Prediabetes – More deadly than COVID-19

Before we understand why is prediabetes more deadly than COVID-19 we need to understand. “What is prediabetes?”

A prediabetes stage is a metabolic disorder of the body in which the blood sugar levels are not elevated enough to be called as diabetes level but the blood sugar levels are above normal levels. The prediabetes blood sugar levels can be better understood by below values.

Why is there sugar in the blood?

The food that we eat consists of three macronutrients. Carbohydrates/complex-sugars / Starch , Fats and Proteins. During the process of digestion in the GI( Gastrointestinal) tract various organs of the GI system like mouth, esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder and anus process the macronutrients of the food to much simpler forms.

Like Carbohydrates are converted to Glucose , Protein to Amino acids and Fat to Fatty acids and Glycerol. These simple form conversions happen with the help of enzymes and acids by various parts of the GI system.

Digestion of food starts along with ingestion and as soon as food enters mouth it is mixed with Saliva which contains an enzyme Amylase. Amylase acts as a catalyst and through enzymatic hydrolysis begins the process of breaking complex sugars of the starch into much simpler sugar molecules by breaking bonds between disaccharides, oligosaccharides, and starches. Amylase an enzyme in the saliva along with Lingual Lipase another enzyme is released in the mouth through chewing. These two enzymes begin the  fat digestion process in the mouth.

The prechewed food from mouth travels through the Pharynx and Esophagus to enter the Stomach. In the Stomach the food is processed by a fluid called as Gastric Juice which is made of water, mucus, hydrochloric acid, potassium chloride, sodium chloride, pepsin, gastrin, bicarbonates, enzymes and intrinsic factor.

Hydrochloric acid and pepsin break protein down into smaller chains of amino acids.

The food and Gastric Juice mixture get turned into a slurry called Chyme. The Chyme is then gradually passed on to the small intestine. The small intestine consists of three main parts duodenum, jejunum, and ileum.

In the duodenum bile juices from gallbladder / liver though a common duct and juices from pancreases mix. The duodenum also secretes a mucus rich in hydrates to regulate the acidity of the chyme and protect the intestine lining. The duodenum is primarily dedicated to digestion. Small amounts of sugars, amino acids and fats, along with micronutrients are absorbed in the duodenum. After passing though the duodenum, the slurry enters the jejunum. In the jejunum majority of broken-down macronutrients like sugars , fatty acids and amino acids are absorbed. The absorbed macro nutrients enter blood stream through various mechanisms like diffusion.

So, the sugar in the blood comes through breakdown of carbohydrates or starch from the food we eat. The liver stores , produces and releases sugar in the blood depending on the body’s need. Sugar is stored in the liver and muscles in the form of glycogen.

Why is diabetes called a Metabolic Disorder ?

Even before we understand diabetes as a metabolic disorder it is important to understand what is metabolism and before we understand metabolism, we need to understand how do living organisms function . The basic building block of all living organisms including humans is cells. The role of cells in a multicellular organism is to perform specialized functions and to provide structure. To perform those specialized functions or to do work cells need energy like any work needs energy to be spent. Inside each of the trillions of cells of the human body is a structure called mitochondria. mitochondria are the kitchen of the cell where  energy from food is converted to a form that can be used by the cell to perform its functions. There are several essential chemical processes going on in the cell , converting food to energy , converting food to essential compounds required for functioning of the cell , eliminating wastes or products which are not used by the cell and transfer of substances to and from cells where required.  All these processes combined together represent the chemical reactions going on inside a cell or inside the multicellular organism and are termed as metabolism of the body. These metabolic functions are catalysed by enzymes. Metabolic chemical reactions are of two types , Anabolic and Catabolic. Catabolic reactions convert food to energy while Anabolic reactions generate compounds for functioning of body using energy.

The form of energy or currency of energy that can be used by the cells is called ATP ( Adenosine triphosphate) . Several enzymes convert glucose into pyruvate using a process called Glycolysis. Acetyl-CoA is synthesized in mitochondria of the cell by a number of reactions. Oxidative decarboxylation of pyruvate; catabolism of some amino acids  and β-oxidation of fatty acids. Stored energy is released through the Oxidation of Acetyl-CoA through a series of chemical reactions called the citric acid cycle (CAC) or TCA cycle (tricarboxylic acid cycle) or the Krebs cycle in the form of ATP.

