Su­gar in the blood

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

The Star Malaysia - Star2 - - FRONT PAGE - By Emer­i­tus Prof Datuk Dr MUSTAFFA EMBONG

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.

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

Just a fin­ger prick: a sim­ple and quick way to screen for pre­di­a­betes is by giv­ing a drop of blood to be read by a por­ta­ble glu­come­ter. — Filepic

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