Pre-diabetes is a real risk

Q: My doctor told me I had pre-diabetes. Is this real, or is she just trying to scare me to get me to lose weight?

A: Yes, it is real, and yes, if you need to lose weight she may be using this to motivate you. Since November is diabetes mellitus (DM) awareness month, this is a timely topic for today's column.

Diabetes is a condition where the body's cells cannot properly utilize the glucose (sugar) in the blood. Insulin is a hormone made in the pancreas that allows the body's cells to utilize glucose; it is problems with insulin that cause diabetes. When the cells cannot utilize the blood glucose properly, it builds up in the blood stream.

Since people with diabetes have high blood sugars, measuring fasting blood sugars (FBS) is the method used to diagnose it. High fasting blood sugars, over 125 mg/dL, is diagnostic of DM. However, if the blood glucose is slightly high (over 100 mg/dL but less than 125 mg/dL), pre-diabetes is diagnosed.

Type 1 diabetes (the more common type in childhood) accounts for 5 percent to 10 percent of all diabetes patients and is caused by failure of the pancreas to produce insulin. It occurs sporadically - it does not run in families, and no specific risk factors or triggers have been identified. These patients require insulin injections to survive.

Type 2 diabetes, which accounts for 90 percent to 95 percent of all cases of DM, is due to the body's cells becoming resistant to insulin, and is the type most common in adults. Patients with it have relative insulin deficiency since they need higher levels of insulin to regulate their blood sugars. Type 2 runs in families. It is more common in certain ethnic groups, for example, African Americans. It is much more common in people who are overweight, lead sedentary lives and have poor diets. In fact, due to the increase of these risk factors in our population, the incidence of type 2 diabetes has doubled in the last 10 years.

Most people with type 2 diabetes (about 60 percent) are controlled on oral medications (pills) that help their system increase its insulin production and help their cells to better utilize insulin. About 10 percent to 15 percent of type 2 diabetics use only insulin, another 10 percent to 15 percent use both insulin and pills, and the rest utilize diet modification without medications.

The symptoms of diabetes include fatigue, the need to urinate frequently, increased thirst and hunger, and poor wound healing; pretty non-specific symptoms that can come from many other conditions.

Diabetes is the seventh leading cause of death in the U.S. (very likely an underestimate) and causes many complications. It's the leading cause of kidney failure, affecting over 45,000 Americans per year. About two-thirds of people with diabetes develop peripheral neuropathy, a nerve condition causing pain and numbness is the feet and hands. This, in addition to the poor blood circulation and poor wound healing, makes it the leading cause of non-traumatic amputations. People with diabetes have a 2 to 4 times higher risk of dying from a heart attack, and up to 8 times higher risk of dying from a stroke. It is a leading cause of blindness, dental problems and problems during pregnancy, as well as many other complications.

Diabetes is extremely common. It is estimated that 24 million Americans have diabetes, although 6 million are unaware that they have the disease. This is extremely concerning since regulating the blood sugar - whether with insulin, pills or other means - can decrease complications.

Over 55 million Americans have pre-diabetes; however, pre-diabetes does not necessarily have to lead to diabetes. The Diabetes Prevention Program showed that with certain lifestyle changes, including modest weight loss, increased physical activity and behavior changes (reducing fat and salt intake), progression to DM can be delayed or averted in over 50 percent of pre-diabetics.

Noting the high prevalence of diabetes, the many severe complications that can come from it and the fact that there are treatments that can help prevent many of these complications, it is easy to understand why everyone should talk to their healthcare provider about being screened. Furthermore, maintaining a healthy weight, getting regular physical activity and eating a good healthy diet will decrease your chances of getting diabetes and get you on the road to a healthier and happier life.

Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.com.