How Do Doctors Diagnose Insulin Resistance And Prediabetes
Doctors use blood tests to find out if someone has prediabetes, but they dont usually test for insulin resistance. The most accurate test for insulin resistance is complicated and used mostly for research.
Doctors most often use the fasting plasma glucose test or the A1C test to diagnose prediabetes. Less often, doctors use the oral glucose tolerance test , which is more expensive and not as easy to give.
The A1C test reflects your average blood glucose over the past 3 months. The FPG and OGTT show your blood glucose level at the time of the test. The A1C test is not as sensitive as the other tests. In some people, it may miss prediabetes that the OGTT could catch. The OGTT can identify how your body handles glucose after a mealoften before your fasting blood glucose level becomes abnormal. Often doctors use the OGTT to check for gestational diabetes, a type of diabetes that develops during pregnancy.
People with prediabetes have up to a 50 percent chance of developing diabetes over the next 5 to 10 years. You can take steps to manage your prediabetes and prevent type 2 diabetes.
The following test results show Prediabetes2
- A1C5.7 to 6.4 percent
- FPG100 to 125 mg/dL
- OGTT140 to 199 mg/dL
You should be tested for prediabetes if you are overweight or have obesity and have one or more other risk factors for diabetes, or if your parents, siblings, or children have type 2 diabetes. Even if you dont have risk factors, you should start getting tested once you reach age 45.
Possible Complications For The Baby
Unlike type 1 diabetes, gestational diabetes generally occurs too late to cause birth defects. Birth defects usually originate sometime during the first trimester of pregnancy. The insulin resistance from the contra-insulin hormones produced by the placenta does not usually occur until approximately the 24th week. Women with gestational diabetes mellitus generally have normal blood sugar levels during the critical first trimester.
The complications of GDM are usually manageable and preventable. The key to prevention is careful control of blood sugar levels just as soon as the diagnosis of diabetes is made.
Infants of mothers with gestational diabetes are vulnerable to several chemical imbalances, such as low serum calcium and low serum magnesium levels, but, in general, there are two major problems of gestational diabetes: macrosomia and hypoglycemia:
Blood glucose is monitored very closely during labor. Insulin may be given to keep the motherâs blood sugar in a normal range to prevent the babyâs blood sugar from dropping excessively after delivery.
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What Happens If I Have Too Little Insulin
People with diabetes have problems either making insulin, how that insulin works or both. The main two types of diabetes are type 1 and type 2 diabetes, although there are other more uncommon types.
People with type 1 diabetes produce very little or no insulin at all. This condition is caused when the beta cells that make insulin have been destroyed by antibodies , hence they are unable to produce insulin. With too little insulin, the body can no longer move glucose from the blood into the cells, causing high blood glucose levels. If the glucose level is high enough, excess glucose spills into the urine. This drags extra water into the urine causing more frequent urination and thirst. This leads to dehydration, which can cause confusion. In addition, with too little insulin, the cells cannot take in glucose for energy and other sources of energy are needed to provide this energy. This makes the body tired and can cause weight loss. If this continues, patients can become very ill. This is because the body attempts to make new energy from fat and causes acids to be produced as waste products. Ultimately, this can lead to coma and death if medical attention is not sought. People with type 1 diabetes will need to inject insulin in order to survive.
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Classification And Diagnosis Of Diabetes
Diabetes can be classified into the following general categories:
Type 1 diabetes
Type 2 diabetes
Gestational diabetes mellitus
Specific types of diabetes due to other causes, e.g., monogenic diabetes syndromes , diseases of the exocrine pancreas , and drug- or chemical-induced diabetes
This section reviews most common forms of diabetes but is not comprehensive. For additional information, see the American Diabetes Association position statement Diagnosis and Classification of Diabetes Mellitus .
Assigning a type of diabetes to an individual often depends on the circumstances present at the time of diagnosis, with individuals not necessarily fitting clearly into a single category. For example, some patients cannot be clearly classified as having type 1 or type 2 diabetes. Clinical presentation and disease progression may vary considerably in both types of diabetes.
How Do People Add Up Inches Lost In Weight Loss
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What Will Insulin Be Like In The Future
Pharmaceutical companies are working on very long-acting versions of insulin that could last for a week. There is also an ultra-fast version of insulin under development that will act in less than 15 minutes.
Another group of researchers is looking at glucose responsive insulin , which would react to the needs of your body in real time. It would have nanosensors bound to the insulin so that when insulin is needed, it releases, and when it isnt, it stops, according to Dr. Hirsch.
