CHECK YOUR WEIGHT – AND YOUR WAIST WATCH OUT FOR OTHER HEART RISKS Prediabetes: What is it – and how do you know if you’re one of the thirteen million at risk

DIABETES doesn’t develop overnight. It begins with very subtle ‘communication problems’ within the body’s cells and can take years before it seriously affects your health. And this gives us plenty of time to do something about it. But it is vital to understand whether you might be at risk and how the problem develops. Type 2 diabetes begins life as prediabetes, when blood sugars are abnormally high and, without lifestyle changes, the full-blown disease may well strike. In prediabetes, the hormone insulin, which moves sugars from food into our blood, where it is used for energy, is not working as well as it should. Sugar stays in the blood, raising its levels to higher than normal but not high enough to develop type 2 diabetes or to cause obvious symptoms.

Which begs the question: if there are no symptoms, how do you know if you’re at risk?

First, it’s worth taking a look at the free online questionnaire on the Diabetes UK website (diabetes.co. uk), which analyses your personal diabetes risk by taking into account everything from family history and ethnicity to weight and diet. The results will give you an idea of whether or not prediabetes is something you ought to be concerned about either now or in the future.

And if it is a worry, your GP can organise a blood test, which we’ll explain in more detail later.

But what is crucial is being aware of the most important factors that could already be putting you in harm’s way. Here is how to know if your blood sugar levels are likely to reach the danger zone and what you can do about it.

THE single biggest risk factor for prediabetes is excess body fat.

Research shows that an accumulation of fat around or in the organs can affect how cells in the body respond to insulin, disrupting blood sugar control. Checking your body mass index, or BMI, gives a good indication of whether this could be happening.

People living with obesity – that is, who have a BMI of 30 or above – are up to 80 times more likely to develop diabetes than those with a healthy BMI of less than 22, according to studies. A BMI calculator is available on the NHS website. Anything over 25 is deemed overweight.

Waist size is also a good indicator of diabetes risk because it is a sign of excess fat close to or in the organs, such as the liver. This type of fat – known as ectopic fat – significantly impairs insulin function.

Men should have a waist measurement of less than 37 inches, while women should keep to a more trim 31½ inches.

PREDIABETES often goes hand in hand with other obesity-related conditions, such as high blood pressure and high cholesterol.

Nowadays, doctors often diagnose patients with a combination of these problems with metabolic syndrome. In these cases, it is almost always a result of lifestyle factors such as poor diet, high alcohol intake and inactivity. This group carries the highest risk of suffering a life-threatening stroke or heart attack, because all three conditions play into each other.

Cholesterol, produced mostly in the liver, is essential for the healthy functioning of bodily cells.

It is carried around the body in packages called lipoproteins – a combination of cholesterol and other fats and proteins. Low-density lipoproteins (LDL) carry cholesterol from the liver to the body. There are other types of lipoproteins, but it’s the amount of LDL that doctors pay most attention to, because this type is a known risk factor for heart disease.

If you have prediabetes or type 2 diabetes, you may be given medicabe

tion to reduce that risk. Scientists have found that having high blood pressure makes you 50 per cent more likely to develop type 2 diabetes. Some 4.3million Britons are living with high blood pressure but don’t know it – because there are no symptoms.

You can check yours at most local pharmacists for free, or at your GP surgery.

Regular exercise, reducing salt intake and eating a healthy, balanced diet are all important steps for keeping your blood

pressure down.

SKINNY PEOPLE CAN GET PREDIABETES TOO

IF YOU’RE a healthy weight, it doesn’t mean you’re out of the woods. In fact, 15 per cent of people with type 2 diabetes are not overweight.

Slim people can have an accumulation of fat inside the abdomen, which infiltrates organs such as the liver and pancreas (where insulin is produced).

This affects how the body’s cells respond to insulin.

Some leading researchers have suggested that everyone has their own fat threshold – the point at which fat levels begin to trigger insulin resistance and affect blood sugar control. But there are other factors that can influence diabetes risk, regardless of weight.

Medication, for instance. Some drugs have side effects that raise your blood sugar levels. These include a group of drugs used to treat asthma and arthritis – antiinflammatories called corticosteroids – certain diuretics for high blood pressure, beta-blockers to prevent heart attacks, antipsychotic drugs used to treat schizophrenia and bipolar disorder, and even statins. The risk is slight and benefits often outweigh any small harms, so don’t stop these medicines without discussing it with your GP first.

Gestational diabetes, which happens when pregnancy triggers insulin resistance, can also affect women who are a healthy weight, although it is more common in those who are borderline overweight or heavier.

In some cases blood sugars don’t come back down to normal after giving birth. Since 2009, everyone aged between 40 and 74 is invited for a free NHS health check every five years.

This now includes screening for prediabetes, which usually involves a blood test that indicates whether your blood sugars are consistently high.

This is a good opportunity for everyone – regardless of weight – to get tested.

The Covid backlog has affected routine appointments like this in some local areas, so call your GP to ask for a health check if you are due one.

DIABETES IN THE FAMILY COULD BE A RED FLAG

SOME people are predisposed because of their ethnic background or genetic profile.

For these groups, only a small amount of excess fat is needed to develop prediabetes.

It is thought that people from South Asia, the Middle East and those with African and Caribbean heritage are more susceptible to type 2 diabetes because of the way their bodies store and process fat. Meanwhile, genetic factors mean anyone with a mother, father or sibling who has type 2 diabetes are up to 200 per cent more likely than others to develop it.

There are a multitude of genes that influence where we store fat in the body, and how well sugar from our food is absorbed into the blood. Those who inherit genes that programme for the condition usually develop it in their 40s or younger, sometimes without being significantly overweight.