Prediabetes in adults and children

There has been so much written and spoken about a disease such as diabetes that only a very small child could not have an idea about it. But in medical practice there is also such a concept as prediabetes (or prediabetes), which is clearly related to the previous diagnosis, but still differs significantly from it.

It is worth noting right away that prediabetes is not exactly a diagnosis. Doctors make such a verdict when the patient's condition indicates a violation of glucose absorption, but these symptoms are not enough to make a diagnosis such as insulin-independent diabetes, which is otherwise called type 2 diabetes.

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Epidemiology

Despite the fact that advanced age is considered one of the risk factors for the development of prediabetes, this pathology is also 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 metabolic pathology in this case is most often past infectious diseases, which, in combination with a hereditary predisposition, create a vicious circle that causes inhibition of glucose metabolism. Prediabetes is diagnosed in children as well as in adults.

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

In 2015, an estimated 33.9% of U.S. adults aged 18 and older (84.1 million people) had prediabetes based on their fasting glucose or A1C levels. Nearly half (48.3%) of adults aged 65 and older had prediabetes.

Among adults with prediabetes, 11.6% reported being told by a health care provider that they had the condition.

Age-adjusted data for 2011–2014 showed that prediabetes was more common among men (36.6%) than women (29.3%). The prevalence of prediabetes was similar among racial and ethnic groups.

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Causes prediabetes

A condition such as prediabetes manifests itself primarily by an increase in blood sugar levels. Most often, it is detected completely by accident, when a person donates blood due to another disease, for preventive purposes, when detecting pregnancy, etc. High blood sugar levels cannot but worry both the doctor and his patient, who immediately has 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 the pathological increase in sugar levels in biological fluids, which is the main characteristic of prediabetes, is unlikely to be the consumption of large amounts of sweets, unless the body has a violation of glucose absorption. If sugar levels are low, it is too early to talk about the development of diabetes, so such patients are included in the risk group for the development of this pathology.

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Risk factors

But the risk factors for developing prediabetes may differ in different patients. For women, the following may be a provoking factor:

• gestational diabetes or glucosuria during pregnancy
• birth of a large baby weighing more than 4 kg
• birth of a child with developmental defects or stillbirth
• miscarriages
• development of polycystic ovary syndrome.

Both male and female patients are more likely to develop prediabetes if they are over 45 years old and are overweight. Prediabetes can also develop in younger people with a body mass index of over 25.

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

The tendency to develop prediabetes is observed in representatives of certain races. The Caucasian race does not have such a predisposition. But if the child is the fruit of love of a mixed marriage, and one of his parents is a representative of the Asian or Negroid race, or an immigrant from America, the baby will have a significantly higher probability of developing prediabetes than his European relatives.

Identical twins also have a high risk of developing prediabetes if one of their parents or close relatives has been diagnosed with diabetes.

Some health pathologies can also contribute to the development of prediabetes. Patients with obesity, vascular atherosclerosis, arterial hypertension, gout, chronic liver, kidney and biliary tract diseases, UTI, infectious respiratory diseases and neuropathies also belong to the risk group for carbohydrate metabolism disorders.

Prediabetes can be provoked by such diseases and pathological conditions as hyperuricemia, alimentary and renal glucosuria, episodic glucosuria and hyperglycemia, manifested in a state of stress, periodontosis, furunculosis, spontaneous hypoglycemia. And, of course, there is nothing surprising if prediabetes develops in patients with pancreatic dysfunction.

The presence of one of the risk factors does not necessarily mean that at some point glucose in the blood will necessarily be detected. This is more likely if there are 2 or more provoking factors. For example, age over 45 and a large body weight or high blood pressure, the birth of a large child at a young age and problems with the pancreas at an older age, etc.

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Pathogenesis

Our body is a complex system, for the full functioning of which proteins, fats and carbohydrates are equally necessary. We can get all this in food products. And our body subsequently derives certain benefits from this.

Thus, carbohydrate-containing products supply our body with glucose, which is the main source of energy for it. In order for cells to be able to freely extract this very energy from glucose, the pancreas produces a special enzyme - insulin. Insulin is involved in glucose metabolism, as a result of which the normal functioning of the body is ensured.

