What’s the difference between insulin resistance, prediabetes and diabetes?
Insulin resistance occurs when your body doesn’t respond well to insulin. It takes more insulin to lower glucose levels into the normal range. Over time, if the pancreas can’t produce enough insulin to overcome the resistance, prediabetes or diabetes can develop.
Why are my liver and pancreas important?
Your liver and pancreas are vital organs that control your blood sugar levels. The pancreas is responsible for making insulin, a hormone which lowers your blood sugar levels. The liver keeps your blood sugars steady by storing and releasing sugar, also known as glucose, when needed.
But a build-up of fat in the liver and pancreas can stop them from working properly to keep your blood sugar levels in a safe, non-diabetes range. Losing weight can help reduce the amount of fat stored in these organs and kickstart them into managing your blood sugar levels again. For some people this means they can stop taking medications that lower their blood sugar levels and go into remission from type 2 diabetes.
How do I know if I have a build up of fat?
There’s no easy way of knowing how much fat is stored in your liver and pancreas. You can’t tell by looking at someone’s weight or body size. That’s because regardless of our weight or size, we all have different levels of fat that we can safely store before the fat affects how the liver and pancreas work. The only way to reduce the excess fat is to lose weight.
What Is Prediabetes?
Prediabetes is when you have higher than normal blood glucose levels but not high enough to be diagnosed with diabetes. Prediabetes typically has no symptoms, so it’s vital to be screened with blood tests.
Are there prediabetes symptoms?
The first step is to know the risk factors, which can help determine whether or not you should be screened for the condition. Without screening, early signs of insulin resistance can be hard to identify—a person can have prediabetes for years without knowing it. Symptoms that are associated with type 2 diabetes, such as increased urination, won’t necessarily surface with prediabetes.
Obesity, an underlying cause of insulin resistance, is a major risk factor. A study published in 2020 found that participants who had obesity were about six times more likely to develop type 2 diabetes than those at a healthy weight, regardless of genetic predisposition; people who were overweight had 2.4 times the normal risk.
Other common risk factors for prediabetes include being older than 45, exercising fewer than three times a week, having a parent or sibling with (or a family history of) type 2 diabetes, and giving birth to a baby that weighed more than 9 pounds. Women who have polycystic ovary syndrome (PCOS), a hormonal disorder, are also at higher risk for the condition.
However, risk can be complicated for some people. For instance, some people with obesity don’t develop obesity-related diseases, and others develop type 2 diabetes without being overweight. If you are overweight and struggling to lose weight, if you’re not physically active, and if you have other health problems, like high blood pressure and high cholesterol, you are at risk.
Are there tests that can diagnose prediabetes?
Yes, the following blood tests can diagnose the condition:
- A1C test measures blood sugar over the past two to three months (and it’s the easiest test, since it’s not necessary to fast beforehand). A result in the range of 5.7%–6.4% indicates prediabetes.
- Fasting blood sugar test measures blood sugar after an overnight fast. A result of 100–125 mg/dL (5.6 – 6.9mmol) indicates prediabetes.
- Glucose tolerance test measures blood sugar before and after drinking a glucose liquid. A result of 140–199 mg/dL (7.8 – 11.1 mmol) indicates prediabetes.
Is there a higher risk for prediabetes at certain times in life?
For those who are diagnosed with or concerned they might be at risk for prediabetes, the first thing to do is focus on weight loss and dietary changes. This isn’t always easy, and stress can interrupt lifestyle management in different ways, depending on a person’s situation and stage in life, whether it’s during adolescence, pregnancy, menopause, or even retirement.
Problems with insulin often start around puberty. The big thing around this age is a lot of anxiety and depression, disordered eating behaviors, sedentary behavior, and excessive interaction with social media.
Pregnancy can also lead to struggles with weight for many women. Gestational diabetes, which usually resolves after the baby is born, is another prediabetes trigger. Around menopause, changes in estrogen levels are associated with an increase in fat around the waist, which is considered a risk factor for diabetes.
In general, those who maintain good physical health as they age can avoid prediabetes. But as you get older, you may develop joint pain, which can limit physical activity, so it’s important to pay attention to those issues. Heart disease can impact physical activity, as can the use of multiple medications, including glucocorticoids—steroids that, among other things, increase insulin resistance and glucose production by the liver, resulting in increased blood glucose levels. They can also make people who take them feel hungrier, which leads to increased food intake and further contributes to hyperglycemia. All these things add up.
Can children get prediabetes?
Yes. The CDC reports that 18% of adolescents have prediabetes, and it’s on the rise in that group.
All children experience metabolic and hormonal changes during puberty, along with a decrease in insulin sensitivity; problems tend to develop when an adolescent has obesity. Children who have obesity are much more likely to grow up to be adults who have obesity, and then they are likely to develop weight-related diseases like type 2 diabetes, kidney problems, and heart problems.
Lifestyle changes are critical to prevention in kids because there are no effective medications for reversing prediabetes in that age group. We know that prediabetes and type 2 diabetes are more aggressive in kids than they are in adults.
In the “Treatment Options for Type 2 Diabetes in Adolescents and Youth” (TODAY) study, a major clinical trial funded by the National Institutes of Health (NIH), youth who developed type 2 diabetes at a young age had more severe cases than adults with the disease.
What happens when prediabetes becomes type 2 diabetes?
It’s important to note that type 2 diabetes is different from type 1 diabetes, a condition in which the body produces little to no insulin, resulting in high blood glucose levels.
In people with type 2 diabetes, the body’s cells don’t respond properly to insulin, and glucose doesn’t move efficiently from the bloodstream into the cells. This is known as insulin resistance. As a result, the level of glucose in the blood rises.
The pancreas initially responds by producing more insulin, but it will inevitably not be able to keep up, resulting in high blood glucose levels—a condition called hyperglycemia. This can lead to such serious health issues as blindness, heart attack, stroke, kidney failure, and amputations of the feet, legs, or toes if it is not managed properly.
But prediabetes itself is a serious health issue. Prediabetes goes hand in hand with metabolic syndrome, the term for a condition that includes hypertension, obesity, and high cholesterol. Each of those conditions raises the risk for serious issues, such as heart disease, stroke, and cancer.
In people with prediabetes, some of the long-term damage to the blood vessels, heart, and kidneys may already be starting. The condition has also been linked to what are called “silent” heart attacks, with symptoms so mild people may not realize they occurred.
Read next: Can You Get Rid of Diabetes? – Remission of Type 2 Diabetes
References:
- https://medschool.ucla.edu/news-article/can-diabetes-be-reversed#:~:text=There’s%20no%20cure%20for%20diabetes,routine%20of%20diet%20and%20exercise.
- https://www.nebraskamed.com/diabetes/is-it-possible-to-reverse-diabetes
- https://www.diabetes.org.uk/diabetes-the-basics/type-2-remission/type-2-reverse
- https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/ask-the-experts/reversing-diabetes
- https://www.yalemedicine.org/news/prediabetes
- https://www.joslin.org/patient-care/diabetes-education/diabetes-learning-center/can-type-2-diabetes-be-reversed
