Every patient who comes to SETMA has their risk of developing diabetes assessed. If you are at risk, the presence of Pre-diabetes is evaluated by a 12-hour fasting blood glucose to see if you have impaired fasting glucose. If you do -- if your blood sugar is between 100-125 after a twelve-hour fast -- you will be given a 2-hour glucose tolerance test to evaluate you for impaired glucose tolerance, which is a more serious problem. If you are pre-diabetic, you will be given an appointment with SETMA's Metabolic Education department to learn how you can prevent from progressing on to diabetes.
The realization of the task which a diabetic has in order to maintain their health motivates us to become more aggress in treating diabetics, but it also lets us know that the best way to treat diabetes is not to develop it. While that is not possible with some patients, particularly those with type I diabetes, it is possible with patients who are pre-diabetic.
The diagnosis of pre-diabetes is relatively easy to make. First, patients at risk of developing diabetes can be identified. They are patients with:
- A family history of diabetes type 2, hypertension or cholesterol problems.
- A Body Mass Index (BMI) over 25%, this problem includes 90% of Americans over the age of 40 and/or a waist in males of 38 inches and in females of 35 inches.
- A birth weight under 2,500 grams (about 5 pounds 7 ounces)
- A blood pressure over 130/80
- An abnormal total cholesterol, HDL and/or triglycerides
- Non-Caucasian ethnicity
- And, females who had diabetes when they were pregnant.
Unfortunately, it only takes one of these to place you at higher risk of developing diabetes than the average, which means that more people are at risk than think they are.
Second, each person who is at risk of developing diabetes needs to have a blood glucose (sugar) determined after a twelve-hour fast. If your blood sugar, after a twelve hour fast is over 100 and less than 126, you are pre-diabetic and you need aggressive treatment to prevent the development of diabetes. You also need blood glucose to be determined after a 75-gram-glucose challenge. This is called a glucose tolerance test. If your blood sugar is between 140 and 200, two hours after this challenge, you are pre-diabetic.
Pre-diabetes and its risk of diabetes
A person with a fasting blood glucose between 100-126 is said to have impaired fasting glucose , and each such person needs to have a glucose tolerance test. Those who have a blood glucose between 140-200 after a 75-gram glucose load, are said to have impaired glucose tolerance . Patients with both conditions are pre-diabetic, but those with impaired glucose tolerance are at much higher risk of developing diabetes, although those with impaired fasting glucose are also at risk.
Patients identified with pre-diabetes can reduce their risk of developing diabetes in the following ways:
- Lose weight
- Exercise
- Stop Smoking
Recognize this trilogy? Therefore, in future visits to SETMA, you can be expected to have your risk of developing diabetes assessed by your healthcare provider and the healthcare team at SETMA.
Finally, in a very large study of nurses, the Nurses Health Study, the subgroup found to have a low risk of diabetes:
- had a low BMI;
- consumed a diet high in cereal fiber
- had a diet high in polyunsaturated fat (
- had a diet low in trans-fatty acids
- used food with low glycemic index
- engaged in moderate to vigorous physical activity for at least half an hour a day;
- did not currently smoke
The study concluded, "The epidemiologic data from the Nurses Health Study suggest that physicians should counsel their patients of lifestyle interventions that may help reduce the risk of diabetes, with the exception of recommending daily alcohol intake to nondrinkers."
Screening for Diabetes
In the same process of screening for pre-diabetes, patients unknown to have diabetes can be discovered. By the following definitions, you have diabetes if:
- You have two twelve -hour fasting glucoses above 126.
- You have a non-fasting glucose over 200.
- You have a glucose over 200, two hours following a 75 gram glucose load, i.e., in a glucose tolerance test.
The imperative for discovering diabetes is that most patients have had it for several years before knowing it and many already have eye damage or kidney damage from diabetes before they ever become aware that they have it. If you have any of the risk factors listed above, ask you healthcare provider for a diabetes screen immediately. If you are negative and have several risk factors, make sure you lose weight, exercise, stop smoking and get check again every three years.
SETMA is not only committed to treating diabetes effectively and excellently but to preventing diabetes where possible. |