When the cells need energy to function, they will convert the glucose, amino acids and fatty acids available in the blood to ATP and hence glucose in the blood is consumed for energy and other functions. After a meal digestion takes place or post digestion glucose , amino acids and fatty acids are released to the blood stream. The movement of glucose from extracellular space to intracellular space happens through glucose transporters or GLUT. When the beta cells of the pancreases receive blood glucose through a transporter called GLUT2 , the pancreas secret a hormone called insulin. Insulin in turn takes the excess glucose in the blood and stores it either in Liver , Fat cells or Muscle cells. Hence insulin is highly anabolic in nature which takes the energy in the form of glucose, puts them inside the cell to generate substances like muscles and fat.  

When a human has diabetes there is not enough generation of the hormone insulin from the beta cells of the pancreas which result in lower absorption of glucose from the blood to the cells and hence lower anabolic or metabolic rate . For this reason, Diabetes is called as a Metabolic disorder.

In prediabetes stage there is sufficient insulin produced by the pancreas but for some reason the cells develop an insulin resistance due to which the effectivity of insulin decreases and elevated blood glucose level triggers more and more secretion of insulin . This higher concentration of insulin triggers conversion of glucose into fatty acids which gets stored in liver and fat cells. Hence the prediabetics will have higher BMI in most cases .The exact reason for insulin resistance is not known but one of the reasons can be certain individuals with  a body type with lower metabolic rate , due to lower metabolic rate the glucose in the blood is not used resulting in more than normal secretion of insulin, more insulin secretion results in fat accumulation and higher BMI. The exact relationship of insulin resistance and higher BMI is not known but higher BMI individuals have shown a higher risk of insulin resistance.

Insulin also has the role to trigger liver to take up glucose in the blood but during diabetes lack of insulin doesn’t trigger liver to do so and hence the body enters a vicious cycle of high blood glucose levels.

Like the beta cells which secret the hormone insulin to bring down the blood glucose levels, there is another hormone called glucagon secreted by the alpha cells of the liver. Glucagon has opposite action of insulin, when the blood glucose level drops glucagon in released in the blood which triggers the liver to start gluconeogenesis . During gluconeogenesis the liver can generate glucose from other sources like fat through ketones and from protein using glucogenic amino acids.  Liver can also produce glucose from its stored form glycogen though the process of Glycogenolysis.

The lack of glucose in the blood during fasting triggers release of hormone glucagon from the pancreas which in turn trigger Glycogenolysis or Gluconeogenesis to produce glucose. This excess glucose in the blood during fasting or during early morning is termed as the Dawn Phenomenon. Prediabetics who are not on medication show the dawn phenomenon more often as the body is insulin resistant and hence not able to utilise the available glucose. While in diabetics the medication taken before sleep may be regulating the high blood sugars and hence the Dawn phenomenon is not that pronounced in diabetics on medication.

Why is the Prediabetes Stage important?

Prediabetes is a pre cursor to diabetes and an indication that there is something wrong inside the body and the regulation of sugar is affected resulting in more than normal blood glucose levels. Prediabetes provides a window of opportunity to delay or completely eliminate the onset of diabetes if certain life style changes are made in early stages of prediabetes. Prediabetes is difficult to diagnose since it doesn’t provide any noticeable symptoms as in case of diabetes where the symptoms are very prominent. But there are certain subtle  changes in the body that can indicate or should necessitate monitoring of blood glucose levels despite of the text book diabetic symptoms not being prominently present.

