Stages of diabetes: prediabetic

diabetes mellitus is a heterogeneous group of diseases that have in common the increased blood sugar (hyperglycemia) in a sustained manner.

Phases of blood sugar disturbance

Before the onset of diabetes as such, that is, before hyperglycemia appears with its typical symptoms (increased amount of urine, significant thirst, desire to eat without stopping, weight loss), the disease goes through a phase of slight changes in blood sugare and few or no symptoms due to increased sugar.

• In the diabetes type 1 this phase is usually very brief, so that quickly hyperglycemia produces symptoms and the diagnosis is made.
• In the type 2 diabetes happen sometimes several years before symptoms lead to suspicion and diagnosis. There is a first phase in which the sugar levels are only slightly above the normal value in the blood test (fasting glucose disorder). If that individual was subjected to a sugar overload test, after 2 hours everything would still be normal. Later, the sugar load test would be altered, but the patient would have no symptoms or they would be very mild (impaired glucose tolerance). These states could be defined as prediabetes. Symptoms due to sustained hyperglycemia appear at a later stage and, if a blood test is done, the sugar is persistently high (not necessarily very high); we reached the stage of overt diabetes.

How is prediabetes detected?

A percentage of these prediabetic individuals progress to clinical diabetes in the following 10-15 years, but another part does not progress towards diabetes or even revert to normality, especially if they lose weight and improve their lifestyle (mainly in terms of diet and physical activity).

States of prediabetes are diagnosed as follows:

• Altered fasting blood glucose or Altered basal blood glucose: These are individuals who do not meet the criteria for diabetes but with fasting blood sugar between 110 and 125 mg / dl.
• Impaired glucose tolerance: These are individuals who do not meet the criteria for diabetes but with alterations in the sugar overload curve (blood glucose levels two hours after an oral overload with 75 g of glucose between 141 and 199 mg / dl.

The purpose of this diagnosis is to identify those people at risk of suffering from complications of diabetes, both arterial (macrovascular or cardiovascular diseases) and microvascular (lesions in the retina, kidney and nerves), and determine a treatment to prevent them.

It is important detect these patients with altered sugar but even without the diagnosis of diabetes because they will present, more frequently than the general population, the complications seen in diabetes:

• Hypertension
• Changes in blood fats
• Greater tendency to thrombosis
• cardiovascular disease and death from it.

Remember that insulin has a key effect on carbohydrate metabolism; its absence produces an increase in blood sugar. But insulin also controls fat metabolism; the insulin deficit will be accompanied by an increase in triglycerides and a decrease in HDL cholesterol.