Prediabetes

prediabetes

 

 

 

 

 

In the last article we looked at the glucose profile of a group of healthy individuals of normal weight and insulin production.  I'm signaling out these two characteristics, because when things start to go wrong, both these components start to elevate.

It's not always the case though that one becomes obese or even overweight when insulin production starts risking, as there's more to gaining weight than just insulin, although it is the main driver of this for sure.  One's metabolism matters as well, for instance if thyroid hormone function is low, this can affect one's weight to be sure, although insulin is involved in this as well, as it is in all fat storage problems because it's the hormone that controls it.

So we can use an analogy here of insulin as controlling the fuel for our engine, our metabolism, and thyroid hormone controlling the engine itself.  So if there is too much fuel we have a problem, which is overload, and if the engine isn't working properly, which of course involves more than thyroid hormone but that can be seen as the throttle here, then we have a problem as well, as we're not burning enough fuel and therefore we can end up with a bigger stockpile of excess fuel that way.

We need to keep in mind that with the glucose dysregulation of type 2 diabetes in particular, although this does apply to type 1 as well but to a lesser extent, the problem that we encounter here is excess supply, and while we don't fully understand how diabetes starts, the most plausible explanation is that our glucose metabolism becomes overloaded by a combination of too much energy consumed in the diet, as glucose sources, and too much extra glucose being secreted by way of gluconeogensis, the creation of glucose from non glucose sources, primarily by our liver.

So if you remember, this liver glucose is designed to keep our blood sugar stable, and if we just relied on diet well our blood sugar would go too low when we haven't eaten for a while, and the body requires  constant and steady supply of glucose to maintain life, at least the brain does anyway.

So now that we have an idea of what this is all supposed to look like when we have a healthy glucose metabolism, when we start developing an excess of glucose in our blood, from an oversupply involving one or both of these sources, then we have problems, and we know that this starts happening long before even prediabetes.

Small changes though in blood sugar manifest themselves first though, and for instance we may start out with an A1C of 5, and then move down the road toward the range of prediabetes, which is 5.7 to 6.4.  We just don't leap from 5 to 5.7 though, this process takes time, and even before we start moving down this road, there is a period where we're able to maintain good blood sugar from higher insulin levels, and the blood sugar trail doesn't actually start until later, when we're no longer able to handle things.

This is why insulin screening is so important, as we can detect problems far sooner by measuring insulin levels than by measuring blood sugar levels, even ones that are only slightly elevated and nowhere near enough to be diagnosed as prediabetic, which we don't even take that seriously anyway.

While even prediabetic blood sugar levels aren't really much of a concern in themselves, as this involves only mild elevations and not ones that present a very meaningful increased risk of complications, the concern here is that this is just a stop on the road and the road leads to the worse fate of diabetes, which in itself is a long road from the threshold where it's diagnosed to some very disturbing blood sugar levels, with A1C's in the double digits, that's where I found out I had this actually, 11.7 A1C.

So I found out actually when I got perhipheral neuropathy, and that led me to test my blood sugar for the first time, and I had no other symptoms really and it came as quite a shock.  So we can't really go by symptoms either, people aren't even screened for blood sugar anywhere near as much as they should be either.

On the other hand, people are screened voraciously for hyperlipidemia, high cholesterol and triglycerides, and if we spent only a fraction of the time worrying about people's blood sugar and insulin levels that we spend on this stuff, we'd at least be closer to managing blood sugar issues better, although we have a lot of work to do as far as how the conventional medicine manages diabetes as well, which is absolutely terribly by the way.

So getting back to prediabetes, my definition of it is when one's glucose metabolism starts breaking down, and that can be detected when we see pathologically high insulin levels, hyperinsulinemia, which occurs well before any hyperglycemia.

So if you're reading this and haven't been diagnosed as either a diabetic or prediabetic, while it's still a good idea to check your blood sugar, and people should be doing this a whole lot more than they do, every house should have a glucose meter, not just ones with diabetics in it, it's an even better idea to have your fasting insulin tested, either with a serum insulin test or a c peptide test. I'd recommend the fasting serum insulin by the way unless you are already on insulin, where the c peptide will tell you how much you are making yourself, although that will tend to be blunted due to your pancreas not having to work as hard as normal.

Of course, what you are going to do about this if you do see abnormalities in either blood glucose or insulin secretion is another matter, but we'll be talking about that plenty in upcoming articles.

Next: Being Diagnosed With Diabetes

Previous: What's Normal Blood Sugar?

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