If any of the below reasons are present the person should check for prediabetes :

1. A BMI of > 25 or fat accumulation in the abdomen
2. Lower metabolic rate and lower physical activity
3. Lower testosterone levels or lack of libido in men
4. Women with difficulty in getting pregnant and diagnosed with Polycystic Ovary Syndrome
5. Women with signs of higher male hormones like male pattern baldness , facial hair
6. Lack of sleep during certain time of the night , like early hours or sudden sweating during sleep
7. Women who had gestational diabetes
8. Craving to eat sugars , chocolates  and carbohydrates
9. A family history of diabetes
10. Age above 30 years should check for blood glucose levels without any symptoms and monitor HbA1c
11. Unexplained lack of enthusiasm and feeling weak to perform day to day tasks
12. High levels of bad cholesterol
13. High blood pressure
14. Tingling sensation in limbs
15. Decrease in eye vision
16. Unexplained thirst
17. Frequent urination
18. Slow healing wounds

Despite of the blood tests showing normal results , a person should continue to have a lifestyle that supports healthy blood sugar levels as the risk of becoming prediabetic or diabetic is always present and once diagnosed the fight to stay healthy is never ending. Diabetes or prediabetes can’t be cured forever, it can only be managed for time being and the fight against rising blood glucose levels is forever. Even if the prediabetes can be reversed it doesn’t mean the steps taken to control prediabetes are abandoned, they must continue lifelong to minimize the risk of getting diabetic.

Knowing the food and Metabolic Rates

Knowing the composition of the food in terms of macro nutrients is necessary to manage healthy blood glucose levels along with how the food effects blood sugar levels. One such parameter is knowing the Glycemic Index ( GI) of the food. GI is the measure of food’s influence on blood sugar levels. It’s a value that ranges from 0-100, higher the glycaemic index more is the increase of blood glucose levels after the meal consumption. So, people prone to diabetes , in prediabetic state or having diabetes should aim for foods in low GI and Glycemic Load ( GL).

Food	Glycemic Index	Food	Glycemic Index	Food	Glycemic Index	Food	Glycemic Index
Chicken	Very Low	Garbanzo Beans	37	Milk	30	Grapes	46
Fish	Very Low	Pepsi	63	Yogurt	14	Broccoli	45
Egg	Very Low	Coke	63	Pasta	55	Potato	63
Apple	38	Fanta	68	White Bread	67	Carrot	47
Orange	42	Cheese	Very Low	Rice	90	Chick Peas	31
				Dates	61	White Sugar	100

The food that we eat is source of energy and this energy is the capacity to do work for the body. The body through Catabolic and Anabolic reactions spend the energy from food. On an average, men of middle age with low BMI and low physical activity may require 1500-2000 calories per day while middle aged women with low BMI and low physical activity may need 1300-1600 calories per day of energy to meet minimum body functions like breathing , blood circulation, maintaining body temperature , digestion etc. The food that you eat should provide to the calorific requirements of the body, we have already seen in this article that through Krebs cycle all three macro nutrients can provide ATP or the energy currency of the cells. For a normal person an optimum composition of the three macronutrients for daily calorie requirements can be 45 % from Carbohydrates + 20 -35 % from Fat+ 15 to 20 % from proteins along with 25 grams of dietary fibres. For people prone to diabetes the Carbohydrate source should be such that it is not easily absorbed by the body and should slowly gets released to the blood avoiding a quick spike in blood glucose levels post meals. Simple sugars are a strict no for people prone to diabetes , complex carbohydrates with low GI and GL and good proportion of fibres can be consumed such that the blood sugar levels do not rise beyond normal levels.

There are lots of hidden carbohydrates and calories in our food which should be counted and limited in intake. For example, even though the GI of grapes is 46 , a glass of grape juice can have 14 % sugars and can elevate blood glucose levels quickly. White bread , pasta , Rice , cakes, chocolates , ice creams , soda all of these food items will throw off blood sugar levels from the normal ranges and should be completely avoided .

Carbohydrates have 4 calories/gram , protein has 4 calories/gram and fat has 9 calories/ gram of energy.  Considering an average of 1500 calories/day of energy requirement for basal metabolism it translates to 168 grams of carbs, 131 grams of protein and 33 grams of fat. 100% of Carbohydrates are broken down into simple sugars and hence effect the blood glucose levels quickly after meals, proteins break down into amino acids and used by cell functions like building muscles , any excess protein or 50 % of the protein is then converted by the liver into glucose and hence the overall process takes 3-4 hours to become glucose through gluconeogenesis  and hence the blood glucose rise is gradual due to protein. Only 10 % of the Fat intake is covered to glucose and hence the impact of fat intake on blood glucose levels is the minimum after a diet.