What Are Alternative Medications For People With Diabetes That Arent Insulin
- Metformin a pill that stops sugar production in the liver
- Glitazones pills that remove sugar from the bloodstream
- Sufonylureas and glinides pills that increase the release of insulin from your pancreas
- Starch blockers pills that slow starch absorption
- Incretin therapies and amvlin analogs pills and injections that reduce sugar production in the liver and slow food absorption. Types of the former include DPP4 inhibitors and GLP1 analogs .
- SGLT2 inhibitors pills that are taken before meals that prevent the reabsorption of glucose
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What Causes Insulin Resistance
Scientists are beginning to get a better understanding of how insulin resistance develops. For starters, several genes have been identified that make a person more or less likely to develop the condition. Itâs also known that older people are more prone to insulin resistance. Lifestyle can play a role, too. Being sedentary, overweight or obese increases the risk for insulin resistance. Why? Itâs not clear, but some researchers theorize that extra fat tissue may cause inflammation, physiological stress or other changes in the cells that contribute to insulin resistance. There may even be some undiscovered factor produced by fat tissue, perhaps a hormone, that signals the body to become insulin resistant.
Doctors donât usually test for insulin resistance as a part of standard diabetes care. In clinical research, however, scientists may look specifically at measures of insulin resistance, often to study potential treatments for insulin resistance or type 2 diabetes. They typically administer a large amount of insulin to a subject while at the same time delivering glucose to the blood to keep levels from dipping too low. The less glucose needed to maintain normal blood sugar levels, the greater the insulin resistance.
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What Happens If I Have Too Much Insulin
If a person accidentally injects more insulin than required, e.g. because they expend more energy or eat less food than they anticipated, cells will take in too much glucose from the blood. This leads to abnormally low blood glucose levels . The body reacts to hypoglycaemia by releasing stored glucose from the liver in an attempt to bring the levels back to normal. Low glucose levels in the blood can make a person feel ill.
The body mounts an initial ‘fight back’ response to hypoglycaemia through a specialised set of of nerves called the sympathetic nervous system. This causes palpitations, sweating, hunger, anxiety, tremor and pale complexion that usually warn the person about the low blood glucose level so this can be treated. However, if the initial blood glucose level is too low or if it is not treated promptly and continues to drop, the brain will be affected too because it depends almost entirely on glucose as a source of energy to function properly. This can cause dizziness, confusion, fits and even coma in severe cases.
Some drugs used for people with type 2 diabetes, including sulphonylureas and meglitinides , can also stimulate insulin production within the body and can also cause hypoglycaemia. The body responds in the same way as if excess insulin has been given by injection.
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Talk With Your Doctor
Knowing how your body works can help you stay healthy. Insulin and glucagon are two critical hormones your body makes to keep your blood sugar levels balanced. Its helpful to understand how these hormones function so you can work to avoid diabetes.
If you have more questions about insulin, glucagon, and blood glucose, talk to your doctor. Questions you have might include:
- Is my blood glucose at a safe level?
- Do I have prediabetes?
How Do You Take Insulin Without A Syringe
- Insulin pens look like large writing pens and can help prevent under- and overdosing. They also dont require refrigeration, are conveniently prefilled, and are more durable than syringes.
- Insulin pumps are attached to a thin tube thats implanted under your skin. Pumps are computerized or motorized, and some models also act as glucose monitors. They deliver insulin before each meal along with small amounts through the course of the day. In the US, about 60% of people with diabetes use some form of insulin pump.
- Jet injection devices are a good option if you hate needles. A jet injector holds several doses of insulin. After placing it against your skin, you press a button, and the insulin is pushed through.
- Inhalable insulin comes in a premeasured inhaler and was first approved in 2014. Its short-acting and usually not covered by insurance, which makes it more cost prohibitive than other types of insulin for most people with diabetes.
Unless you have an insulin pump that also works as a glucose monitor, insulin dosing is based on self-monitoring your blood glucose levels. You can check them by doing finger pricks or wearing a device that continuously monitors them for you.
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How Do You Choose The Right Syringe For Injecting Insulin
Just as there are different sizes of syringes for administering insulin, there are also varying sizes of insulin needles. Shorter needles usually mean less sting when injecting. The downside is that the shallower the injection is, the longer it takes for the insulin to work. Your doctor will help you find the balance thats best for you.
Factors Influencing Insulin Biosynthesis And Release
Insulin secretion may be influenced by alterations in synthesis at the level of gene transcription, translation, and post-translational modification in the Golgi as well as by factors influencing insulin release from secretory granules. Longer-term modification may occur via influences on cell mass and differentiation. Given insulins pivotal role in glucose utilisation and metabolism, it is not surprising that glucose has multiple influences on insulin biosynthesis and secretion. However, other factors such as amino acids, fatty acids, acetylcholine, pituitary adenylate cyclase-activating polypeptide , glucose-dependent insulinotropic polypeptide , glucagon-like peptide-1 , and several other agonists, together in combination, also influence these processes.
