Dr Aidin Rawshani

Prediabetes — symptoms and clinical findings

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Prediabetes — a quiet condition that usually does not give rise to symptoms, learn to recognize the subtle signs of the disease

Symptoms and clinical findings

People with reduced insulin sensitivity (insulin resistance) usually develop type 2 diabetes if it lasts long enough. Insulin resistance most often occurs to some degree in the majority of individuals with prediabetes and only a small percentage of these people know that they have the disease.

Prediabetes is a quiet condition, so it is extremely important to detect the symptoms early and then go to health check if there is a suspicion of the disease. If you think you have pre-diabetes, you should discuss your problems with your doctor.

Your doctor will most likely take a blood test for long-term blood sugar (HbA1c) or perform an oral glucose tolerance test (OGTT). HbA1c is an indicator of your blood sugar levels over the last two to three months, so that test often gives a better overall picture than other blood sugar controls. An HbA1C level between ≥ 42 and 48 mmol/mol indicates prediabetes.

Prediabetes generally has no signs or symptoms. However, when the condition is progressing towards diabetes, people may experience symptoms such as type 2 diabetes, such as increased thirst, frequent urination, blurred vision and fatigue. For example, a condition called acanthosis nigricans is seen in medical language, which means darkening of the skin in places such as neck, armpits, elbows, knees and knuckles. If you notice such skin changes, it’s a good idea to have them examined by a doctor.

Prediabetes is usually suspected in people who have a first-class relative with type 2 diabetes. Some ethnic groups are at greater risk of prediabetes than, for example, Caucasians; individuals with African American, Latin American, Indian and Asian people are at higher risk of the condition.

Women with multiple ovarian follicles on one or two ovaries and digitis (polycystic ovary syndrome, PCOS) as well as fasting blood glucose between 5.6 and 6.9 mmol/l and an HbA1C test result between 39 and 46 mmol/mol indicate prediabetes.

The oral glucose tolerance test (OGTT), which involves fasting overnight, then drinking a glucose solution and with blood sugar measured one hour and two hours afterwards, is sometimes used to diagnose prediabetes. But that test is generally only used for screening for gestational diabetes because it is more time-consuming and expensive than other tests. It can also be used to diagnose type 2 diabetes.

The following symptoms or clinical findings are common in individuals with prediabetes:

  • Most often, the condition is asymptomatic, disturbances in blood sugar metabolism usually lead to elevated blood sugar levels (hyperglycemia). This condition develops slowly over many years and usually does not give symptoms until very late.
  • Prediabetes is usually detected as bee findings The significant proportion of individuals suffering from myocardial infarction, stroke or other cardiovascular disease usually suffer from prediabetes or some other disorder in blood sugar metabolism.
  • The metabolic syndrome is a constellation of cardiovascular risk factors. Usually seen overweight, central abdominal obesity, physical inactivity, age 45 years, high blood pressure, sleep apnea syndrome, elevated blood lipids, as well as heredity for diabetes, obesity or another cardiovascular disease.
  • Fatigue – Insulin resistance, they also fail to perform their everyday functions leading to fatigue, this is a common symptom but nonspecific when seen in several other conditions.
  • Abnormal blood tests are usually observed. Dysglycemia) of different degrees and types; sometimes even increased sugar levels in the urine (glucosuria), hypertension (hypertension), impaired blood lipidemia (dyslipidemia) and elevated levels of insulin in the blood (hyperinsulinemia).

Other common symptoms seen in both prediabetes and type 2 diabetes are as follows:

  • Increased urination
  • Increased thirst
  • Increased hunger
  • Severe fatigue
  • Vision problems (blurred vision)
  • Slowly healing sore
  • Tingling sensation, pain or numbness in legs and feet

How should one investigate a person with suspected prediabetes?

Issues that should be addressed in the medical history

  • Consider symptoms such as fatigue and lack of strength before seeing a doctor as it is a common symptom.
  • What do your exercise habits look like?
  • What do your diets look like?
  • Do you smoke cigarettes, have you smoked, and if so, how long and when did you quit?
  • Do you have problems with your sleep? Lately, do you feel unusually tired in the morning, and do you experience morning headaches?
  • Is there anyone in the family with prediabetes, obesity, metabolic syndrome or type 2 diabetes?

Examination of a patient with suspected prediabetes

  • Calculate BMI
  • Measure waist circumference because central abdominal obesity is an important risk factor for metabolic diseases
  • Record blood pressure
  • Examine the skin to exclude dark skin areas, reduced hair on the lower limbs that may be a sign of impaired blood supply
  • Ask a doctor or other healthcare professional if they can conduct an examination called ECG (rest ECG)
  • Ask a doctor or other healthcare professional if they can examine reflexes and vibrational sense to rule out nervous system damage

What blood tests should be measured?

  • Fasting blood glucose (FP glucose)
  • Long-term blood sugar (HbA1c) If there are uncertainties about the diagnosis, an oral glucose tolerance test (OGTT)
  • Do a complete examination of your lipid profile, which means checking several different blood lipids (lipid profile)
  • Check kidney function and exclude leaking proteins in the urine (U-albumin/Creatinine quota)

How should people with prediabetes be followed up in healthcare?

Individuals with pre-diabetes should be monitored regularly in healthcare. The factors that need to be examined at regular intervals are as follows:

  • Blood sugar (stuck blood glucose, long-term blood sugar)
  • Blood lipids (LDL, apolipoproteins and HDL)
  • Other known and modifiable risk factors for cardiovascular disease such as weight, waist circumference, blood pressure, kidney function, smoking, physical activity level and diet habits need to be discussed regularly between health workers and individuals with prediabetes.
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