But what happens to the fat that we eat ?

There are four main types of dietary fats :

1. Saturated fats ( Bad Fats): Examples are animal fats like cheese and are typically solid at room temperature.
2. Trans fats(Bad Fats): Primarily artificially produced by chemical alteration of vegetable oils and stay solid at room temperatures
3. Monounsaturated fats(Good Fats): Plant based oils like Olive oil , sunflower oil avocadoes are sources. These fats stay liquid at room temperature.
4. Polyunsaturated fats(Good Fats): These are Omega-3 and Omega -6 fats. Oils from Fish are high in Omega-3 while oils from plants like Sunflower are high in Omega -6 fats.

The above saturated and unsaturated fats are called triglycerides.

An acid is a molecule or ion capable of donating a hydrogen ion(H+) while an alkyl is a molecule missing one hydrogen. When an alkyl group bonds with oxygen it forms an alkoxy group.  When a hydroxyl group from the acid (-OH) is replaced by the alkoxy group it forms a group of compounds called esters. An organic compound Glycerol has the  chemical formula C3H8O3 containing 3 carbon (C) atoms, 8 hydrogen (H) atoms, and 3 oxygen (O) atoms. When an organic acid with carboxyl  group is thatched to an alkyl group it forms carboxylic acid . When these carboxylic acid groups form long chains, they are called fatty acids. These chains are of two types saturated and unsaturated. When the hydroxyl groups of the glycerol join the carboxyl groups of three fatty acid to form ester bonds it’s called a triglyceride.

The dietary fat or triglycerides that enter the body influence the metabolism of an organic molecule inside the body called cholesterol. Cholesterol is a fat like substance which has role in many important processes of the body for example cholesterol is used by the cells to make membrane structures , used for cell signalling , used in synthesis of hormones and synthesis of vitamin-D. Cholesterol is manufactured by each cell of the body and the prime source of Cholesterol in the liver. Synthesis of Cholesterol starts with the same Acetyl-CoA which was part of the  Krebs cycle. Through various steps and enzymes Acetyl-COA is converted into Cholesterol. Since fats are not soluble in blood,  cholesterol needs a mode of transportation to various cells . These modes by which cholesterol is distributed in the body are specialized particles called lipoproteins. There are several types of these particles like chylomicrons, very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL).

During digestion of the dietary-fat fat breaks down to Fatty acids and Glycerol in the small intestine and again put back as triglycerides and packed inside the lipoprotein chylomicrons before leaving the epithelial cells of the intestine. The chylomicrons take the triglycerides and dietary cholesterol  to various cells of the body like liver , skeletal muscles and adipose tissue. The triglycerides are stripped by the cells for their use and the chylomicrons become Chylomicron remnants and are absorbed by liver along with remaining triglycerides. The liver generates lipoproteins like VLDL for distribution of triglycerides , as the triglycerides are stripped the VLDL becomes IDL and in the end they become LDL. At the LDL stage , the concentration of the cholesterol  is as high as 50% and hence LDL becomes the prime cholesterol distributor among various cells of the body. Cholesterol is also recycled in the body and the unused Cholesterol from the blood is given back to the liver using the lipoprotein HDL.

So, LDL results in higher cholesterol while HDL results in lower cholesterol in the blood. The LDL cholesterol forms plaque in the arteries which can ultimately cause strokes and heart attacks causing death. People prone to diabetes are particularly at risk of developing plaque because the smooth surface of the arteries are affected by the abrasive blood glucose and hence the arteries provide a site for the LDL to stick and over a period of time it becomes a lump or plaque.  From the type of fat we eat Saturated Fats are known to promote LDL and Unsaturated Fats are known to promote HDL. All the fat that is not used by the body gets stored as energy reserve in the adipose tissues as well as all those extra calories that are not used by the metabolic function also get converted to fat and stored in liver and adipose tissues causing fatty liver and fat in unwanted area like lower abdomen. People who are prone to diabetes have bad regulation of blood glucose due to improper insulin response , higher levels due to insulin resistance in prediabetes takes all those extra energy in the blood and stores it in the adipose tissues. 

