Introduction

Prediabetes is a condition in which your blood sugar level is higher than normal, but not high enough to be classified as type 2 diabetes.

Prediabetes shouldn't be taken lightly. It means that you're at risk of developing type 2 diabetes, heart disease and stroke.

An estimated 41 million U.S. adults ages 40 to 74 have prediabetes, according to the Centers for Disease Control and Prevention. And the condition isn't a concern only for adults. The American Academy of Pediatrics reports that one of every 10 males and one of every 25 females ages 12 to 19 have prediabetes.

Prediabetes doesn't have to become type 2 diabetes. With healthy lifestyle changes, you can bring your blood sugar back to normal levels.

Signs and symptoms

Often, prediabetes has no signs or symptoms. But it's important to watch for the classic red flags of type 2 diabetes — excessive thirst and frequent urination.

Other signs and symptoms of type 2 diabetes may include:

  • Constant hunger
  • Unexplained weight loss
  • Weight gain
  • Flu-like symptoms, including weakness and fatigue
  • Blurred vision
  • Slow healing of cuts or bruises
  • Tingling or loss of feeling in hands or feet
  • Recurring gum or skin infections
  • Recurring vaginal or bladder infections

Causes

To understand prediabetes, first you have to understand how sugar (glucose) is normally processed in your body.

Glucose is vital to your health because it's a main source of energy for the cells that make up your muscles and tissues. Glucose comes from two major sources: the food you eat and your liver. During digestion, glucose is absorbed into your bloodstream. Normally, glucose then enters your body's cells with the help of insulin.

The hormone insulin comes from your pancreas. When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key, unlocking microscopic doors that allow glucose to enter your cells. Insulin lowers the amount of sugar in your bloodstream and prevents it from reaching high levels. As your blood sugar level drops, so does the secretion of insulin from your pancreas.

Your liver acts as a glucose storage and manufacturing center. When your insulin levels are low — when you haven't eaten in a while, for example — your liver releases the stored glucose into your bloodstream to keep your glucose level within a normal range.

If you have prediabetes, this process is beginning to work improperly. Instead of being transported into your cells, a small amount of glucose builds up in your bloodstream. This occurs when your cells become resistant to the action of insulin. Exactly why the cells become resistant to insulin's effects is uncertain, although excess weight and fatty tissue seem to be important factors. Most people with prediabetes are overweight or obese and get little, if any exercise.

Risk factors

Screening and diagnosis

Many people find out they have prediabetes through blood tests done for another condition or as part of a routine exam. The American Diabetes Association recommends blood glucose screening for everyone at age 45. If you're overweight with one or more additional risk factors for type 2 diabetes, ask your doctor about earlier testing.

Two blood tests can be used to determine whether you have prediabetes.

  • Fasting blood glucose test. The amount of sugar in your bloodstream naturally fluctuates within a narrow range. Your blood sugar level is typically highest after a meal and lowest after an overnight fast. The preferred way to test your blood sugar is after you've fasted overnight or for at least eight hours. Blood is drawn from a vein and sent to a lab for evaluation.

    A fasting blood sugar level under 100 milligrams of glucose per deciliter of blood (mg/dL) is considered normal. If your blood sugar level is 100 to 125mg/dL, you have prediabetes — also called impaired fasting glucose (IFG).

  • Oral glucose tolerance test. An oral glucose tolerance test requires that you visit a lab or your doctor's office after at least an eight-hour fast. There you will drink about 8 ounces of a sugary liquid. Your blood sugar level is measured before you drink the liquid, then after one hour and again after two hours. If your blood sugar reaches 140 to 199 mg/dL after two hours, you have impaired glucose tolerance (IGT) — another prediabetes condition.

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