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Prediabetes - Diagnosis and treatment

Diagnosis
The American Diabetes Association (ADA) recommends diabetes screenings for most adults age 45 and older. The ADA advises that you get screened for diabetes before age 45 if you are overweight and have additional risk factors for prediabetes or type 2 diabetes.

There are several blood tests for prediabetes.

Glycated hemoglobin (A1C) test
This test shows the average blood glucose level for the last three months. The test measures the percentage of blood glucose bound to the oxygen-carrying protein in red blood cells called hemoglobin. The higher your blood glucose levels, the greater the amount of hemoglobin with sugar.

Usually:

• An A1C level below 5.7% is considered normal
• An A1C level between 5.7% and 6.4% is considered prediabetes
• An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes

Certain conditions can make the A1C test inaccurate, such as if you are pregnant or have a rare type of hemoglobin.

Fasting blood sugar test
A blood sample is taken after a fast of at least eight hours or an overnight fast.

Usually:

• A fasting blood glucose level below 100 milligrams per deciliter (mg / dl) (5.6 millimoles per liter [mmol / l]) is considered normal.
• A fasting blood glucose level between 100 and 125 mg / dL (5.6 to 7.0 mmol / L ) is considered prediabetes. This result is sometimes called impaired fasting glucose.
• A fasting blood glucose level of 126 mg / dL (7.0 mmol / L ) or higher indicates type 2 diabetes.

Oral glucose tolerance test
This test is often used to diagnose diabetes only during pregnancy. A blood sample is taken after a fast of at least eight hours or overnight. Then you will take a sugar solution and your blood glucose level will be measured again after two hours.

Usually:

• A blood glucose level lower than 140 mg / dl ( 7.8 mmol / l ) is considered normal.
• A blood glucose level between 140 and 199 mg / dl ( 7.8 to 11 mmol / l ) is considered prediabetes. This is often known as impaired glucose tolerance.
• A blood glucose level of 200 mg / dl (11.1 mmol / l ) or higher indicates type 2 diabetes.
• If you have prediabetes, your doctor will normally check your blood glucose levels at least once a year.

Children and prediabetes testing
Type 2 diabetes is becoming more common in children and adolescents, probably due to the increase in childhood obesity. The ADA recommends prediabetes testing for overweight or obese children who have one or more risk factors for type 2 diabetes.

These other risk factors include the following:

• Family history of type 2 diabetes.
• Race. African American, Hispanic, American Indian, Asian American, and Pacific Islander children are most at risk.
• Low birth weight
• Mother who had gestational diabetes.

The ranges of blood glucose levels considered normal, prediabetic, and diabetic are the same for children and adults.

Children with prediabetes should have yearly tests for type 2 diabetes, or more frequent if the child experiences a change in weight or develops signs or symptoms of diabetes, such as increased thirst, increased urination, fatigue or vision blurred.




Treatment
Healthy lifestyle choices can help bring your blood glucose level back to normal, or at least prevent it from rising toward the levels seen in type 2 diabetes.

To prevent prediabetes from progressing to type 2 diabetes, try the following

• Eating healthy food. Choose foods that are low in fat and calories and high in fiber. Focus on fruits, vegetables, and whole grains. Eat a variety of foods that help you reach your goals without compromising taste or nutrition.
• Be more active. Aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity per week.
• Lose excess weight. If you are overweight, losing just 5% to 7% of your body weight - about 6.4 kilograms (14 pounds) if you weigh 91 kilograms (200 pounds) - can lower your risk of type 2 diabetes. weight in a healthy range, focus on permanent changes in your eating and exercise habits.
• Quit smoking Smoking can increase your risk of developing type 2 diabetes.
• Take the necessary medications. If you are at high risk for diabetes, your doctor might recommend metformin (Glumetza, others). Medications to control cholesterol and high blood pressure may also be prescribed.

Children and Treatment for Prediabetes
Children with prediabetes should make the recommended lifestyle changes for adults with type 2 diabetes, including:

• Lose weight
• Eat less refined carbohydrates and fats, and more fiber
• Reduce portion sizes
• Eating out less often
• Spend at least an hour a day doing physical activity
• Medication is generally not recommended for children with prediabetes unless lifestyle changes do not improve blood glucose levels. If a drug is needed, metformin (Glumetza, others) is usually the recommended drug.

Clinical studies
Explore Mayo Clinic studies testing new treatments, interventions, and tests to prevent, detect, treat, or manage this condition.

Alternative medicine
Many alternative therapies have been touted as possible ways to treat or prevent type 2 diabetes. But there is no definitive evidence that alternative treatments are effective. Therapies that have been said to be helpful in type 2 diabetes and are also likely to be safe include the following:

• Cassia cinnamon
• Flax
• Ginseng
• Magnesium
• Oatmeal
• Soy
• Xanthan gum

If you are considering taking dietary supplements or other alternative therapies to treat or prevent prediabetes, consult your doctor. Some supplements or alternative therapies can be harmful when combined with certain prescription drugs. Your doctor can help you discuss the advantages and disadvantages of specific alternative therapies.

Preparation for the consultation
You will likely see your primary care physician first. They will most likely refer you to a doctor who specializes in treating diabetes (endocrinologist), a registered dietitian, or a diabetes educator.

Here is information to help you prepare for your appointment.

What can you do
Before your appointment, take these steps:

• Ask about pre-appointment restrictions. You may need to fast for at least eight hours before your appointment so that your doctor can measure your fasting blood glucose level.
• Make a list of the symptoms you've had and their duration.
• Write down all the medications, vitamins, and supplements you take, including the dosages.
• It lists key personal and medical information, including other conditions, recent life changes, and stressors.
• Prepare questions to ask the doctor.

In the case of prediabetes, these are some basic questions to ask your doctor:

• How can I prevent prediabetes from turning into type 2 diabetes?
• Do I need to take medication? If so, what side effects can I expect?
• I have other medical conditions. How can I control them together?
• How much do I have to exercise each week?
• Should I avoid any food? Can I continue to consume sugar?
• Should I see a dietitian?
• Can you recommend any local programs to prevent diabetes?

What to expect from the doctor
Your doctor will likely ask you a series of questions, such as the following:

• Has your weight changed recently?
• Do you exercise regularly? If yes, how long ago and how often?
• Do you have a family history of diabetes?