Our body can burn fat only when it is not able to meet the metabolic energy requirements through glucose. When the body doesn’t get enough energy from glucose glucagon from beta cells of the pancreas trigger release of fat from adipose tissues. These fat cells are converted by liver to an alternate energy currency called Ketones. Ketones can then replace glucose as the source of energy.

What to do when you are Prediabetic ?

It is important to take prediabetic stage seriously because the actions to bring back the blood sugars to normal are easier than in diabetes. The steps taken during prediabetic state can either prolong entry to diabetes or completely reverse the abnormality in the insulin and glucose metabolism.

1. Gain lean mass : Decrease the amount of fat in the body by eating a calorie deficit diet. Burn off the extra calories that you eat by performing cardiovascular exercises like running , brisk walking , swimming etc. Weight training or resistance training will help to gain muscle mass or lean mass. During calorie deficit diet there is a chance of muscles getting degenerated, so a healthy proportion of protein is important. Count the overall calorie intake and restrict diet with high GI and GL.
2. Check your blood glucose levels regularly or multiple times a day to find the effect of diet on your body. Adjust your diet such that the blood glucose levels do not spike. This may involve eating smaller meals and a greater number of times. So that no one meal contributes to a blood glucose spike.
3. There can be stricter dietary changes under supervision of a dietician like Low Carbohydrate  Diet, Intermittent fasting , Ketogenic Diet etc. The goal of all these extreme diets is to burn fat instead of glucose to get energy. But they are extreme diets and should be supervised to understand the impact on the body.
4. Stop substances like smoking , alcohol , caffeine and misuse of Psychotropic Drugs. All of these things interfere with the body’s natural metabolism and hence can worsen diabetic symptoms and can have other harmful effects on the body.
5. Once you have the prediabetic markers , include other blood tests as routine like Lipid Profile , Blood Pressure , HbA1c every three months , Uric Acid, Heart health, thyroid  etc. 
6. Manage your stress: Stress hormones such as cortisol increase the amount of sugar in our blood. Management of stress is important to manage blood glucose levels and hence enough sleep is also necessary for a healthy blood glucose level.
7. Increase intake of dietary fibres. Fibres are hard to digest and respond less to enzymes during digestion. Hence high fibre foods do not increase the blood glucose levels drastically as in the case of high glucose diets. Fibre also reduces cholesterol and facilitates waste removal from the body.
8. If you are new to the diabetic world or have any precursors to be in the suspectable population it will be wise to take medical advice for management of blood glucose levels.
9. Men should keep a watch on testosterone levels as lower testosterone levels may indicate insulin resistance and lower testosterone levels also indicate a lower metabolic rate which again is a precursor to diabetes.
10. In women when estrogen is low and progesterone is high it may lead to insulin resistance and hence likely to develop higher blood glucose. Women in Menopause are suspectable to this condition and hence should watch blood glucose levels regularly.

 

Prediabetes Socioeconomic Study :

The World Bank defined extreme poverty as people living on $1 or less a day. Around 1.89 billion people, or nearly 36% of the world’s population, lived in extreme poverty. Nearly half the population in developing countries lived on less than $1.25 a day.

The rate of diabetes in the world in around 10 % of total population. Going by that numbers around 180 million poor people worldwide should have diabetes .

180 million people in the world live is such economic conditions that they will not be able to bear the cost of diabetes care , be it testing , medical bills , disability or mortality. All these 180 million people are at the risk of loosing their lives due to complications arising from diabetes. Diabetes can be the worst pandemic of the world, worst than below pandemics :

1918 H1N1 (Spanish flu): Killed around 50 million people worldwide

1957 H2N2 (Asian flu): Killed around 4 million people worldwide

1968 H3N2 (Hong Kong flu): Killed 1 million people worldwide

2005 H5N1 (Bird flu): Which mostly affected more birds and few human causalities

2009 H1N1 (Swine flu): Killed around 18,000 people worldwide

2020 COVID-19 : 50 million effected , 1.2 million deaths

36% of 1.89 billion people living under poverty are extreme poor or live with an income of less than $1 a day . These people will not be able to afford diabetes health care. One of the solutions is to not have diabetes in the poor population and one such step would be to catch prediabetes or even better to not have prediabetes. 1.89 billion people can’t afford diabetes testing , the food that they eat is primarily carbohydrates like corn, starch , rice , wheat etc. Protein sources like meat are a very rare luxury. There has to be special prediabetic awareness in the world if the worst of the pandemics has to be cured. The awareness has to be minimum at the same level of COVID-19 if not better.

