What is Prediabetes?

Irene Sours, RN
It is estimated 86 million people in this country over age of 20 have pre-diabetes.  Diabetes mellitus is a chronic, progressive metabolic condition characterized by hyperglycemia resulting from defects in insulin action, insulin secretion, or both.  If a person has pre-diabetes they are at high risk of developing type 2 diabetes within a decade unless a healthier lifestyle is adopted that includes weight loss and more physical activity.
Pre-diabetes is blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes. 

Results indicating prediabetes are:
  • An A1C of 5.7%- 6.4%
  • Fasting glucose of 100- 125 mg/dl
  • An GTT 2 hour blood glucose of 140 mg/dl- 199 mg/dl
Understanding diagnostic test:
  • The A1C test measures your average blood glucose for the past 2 to 3 months. The purpose of this test is the resident does not have to fast or drink anything to be diagnosed,
  • Fasting blood sugar measures blood glucose after the patient has not eaten for at least eight hours.  It is often the first test to check for prediabetes and diabetes.
  • A 2 hour glucose tolerance test level of 200 mg/dcL or higher is used to diagnose diabetes.

The exact cause of prediabetes is unknown, but family history and genetics appear to play an important role.  What has been established is people with prediabetes do not process glucose properly with an accumulation in the bloodstream.  High blood glucose occurs when the pancreas doesn’t make enough insulin or the cells become resistant to the action of insulin, or both.

Additional risk factors:
  • Habitually physically inactive
  • Previously been identified as having IFG (impaired fasting glucose) or IGT (impaired glucose tolerance)
  • Family history of diabetes
  • Members of certain ethnic groups(including Asian American, African-American, Hispanic American, and Native American)
  • Have had gestational diabetes or have given birth to a child weighing more than 9 pounds
  • Elevated blood pressure
  • HDL cholesterol level (the “good” cholesterol) of 35 mg/dl or lower and/or triglyceride level of 250 mg/do or higher
  • History polycystic ovary syndrome
  • History of vascular disease
Usually prediabetes has no symptoms. But a resident may report these symptoms of type 2 diabetes, such as:
  • Feeling very thirst
  • Urinating more often than usual
  • Feeling very hungry
  • Having blurred vision
  • Losing weight without trying
Treatment for prediabetes:
  • Healthy diet and weight loss.  Loosing 5% to 10% of weight can make a difference
  • Exercise at least 5 times a week
  • Stop smoking
  • Treat high blood pressure and high cholesterol
Nurses play a key role within the facilities to monitor the residents who are prediabetes and have other risk factors (stated above) for developing diabetes.  Diabetes is a complex and unrelenting disease that is responsible for much of the medical morbidity and functional impairment evident in many residents residing in LTC facilities.  Monitoring and education play key roles within the facility including all ancillary staff in a team approach.
Diabetes Management in the Long-Term Care Setting.  Clinical Practice Guideline by AMDA revised 2010.

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