Prediabetes, definition and what to look for
Prediabetes, sometimes known as borderline diabetes, is a condition where blood sugar is higher than normal but not high enough to qualify for a diagnosis of type 2 diabetes mellitus. Type 2 diabetes mellitus is a condition when the body is not responsive enough to the effects of insulin (called peripheral insulin resistance) which help to regulate glucose. Your doctor may base this on your fasting serum glucose level. A fasting serum glucose level is normally 100 mg/dL or less. Type 2 diabetes mellitus occurs when the fasting glucose is above 126 mg/dL. Prediabetes, therefore, occurs when the fasting serum glucose is between 100 - 126 mg/dL. People with prediabetes normally do not show symptoms associated with the actual diagnosis of type 2 diabetes mellitus such as polyuria (increased urine output), polydipsia (increased thirst), fatigue, blurred vision, etc.
Because prediabetes often occurs without symptoms, it should be monitored by your physician with routine blood work. Your doctor may order this once per year at your annual physical. It may be done more often if you have other medical conditions for which you are being treated. When prediabetes does produce symptoms, those are often first seen in the lower extremities.
Symptoms that could present with prediabetes or type 2 diabetes mellitus:
Diabetic peripheral neuropathy - This can occur and can become progressively worse due to the negative effect of elevated glucose on the peripheral nervous system. Symptoms could include numbness, burning, pain, hypersensitivity, tingling, shooting pain, etc. Sensation is the body’s defense mechanism against injury. Individuals with diabetic peripheral neuropathy or loss of sensation may be at greater risk for minor injury such as wearing shoes that do not fit properly.
Recurring infections - Type 2 diabetes mellitus can have a depressive effect on the immune system, resulting in recurring infections.
Circulation - Elevated glucose in the bloodstream can cause a decrease in circulation. Because the feet of the farthest part of the body away from the heart, they are often affected first. Symptoms might include a change in temperature (coldness), discoloration of the skin and pain.
Wound healing - The immune system and circulation play vital roles in wound healing. If prediabetes or type 2 diabetes has negatively impacted immune function or circulation then injuries such as cuts and bruises may be slow to heal. If this effect progresses then wounds may not heal at all.
Risk factors for the development of prediabetes or type 2 diabetes mellitus include:
Obesity
sedentary lifestyle
family history.
If any of the aforementioned symptoms are experienced then scheduling a consultation with your doctor is important. Identifying diabetes and treating it early can help to prevent many complications.
James R Hanna, DPM, FACFAS