For those who can afford proactive prediabetes management should avoid progressing to diabetes at all cost and should keep curing prediabetes as a health priority. If prediabetes is not acted upon, it may result into below complications as the prediabetes progress into diabetes.

Complications of Diabetes

1. Nerve Damage : High blood sugar levels damage the small nerve endings and can happen anywhere in the body. Minor injuries can go unnoticed and infections can lead to amputation of limbs. Can lead to dysfunction  of digestion , reproduction , motor coordination etc.
2. High Blood Pressure : High glucose levels effect the way blood travels in the body and hence can cause elevated blood pressure levels or hypertension.
3. Diabetic Retinopathy : Diabetes affects blood vessels in the retina of the eye and can cause vision loss and blindness. Several eye conditions like Cataracts and Open-angle glaucoma can be elevated due to diabetes.
4. Kidney Diseases: High blood glucose levels cause damage to small blood vessels in the kidneys leading to kidney failure, and eventually death. A kidney failure requires expensive medical interventions like dialysis ad kidney transplants.
5. Cardiovascular diseases: We have seen the impact of low insulin levels on fat metabolism ad how LDL cholesterol plaques arteries. This may result in a heart attack and brain strokes due to blocked arteries or breaking of plaque and formation of blood clots. Heart attacks or strokes are a leading cause of death among diabetics.

6. Diabetes induced depressions : There is a high chance of having depression among people with diabetes due to a complex mood  and feel good hormonal association and metabolism effect of insulin and blood glucose imbalance.

Medical Treatment of Diabetes and Prediabetes

Prediabetes : If lifestyle changes are not helping to regulate blood glucose levels from prediabetic stage to normal and there is risk of bad cholesterol effecting cardiovascular system your doctor may consider prescribing the only approved drug for prediabetes that is Metformin. Metformin helps to reduce insulin resistance and hence decreases the blood glucose levels.

Diabetes (Oral Drugs) : A wide variety or class of drugs are used by medical practitioners to control blood glucose level in people suffering from diabetes .

1. Alpha-glucosidase inhibitors (AGIs) are used in the treatment of patients with type 2 diabetes. AGIs delay the absorption of carbohydrates from the small intestine and thus have control post meal blood glucose levels.
2. Biguanides or Metformin : Decreases the amount of sugar made by the liver.
3. Sulfonylureas: These drugs stimulate beta cells and improve production of insulin

Likewise, there are many more classes of drugs used in treatment of diabetes like Dopamine agonist, Dipeptidyl peptidase-4 (DPP-4) inhibitors, Glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists),Meglitinides, Sodium-glucose transporter (SGLT) 2 inhibitors and  Thiazolidinediones.

Diabetes ( Injectables ) : When none of the methods prescribed like life style changes , food changes and oral medication help to control blood glucose levels artificial insulin as injectables  will be prescribed by doctors to control the blood glucose levels.

Diabetes ( Surgical ) :

Bariatric Surgery : In this type of surgery the GI system of the body is altered by following one of the various techniques available like Gastric Bypass, Sleeve Gastrectomy, Adjustable Gastric B and Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass. In all these procedures the size of the stomach and/or the path of the small intestine’s duodenum  is changed to crate lesser surface of food absorption and lesser appetite. The Bariatric surgery dramatically reduces weight due to lower food intake and also alters the hormones which completely reverses diabetes and promote health through weight loss and improvement in cardiovascular health.  

Duodenal Mucosal Resurfacing (DMR): In patients who have undergone  bariatric surgery it was observed that  blood glucose control was getting better even before the weight loss started. This prompted the new treatment proposal for diabetes by resurfacing the Duodenal Mucus. This procedure is believed to alter the hormones involved in glucose metabolism in the same way as bariatric surgery. It is an endoscopic technique in which a hydrothermal ablation is crated on the duodenal mucosa. The procedure comprises catheter-based mucosal lifting with saline, and circumferential mucosal ablation with a hot fluid-filled balloon at the tip of the catheter.

