Dr Aidin Rawshani

Glucose intolerance (pre-diabetes): almost having diabetes

Contents

General about blood sugar

Blood sugar is the concentration of sugar (glucose) in the blood. In the human body, about 4 grams of sugar (glucose) are contained in the blood at any given time (this applies to a person weighing 70 kg). The body regulates blood sugar constantly through a complex system involving many different hormones and organs. The vast majority of people know the hormone insulin, which lowers blood sugar and the hormone glucagon, like right blood sugar. Even today, scientists are working very intensively to identify exactly how the body regulates blood sugar and how high blood sugar causes complications (see Complications of diabetes).

Glucose is mainly stored in the liver, muscles and fat. Relatively small disturbances in the way blood sugar is regulated can cause acute and chronic diseases. The absorption of sugar (glucose) into the cells of the body is primarily regulated by the hormone insulin, a hormone produced in the pancreas (pancreas). Blood sugar is usually the lowest in the morning, before the first meal of the day and then rises after meals for about 1 to 2 hours before the body absorbed the sugar contained in the food, thereby returning to normal levels. There are different methods for measuring blood sugar.

Impaired glucose tolerance (glucose intolerance)

Most clinics indicate that a normal blood sugar is between 4.0 and 6.0 mmol/L. As mentioned above, the body has many hormones and organs that work together to keep blood sugar in the range 4.0 to 6, .0 mmol/L. People with type 1 diabetes and type 2 diabetes have high blood sugar. There is additionally a condition called glucose intolerance, which means that the body is worse at regulating blood sugar, to the extent that it tends to become too high. Glucose intolerance has many similarities with type 2 diabetes; in fact, many with glucose intolerance developers type 2 diabetes later.

Glucose intolerance is due to the fact that the cells of the body (muscles, fat and liver) are worse at taking up sugar (glucose) from the blood. Then blood sugar rises, even if it does not reach the levels required to diagnose diabetes. In order to be diagnosed with diabetes, blood sugar should exceed 7.0 mmol/L. People with glucose intolerance have a blood sugar between 6.0 and 7.0 mmol/L. So glucose intolerance is between “normal” and “diabetes”. As mentioned earlier, it is common for people with intolerance to glucose sooner or later to get type 2 diabetes. Glucose intolerance and type 2 diabetes develop very slowly. Usually it takes several years to go from “normal” to “glucose intolerance” and another few years before getting diabetes.

  • Everyone with type 2 diabetes has previously had glucose intolerance.
  • Many with glucose intolerance develop type 2 diabetes, if they do not prevent the progression of the disease.

Glucose intolerance is common in the population

Glucose intolerance is common in Sweden. It is important to know if you are glucose intolerance because you are at a high risk of type 2 diabetes. The sooner you diagnose the condition, the longer you have to prevent getting type 2 diabetes and complications. There are currently no reliable figures from Sweden, but it is known that about 10 to 15% of all people in the US have glucose intolerance.

Definition of impaired glucose tolerance (glucose intolerance) and associated conditions

  • Blood sugar in fasting above 6.0 mmol/L according to WHO (World Health Organization). However, the American Diabetes Organization states that blood sugar above 5.6 mmol/L should be interpreted as glucose intolerance.
  • Blood sugar between 8.9 mmol/L and 12.1 mmol/L two hours after ingestion of 75 g of sugar in 250 — 350 ml of water (this is called OGTT, oral glucose tolerance test).
  • Symptoms of diabetes (increased thirst, dry mucous membranes, unusual fatigue, blurred vision, dizziness, increased urination, loss of muscle mass).
  • Many with glucose intolerance have high blood lipids, especially high triglycerides and LDL cholesterol.
  • Many with glucose intolerance have increased production of insulin (hyperinsulinemia).
  • Overweight and abdominal obesity.

Most people have no symptoms

Glucose intolerance most often does not give any symptoms. If you have symptoms, the condition has usually existed for many years. The fact is that glucose intolerance is often detected in passing, not infrequently after a heart attack, stroke or for some other reason come into contact with the healthcare system.

Metabolic syndrome is common in people with impaired glucose tolerance. Metabolic syndrome is a constellation of the following risk factors:

  • Age 45 year
  • Overweight, abdominal obesity
  • Physical inactivity
  • High blood pressure (hypertension)
  • Sleep apnea syndrome
  • Susceptibility to diabetes or cardiovascular disease

Treatment of glucose intolerance

It is possible to treat reduced glucose tolerance but it requires lifestyle changes and possibly medicines used in the treatment of diabetes. Exercise forms the basis in the treatment of impaired glucose tolerance. Exercise stimulates rapid glucose uptake in especially the muscles. In addition, increased exercise may result in, or facilitate, weight loss. Increased physical activity may slow the development of type 2 diabetes in individuals with impaired glucose tolerance. Lifestyle changes also mean quitting smoking and drinking less alcohol.

If an individual with impaired glucose tolerance needs medication, a tablet called metformin is recommended in the first place. Some people may need medication. The diet recommended is a balanced diet based on whole grain products, a lot of fruits and vegetables, as well as low content of sugar, salt and saturated fat.

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