Diabetes Diagnosis and When to Get Screened

Published on April 17, 2018
By : Suvarna Sheth

An unprecedented number of people are living with diabetes today in the United States without even knowing it.  According to the National Institute of Health, diabetes affects nearly 26 million American children and adults, including seven million people who have yet to be diagnosed with the disease.

The disease often goes undiagnosed until much later, simply because the symptoms are not always easy to detect.

Dr. Rajsree Nampudripad, a primary care physician specializing in integrative medicine in Orange County, Calif., says diabetes is becoming more prevalent these days as people are becoming more sedentary, spending more time commuting, or in front of a computer screen.

She says the problem of insulin resistance, fatty liver, and diabetes is also growing in children and adolescents.  This again is due to the change in diet toward processed foods which are laden with sugar and carbohydrates, along with more sedentary lifestyles with children spending time in front of screens and electronic devices.

Nampudripad blames food choices that are based on convenience, meaning more processed carbohydrates and sugary foods, which have caused an epidemic of obesity as well as diabetes.

“Unfortunately, processed foods are often cheaper and more convenient for families, but promote weight gain and inflammation in the body,” she says.

She stresses that children need the opportunity to experience real whole foods and vegetables to develop a taste for them and healthy habits that will determine their food choices through adulthood.

About a quarter of Nampudripad’s patients have either diabetes or insulin resistance.  Insulin resistance, she explains, is the root cause of diabetes.

“It’s when your body starts to ignore insulin, which is a hormone produced by the pancreas,” she explains.

“Your body’s receptors don’t listen to insulin anymore so sugar levels go higher and more and more insulin has to be released by the pancreas.”

Unfortunately, insulin is inflammatory to the body.  The process begins as insulin resistance and ultimately becomes full-fledged diabetes when sugars remain high despite the high insulin levels.

“My goal with patients is to diagnose insulin resistance early on so we can reverse the process and prevent the progression to diabetes,” Nampudripad says.  “In those who have diabetes, my goal is to reverse their disease through diet, exercise, and sometimes supplements to improve insulin recognition in the body.”

This approach is empowering to patients who are motivated to change their diet and often allows them to avoid using prescription medications for diabetes.

Conventionally, the guidelines are to screen for diabetes in those over 40 who are overweight or obese.

In Nambudripad’s opinion, this is far too late.  “In my practice, I screen patients of any age who are overweight or carrying abdominal fat by checking their fasting insulin and glucose levels.”

She also checks for diabetes in patients who have unexplained fatigue, frequent yeast infections, frequent urination, or symptoms of nerve pain or tingling in their hands or feet.

“We often catch patients at an earlier stage called, ‘pre-diabetes’ which again, is a form of insulin resistance.  This allows us to make lifestyle changes and reverse the condition,” Nampudriapad says.  This is a condition when blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes.

Prediabetes is often referred to as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG).  There are no clear symptoms of prediabetes so you may have it without knowing it.

The following are a list of tests used for testing diabetes, compiled by the American Diabetes Association:

A1 Test

  • The test measures your average blood glucose for the past 2-3 months.
  • The test does not require fasting.
  • Diabetes is diagnosed at an A1C if greater than or equal to 6.5%
  • Prediabetes is diagnosed at an A1C of 5.7%-6.4%
  • Normal ranges are less than 5.7%

Fasting Plasma Glucose (FPG)

  • Test checks fasting glucose levels (levels of blood glucose without food or drinks for at least 8 hours prior to the test.)
  • The test is done first thing in the morning, before breakfast
  • Diabetes is diagnosed at fasting blood glucose 126 mg/dl or higher

Oral Glucose Tolerance Test (OGTT)

  • A two-hour test that checks your blood glucose levels before and 2 hours after you drink a high-glucose drink
  • The test is used to measure how the body processes large amounts of sugar
  • If the blood sugar measured in the test passes a certain level, this can mean the sugar is not being absorbed by the body’s cells.
  • Diabetes is diagnosed at 2 hours blood glucose of 200 mg/dl or higher.
  • Prediabetes is diagnosed at 140 mg/dl to 199 mg/dl
  • A normal result is less than 140 mg/dl

Random Plasma Glucose Test

  • A blood test at any time of the day when you have severe diabetes symptoms
  • Diabetes is diagnosed at a blood glucose of greater than or equal to 200 mg/dl.

Results indicating Prediabetes:

  • A1C of 5.7% – 6.4%
  • Fasting blood glucose of 100 – 125 mg/dl
  • An OGTT 2 hour blood glucose of 140 mg/dl – 199 mg/dl

Risk Factors for Developing Diabetes:

  • A parent or sibling has diabetes
  • You are overweight
  • You belong to a high-risk population (African American, Hispanic American, Native American, Native American, Asian American or Pacific Islander.
  • You had gestational diabetes or a baby weighing over 9 lbs
  • Your HDL cholesterol levels are 35 mg/dl or less, and/or your triglyceride level is 250 mg/dl or above
  • You have high blood pressure
  • You have polycystic ovarian syndrome
  • Upon previous testing, had impaired glucose tolerance or impaired fasting tolerance
  • There is also a clear correlation between family history and new diabetes diagnosis.  If you have a parent who is diabetic, you have a 1/3 chance of becoming diabetic.

Nambudripad recommends people who are at risk for developing diabetes ask their doctors to check their fasting glucose and insulin levels, so they can know early whether they exhibit any insulin resistance.  Diagnosing diabetes early and getting on a pathway of management is imperative for the quality of life and longevity.  Learn more about blood tests for diabetes here.

Sources:

American Diabetes Association. “Diagnosing Diabetes and Learning About Prediabetes.”  Accessed March 13, 2018.  http://www.diabetes.org/are-you-at-risk/prediabetes/?loc=atrisk-slabnav

Joslin Diabetes Center. “How is Diabetes Diagnosed.”  Accessed March 13, 2018. http://www.joslin.org/info/how_is_diabetes_diagnosed.html

Mayo Clinic. “Glucose tolerance test.” Accessed March 14, 2018. https://www.mayoclinic.org/tests-procedures/glucose-tolerance-test/about/pac-20394296

PubMed Health, “Glucose tolerance tests: What exactly do they involve?” https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0022141/

What’s the Difference Between Type 1 and Type 2 Diabetes, Iliades, Chris.https://www.everydayhealth.com/diabetes/difference-between-type-1-type-2-diabetes/