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What Are The Symptoms Of Insulin Resistance And Prediabetes
Insulin resistance and prediabetes usually have no symptoms. Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck, a condition called acanthosis nigricans. Many small skin growths called skin tags often appear in these same areas.
Even though blood glucose levels are not high enough to cause symptoms for most people, a few research studies have shown that some people with prediabetes may already have early changes in their eyes that can lead to retinopathy. This problem more often occurs in people with diabetes.
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Regulation Of Blood Glucose Levels By Insulin And Glucagon
Glucose is required for cellular respiration and is the preferred fuel for all body cells. The body derives glucose from the breakdown of the carbohydrate-containing foods and drinks we consume. Glucose not immediately taken up by cells for fuel can be stored by the liver and muscles as glycogen, or converted to triglycerides and stored in the adipose tissue. Hormones regulate both the storage and the utilization of glucose as required. Receptors located in the pancreas sense blood glucose levels, and subsequently the pancreatic cells secrete glucagon or insulin to maintain normal levels.
Receptors in the pancreas can sense the decline in blood glucose levels, such as during periods of fasting or during prolonged labor or exercise ). In response, the alpha cells of the pancreas secrete the hormone glucagon, which has several effects:
- It stimulates the liver to convert its stores of glycogen back into glucose. This response is known as glycogenolysis. The glucose is then released into the circulation for use by body cells.
- It stimulates the liver to take up amino acids from the blood and convert them into glucose. This response is known as gluconeogenesis.
- It stimulates lipolysis, the breakdown of stored triglycerides into free fatty acids and glycerol. Some of the free glycerol released into the bloodstream travels to the liver, which converts it into glucose. This is also a form of gluconeogenesis.
|Hormones of the Pancreas|
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Why Does Sodium Affect Weight Loss
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Cellular Mechanisms Of Insulin Resistance
In relation to external factors, the increase in free fatty acids induced by obesity can trigger insulin resistance through lipid accumulation . This may activate atypical PKC that inhibits insulin signaling and insulin-stimulated glucose uptake in skeletal muscles, as well as decreases the insulin-stimulated hepatic glycogen synthesis . This can lead to insulin resistance and increased glucose delivery by the liver . Additionally, FFA triggers insulin resistance by direct activation of Toll-like Receptor 4 and the innate immune response .
Furthermore, obesity is associated with inflammatory factors characterized by an increase in the accumulation of ATMs . The inflammatory factors increase lipolysis and promote hepatic triglyceride synthesis, and hyperlipidemia due to increased fatty acid esterification. ATM also stimulates inflammatory cytokines that inhibit insulin signaling and expedites hepatic gluconeogenesis, and postprandial hyperglycemia .
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Symptoms Of Insulin Resistance
You canât tell that you have insulin resistance by how you feel. Youâll need to get a blood test that checks your blood sugar levels.
Likewise, you wonÃ¢t know if you have most of the other conditions that are part of insulin resistance syndrome without seeing your doctor.
Some signs of insulin resistance include:
- A waistline over 40 inches in men and 35 inches in women
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Sodiumglucose Cotransporter 2 Inhibitors
Sodiumglucose cotransporter 2 inhibitors act on the kidney to reduce blood levels of glucose and are used to treat T2DM. In patients with T2DM, treatment with SGLT2is reduced infiltration of inflammatory cells into arterial plaques and decreased the mRNA expression levels of some cytokines and chemokines, such as TNF, IL-6 and monocyte chemoattractant protein 1 . However, SGLT2i treatment can cause ketoacidosis, especially in critically ill patients. Importantly, SGLT2is have profound effects on urinary glucose and sodium excretion, resulting in osmotic diuresis and potentially dehydration, and increased urinary uric acid excretion, which has been suggested to be a risk factor for acute kidney injury through both urate crystal-dependent and crystal-independent mechanisms. As such, the use of SGLT2is might be difficult in patients under critical care, who need meticulous control of their fluid balance. In addition, these drugs must be discontinued in the face of a reduced estimated glomerular filtration rate, which limits their glucose-lowering effects substantially, and will be a typical risk in critically ill patients. Nonetheless, an international study is ongoing to evaluate the effect of dapagliflozin versus placebo, given once daily for 30 days, in reducing disease progression, complications and all-cause mortality in all patients admitted with COVID-19 . The result of this study might help reveal the implications of the use of SGLT2is in such patients.
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