Khamis, 5 Disember 2013

The Star Online: Lifestyle: Health

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The Star Online: Lifestyle: Health

Sugar in the blood


With no signs or symptoms, it is crucial to screen for prediabetes, before it becomes full-on diabetes.

MANY people are probably unaware that prediabetes is almost as serious a condition as diabetes itself.

Like diabetes, its onset is insidious, and many do not realise that they have it until it is too late.

Most people only know about it when it has already progressed to full-blown diabetes, or when they develop complications such as heart attack or stroke.

It makes sense to know if you have prediabetes early, so that you can take the necessary steps to improve your health and prevent serious complications.

When to check

You should go for blood glucose (sugar) screening if you have any risk factors for diabetes; this is especially if you have a close relative with diabetes, are overweight, or lead a sedentary lifestyle.

The more risk factors you have, the more likely that you might have prediabetes.

The combination of a strong family history, being overweight or obese (and physically inactive) is especially bad, but the good news is that you still have time to take positive steps to improve your health before things get worse.

How to check

The blood glucose level of people with prediabetes, although higher than that in normal persons, is not as high as in people with (untreated) diabetes.

Testing for sugar in the urine (or getting the ants to do it for you) is of no use, as the blood sugar may not be high enough for it to spill into urine.

Worse, as noted in my previous article (What is prediabetes?, Star2, Nov 14, 2013), most people with prediabetes usually do not have any symptoms, and you may be living blissfully without knowing that you have a potentially serious condition.

The only reliable way of knowing if you have prediabetes is to have a blood test, as the condition can only be confirmed based on blood glucose levels.

If you were diagnosed with gestational diabetes while pregnant, it is a good idea to be tested regularly for prediabetes. ¿ Filepic

If you were diagnosed with gestational diabetes while pregnant, it is a good idea to be tested regularly for prediabetes. — Filepic

Presently, there are three ways to test your blood for prediabetes:

·Fasting blood glucose test

Your doctor will take a blood sample after you fast overnight (for at least eight hours).

You are considered to have prediabetes if your blood glucose is in the intermediate range (between that of normal and diabetic individuals), that is from 5.6 to 6.9 mmol/L.

People with this intermediate fasting blood glucose level are also said to have impaired fasting glucose (IFG).

·Modified oral glucose tolerance test

A blood sample will be taken after you fast overnight (for at least eight hours) to determine if you have IFG (as in the fasting blood glucose test).

You will then drink a sugary solution (that contains 75gm of glucose in 250ml of water). Your blood sugar level is measured again after two hours.

Your blood sugar is considered normal if the two-hour blood glucose level is less than 7.8 mmol/L.

A blood glucose level of 11.1 mmol/L or higher may indicate that you have diabetes.

If your blood glucose is between 7.8 to less than 11.1 mmol/L, then you are deemed to have prediabetes.

People with this intermediate range of blood glucose level two hours after the glucose drink are also said to have impaired glucose tolerance (IGT).

·Glycated haemoglobin (HbA1c) test

This blood test has recently been endorsed to differentiate between individuals with normal blood glucose levels and those having prediabetes or diabetes.

The test is a measure of the amount (percentage) of haemoglobin (the oxygen-carrying protein in red blood cells) that have glucose attached to them.

The higher your blood glucose levels, the higher will be the percentage of your HbA1c.

An HbA1c value of less than 5.7% is considered normal, and more than 6.5%, diabetic.

A person with an HbA1c of between 5.7% and 6.5% is classified as having prediabetes.

What's next?

You will know that you have prediabetes if you have borderline results in any or all of the above blood tests.

The fasting blood glucose test is the easiest to perform (and the cheapest). But the gold standard to diagnose prediabetes is still the oral glucose tolerance test (OGTT).

Thus, if your risk is high, but your blood glucose level is normal, your doctor might direct you to have the OGTT done, to be sure that you do not have prediabetes (or diabetes).

Sometimes, your healthcare provider will perform an initial screening test using a portable glucometer, where a drop of blood is obtained by pricking your finger with a needle, and placed on a test strip to be read by the glucometer.

The result is available almost immediately.

If your above tests are normal and you do not have a risk factor for diabetes, then your doctor may recommend that you do the (screening) test(s) once every three years.

Your doctor may want you to have the test done more frequently (e.g. every year), if you have risk factors for diabetes, such as a positive family history of diabetes, being overweight or obese, leading a sedentary lifestyle with little exercise, having high blood pressure or blood cholesterol levels, or having previously been diagnosed with diabetes during pregnancy.

If you have prediabetes, your doctor may ask you to go for further testing to check your risk for complications of prediabetes, especially that of heart disease.

For example, after checking your BMI (body mass index; obtained by dividing your weight in kg by the square of your height in metres) and blood pressure, your doctor would request for a chest X-ray and electrocardiogram (ECG), lipid profile (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglyceride levels), kidney profile (blood urea and serum creatinine levels), and a microalbuminuria test (to check for the presence of proteins in your urine as an early sign of damage to your kidneys).

If you are found to have prediabetes, you should now be very eager and ready to start taking good care of your health.

In the next article (on Dec 19), we will learn more about why this is so important, especially with prediabetes.

Emeritus Professor Datuk Dr Mustaffa Embong is a consultant diabetologist and (honorary) executive chairman of the National Diabetes Institute (NADI) of Malaysia. This article is provided by NADI under the "Prevention of Diabetes and Heart Disease" Programme, which is fully funded by the Health Ministry's Health Promotion Board.


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