Prediabetes in adults and children

About such a disease as diabetes mellitus wrote and talked so much that not to have an idea about him can only a very small child. But in medical practice there is also such a thing as prediabetes (or prediabetes), which is clearly connected with the previous diagnosis, but still differs markedly from it.

It should be noted immediately that prediabetes is not quite a diagnosis. Doctors endure such a verdict when the patient's condition indicates a violation of glucose uptake, but this symptomatology is not enough to make a diagnosis such as insulin-independent diabetes, which is otherwise called type 2 diabetes.

[1], [2], [3], [4], [5]

Epidemiology

Despite the fact that a solid age is considered one of the risk factors for the development of prediabetes, this pathology is diagnosed in childhood. According to statistics, the number of "sick" children is equal to the number of adult patients with this diagnosis. The cause of the development of this pathology of metabolism in this case is most often the transferred infectious diseases, which, combined with a hereditary predisposition, create a vicious circle that causes inhibition of glucose metabolism. Diagnosis of prediabetes in children as well as in adults.

Women can suffer from pre-diabetes more often than men. This is due to the physiological characteristics of the female body, called to continue the human race. Any abnormal phenomena during pregnancy and childbirth, including the large weight of the newborn, may in the future provoke the appearance of symptoms of prediabetes.

[6], [7], [8], [9], [10], [11], [12], [13],

Causes of the prediabetes

Such a condition as prediabetes is manifested primarily by an increase in the level of sugar in the blood. Most often, it is revealed quite by accident, when a person gives blood in connection with another disease, for prophylactic purposes, when pregnancy is detected, etc. High blood sugar can not but worry both the doctor and his patient, who immediately raises an urgent question: how could this happen and what caused the appearance of a significant concentration of glucose in the blood plasma?

The cause of pathological increase in the level of sugar in biological fluids, which is the main characteristic of prediabetes, is unlikely to be the use of a large number of sweets, unless the body has a violation of glucose uptake. If the sugar is low, it is still too early to talk about the development of diabetes, so these patients are considered a risk group for this pathology.

[14], [15],

Risk factors

But the risk factors for the development of prediabetes in different patients may be different. So for women, a provoking factor may be:

• Gestational diabetes or glucosuria during pregnancy
• birth of a large child weighing more than 4 kg
• birth of a child with malformations or a dead infant
• miscarriages
• development of polycystic ovaries.

In patients, both male and female, the probability of pre-diabetes development is higher if they are already 45 years old and, moreover, there is excess weight. Prediabetes can also develop in young people with a body mass index of more than 25.

Factors for the development of prediabetes may be high blood pressure (from 140/90 and above) and poor heredity. As for the hereditary predisposition, prediabetes is more likely to develop in those whose relatives suffer from diabetes (at least one of the parents).

The propensity to develop prediabetes is observed in representatives of individual races. The Europoid race does not have such a predisposition. But if the child became the fruit of the love of a mixed marriage, and one of his parents is a representative of the Asian or Negroid race or who comes from America, the baby's likelihood of developing prediabetes will be significantly higher than that of his European counterparts.

High risk for the development of the pre-diabetic condition is also characterized by identical twins, if diabetes was diagnosed in one of the parents or close relatives.

Some pathologies of health can contribute to the development of prediabetes. Patients with obesity, arteriosclerosis of the vessels, arterial hypertension, gout, chronic liver, kidney and biliary tract diseases, UTI, respiratory infections and neuropathies are also at risk of metabolic disorders of carbohydrates.

Provoke prediabetes can such diseases and pathological conditions as hyperuricemia, alimentary and renal glucosuria, episodic glucosuria and hyperglycemia, manifested in a state of stress, paradontosis, furunculosis, spontaneous hypoglycemia. And, of course, there is nothing surprising if prediabetes develops in patients with impaired pancreas.

The presence of one of the risk factors does not mean that at some point the glucose in the blood will be found out. This is more likely if there are 2 or more provoking factors. For example, the age of more than 45 years and a large body weight or high blood pressure, the birth of a large child at a young age and disruption of the pancreas in the elder, etc.