If the pancreas, due to some circumstances, does not produce enough insulin, sugar is absorbed only partially, and the rest of it enters the blood, where it is detected in tests. In this case, we speak of the development of diabetes.

If the appearance of glucose in the tests is associated not so much with insufficient insulin production, but with disturbances in the sensitivity of cells to insulin, they speak of the development of a condition called prediabetes, which is the beginning of the finish line leading to diabetes.

Prediabetes is not yet considered a disease, but it is also impossible to call a patient with high blood sugar levels absolutely healthy.

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Symptoms prediabetes

In many patients, such a pathology as prediabetes is detected by doctors absolutely by accident. For example, a person complains of pain in the kidneys, and the tests prescribed show a small but clinically significant increase in the glucose level in the blood plasma. The patient may not even feel any changes in his body, but changes in the blood composition force the doctor to take such a person under control.

If there is a single case of sugar in the blood, and it is associated with the abuse of sweets, there is no reason to worry too much. But if a repeated analysis shows the presence of sugar, you need to think about it and take all measures to prevent prediabetes from developing into a serious, almost incurable disease, forcing a person to adhere to certain restrictions for life.

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

Other symptoms of prediabetes are very similar to those of non-insulin-dependent diabetes mellitus. What signs should you pay attention to?

1. Metabolic disorders provoke hormonal disruptions in the body, which in turn cause problems with night rest (insomnia, difficulty falling asleep, frequent unexplained awakenings, etc.).
2. The increase in sugar concentration causes an increase in blood viscosity, which makes it difficult for the blood 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 deteriorate, because due to increased density, the blood does not provide oxygen and nutrients to the optic nerve.
4. If the sugar concentration exceeds 6 mmol/l, a constant, excruciating thirst appears, which disappears only after the sugar level decreases. The higher the blood sugar, the more our body begins to need liquid. It needs water to thin the blood and maintain the vital activity of cells, which, due to the effects of glucose, begin to experience a moisture deficit.
5. Frequent urination is again caused by the effect of glucose on the kidneys and drinking large amounts of fluid.
6. Unreasonable weight loss is also caused by elevated sugar levels. A person continues to eat the same as before, but due to a violation of glucose metabolism, he constantly experiences a lack of energy. Energy expenditure remains the same, which causes an increase in the conversion of fats into energy, and therefore weight loss. The patient begins to feel very exhausted and tired.
7. Any metabolic disorder causes a deterioration in cellular nutrition, which provokes the appearance of convulsive syndrome.
8. A sharp increase in blood plasma sugar provokes a condition characterized by hot flashes or sudden hot flashes.
9. Disruption of blood flow in the vessels can provoke migraine-like headaches, a feeling of heaviness and pressure in the limbs, especially in the legs.
10. In men, disruption of the blood supply to organs due to increased blood density can cause problems with potency.

When such symptoms appear, the decisive indicator for making a diagnosis is still the blood sugar level. It is by this that we can determine what we are dealing with: the initial stage of diabetes or its precursor.

Prediabetes and pregnancy

During pregnancy, all organs and systems of the expectant mother begin to function in an enhanced mode. The mother 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 large load on the insular apparatus.

If a woman was diagnosed with prediabetes with impaired glucose absorption before pregnancy, then later it can easily develop into type 2 diabetes even without the influence of other provoking factors.

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

But even when prediabetes progresses to a mild stage of overt diabetes, it is not always possible to correct blood sugar levels through dietary treatment, and one must again resort to insulin injections.

Complications and consequences

The fact that prediabetes is not yet considered a pathology does not mean that this condition should be taken lightly. An increase in blood sugar levels above 5.5 mmol per liter is no longer considered normal, although at such an indicator a terrible verdict is not issued. And any deviations from the norm show that not everything is so smooth in the body.

By ignoring such signals, we provoke the transition of the process from the initial embryonic stage to an obvious disease, which is diabetes mellitus type 2. The consequences of prediabetes in the absence of appropriate preventive and treatment measures are such manifestations of diabetes mellitus as obesity, cardiovascular pathologies, visual impairment, deterioration in performance, susceptibility to various infectious factors.