In this article the word Diabetes represent Type-2 diabetes . This article doesn’t deal with Type-1 Diabetes , Gestational Diabetes and Type-3 diabetes or any other rare form of diabetes.

Type-1 Diabetes : Type -1 diabetes or Juvenile Diabetes or Insulin Dependent Diabetes  is an autoimmune decease in which the body’s immune system due to unknown reasons destroy insulin producing beta cells in the pancreases . Due to this condition the insulin production is nearly stopped and the patient has to depend on artificial insulin to regulate blood glucose levels. This type of diabetes should always be managed with a doctor.

Type2 Diabetes: Type -2 diabetes or adult onset diabetes is a metabolic disorder in which the body doesn’t move glucose in and out of blood efficiently. In this type of diabetes either the body develops insulin resistance or the beta cells do not produce enough insulin to metabolise the glucose in the blood. This type of diabetes should always be managed with a doctor.

Type-3 Diabetes : This is not a medically recognized and widely accepted term but this is a condition to define insulin resistance in the brain. Alternatively, this is believed to be the cause of Alzheimer’s disease. Due to insulin resistance developed inside the brain the brain cells are starved for glucose leading to damage.

Gestational Diabetes :As the name suggest this a temporary rise in blood sugars seen in women during pregnancy. Such women are however at a higher risk to develop type-2 diabetes.

Apart from these four types there are many rarer forms of diabetes like Maturity onset diabetes of the young (MODY), Neonatal diabetes, Wolfram Syndrome, Alström Syndrome, Latent Autoimmune diabetes in Adults (LADA), Type 3c diabetes and Steroid-induced diabetes.

Management of Micronutrients for Prediabetes

Trace elements like Boron, Calcium , Cobalt , Chromium , Iodine , Iron , Magnesium, Selenium  and Zinc help to improve insulin resistance. Vitamins A, B , C , E and K all have potential benefits to reduce insulin . However, micronutrition supplementation for diabetic management should be purely under medical supervision. However, fruits and vegetables with low GI and GL should be consumed in abundance to maintain healthy micro nutrients in the body which will help to reduce insulin resistance and at the same time the low GI and GL characteristic will help in reducing post meal insulin spikes. Most fruits and vegetables also contain a good dose of fibres which again control quick absorption of glucose in blood. Vitamin D has a special function in regulating insulin levels , a good source if vitamin-D is sunshine. So one of the steps prediabetics can take is spend some time everyday under sun with precautions as sunlight can cause other complexities like skin cancer and skin burn.

Conclusion

The food that we eat is loaded with hidden calories , specially the food that we buy from shelves and restaurants. Modern life has become sedimentary and the BMR has significantly reduced since ancient times. Prediabetes stage is a window of opportunity for the world to stop the worst of pandemics that is about to hit the modern mankind . Every human above the age of 30 should consider himself or herself to be prone to metabolic disorders like diabetes and should make life style changes to avoid entering prediabetes stage and once in prediabetes stage completely avoid getting diabetic.  A human should look lean with no accumulation of fat in unwanted areas and eat food that feels light on the stomach with lots of emphasis on healthy sources of calories with attention to micronutrients. Diabetes is not a risk worth taking, diabetes is not a disease by itself but it leads to various other diseases in the body as discussed in this article. There is a large population on this planet who can’t afford management of prediabetes and definitely diabetes management is outside their economic reach hence for the sake of all those poor people and every other human in general the goal should be to not need prediabetic care. Do not eat more calories than what your body can spend, if you eat more calories burn it the same day. Keep your metabolism up with regular exercise and gain lean mass. Avoid being prediabetic or diabetic , it’s not a choice anymore.

References :

GI Tract Image reference : https://humanbodyanddiseases.weebly.com/digestive-system.html

Pancreas Image reference : https://www.dreamstime.com/pancreas-anatomical-cross-section-model-vector-illustration-medical-example-pancreas-anatomical-cross-section-model-vector-image169963066

Plaque Image reference: https://www.fairview.org/patient-education/89801

Bariatric Surgery Image reference : https://doctorbariatric.com/procedure/revision-bariatric-surgery/