Health & Wellness with Jackie Jung, CDE RN

Written by Jackie Jung RN on 29 October 2010

9 Million Canadians live with Diabetes or Prediabetes

Certified Diabetes Educator Jackie Jung, RN works out of the Manitouwadge Diabetes Health & Wellness Network, watch for Jackie’s regular column aimed at informing OntarioNewsNorth.com readers in regards to Diabetes Prevention, Healthy Living for everyone (whether living with Diabetes or not) and more. Thank you to Mrs. Jung for providing this great tool to readers as a public service which she is providing at no charge.

Prediabetes: more than a warning sign

Prediabetes refers to blood glucose levels that are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes (a fasting plasma glucose level of 7.0 mmol/L or higher). Although not everyone with prediabetes will develop type 2 diabetes many will and if left untreated, approximately 25 per cent of people with prediabetes will progress to diabetes within three to five years.

The good news is that many people who fall into the prediabetes stage can delay or prevent the development of type 2 diabetes with lifestyle changes and if required, medication. Studies have shown that through lifestyle changes, including moderate weight loss and regular exercise, the onset of type 2 diabetes can be delayed by up to 58 per cent.

What does prediabetes mean? It means that cells in your body are becoming resistant to insulin and your blood glucose levels are higher than they should be. This insulin resistance is also referred to as “metabolic syndrome,” meaning you may also have high blood pressure, high levels of low-density lipoprotein cholesterol (the “bad” cholesterol) and triglycerides, low levels of high-density lipoprotein cholesterol (HDL-C) (the “good” cholesterol) and a tendency toward abdominal obesity. Like type 2 diabetes, prediabetes can occur without you knowing it, so being aware of your risks and being tested are important.

Since the levels aren’t as high as they would be if you had type 2 diabetes, the term “pre-diabetes” is used. Your doctor may also call this condition “impaired fasting glucose” or “impaired glucose tolerance”. It is not “borderline” diabetes as there is no such thing as borderline diabetes– there are set lab value numbers that indicate if you have normal blood sugar levels, prediabetes levels or if you actually have diabetes.

Insulin resistance occurs when the body’s ability to process glucose becomes impaired. Glucose enters the blood after food is eaten andbroken down and converted to glucose (sugar). Normally, the pancreas will excrete insulin, a hormone, which helps the glucose move out of the blood and into the cells, where the body can use it for energy. This insulin resistance happens when the pancreas either does not release enough insulin or the cells become resistant to the insulinand uses it ineffectively and the glucose levels in the bloodstream rise.When blood sugar levels are higher than normal, but not quite as high as those of a person with diabetes, the condition is known as prediabetes. Prediabetes is diagnosed when blood sugars are found at 6.1–6.9 in a fasting state and/or 7.8–11.0 after a lab test called an Oral Glucose Tolerance Test (OGTT) which challenges your pancreasafter drinking a sugary drink.

It is important to know if you have prediabetes, because research has shown that some long-term complications associated with diabetes – such as heart disease and nerve damage – may begin during prediabetes. If you have prediabetes, you are at increased risk for heart disease or stroke, so your doctor may wish to also treat or counsel you about cardiovascular risk factors such as tobacco use, high blood pressure and high cholesterol.

The number of people with prediabetes is rising dramatically due to a number of factors:

An aging population – the risk of developing prediabetes rises with age;
Rising obesity rates – obesity dramatically increases the likelihood of developing prediabetes;
Increasingly sedentary lifestyles are contributing to rising obesity rates, particularly in younger Canadians, which can lead to prediabetes;
People of Aboriginal descent are 3 to 5 times more likely than the general population to develop pre and diabetes; and
Almost 80% of new Canadians are from populations that have a higher risk for pre and diabetes. These include people of Hispanic, Asian, South Asian, or African descent.

Several factors can contribute to the development of insulin resistance:

Are you an apple or a pear?Overweight/Obesity

When a person is overweight, the cells in the body become less sensitive to the insulin that is released from the pancreas. There is some evidence that fat cells are more resistant to insulin than muscle cells.

If a person has more fat cells than muscle cells, then the insulin becomes less effective overall, and glucose remains circulating in the blood instead of being taken in to the cells to be used as energy.

Where the Fat Is At

That spare tire around the midsection is visceral fat or abdominal fat. There is a correlation among abdominal fat, insulin resistance and resulting high blood sugars (hyperglycemia). Visceral fat is very resistant to the effects of insulin.For two people who are overweight, the person whocarries their fat centrally in the abdomen with an appleshape is at higher risk for diabetes and its complicationsthan someone who has a pear shape.