Less dangerous, but no less unpleasant symptoms of developing diabetes are unbearable itching of the skin (in women, this symptom affects the genitals), prolonged healing of various skin lesions, mood swings, a tendency to nervous breakdowns and a weakening of the body as a whole.

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

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Diagnostics prediabetes

Prediabetes is a condition characterized by impaired glucose tolerance. It may be asymptomatic or have mild symptoms resembling those of diabetes. In the first case, pathological changes in the body are detected by taking a blood test.

Even a general blood test will show an elevated sugar level, but you can't make a diagnosis based on its results alone. The fact is that the appearance of glucose in the blood can be caused by excessive consumption of carbohydrates and sweets the day before the tests. If a slight increase in glucose levels is an isolated case, there is nothing to worry about. It's a different matter if the situation repeats itself.

The patient may come to the doctor with certain complaints, which may include the following:

• the appearance of boils on the skin,
• problems with teeth, for example, they become loose and fall out prematurely, and the gums become inflamed and begin to bleed,
• itching of the skin, especially in the area of the external genitalia,
• the skin becomes very dry, hair begins to fall out, nails peel,
• wounds and damage to 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 symptoms should alert the doctor, but he will be able to make a final diagnosis only after conducting a general blood and urine test, a blood sugar test and, if necessary, additional tests.

Blood for sugar is usually given in the morning, before breakfast. The interval between the last evening meal and the time of blood donation should be at least 8 hours. Drinking water at this time is not prohibited.

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

A preliminary diagnosis can be clarified by conducting another test – an oral glucose tolerance test. The patient’s blood is taken from a finger on an empty stomach, then he is asked to drink a glass of water in which 75 g of glucose is dissolved. A repeat blood test is taken 2 hours later. If the result 2 hours after drinking a sweet drink fluctuates between 7.8 and 11 mmol per liter, this most likely indicates the development of prediabetes. Higher values indicate diabetes.

There is another way to determine the pathological condition - to measure glycated hemoglobin for several months. Its percentage to the total blood volume 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 preceding the development of diabetes.

Ideally, fasting insulin levels should be determined in parallel with these studies. Normally, this indicator does not exceed 7 μIU/ml. If it reaches 13 μIU/ml, you should urgently start bringing your body back to normal. Unfortunately, this type of study is not always carried out, and not all doctors can interpret it correctly.

Instrumental diagnostics for prediabetes makes sense only if the patient also complains of other health problems that can only be identified in this way. It is usually carried out if there is a suspicion of heart and vascular pathologies (blood pressure and pulse are measured, an ECG and other diagnostic procedures are performed).

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Differential diagnosis

Differential diagnostics is carried out between prediabetes and its next stage - diabetes mellitus. For other types of diabetes (insipidus and insulin-dependent) the development of prediabetic condition is not typical.

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Treatment prediabetes

If the doctor has diagnosed you with prediabetes, there is no need to panic, as this condition is reversible. Following certain requirements will help normalize the pancreas and return blood counts to normal.

At the same time, treatment of prediabetes involves not only taking medications that help reduce blood sugar levels, but also some changes in a person's lifestyle. He will have to give up such bad habits as smoking, drinking alcohol, and overeating.

If you are overweight (or even obese), you will also have to fight it. This will not be so difficult if you consider that important requirements for treating prediabetes are diet and regular feasible physical activity (active walks in the fresh air, exercise, gardening, etc.) lasting at least half an hour, which helps control the sugar and cholesterol levels in the blood. Active physical activity stimulates the conversion of glucose into energy, and proper nutrition facilitates the work of the pancreas, which is responsible for producing insulin, which is involved in glucose metabolism.

Why is it so important to get rid of fat reserves? It is not for nothing that they say that excess weight is one of the risk factors for the development of prediabetes. The thing is that fat cells, which do not need energy obtained from glucose, make it difficult for muscle tissue, which simply needs energy, to access it. Glucose enters the body, but is not used up to the full extent. Its excess is subsequently found in the blood, which as a result becomes thicker.

