HAVE YOU GOT PRE- DIABETES?

One in three of us is on the brink of full diabetes — which cuts SIX YEARS off your life. And fat or slim, you may be a victim

The f i gures are grim. More than one in three adults has ‘pre-diabetes’ and has no idea they’re at risk, according to research just published in the British Medical Journal. As a result, Britain is facing a type 2 diabetes epidemic of unprecedented proportions. Type 2 diabetes, the kind that develops in adulthood and is linked to lifestyle, is not a condition to be dismissed lightly— it can reduce life expectancy and lead to complications such as blindness and amputation that seriously affect quality of life.

Pre-diabetes is a term used to indicate you have raised blood sugar levels and are therefore at greater risk of developing type 2 diabetes in future.

The rapid rise in the numbers said to be affected by pre- diabetes — three times what they were a decade ago — has come as a shock even to medics.

‘This study has taken us all by surprise — it’s been a bit of a health bombshell,’ says Dr Stephen Lawrence, a GP and clinical adviser on diabetes to the Royal College of General Practitioners.

The figures are ‘alarming’, says Simon O’Neill, director of policy at Diabetes UK. ‘It’s worse than we expected.’

It must be acknowledged that some specialists aren’t convinced that pre-diabetes exists.

‘It’s nonsense,’ says Craig Currie, professor of applied pharmacoepidemi-ology, Institute of Primary Care and Public health at Cardiff University.

‘either you have type 2 diabetes or you don’t have type 2 diabetes. I think this is simply a scare tactic to make people take notice.’

however, the consensus is that raised blood sugar levels, whether they’re labelled pre-diabetes or not, are not healthy. So, how can you tell if you are at risk — and what can you do to protect yourself? We talked to the experts . . .

HOW CAN I TELL IF I’M PRE-DIABETIC?

There are no symptoms — pre- diabetes just means your blood sugar levels are at the very high end of the normal range, but not quite high enough for a diagnosis of type 2 diabetes.

In Britain, it is measured using a test called hbA1C — if your blood sugar is between 6 to 6.4 per cent, this is called pre-diabetes (6.5 is officially diabetes).

high blood sugar is a tell-tale sign that your body is producing the hormone insulin, but is no longer able to use it effectively — known as insulin resistance.

Insulin mops up excess sugar from the blood and takes it to the cells to use for energy. But when your body becomes i nsulin resistant, sugar starts to build up in the blood, causing damage to blood vessels and nerves.

The closer your blood sugar readings are to 6.5, the more likely y ou will start to develop complications because of high blood sugar levels, says Melanie Davies, professor of diabetes medicine at Cardiff University. ‘This is the point where the first complications begin, in particular problems with changes to cells at the back of the eye, known as retinopathy, which can lead to blindness.’

S y mptoms include blurred vision, floaters and sudden vision loss.

DO YOU GET IT FROM SUGAR?

TheRe are some studies that suggest eating too much sugar could be to blame, but the evidence is not yet strong enough to say for sure, says Mr O’Neill.

In fact, the major risk factor for pre-diabetes is having a BMI of 25 and above, especially if you tend to be ‘apple shaped’ and carry fat round your waist.

‘We believe anything that makes you put on excess weight is the problem — whatever you are eating,’ says Mr O’Neill.

This is because fat sits close to the vital organs, including the pancreas, which reduces i ts ability to produce insulin.

Another risk factor is age — from 40 your risk steadily starts to i ncrease. As we age, t he mitochondria — t he t i ny powerhouses — in our muscle cells start to slow; this increases the fat content in the cells, leading to insulin resistance. ethnic ori gi n is another risk factor. ‘People of South Asian origin are up to six times more likely to develop pre -diabetes as a genetic suscep-tibility means t hey start to develop i nsulin r esistance at a much l ower BMI,’ says Mr O’Neill. Black and other ethnic minorities are also at increased risk.

I’M SLIM, SO AM I SAFE?

ThOUGh weight plays an impor-tant role in who might develop pre-diabetes, not all people with the condition are overweight.

even if you are thin, you could still develop pre- diabetes, says Douglas Twenefour, a specialist diabetes and obesity dietitian at Central London Community healthcare NhS Trust and a spokesman for Diabetes UK.

As he explains: ‘You may have a family history of type 2 diabetes or polycystic ovarian syndrome — a hormonal disorder where multiple cysts grow on the ovaries — which raises your risk of type 2 diabetes, regardless of your weight.’

If a woman has given birth to a baby who weighs more than 10 lb, she may also be at greater risk of developing pre- diabetes — it’s thought that women who have heavier babies tend to be heavier themselves.

SHOULD I ASK MY GP FOR A TEST?

If YOU think you might have pre-diabetes, you could start by taking a risk assessment test — the easiest way to do this is online at diabetes.org.uk/risk.

Another option is to ask your pharmacist t o do t he r i sk assessment for you.

Note, this is not a blood test, but based on your answers, it will show if you should go to your GP to request for further assessment, which may include a blood test.

If you are over 40 and live in england, you can ask for a blood test at your local GP surgery as part of the NhS health Check, says Mr Twenefour. ‘If you are under 40, you will need to have some justification for your request, for example, because a close fam-ily member had the disease,’ he says.

The NhS health Check is a five-year check that’s meant to be offered to everyone aged between 40 and 74.

It aims to assess people for a r ange of health problems, i ncluding pre - diabetes and diabetes — however, less than half the people who should have been offered the checks have been.

In any event, GP Dr Lawrence suggests that people who are 40 or older and have a BMI above 25 s hould be c hecked f or pre- diabetes, as should those with a close relative — parent or sibling — who already has type 2 diabetes.

In the past, doctors used one of two blood tests to check for blood sugar levels.

The fasting plasma glucose test showed how much glucose was in the blood after fasting for at least eight hours.

Meanwhile, the oral glucose tolerance test showed how much glucose remained in the blood two hours after eating sugary foods.

These tests do provide a snap-shot of someone’s blood sugar levels at a given time.

however, a newer test, known as hbA1C, i s now being done universally.

This doesn’t involve fasting and provides a picture of your blood sugar levels over the past two to three months. It counts the