[16], [17], [18], [19], [20], [21], [22], [23], [24]

Pathogenesis

Our body is a complex system for the full work of which proteins, fats and carbohydrates are equally necessary. All this we can get in the composition of food. And our body subsequently derives some benefit from this.

Thus, hydrocarbon-containing products supply glucose to our body, which for it is the main source of energy. In order for cells to be able to extract this energy from glucose without hindrance, the pancreas produces a special enzyme - insulin. Insulin is involved in the metabolism of glucose, resulting in a normal life of the body.

If the pancreas does not produce enough insulin due to some circumstances, the sugar is only partially absorbed, the rest of it gets into the blood, where it is found as a result of the tests. In this case, they speak about the development of diabetes mellitus.

If the appearance of glucose in the analysis is attributed not so much to the insulin production as to the insulin sensitivity of the cells, they speak of the development of a condition such as prediabetes, which is the beginning of the final line leading to diabetes mellitus.

Prediabet is not considered a disease yet, but it is also impossible to name a patient with an elevated blood sugar level absolutely healthy.

[25], [26], [27], [28], [29],

Symptoms of the prediabetes

In many patients, doctors diagnose such a pathology as prediabetes, absolutely accidentally. A person, for example, complains of kidney pain, and the prescribed tests show a slight but clinically significant increase in the level of glucose in the blood plasma. The patient may not even feel any changes in his body, but changes in the composition of the blood force the doctor to take such a person for control.

If there is a single case of the appearance of sugar in the blood, and it is associated with the abuse of sweets, there is no reason to worry particularly. But if the repeated analysis shows the presence of sugar, you need to think and take all measures to prevent pre-diabetes from escalating into a serious, almost incurable disease that causes a person to stick to certain restrictions for life.

Normally, the sugar level in the blood should not exceed 5.5 mmol / l. If it becomes larger, but still does not reach the critical point of 7 mmol / L, this is the first sign of the development of prediabetes. Fluctuations in the concentration of blood sugar in these limits are not considered a sign of diabetes, but only its possible harbinger.

Other symptoms of prediabetes in many ways resemble the manifestations of insulin-independent diabetes mellitus. What are the signs to pay attention to?

1. The metabolic disorder provokes hormonal disruptions in the body, and they in turn cause problems with night rest (insomnia, difficulties with falling asleep, frequent unreasonable awakenings, etc.).
2. An increase in the concentration of sugar causes an increase in the viscosity of the blood, which makes it difficult to flow through small vessels. The patient begins to feel these difficulties in the form of itchy skin.
3. For the same reason, visual acuity may worsen, because due to the increased density of blood does not provide the supply of oxygen and nutrients to the optic nerve.
4. If the concentration of sugar exceeds the figure of 6 mmol / l, there is a constant, painful thirst, which disappears only after lowering the sugar level. The higher the blood sugar, the more our body begins to need fluid. He needs water to dilute the blood and maintain the vital functions of cells, which, due to the action of glucose, begin to experience a moisture deficit.
5. Rapid urination is again caused by the impact of glucose on the kidneys and the use of a large amount of fluid.
6. An unreasonable decrease in body weight is also caused by an elevated level of sugar. The person continues to eat the same way as before, but because of a disturbance in glucose metabolism, he constantly suffers from a lack of energy. The energy expenditure remains the same, which causes an increase in the conversion of fats into energy, and hence a decrease in weight. The patient begins to feel very exhausted, tired.
7. Any metabolic disorder causes deterioration of the cellular nutrition, which provokes the appearance of convulsive syndrome.
8. A sharp increase in sugar in the blood plasma provokes a condition that is characterized as hot flashes or sudden heat attacks.
9. Violation of the blood flow in the vessels can provoke migraine headaches, a sense of heaviness and squeezing in the limbs, especially in the legs.
10.  In men, impaired blood supply to organs due to increased blood density can cause problems with potency.

