Millions of people in the United States are prediabetic and don’t know it.

According to the Centers for Disease Control and Prevention, about 88 million American adults are prediabetic. That’s more than one in three people, and more than 84% of them don’t know they have it.

Being prediabetic isn’t something to ignore or procrastinate about doing something about it.

Dr. Lakshima Kannan, an endocrinologist

with Coordinated Health, part of Lehigh Valley Health Network, said, “Before you develop symptoms, a lot is happening in your body and it may be too late to wait for symptoms.

“It is important for us to check even though the person is feeling well.”

Kannan explained that diabetes is a chronic disease, which means it is a condition that many people live with for the rest of their lives.

“If not managed well, diabetes can affect every organ in your body,” she said.

What is diabetes?

Diabetes is a multifactorial disease, which means there are multiple factors that interplay to cause the condition, but the main problem is high blood sugar, Kannan said. The other factors include genetics, family history, lifestyle, body weight, other medical conditions, and the medications a person takes.

“These factors ultimately lead to inadequate action of insulin, which is the major hormone controlling your blood sugar levels,” she said.

Kannan explained that if a person cannot make enough insulin, then the condition is known as Type 1 diabetes. If a person cannot use their insulin well, also known as insulin resistance, then the condition is called type 2 diabetes. Type 2 diabetes, which usually develops later in life, is the most common of the two.

“High blood sugar levels are toxic to blood vessels,” she said. “Over time, they damage small and large blood vessels in our body. Depending on which organ is supplied by the damaged blood vessels, the complications vary.”

For example, diabetes can damages the cells in the blood vessels of the eye, which can lead to retinopathy. It also can cause dry eye, premature cataract formation, diseases within the chambers of the eye, and retinal disease, which can lead to blindness.

In other parts of the body, diabetes can cause nerve damage or neuropathy, kidney failure, slow gut or gastroparesis, infections, poor wound healing, peripheral arterial disease in the feet, as well as increase the risk of heart attack and stroke, Kannan said.

In the case of COVID-19, people with diabetes are at a higher risk of experiencing complications.

“The high blood sugars pose a challenge to our body’s immune system,” Kannan said. “Since germs thrive on sugar, the risk of any infection is higher for people with diabetes than those without.”

Risk factors and symptoms

So how do you know if you have diabetes or are prediabetic?

The first step is to discuss the risks with a doctor.

According to the American Diabetes Association, the risk factors include:

• being 45 years old or older;

• overweight;

• physically inactive;

• having a parent or sibling with diabetes;

• being black, Hispanic/Latino, American Indian, Asian American or Pacific Islander;

• having high blood pressure or take medication for high blood pressure;

• having low HDL cholesterol and/or high triglycerides;

• experiencing diabetes during pregnancy, or;

• having polycystic ovary syndrome.

Kannan said some symptoms include unexplained urinary frequency, increased thirst and or increased hunger, or unintentional weight loss should get tested.

“People without symptoms should also be tested periodically if they are at high risk of developing diabetes,” she said.

People with fatty liver disease should also be tested for diabetes, because insulin resistance can occur.

“There are glycogen stores, glucose stores within the liver, and fat disposition within the liver absolutely can increase insulin resistance in the body,” Kannan said. “It is recommended that a person with fatty liver disease get their blood sugar levels tested regularly.”

Most people with fatty liver disease also struggle with weight issues, which is one of the risk factors for diabetes.

Screening

If a doctor orders a blood glucose screening, it is usually done after a person has been fasting for several hours.

According to the ADA, a normal level of glucose after fasting is below 100mg/dL (milligrams per deciliter). A prediabetic level is between 101 and 125mg/dL. And a diabetic range after fasting is above 126mg/dL.

“Our body absorbs sugar from food and stores it. When we fast between meals and during sleep at night, sugar is released from these stores to the blood,” Kannan said.

Two hours after a meal, the peak of blood sugar should be below 140mg/dL for a person with a normal level. People who are prediabetic would be between 140 and 199mg/dL. And people with diabetes would be above 200mg/dL post meal.

If the blood sugar levels are normal, then the test should be repeated every three years.

“These blood sugar values define the diagnosis,” she said. “Diabetes can be conquered through meticulous efforts, as long as we pay close attention. It can be too late before you develop symptoms. Hence, it is very important to actively seek medical care.”

Managing diabetes

Diabetes is conquered through several methods including diet and lifestyle changes, exercise and medication.

“Exercise plays an inherent role in treatment for many reasons,” she said.

Kannan explained that the body needs insulin in order to lower blood sugar. When a person exercises, the body is able to bring down blood sugar independently of insulin.

“It can, to a certain extent, bypass insulin resistance,” she said. “And it has a metabolic benefit, so exercise is very important in the treatment of diabetes.”

In general, moderate aerobic exercise five times a week for 30 minutes a day is recommended for basic health and body weight maintenance. Moderate aerobic exercise means that a person can talk while exercising, but not sing.

If medication is needed, Kannan said there have been many new developments. testing blood sugar at home every day isn’t the standard any more. Some people may only have to test once a week, and new technology is enabling people to not have to prick their finger at all.

“We’ve made a lot of progress in terms of treatment options,” she said. “We’ve had more come out in the past seven years than in the last 40 years.”

Overall, Kannan said her biggest concern for her patients is their general health.

“Diabetes is the part and parcel of how you feel now, how you’re going to feel in the future, and what’s going to happen through every walk in life. It’s something you live with. Generally, it will have an impact on all aspects of your health.”