Perhaps the simplest indicator of fat distribution is your waist circumference.

How to measure your waist circumference

Locate the top of you hip bone
Place a tape measure evenly around the bare abdomen at this level

Once you have your measurement, you’ll be able to see whether your waist measurement puts you into a category that is considered to pose health risks. For men,the cut-off for risk is a waist circumference of greater than 102 cm (40 inches). For women, the cut-off is greater than 88 cm (35 inches). (Because people of different ethnicities have different susceptibility to deposit fat around their waist, different cut-off values have been established for certain ethnic groups.)

The more fat concentrated in this area, the more insulin resistance occurs. Carrying extra abdominal fat can not only lead to diabetes, it can also increase the risk of high blood pressure and cardiovascular disease – heart and stroke risks.

The Aging Process

As we age, our body processes can become slower or diminished. The pancreas is no exception. Sometimes the pancreas naturally produces less insulin as we get older.

Activity Matters

When someone lives a sedentary lifestyle, using minimal exertion to carry out the tasks of the day, their body doesn’t use insulin effectively, resulting in insulin resistance. Incorporating this amount of exercise into your life also improves insulin sensitivity and helps with weight loss as well.This has been proven in two large studies: the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. These studies is showed moderate-intensity physical activity of at least 150 minutes per week resulted in a 58 per cent reduction in the number of people who progressed from prediabetes to diabetes over the next four years, even though weight loss was modest.

According to Canada’s Physical Activity Guide to Healthy Active Living, 63 per cent of Canadians are not active enough to achieve the health benefits they need from physical activity. Only one hour a day is enough to stay healthy and reduce your risk of disease! So what’s stopping you?

The Guide recommends starting slowly and progressing gradually, andbuilding up to 30 to 60 minutes of activity a day. You can add up youractivity in periods of at least 10 minutes each. And choose from each

of the three activity groups: endurance, flexibility and strength.

Medications that Cause Insulin Resistance

Some medications prescribed for other disorders increase the risk of insulin resistance. Some drugs used to manage bipolar disorder fall into this category. Other medications, such as some steroids, also can lead to insulin resistance.

Risk Factors

Like type 2 diabetes, prediabetes can occur without you knowing it, so being aware of your risks and being tested are important. This is especially true if you have prediabetes as part of the “metabolic syndrome,” Risk factors for prediabetes and type 2 diabetes are:

Being 40 years of age or older
Having a close relative (parent or sibling) who has type 2 diabetes;
Being a member of a high-risk population, such as those of Aboriginal, Hispanic, Asian, South Asian or African descent;
Having a history of prediabetes (impaired glucose tolerance or impaired fasting glucose);
Having already some evidence of the complications of diabetes, such as eye, nerve or kidney problems;
Having heart disease;
Having a history of gestational diabetes mellitus;
Having high blood pressure;
Having high cholesterol;
Being overweight, especially around your abdomen.

The risk for type 2 diabetes is higher as you grow older, so the Canadian Diabetes Association recommends screening by testing fasting plasma glucose for everyone once they reach age 40 and every three years after that. If you have risk factors that increase the likelihood of developing type 2 diabetes, you should be tested more frequently or start regular screening earlier.

The important thing to remember about prediabetes is that it doesn’t always lead to diabetes. Determining whether or not you have it gives you a chance to change your future to one that does not include type 2 diabetes.

Keep reading OntarioNewsNorth.com for Part 2 – Preventing Diabetes! From Jackie Jung, CDE RN

For more information on prediabetes, diabetes and your risk factors please call Jackie Jung, Certified Diabetes Educator at the Manitouwadge Diabetes Health & Wellness Program at 826-3251 Ext. 208.

LINKS & SOURCES

The opinions expressed on OntarioNewsNorth.com and by Jackie Jung, CDE, RN are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis and treatment. Please consult a local physician or other health care professional for your specific health care and/or medical needs or concerns.

Neither OntarioNewsNorth.com nor Jackie Jung, CDE, RN endorse or recommend any commercial products, medical treatments, pharmaceuticals, brand names, processes, or services, or the use of any trade, firm, or corporation name is for the information and education of the viewing public, and the mention of any of the above on OntarioNewsNorth.com does not constitute an endorsement, recommendation, or favoring by OntarioNewsNorth.com or Jackie Jung, CDE, RN.