If the blood pressure readings are elevated, measures must be taken to normalize it. This may include taking special medications (Enalapril, Phenigidin, etc.) as prescribed by a doctor or consuming foods and herbs that normalize blood pressure.

Physiotherapy and surgery are not relevant for prediabetes.

Correcting blood sugar levels with medications

Doctors do not often resort to drug treatment of prediabetes. The indication for the use of this method of treatment is the lack of positive results of therapy with the help of diet and a specially developed system of physical exercises.

Most often, doctors prescribe the antidiabetic drug Metformin to patients with advanced prediabetes, which improves the sensitivity of body 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 excess, and reduces cholesterol levels.

"Metformin" for prediabetes is prescribed by the attending physician individually in a dosage depending on the severity of the pathological process.

Contraindications to the use of the drug are:

• renal failure or impairment (elevated creatinine levels),
• conditions that negatively affect kidney function (dehydration, severe infectious processes, shock, intravascular administration of contrast solutions containing iodine, etc.),
• pathologies leading to tissue oxygen starvation (heart failure, severe respiratory diseases, recent myocardial infarction),
• liver failure,
• alcohol abuse,
• breast-feeding,
• the period of pregnancy and before 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 drugs complain of nausea, leading to vomiting, loss of appetite, diarrhea, epigastric pain, and a metallic taste in the mouth. Much less frequently, symptoms such as erythema, lactic acidosis (accumulation of lactic acid in the blood), and impaired absorption of vitamin B12 appear.

Precautions. The drug can be used both as part of monotherapy and in combination with other hypoglycemic agents, which, in the absence of blood control, can lead to the development of hypoglycemia, which in turn leads to impaired concentration and the inability to perform work that requires concentration.

During treatment with the drug, it is necessary to monitor kidney function, especially if the patient, for some reason, is taking drugs to lower blood pressure, diuretics, or NSAIDs.

During therapy with the drug, you should avoid drinking alcoholic beverages and alcohol-based drugs, which increase the side effects of the drug.

When preparing for a surgical intervention that requires anesthesia, the drug is discontinued two days before the start of the operation.

An analogue of the drug "Metformin" is the antidiabetic drug of the same class of biguanides "Siofor", which is prescribed for prediabetes for the same indications. Preference is given to the drug with a lower dosage "Siofor 500".

Method of administration and dosage. The initial daily dose of the drug is 2-3 tablets. They should be taken one at a time during or after meals. After 1.5-2 weeks, the dose is adjusted depending on the results of the blood sugar test. The maximum dose is 6 tablets per day.

Contraindications for use. The same as for the drug "Metformin".

Side effects: Identical to those observed during the intake of "Metformin".

The above-described drugs for prediabetes can be used in combination with hypoglycemic drugs such as Maninil 5, Amaril, etc.

The oral hypoglycemic drug "Maninil 5" is a sulfonamide, a urea derivative. The active substance of the drug is glibenclamide, which stimulates beta cells of the pancreas and thereby increases insulin secretion.

The drug is used both for the treatment of patients with diabetes and for the correction of sugar levels in prediabetes.

The selection of an effective dose is carried out by a doctor, based on the individual characteristics of the patient's body and body weight. Treatment begins with minimal doses of the drug: 0.5-1 tablet per day. Then the dose is adjusted depending on the patient's well-being and blood counts.

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

Contraindications for use. The drug is not intended for the treatment of type 1 diabetes. It is not used in cases of high risk of acidosis, after pancreatic resection, or severe kidney and liver pathologies. The drug should not be used during pregnancy and lactation. It is not used in pediatrics.

The drug is not prescribed in case of hypersensitivity to its components, or in case of increased sensitivity to sulfonamides and sulfonylurea drugs.

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

"Amaril" is a hypoglycemic drug of the same class as "Maninil 5". The active substance of the drug is glimepiride.

Method of administration and dosage. The initial dose of the drug is 1 mg. If it is insufficient, the doctor revises the prescriptions towards increasing the dosage or replacing the drug.

In prediabetes, the drug is usually prescribed when Metformin therapy is ineffective.

Contraindications for use. The drug is not recommended for use in children, pregnant women, nursing mothers.

