Everything You Need to Know About Diabetes and Pre-Diabetes
Did you know that 12% of the US population has diabetes and 30% (100M of us) are pre-diabetic, many of whom are unaware? And that this chronic condition is associated with a range of health problems, from kidney disease and nerve damage to foot ulcers and various infections?
In this two-part blog, we’ll share what you should know about diabetes and prediabetes.
Physiology of Diabetes
Imagine your body is like a car that runs on fuel, and that fuel is sugar, also known as glucose. When you eat, your body breaks down the food into glucose.
In diabetes, there is an issue with how your body handles this glucose. Normally, glucose released from food enters the bloodstream. This causes a rise in blood sugar levels and alerts an organ called the pancreas. The pancreas responds to the surge by releasing a hormone called insulin. Now, insulin acts like a key. It allows glucose to enter your body cells and be used as energy.
In diabetes, either the body does not produce enough insulin or the cells do not respond properly to the insulin that is produced. This means that glucose remains in the bloodstream instead of entering cells.
Over time, high levels of blood sugar can lead to serious health issues like heart disease, vision problems, and kidney disease.
What are the different types of diabetes?
There are three fundamental forms of diabetes: Type 1, Type 2, and gestational diabetes. While this blog will specifically focus on T2D, let’s take a moment to delve into the other two to provide the necessary context.
Type 1 Diabetes (T1D)
T1D is believed to be caused by an autoimmune reaction. This is a fancy term that basically describes a situation where our body’s immune system mistakenly attacks our own cells and tissues, viewing them as ‘foreign invaders.’
In T1D, cells from the pancreas that produce insulin are attacked and destroyed, thus limiting the amount of insulin that can be made. The condition is believed to be caused by genetic and environmental factors. Approximately 5-10% of people with diabetes have T1D and require daily insulin to survive.
Gestational Diabetes (GD)
GD is a form of diabetes that is diagnosed for the very first time during pregnancy. Like other types of diabetes, GD affects the way our cells respond to glucose. Researchers are not sure on the exact cause of GD. However, excessive body weight before pregnancy often plays a role. Every year, around 2-10% of women in the US are affected by GD.
It can cause blood sugar levels to rise, affecting the health of not just the mother, but also the baby. The mother is likely to develop high blood pressure while the baby is at increased risk of being born heavier (9 pounds or more), earlier (premature delivery), and also have lower blood sugar levels. While blood sugar levels of most women return to normal post-delivery, around 50% of women with GD go on to develop T2D.
Type 2 Diabetes (T2D)
The most common type of diabetes is T2D. This is a chronic condition in which our body cells do not want to listen to the effects of insulin (called insulin resistance). Normally, as discussed, insulin allows glucose from the bloodstream to enter the cells to be used for energy. However, in T2D, our cells do not respond very well to insulin. This blocks the entry of glucose into cells and instead, builds up in the bloodstream.
When our body’s cells start ignoring insulin, the pancreas tries to make up for it by pumping out more insulin. But all that extra insulin production can wear out the pancreatic cells, leading to less insulin being released in the long run.
So then, what causes insulin resistance in the first place?
Risk Factors for insulin resistance and T2D onset
- Weight: If you’re carrying extra weight, your chances of getting T2D diabetes go up. This is because, in people with extra pounds, the fat cells can churn out substances that cause inflammation. Inflammation interferes with the action of insulin, contributing to the development of insulin resistance.
- Family history: If someone in your family has T2D, your own risk goes up. Just like with T1D, there is a genetic side to T2D. If it runs in your family, you might have genes that predispose you to how your body handles insulin and glucose. But here is the good news: these genetic factors usually don’t cause trouble unless they team up with lifestyle risk factors.
- Ethnicity: Some groups like African Americans, Hispanic Americans, Native Americans, and Asian Americans are more likely to get T2D. In the US, adults overall have a 40% chance of getting it at some point in their lives.
- Age: Age is a major risk factor for the development of T2D. This is often due to physical changes in our body that come with age:
- Insulin Resistance: As we age, our body’s cells might not respond to insulin as well, so they become resistant to it. This makes it harder for the pancreas to keep up with the need for insulin, leading to higher blood sugar levels and a higher risk of T2D.
- Pancreatic Function: Over time, the cells in the pancreas that make insulin might not work as well, so they produce less insulin. This can mess with how our body regulates glucose and make T2D more likely.
- Muscle Mass and Physical Activity: When people get older, they often lose muscle mass and become less active. This can make our bodies less sensitive to insulin, making it tough to use glucose effectively and increasing the risk of insulin resistance and T2D.
- Prediabetes: If you have prediabetes, it means your fasting blood sugar levels are higher than normal but not quite high enough for full-on T2D. Having prediabetes makes it more likely that you’ll end up getting real-deal diabetes down the road.
How to Diagnose Diabetes
Your doctor will run these tests to assess your risks for diabetes:
1. Glycated hemoglobin (A1C) test: This test shows your average blood sugar level for the past two to three months. If your result is below 5.7%, you are all good and healthy. If it falls between 5.7% and 6.4%, you are diagnosed with prediabetes. But if the level is more than 6.5% or higher on two separate tests, then you have diabetes. It is important to note that the test may not be reliable under specific conditions, such as pregnancy or in cases where there is an abnormal form of hemoglobin, the protein responsible for transporting oxygen in your blood to sustain the health of your tissues.
2. Fasting blood sugar test: In this test, a blood sample is collected after fasting for at least eight hours or overnight. The results show your blood sugar levels in milligrams of sugar per deciliter (mg/dL) or millimoles of sugar per liter (mmol/L) of blood. If it is less than 100 mg/dL (5.6 mmol/L), then you are healthy and normal. If it is between 100 to 125 mg/dL (5.6 to 6.9 mmol/L), you have prediabetes. Finally, if it is 126 mg/dL (7.0 mmol/L) or higher on two separate tests, then that is diabetes.
3. Oral glucose tolerance test: This particular test is not as commonly used, except during pregnancy. You will have to fast overnight and then drink a sugary liquid at your primary care provider’s office or a lab testing site. Blood sugar levels will then be checked periodically over the next two hours. Generally, a blood sugar level of less than 140 mg/dL (7.8 mmol/L) is considered normal, while a level of 140 to 199 mg/dL (7.8 to 11.0 mmol/L) indicates prediabetes, and a level of 200 mg/dL (11.1 mmol/L) or higher after two hours suggests diabetes.
4. Fasting insulin test: This test is used to measure the insulin level in your bloodstream after an overnight fast of typically eight to 12 hours. It provides valuable information about your body’s receptiveness to insulin and according to metabolic experts, is one of the KEY markers for diabetes. Unfortunately, this test is RARELY run by doctors as they rely solely on A1C and fasting glucose levels. Current standards show that fasting insulin range below 25 microunits per milliliter (uIU/mL) is considered normal. However, experts consider this to be way too high and here’s the reason why. When your cells become less sensitive to insulin, your body creates more to try to get it into the cells. The elevated insulin levels then reduce your insulin resistance, leading to a vicious cycle where you cannot create enough insulin and glucose levels begin to run dangerously high. And this process can take decades to unfold. High insulin levels today may be an indicator of future problems EVEN if your glucose levels are within the normal range and you have no diabetes/pre-diabetes. One study showed that high insulin levels were present before high glucose by almost 13 years. So, talk to your doctor about getting tested for fasting insulin regularly alongside A1C and fasting glucose so you get a more complete picture of your metabolic function.
