Do you have prediabetes?

Britain is facing a Type 2 diabetes epidemic of unprecedented proportions. Around seven million adults in the UK are estimated to have prediabetes without realising it – putting them a 50 per cent chance of developing full-blown diabetes within ten years.

So what it Prediabetes?

Prediabetes is not a medical condition in itself – and there are no symptoms. It is just a form of shorthand to show that people with it are more at risk of developing Type 2 diabetes .

‘People with pre-diabetes are those whose blood sugar levels are not high enough for diagnosis of Type 2 diabetes, but are at the very high end of the normal range, edging near the point where they will be diagnosed with the full-blown disease,’ explains Simon O’Neill, director of health intelligence, Diabetes UK. In the UK, glucose in the blood is measured using a test called HbA1C, which sets a prediabetic range from 6 per cent, up to (and including) 6.4 per cent. This test measures how much glucose is attached to red blood cells over a 2-3 month period. Rather confusingly, it is not a percentage of glucose in the blood in proportion terms. The US standard sets the prediabetic range from 5.7 and 6.4 per cent. A score of 6.5 per cent or higher means a diagnosis of Type 2 diabetes.

High sugar in the blood points is a telltale sign that the body is producing insulin but is no longer able to use it effectively – known as insulin resistance. When this happens, not all the sugar is taken up by the cells to be used as energy and builds up in the blood instead, which leads to Type 2 diabetes.

The closer you get to 6.5, the more likely you will start to develop complications because of high blood sugar levels, says Melanie Davies, professor of diabetes medicine at the University of Leicester. ‘This is the point where the first complicationsbegin, in particular problems with changes to cells at the back of the eye, known as retinopathy, which can lead to blindness.’ If you have diabetes, you are 20 times more likely to develop retinopathy than the rest of the population, but unfortunately symptoms may not show until the condition is very advanced. Symptoms include blurred vision, floaters, and sudden vision loss.

Some specialists don’t agree with the idea that prediabetes has its own defined range. Prediabetes cannot lead to Type 1 diabetes, which is an autoimmune disorder which is normally present from childhood and occurs when the body cannot produce its own insulin. Adult-onset diabetes, known as Type 2 diabetes, is linked to lifestyle and being overweight.

How do I know if I’ve got it?

There are no symptoms that will alert you that you have prediabetes, but certain factors can warn you if you are at risk. A BMI of 25 and above for most people is a risk factor, especially if you tend to be ‘apple shaped’ and carry fat round your waist. This is because fat sits close to the vital organs, including the pancreas, which inhibits its function of producing insulin.

The risk increases with age as older people are more likely to develop the full-blown disease. ‘People from South Asian origin are 3-6 times more likely to develop prediabates than Caucasians because they have a genetic susceptibility which means they start to develop insulin resistance at a much lower BMI,’ says O’Neill. People of black ancestry are also more at risk. Women and men are equally at risk.

‘There are two main reasons why the number of people with prediabetes is growing,’ says O’Neill. ‘Firstly, the population is ageing and older people are more at risk of getting Type 2 diabetes.’

The reason that Type 2 diabetes becomes more common in older people is because muscle mitochondrial activity starts to slow which increases fat content in muscle cells. This can lead to muscle insulin resistance, a big cause of diabetes.

‘But the biggest single risk factor is being overweight (having a BMI of 25 and over) and not doing enough exercise,’ says O’Neill. ‘The steady rise in the number of people who are being diagnosed with type 2 diabetes mirrors the rise in the number of people who carry more weight.’

If you are a normal weight and active, your body will efficiently process the food you eat. However, if you lead a sedentary lifestyle, your body finds it harder to burn off calories and you end up being heavier. You are also more likely to have high blood pressure and higher cholesterol. You don’t have to be obese to be more at risk of developing Type 2 diabetes.

But I am slim and don’t eat sweets, so how can I have it?

‘Although weight plays an important role in who might develop prediabetes, not all people with prediabetes are overweight. Even if you are thin you could still develop pre-diabetes,’ says dietitian Douglas Twenefour, a clinical adviser at Diabetes UK.

‘You may have a history of type 2 diabetes or polycystic ovarian syndrome, you are more likely to develop Type 2 diabetes, regardless of your BMI.’ If a woman has given birth to a baby over 10lbs in weight, she may also be at greater risk of developing prediabetes. 

Where can I be tested for Prediabetes?

‘You can do an online risk assessment without having any symptoms or concerns at all. As long as you are over 40, as part of the NHS Health Check in England, you can ask for a blood test at your local GP surgery,’ explains dietitian Douglas Twenefour . ‘If you are under 40, you will have to have some justification for your request, for example because a close family member died of the disease.’ Private clinics also offer blood tests to patients who have concerns.

The NHS in England offers a NHS Health Check to everyone aged between 40-74 every five years, which assesses people’s risk of a range of health problems including prediabetes and diabetes, by measuring weight and waist, as well as looking at family history and ethnicity. But not all areas of the country offer the service and less than half the people who should have been offered the checks have been. Tesco and Boots Pharmacy now run a risk assessment and you can do your own risk assessment online at www.diabetes.org.uk/risk.

In the past, most doctors used two blood tests. The Fasting Plasma Glucose Test showed how much glucose was in the blood after a period of fasting for at least eight hours. The Oral Glucose Tolerance Test revealed how much glucose remained in the blood two hours after eating sugary foods. These tests do show a snapshot of someone’s blood sugar levels at a given time. However, a newer kind of test, known as HbA1C, is now being done universally, which reads glycation in the blood – in other words, how many glucose molecules are sticking to a protein in haemoglobin, carried in red blood cells. This reveals how much sugar you have carried in your blood over the two-three month lifespan of the red blood cell and doctors can average that out.

Type 2 diabetes is serious

‘There’s a myth that Type 1 diabetes is the serious one because you need insulin injections. But don’t think that Type 2 diabetes is nothing to worry about,’ says Simon O’Neill of Diabetes UK. ‘The consequences of developing Type 2 diabetes can be very serious. Better treatment means that the average reduction in life expectancy has gone down from 10 years to just six, but losing six years of your life is still a lot if you are diagnosed with Type 2 diabetes when you are 65.’

Type 2 diabetes is a lifelong condition that already affects more than 3 million people and can lead to serious health complications such as heart disease and stroke. Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Some people with type-2 diabetes will ultimately undergo amputations. This is usually due to neuropathy, a condition which results in nerve damage. ‘Patients lose sensation and don’t notice when they knock or damage their limbs. Because diabetes can also affect circulation, it means that tissue repair takes longer,’ explains Douglas Twenefour.  Another complication is blindness, due to diabetic retinopathy, when blood vessels at the back of the eye begin to bulge and leak blood. He adds: ‘This really is a very serious condition which needs to be taken seriously.’

www.diabetesuk.org.uk