Do You Have Prediabetes or Diabetes?

October 31, 2016

By Gretchen Shull, MD
Mercy Clinic Endocrinology
Mercy Diabetes Education

About 1 in 4 people reading this article have prediabetes, but likely don’t know it. This is because prediabetic symptoms can be hard to spot or even non-existent.

Symptoms include fatigue, increased thirst, increased urination, increased hunger, poor or slow wound healing and weight loss. Risks include being overweight (body mass index greater than 25), relatives with diabetes, high blood pressure, cholesterol problems and women who delivered a baby weighing more than 9 pounds or are diagnosed with gestational diabetes.

Because diabetes may not be obvious due to a lack of acute symptoms, it can be difficult to convince some people they need to be screened. While there are critically ill cases that can lead to a stint in the intensive care unit, it’s a progressive disease for the majority of patients.

It’s possible that the affects of diabetes won’t harm a patient for as long as 10 years. The problem is trying to convince people who live in a world of immediate gratification that diabetes will harm them down the road. They’ll be better off if they take care of themselves now as the disease and/or its complications can be preventable.

Whether someone is prediabetic or diabetic is determined by a blood test. One option is the hemoglobin A1C percentage. The A1C test provides information about a person’s average blood sugar over the past three months.

Patients are prediabetic if their A1C percentage is between 5.7 percent and 6.4 percent. A percentage of 6.5 or higher is classified as diabetes.

Another simple way to measure diabetes is a blood glucose test. Fasting plasma glucose readings are normal if less than 100 mg/dl, prediabetes between 100 and 125, and diabetes at 126 or higher.

A diabetic is type 1 (insulin dependent) or type 2 (insulin resistant). The type is determined by building a clinical picture of the patient and whether the body is making insulin.

Diagnoses and treatment have a lot more “gray areas” than in the past. Traditionally, type 1 patients were children and type 2 patients were overweight adults.

It is not so simple anymore. More and more children are being diagnosed with type 2 or prediabetes, while type 1 diabetes can lurk at any age.

Both diabetes types now are well recognized with concern for complications, even though type 2 tends to come on subtly and gradually in most cases. It also should be noted that many prediabetic patients have early complications.

Diabetes affects virtually everything in the body. One of the biggest concerns is cardiovascular disease (heart problems, strokes or other blood vessel problems) because it is the leading cause of death or illness and largest contributor to all health care costs.

A second complication is diabetic retinopathy. It’s important to screen for diabetic eye complications such as retinopathy, which can lead to blindness. Patients should get a yearly eye exam.

Another complication can be diabetic neuropathy, which most often starts in the feet. Symptoms include pain and numbness that eventually can be debilitating.

Kidney function also can be compromised in diabetes, which is why you’re encouraged to have a yearly screening.
After diagnosis, the main treatments are diabetes education, nutrition therapy and medication. The goal is for patients to be self-managers of their chronic disease.

Type 1 diabetic patients will require insulin for the rest of their lives short of a transplant.  All diabetic patients should continue screenings even if the disease is under control.

Several new medications have been approved for use in the past two to three years. Further, self-care advances have resulted in smart technology and wearable technology.

Dr. Gretchen Shull is a Mercy endocrinologist and diabetes medical director. For more information on Mercy Diabetes Education or Mercy Clinic Endocrinology, call 417-556-8555.

Diabetes facts, figures

  • 86 million people in the U.S. have prediabetes, but only 10 percent are aware
  • A third of people with prediabetes will progress to diabetes in five years, with 5 percent to 10 percent transitioning annually
  • In 2012, 29.1 million Americans, or 9.3 percent of the population, had diabetes, with about 1.25 million with type 1 diabetes
  • Of the 29.1 million, 21 million were diagnosed and 8.1 million undiagnosed
  • 1.4 million Americans are diagnosed with diabetes every year
  • Diabetes remains the seventh leading cause of death in the U.S.

Source: American Diabetes Association

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