When such symptoms appear, the decisive index for the diagnosis is still the blood sugar level. It is for him to determine what we are dealing with: the initial stage of diabetes mellitus or its precursor.

Prediabetes and pregnancy

During pregnancy, all organs and systems of the future mother begin to function in a strengthened mode. Mommy now breathes and eats for two. It is clear that the production of insulin in her body also increases. This situation is characterized by a heavy load on the insular apparatus.

If a pre-diabetic patient with a glucose uptake was diagnosed before pregnancy, then in the future it can easily develop into type 2 diabetes mellitus even without the influence of other provoking factors.

In addition, during pregnancy, the body's need for insulin can grow greatly. Most often this happens just in the middle of the term (from 20 to 24 weeks). The pancreas can not cope with the duties assigned to it and the pregnant woman has to prick insulin-containing drugs. In this case, the longer the period, the higher the dose of insulin may be required.

But even with the transition of pre-diabetes to a mild degree of overt diabetes, it is not always possible to adjust the blood sugar level through dietary treatment, and we again have to resort to injections of insulin.

Complications and consequences

The fact that prediabetes is not yet considered a pathology does not at all mean that one should treat this state lightly. Increasing blood sugar levels above 5.5 mmol per liter is no longer considered the norm, although with this indicator a terrible verdict is not taken out. And any deviations from the norm show that the body is not all so smooth.

Ignoring such signals, we provoke the transition of the process from the initial embryonic stage to an obvious disease, which is type 2 diabetes. Consequences of prediabetes in the absence of appropriate preventive measures and treatment are such manifestations of diabetes as obesity, cardiovascular pathology, visual impairment, impaired working capacity, susceptibility to various infectious factors.

Not so dangerous, but no less unpleasant symptoms of developing diabetes, are intolerable skin itching (in women this symptom affects the genitals), long-term healing of various skin lesions, mood swings, a tendency to nervous breakdowns and weakening of the body as a whole.

All these unpleasant manifestations of developing diabetes mellitus can be considered complications of prediabetes, which was not detected in time, or the person simply ignored the alarming symptoms.

[30], [31], [32], [33], [34], [35]

Diagnostics of the prediabetes

Prediabetes is a condition characterized by impaired glucose tolerance. It can be asymptomatic or have mild symptomatology, reminiscent of manifestations of diabetes mellitus. In the first case, pathological changes in the body are detected as a result of blood donation for analysis.

An increased level of sugar will show even a general blood test, but you can not make a diagnosis by its results. The fact is that the appearance of glucose in the blood can be caused by excessive consumption of carbohydrates and sweets on the eve of the tests. If a slight increase in glucose level acts as a single case, there is nothing to worry about. It's another matter if the situation repeats.

The patient can come to the doctor and with certain complaints, among which may be the following:

• appearance of furuncles on the skin,
• problems with the teeth, for example, they prematurely loosen and fall out, and the gums become inflamed and begin to bleed,
• itching on the skin, especially in the area of the external genitalia,
• the skin becomes very dry, hair begins to fall out, fingernails are cracked,
• Wounds and lesions on the skin do not heal for a long period of time,
• the appearance of sexual weakness in men and menstrual irregularities in women,
• unexplained thirst, etc.

Such a symptomatology should alert the doctor, but he will be able to make a definitive diagnosis only after conducting a general analysis of blood and urine, a blood test for sugar and, if necessary, additional tests.

Blood for sugar is usually taken in the morning, before breakfast. The interval between the last evening meal and the time of donating blood should be at least 8 hours. Water is not forbidden to drink at this time.

Blood for sugar, like a general blood test, is taken from the finger. In the norm of glucose in blood plasma should not be more than 5.5 mmol per liter, but even its increase to 6 mmol / l can be attributed to the error in preparation for analysis, which requires its retransmission. If the result exceeds 6.1 mmol / l, this indicates the development of prediabetes. The analysis of urine at this stage does not show the presence of sugar in it.