The drug should not be prescribed to patients with liver or kidney problems, or to those who are hypersensitive to the drug's components and sulfonamides.

Side effects are identical to those of Maninil 5.

When taking the above and similar medications, you need to keep in mind that without following the requirements of a low-carbohydrate diet, it is simply impossible to improve the situation. Drug therapy makes sense only in combination with proper nutrition and physical activity.

Taking vitamins and vitamin-mineral complexes will help you stay active and get all the nutrients your body needs.

Prediabetes is a condition that requires special attention to your health and giving up bad habits, which means that alcohol and cigarettes should be forgotten at least for a while. Moreover, taking antidiabetic drugs and alcoholic beverages in many cases can lead to unpleasant consequences.

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Folk remedies

Since drug treatment is not the basis of prediabetes therapy, and preference is given to diet and exercise, the use of folk methods of treating glucose intolerance disorders should be discussed with the attending physician. If he considers such treatment appropriate, you can use folk medicine recipes aimed at improving the functioning of the pancreas, reducing the absorption of glucose in the intestine, and optimizing metabolism.

1. For 3 weeks, before each meal, drink a quarter of a glass of a mixture of fresh beet juice and cabbage brine (take in equal quantities). 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 of buckwheat and pour a glass of low-fat kefir over them, eat 30 minutes before dinner. Do the same at night, and in the morning, consume before breakfast.
3. Healing salad: chop one large onion and a good pinch of dill and parsley mixture and season with olive oil. Pour boiling water over the onion. Eat the salad every day.
4. A decoction of flax seed (1 tbsp. per glass of water) has a positive effect on digestion and metabolism. It should be taken in the morning on an empty stomach.

Treatment of prediabetes with herbs is the use of healthy and tasty decoctions based on elecampane root, blueberry and strawberry leaves, rose hips, yarrow herb, and currant shoots.

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Homeopathy

Since many symptoms of prediabetes resemble those of type 2 diabetes, homeopathic treatment of this condition can be carried out with the same drugs that are used for overt diabetes. But in any case, before starting treatment with homeopathic remedies, you need to consult with your doctor about this.

The very first drug that a person with high blood sugar should pay attention to is Natrium phosphoricum. It is prescribed when the initial symptoms of developing type 2 diabetes appear. The concentration of phosphorus salts is selected individually according to the blood glucose level.

As a preventive measure for diabetes mellitus, when symptoms of prediabetes appear, homeopathic medicines such as Arsenica, Graphitis, Secale cornutum can also be used. Contraindications to such drugs may be individual intolerance to the components or alcohol abuse (in case of prescribing alcohol tinctures).

It is important to pay attention to the fact that homeopathic medicines act on the principle of "fight fire with fire", which means that at the initial stage of therapy, the patient's condition may worsen, which does not indicate the ineffectiveness or danger of the therapy. It is another matter if the medicine does not show any results for a long time (more than 2 months). Then it should be replaced or the dosage should be revised.

Prevention

Prevention of prediabetes and its complications is, first and foremost, taking care of your health. A healthy lifestyle, no bad habits, weight control, proper nutrition, annual medical examinations, timely treatment of any acute and chronic diseases in many cases helped to avoid impaired glucose tolerance even against the background of poor heredity.

Avoiding spicy, very salty, fried, and any heavy food that makes the pancreas work overtime will help maintain its functionality for a long time, which means there should be no problems with insulin production. The ability to cope with stressful situations and depression will also help maintain the health of the digestive system.

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Forecast

The prognosis of prediabetes largely depends on how timely this pathological condition was detected, and how accurately the patient will subsequently follow the doctor's orders. With a frivolous attitude to one's health and late diagnosis, prediabetes can soon develop into a serious, practically incurable pathology, which will dictate its own conditions for further coexistence.

The Institute for Alternative Futures (IAF) has updated its diabetes forecasting model and expanded its projections to 2030. The prevalence of diabetes (type 2 diabetes and type 1 diabetes) will increase by 54% to more than 54.9 million Americans between 2015 and 2030; annual diabetes deaths will increase by 38% to 385,800.

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