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 Diabetes

july 2010
Are you Prediabetic?
Dr. Sambit Das
 
In the next 10 years, India will house the most number of diabetic people in the world. Are you going to be one of them – even if you don’t have diabetes right now?

Characterised by very high blood sugar, diabetes mellitus affects various organs like the kidneys, nerves, eyes and skin. While Type-1 diabetes (occurring in children and requiring insulin) is largely sudden and unpredictable in onset, Type-2 diabetes mellitus (occurring in adults) progresses slowly through an asymptomatic and preventable prediabetic phase.

What is prediabetes?
  • Prediabetes is a state before diabetes, which gradually progresses to clinical diabetes mellitus if not checked at the right moment.
  • This condition does not produce any symptoms, and abnormality in blood glucose is detected only during routine testing.
  • When the fasting blood glucose in an individual is greater than 100 mg/dl and less than  126mg/dl, it is known as Impaired Fasting Glucose (IFG). Post prandial sugar (after 75 gms of glucose load) greater than 140 mg/dl and less than 200 mg/dl is known as Impaired Glucose Tolerance (IGT). Both IFG and IGT are known as prediabetes.
  • Of late, glycosilated haemoglobin (otherwise known as HbA1C) level between 5.7 percent to 6.4 percent is also taken as prediabetes or borderline diabetes.
Why should it bother me?
  • Every year Individuals, those in the prediabetes state have a 3.6 to 8.7 percent chance of progressing to frank diabetes.
  • All the cardiovascular adverse events increase steadily in the prediabetes range of blood glucose and so do the chances of heart attack.
  • Fortunately, the prediabetes state is reversible or at least can be checked if intervened properly.
Who should be screened?
  • Since the condition is clinically asymptomatic, it needs regular screening of people who are at maximum risk.
  • Testing should be done for all people of more than 45 years of age.
  • Those of any age, who are overweight or obese, with any of the additional risk factors like physical inactivity, family history of diabetes, high-risk ethnic population, women who delivered babies weighing more than 9 lb, hypertension, low good cholesterol (HDL cholesterol level lesser than 35 mg/dl) and/or high triglyceride level (higher than 250mg/dl), should also be screened.
  • If results are normal, testing should be repeated at least at three year intervals.
What should I do if diagnosed with prediabetes?
A healthy lifestyle, that includes healthy food, regular exercise and maintenance of ideal body weight, can reverse or at least halt the progression of this condition to overt diabetes. In very high risk patients a drug known as Metformin is also added to the lifestyle changes (but it should be taken only when prescribed by your doctor).

Should I exercise?
Moderate physical activity of at least 150 min/week significantly reduces the progression to frank diabetes. So, brisk walking of 20 to 30 minutes a day is strongly recommended for people with pre diabetes.

What shouldn’t I eat?
  1. A regular and moderate diet, low in calories and low in fat, is what is needed rather than crash dieting courses. Consultation with a registered dietician is a must to calculate the calorie requirement and the exact diet composition according to the need and preference of an individual.
  2. Avoid junk foods, sweets, bakery products, nuts, ghee or butter, red meat, all sweetened aerated beverages and fresh fruit juices.
  3. Food should be rich in dietary fibres like fresh fruits, salads, vegetables, sprouts.
  4. Beverages like clear vegetable soups, tender coconut water, skimmed buttermilk, rasam or red tea can be taken any time of the day without the fear of adding any calories.
Could I have prevented this?
Not always, but do get treatment for underlying illnesses (such as AIDS). Stop smoking, if you do. Children and the elderly could use with vaccinations against certain bacteria.

Ideal body weight
  • It is the weight proportionate to the height of an individual
  • Ideal body weight for men = (height in cms – 100) Kg
  • Ideal body weight for women = (height in cms – 100) x 0.8 Kg
  • Weight loss of at least five percent of the current body weight can significantly reduce the incidence of diabetes
Dr. Sambit Das is Consultant Endocrinologist and Diabetologist at Apollo Hospital, Bhubaneswar


    
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