To clarify the preliminary diagnosis, you can by conducting another analysis - an oral glucose tolerance test. The patient takes blood from the finger on an empty stomach, then he is offered to drink a glass of water in which 75 g of glucose is dissolved. After 2 hours, a second blood test is taken. If its result 2 hours after the reception of a sweet drink varies between 7.8 - 11 mmol per liter, this is likely to indicate the development of prediabetes. The higher rates speak of diabetes mellitus.

There is one more possibility to determine the pathological condition - to measure glycated hemoglobin for several months. Its percentage of the total volume of blood and will be an indicator of glucose tolerance. If the percentage of glycated hemoglobin is within 5.5-6.1 for some time, this indicates a stage that precedes the development of diabetes.

Ideally, in parallel with these studies, the determination of the level of insulin on an empty stomach should also be carried out. Normally, this figure does not exceed 7 μIU / ml. If he reached 13 μIU / ml, it is urgent to start adjusting your body to normal. Alas, this type of research is not always carried out, and not all doctors can correctly interpret it.

Instrumental diagnosis in pre-diabetes is meaningful only if the patient complains about other health problems, which can only be identified in this way. Usually it is carried out with suspicion of the pathology of the heart and blood vessels (blood pressure and pulse are measured, ECG and other diagnostic procedures are performed).

[36], [37],

Differential diagnosis

Differential diagnosis is conducted between pre-diabetes and its next stage of diabetes mellitus. For other types of diabetes (non-sugar and insulin-dependent), the development of the pre-diabetic state is not characteristic.

[38], [39], [40], [41], [42], [43], [44], [45]

Treatment of the prediabetes

If the doctor diagnosed "prediabetes", it is not necessary to panic especially, this condition is reversible. Fulfillment of certain requirements will help to normalize the pancreas and restore blood to normal.

In this case, the treatment of pre-diabetes involves not only taking medications that help reduce blood sugar, but also some changes in the lifestyle of a person. He will have to give up such bad habits as smoking, drinking, overeating.

If there is excess weight (or even obesity), he will also have to fight. This will not be so difficult if you consider that diet and regular physical exercise (active walking in the air, doing exercises, working in the garden, etc.) for at least half an hour, which help control the sugar content and cholesterol in the blood. Active physical loads stimulate the processing of glucose into energy, and proper nutrition facilitates the work of the pancreas responsible for the production of insulin involved in the metabolism of glucose.

Why is it important to get rid of fat stores? No wonder they say that overweight is one of the risk factors for the development of prediabetes. The thing is that fat cells that do not need energy from glucose make it difficult for them to access muscle tissue, which energy is simply necessary. Glucose enters the body, but is not consumed in full. Its excess is subsequently found in the blood, which as a result becomes denser.

If the blood pressure is increased, you need to take measures to normalize it. This may be the taking of special medications (Enalapril, Fenigidin, etc.) as prescribed by the doctor or using products and herbs that bring the pressure back to normal.

Physiotherapeutic and surgical treatment for prediabetes is not relevant.

Correction of blood sugar level with drugs

To medical treatment of pre-diabetes doctors do not use so often. Indication for the use of this method of treatment is the lack of positive results of therapy with diet and a specially developed system of exercise.

Most often, patients with prediabetes at the advanced stage are prescribed antidiabetic drug "Metformin", which improves the susceptibility of the body's tissues to insulin, inhibits the absorption of glucose in the intestine, reduces the secretion of glucose by the liver and stimulates the utilization of its surplus, lowers cholesterol.

"Metformin"  with pre-diabetes is prescribed by the attending physician individually in dosage, depending on the severity of the pathological process.

Contraindications to the use of the drug are:

• insufficiency or impaired renal function (increased level of creatinine),
• conditions that negatively affect the functioning of the kidneys (dehydration of the body, severe course of infectious processes, shock, intravascular injection of contrast solutions containing iodine, etc.)
• pathologies leading to oxygen starvation of tissues (heart failure, severe diseases of the respiratory system, recent myocardial infarction),
• insufficiency of liver function,
• alcohol abuse,
• breast-feeding,
• period of pregnancy and on the eve of conception,
• hypersensitivity to metformin and other components of the drug.

