Impaired Fasting Glucose.
This has been introduced to classify individuals who have fasting glucose values above the normal range but below those diagnostic of diabetes. (fasting plasma glucose >= 6.1 mmol/l but < 7.0 mmol/l)
The BDA recommends that all those with impaired fasting glycaemia (IFG) should have an oral glucose tolerance test to exclude the diagnosis of diabetes, and are actively managed with life style advice
The oral glucose tolerance test reveals a 2 hour result of <7.8 mmol/l (2)
the relative risk of progressing to diabetes for patients with IFG is 1.1-2.2% per year (1)
Patients with IFG may also have manifestations of metabolic syndrome. There is also an increased cardiovascular risk associated with patients with IFG compared with people with fasting glycaemia in the normal range. Patients with IFG need to have their macrovascular risks assessed and the calculated risk increased because of their IFG - a doubling of risk to allow for increased risk has been suggested (1)
these people should be followed up annually to reassess glucose regulation and all other cardiovascular risk factors (3)
Source: gpnotebook.co.uk/simplepage.cfm?ID=-1603600309 (Limited access link)
Impaired Glucose Tolerance.
In the oral glucose tolerance test the patient, after fasting for 15 hours, drinks 75 g of glucose in 300 ml of water, over 5 minutes. Blood glucose is measured before the drink and after 30, 60, 90 and 120 minutes. Urine is collected before the drink, and after 60 and 120 minutes. Before the test, for a period of 6 hours, the patient should avoid smoking and drinking coffee.
There is a normal glucose tolerance if the venous plasma value is less than 7.8 mmol/l after the 2 hour period, i.e. diabetes and impaired glucose tolerance are excluded.
If after 2 hours after the glucose load the value is >=7.8 and <= 11 mmol/l, then there is impaired glucose tolerance.
If glucose is greater than or equal to 11.1 mmol/l, diagnose diabetes mellitus, if symptoms are present; in asymptomatic patients, a further value greater than or equal to 11.1 mmol/l during the oral glucose tolerance test is required.
If the blood glucose reaches its highest level at 30 min and then falls below normal levels at 60 and 90 min then this is a lag curve. This profile is due to rapid glucose absorption followed by a burst of insulin production which over-compensates, resulting in hypoglycaemia.
If the blood glucose rises only a small amount, this is called a flat profile.
Source gpnotebook.co.uk/simplepage.cfm?ID=-1529872364&linkID=19207&cook (limited access link)
There are things you can look out for which may mean you are at risk of becoming pre Diabetic.
So the doctor says I am ‘pre Diabetic.....I don’t really understand what this means ?
Many but not all diagnosed ‘pre Diabetic’ are overweight. (Official definition is BMI 25 – 30) or even heavier.
There are also some who, through other illnesses and medications, such as long term use of steroids can develop Diabetes.
What does BMI mean ?
BMI stands for Body Mass Index, just one of the many tools doctor’s use to calculate risk factors, in this case how heavy you are and whether you are a healthy weight for your height. You can calculate this yourself using an on-line calculator like this one here:
Another useful tool is the waist to hip ratio calculator:
Waist to Hip Ratio Calculator
This shows you how much fat you are accumulating inside your abdomen and which can put you at risk of developing not only Diabetes Type 2 but other health problems as well.
If you are overweight then, by losing up to 10% of body weight you may begin to reduce your insulin resistance and the excess fat around your waist.
Insulin Resistance/Metabolic Syndrome
What is Insulin Resistance and the Metabolic Syndrome ?
The metabolic syndrome refers to a clustering of cardiovascular disease (CVD) risk factors whose underlying pathophysiology may be related to insulin resistance. However, there is uncertainty as to whether all patients with the syndrome are indeed insulin resistant, so the aetiology has been broadened to include concepts of obesity, adipose tissue disorders and other factors.1
Very simply, Insulin resistance is when you over produce Insulin in the body to try and cope with your intake of glucose. The Insulin does not get into specific cells such as fat, muscle, and liver cells therefore the cells do not effectively use the Insulin. In an attempt to cope with the glucose the body overproduces Insulin. Insulin then may have the effect of storing more fat and may increase your weight. This may be characterised by a large waist circumference etc as can be seen in the above link.
Can I reduce my Insulin resistance ?
Insulin is produced in response to eating Carbohydrate which turns into glucose in the body.
Therefore if you reduce the amount of carbohydrate that you eat you reduce the Pancreas’s response to produce Insulin. As the body loses weight especially round the waist the cells become less resistant and the produced Insulin becomes more efficient at coping with the glucose. As the produced insulin is all utilised more efficiently it does not cause so much fat to be stored.
So I don’t need to eat Carbohydrate then ?
Some carbohydrate is necessary for the body to function. Removing totally one food group from your diet would not do you any good at all as we get different nutrients from different foods and have to bear that in mind when tailoring a diet to suit ourselves .There are also other things to consider like other medical conditions which may need a specific diet.
Generally the carbs in fruit and veg are ‘good’ carbs because those foods also contain many micronutrients that are beneficial to us.
The carbs however in starchy foods such as bread, potatoes, pasta, rice and flour based products etc is starch which, in the body converts 100% into glucose. These are the types of food that you need to consider cutting down on, either reduce the portions to small portions or avoid then altogether. The less carbohydrate you eat the less insulin response there is and you may then begin to lose weight.
Buy a carb counter book and then you can prepare your own meals knowing exactly what is in your meal. You may also consider buying a blood glucose meter. However, although the meters are fairly cheap the test strips are expensive but it the best way to see how the different foods are affecting your blood glucose levels. Remember the more glucose in your blood the more Insulin you will produce and this will slow down your weight loss.
Before embarking on any weight loss programme you should consult your Doctor and if possible see a registered Dietician for advice especially if you have other health problems to consider.
Exercise is also an important aspect of trying to lose weight, especially the all important waist circumference ! When you choose to increase your physical activity, your muscles have to work harder. When they are harder at work, they are better able to take up the glucose from your blood for energy. Imagine when you are walking, riding your bike, or swimming, that your muscles are actually pulling glucose from your blood stream and making proper use of it. This might be a motivating image to help keep you going to reduce your risk for Insulin resistance.
However many people for various reasons cannot exercise because of other physical restraints. I would recommend asking a physiotherapist for a set of chair exercises which you can attempt tailored to your specific needs. Anything that raises you heart rate above your normal and make the muscles work harder than normal resting will help burn off more calories. Every little helps !