test can tell you if you do. You’re at risk if you’re overweight, over 45, and you don’t exercise.
So, what must be done? First lose weight. It doesn’t have to be a lot. If you lose just a few kilos it can make a huge difference. Then, eat healthier food with fewer calories. A good rule of thumb is to fill half your plate with non-starchy vegetables (asparagus, Brussels sprouts, and carrots). One quarter should have starchy foods (like potatoes, corn, or peas). The remaining quarter should be protein — chicken, fish, or beans. Be extra careful with “bad carbs” like baked goods or pasta — they can raise your blood glucose. You’ll lose weight faster and feel better if you exercise. A brisk 30-minute walk five times a week should do the trick. Keep regular sleep hours, and stick to a calm, quiet bedtime routine. If you smoke, now’s the time to quit. Smokers are 30% more likely to get type 2 diabetes than nonsmokers. Get support from peer groups. When you have people to share your good days and bad days with, it can make a big difference.
An irrepressible gourmand wrote long ago, “A life without sweets is not much worth living.” But, if those sweets make your life sour we must definitely not die for them.
(Dr Francisco Colaço is a senior most consulting physician, and pioneer of Echocardiography in Goa)