The drug is not used in pediatrics.

Side effects. Most often, patients taking metformin-based medications complain of nausea, vomiting, worsening of appetite, diarrhea, epigastric pain, and metal taste in the mouth. Symptoms such as erythema, lactatacidosis (accumulation of lactic acid in the blood) appear less frequently, and the absorption of vitamin B12 deteriorates.

Precautionary measures. The drug can be used as a part of monotherapy, and in combination with other sugar reducing agents, that in the absence of control over the composition of blood can lead to the development of hypoglycemia, which in turn leads to a violation of concentration and inability to perform works that require concentration.

During treatment with the drug, it is necessary to monitor the work of the kidneys, especially if the patient takes medications for some of the indications to reduce blood pressure, diuretics (diuretics) or NSAIDs.

During therapy with the drug, you should stop using alcohol-containing beverages and alcohol-based drugs that enhance the side effects of the drug.

When preparing for an operation that requires anesthesia, the drug is canceled two days before the operation.

Analogue of the drug "Metformin" is the anti-diabetic remedy of the same biguanide class  "Siofor", which is prescribed with prediabetes for the same indications. Preference is given to the drug with a lower dosage of "Siofor 500".

Method of administration and dose. The initial daily dose of the drug is 2-3 tablets. You need to take them one at a time or after a meal. After 1.5-2 weeks, the dose is adjusted depending on the results of the blood test for sugar. The maximum dose is 6 tablets per day.

Contraindications. The same as the drug "Metformin".

Side effects. Identical to what is observed during the reception of Metformin.

The above preparations with pre-diabetes can be used in combination with sugar-reducing drugs, such as "Maninil 5", "Amaryl" and others.

The peroral hypoglycemic drug  "Maninil 5"  belongs to sulfonamides, derivatives of urea. The active substance of the drug is glibenclamide, stimulating beta cells of the pancreas and thereby increasing the secretion of insulin.

The drug is used both for the treatment of patients with diabetes mellitus, and for the correction of the level of sugar in pre-diabetes.

Selection of an effective dose is performed by a doctor, based on the individual characteristics of the patient's body and body weight. Begin treatment with minimal doses of the drug: 0.5-1 tablets per day. Further, the dose is adjusted depending on the patient's well-being and blood counts.

Take the drug before meals. The tablets are swallowed whole and washed down with water. Take the drug at the same time every day. The course of treatment is adjusted depending on the patient's condition.

Contraindications. The drug is not intended for the treatment of type 1 diabetes. It is not used at a high probability of development of acidosis, after resection of the pancreas, with severe pathologies of the kidneys and liver. Do not undergo treatment with the drug during pregnancy and lactation. Not used in pediatrics.

Do not prescribe medicine for hypersensitivity to its components, with increased sensitivity to sulfonamides and sulfanylurea preparations.

Side effects. As a result of taking the drug may develop hypoglycemia, increase body weight, disturb digestive disorders. At the beginning of therapy, individual patients experienced short-term visual and accommodation discomforts, itching, rashes on the skin, and increased photosensitivity. Severe reactions are extremely rare.

"Amaryl" is a sugar-reducing drug of the same class as "Maninil 5". The active substance of the drug is glimepiride.

Method of administration and dose. The initial dose of the drug is 1 mg. If it turns out to be insufficient, the doctor reviews the appointments in the direction of increasing the dosage or changing the drug.

With pre-diabetes, the drug is usually prescribed in case of ineffectiveness of Metformin therapy.

Contraindications. The drug is not recommended for the treatment of children, pregnant women, nursing mothers.

Do not prescribe the drug to patients with impaired liver and kidney function, as well as those who have increased sensitivity to the constituents of the drug and sulfonamides.

Side effects are identical to the drug "Maninil 5".

Taking the above and similar preparations, it is necessary to take into account that without following the requirements of a low-carbohydrate diet, it is simply impossible to improve the situation. Medication therapy makes sense only in combination with proper nutrition and exercise.

Stay active and receive all the necessary substances to help the body take vitamins and vitamin-mineral complexes.

Prediabetes is a condition that requires special attention to one's health and rejection of bad habits, which means that alcohol and cigarettes should at least temporarily be forgotten. Moreover, taking antidiabetic drugs and alcoholic beverages in many cases can result in unpleasant consequences.

[46], [47], [48], [49], [50], [51]

Alternative treatment

Since medication is not the basis of pre-diabetes therapy, and diet and exercise are preferred, the use of alternative methods of treating glucose tolerance disorders should be discussed with the attending physician. If he considers this treatment expedient, alternative medicine prescriptions can be used to improve the pancreas, reduce glucose uptake in the intestine, and optimize metabolism.

1. For 3 weeks before each meal, drink a quarter cup of a mixture of fresh beet juice and cabbage brine (take in equal amounts). After a week, the course can be repeated. If the patient is diagnosed with pancreatitis, the possibility of using such a "medicine" should be discussed with a gastroenterologist.
2. In the morning, grind 2 tablespoons. Buckwheat and pour a glass of low-fat kefir, eat 30 minutes before dinner. The same thing done at night, and in the morning before breakfast.
3. Medicinal salad: one large onion and a good pinch of dill and parsley mixture chop and season with olive oil. The onion should be doused with boiling water. Eat salad every day.
4. Positive effect on digestion and metabolism is caused by decoction of flaxseed (1 tablespoon per glass of water). Take it in the morning on an empty stomach.

Treatment of prediabetes with herbs is the use of useful and tasty broths based on the root of elecampane, the leaves of blueberries and strawberries, hips, yarrow herbs, currant shoots.

[52], [53], [54], [55]

Homeopathy

Since many of the symptoms of prediabetes resemble manifestations of type 2 diabetes, the homeopathic treatment of this condition can also be carried out with the same drugs that are used for obvious diabetes. But in any case, before starting treatment with homeopathy, you need to consult with a doctor in this regard.

The first drug, which should pay attention to a person with high blood sugar, is considered to be Natrium phosphoricum. It is prescribed when there are initial symptoms of developing type 2 diabetes. The concentration of phosphorus salts is selected individually according to the level of glucose in the blood.

As a preventive measure of diabetes mellitus, when symptoms of prediabetes appear, you can use such homeopathic medicines as Arsenika, Grafitis, Sekale kornutum. Contraindications to such drugs may be individual intolerance of components or alcohol abuse (in the case of the appointment of alcohol tinctures).

It is important to pay attention to the fact that homeopathic remedies operate according to the "wedge knocked out wedge" principle, which means that at the initial stage of therapy, the patient's condition may worsen, which does not indicate ineffectiveness or danger of therapy. Another thing is if the drug does not show any results for a long time (more than 2 months). Then it should be replaced or revised dosage.

Prevention

Prevention of the development of prediabetes and its complications is first and foremost a concern for one's health. A healthy lifestyle, the absence of bad habits, the fight against excess weight, proper nutrition, annual medical examinations, timely treatment of any acute and chronic diseases in many cases helped to avoid the violation of glucose tolerance even against a background of poor heredity.

Refusal of acute, strongly salted, fried, any heavy food, which causes the pancreas to work with an angina, will help to keep it working for a long time, and therefore problems with the development of insulin should not arise. To maintain the health of the digestive system will help and ability to cope with stressful situations, depression.

[56], [57], [58]

Forecast

The prognosis of pre-diabetes largely depends on how timely this pathological condition was revealed, and how exactly the patient will continue to perform the doctor's appointments. With a non-serious attitude to their health and late diagnosis, prediabetes can soon develop into a serious, practically incurable pathology that will dictate its conditions for further coexistence.

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