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A staggering 30.3 million people in the United States have diabetes, millions of which are undiagnosed. Diabetes is a condition where blood sugar (glucose) levels are higher than recommended for good health.  Glucose is a type of sugar found in the foods we eat and is an important source of energy for the body.  Sources of glucose in the diet include: breads, cereals, rice, noodles, fruits, starchy vegetables, dried beans (examples navy and pinto), and milk.  Insulin allows the body to use glucose for energy. Type 2 diabetes accounts for 90-95% of all diabetes.  People with type 2 diabetes, the majority of who are adults, do not have adequate amounts of insulin or the insulin they do have does not work as effectively. This results in elevated blood sugar (glucose) levels and diabetes.

The impact diabetes has on our health and wallet is eye-opening.  Diabetes contributes to cardiovascular disease, cancer, dementia, kidney disease and blindness.  The estimated cost of diagnosed diabetes in 2017 was in the hundreds of billions of dollars!

In addition to diabetes, prediabetes has become a major health concern in the United States.  Over 86 million Americans have prediabetes, a condition where blood glucose levels are higher than normal, but are not high enough to be classified as diabetes.  Prediabetes increases the risk of developing type 2 diabetes in the future.  Because prediabetes is often without symptoms, most people are unaware they have it.  Testing for prediabetes and diabetes identifies those with the disease and allows healthcare professionals to manage the disease sooner. Lifestyle changes, which include weight loss, may help to prevent or delay type 2 diabetes.  If diagnosed with diabetes, early treatment can help prevent long-term complications of the disease.

picture of finger stick blood sugar test

Symptoms of diabetes include the following: increased urination, increased thirst, unexplained weight loss, fatigue, blurred vision, and sores that do not heal.  Anyone who has these symptoms should be tested for diabetes.  People without symptoms who are overweight or obese and have one or more of the additional risk factors, should be screened for prediabetes and diabetes.  These risk factors include: parent or sibling with diabetes, African American, Latino, Native American, Asian American, Pacific Islander ethnicity, history of cardiovascular disease, hypertension, low HDL (less than 35mg/dl), elevated triglycerides (greater than 250 mg/dl), polycystic ovary syndrome, and physical inactivity.  Other forms of diabetes include type 1 diabetes and gestational diabetes. Type 1 diabetes usually is found in children and young adults. Often these individuals have diabetes symptoms and significantly high levels of glucose in their blood when they are diagnosed.  Gestational diabetes, is diabetes newly diagnosed in women between their 24-28th week of pregnancy.

Testing for diabetes is done through blood tests in a variety of ways.  These blood tests include: fasting plasma glucose, oral glucose tolerance test, random plasma glucose and a hemoglobin A1C test.  Below find a description of the main types of tests used to diagnose diabetes and prediabetes:

Fasting plasma glucose test– Blood glucose level is measured after not eating or drinking anything except small amounts of water for at least 8 hours.

Oral glucose tolerance test– Blood glucose level is measured every hour for 2 to 3 hours after drinking a glucose-containing beverage. First, you must have fasted (nothing to eat or drink except water) for 8 hours before drinking the glucose-containing beverage.

Random plasma glucose test– Blood glucose is measured at any time with no consideration to whether you have eaten or not. **Cannot be used to diagnose prediabetes.

Hemoglobin A1c test– This blood test gives you an average blood glucose level over the last 2-3 months.  This test is not accurate if you have anemia.

In order to confirm the diagnosis of diabetes it is normally verified with a second test on a different day.  A fasting blood glucose of 126 mg/dl or above on two different occasions, confirms diabetes.  A random plasma blood glucose of 200 or greater on more than one occasion is considered a positive test result for diabetes.  A hemoglobin A1C result of 6.5 % or above on more than one occasion is also symptomatic of diabetes.  Positive oral glucose tolerance test results differ between pregnant and non-pregnant populations. The main differences include the amount of glucose-containing beverage consumed, and the frequency of blood glucose measurements.  Generally, in non-pregnant women, a blood glucose value over 200mg/dl two hours after drinking a glucose-containing beverage (containing 75 grams of glucose) is indicative of diabetes.  In the pregnant population more glucose is given and blood glucose levels are measured multiple times.

Prediabetes is also diagnosed with blood testing.  Fasting plasma glucose levels between 100-125 mg/dl indicate the presence of prediabetes.  An oral glucose tolerance test between 140-199 mg/dl two hours after drinking a glucose-containing beverage also indicates prediabetes.  More recently hemoglobin A1C has been used to diagnose prediabetes.  A hemoglobin A1C result of between 5.7% and 6.4 % is consistent with prediabetes.

Please find below two links that can help determine if you are at risk for diabetes or prediabetes.

Diabetes Risk Test:  http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/

Prediabetes Risk Test: https://doihaveprediabetes.org/prediabetes-risk-test.html

WITTEN BY: Joyce Riley, MS, RD, LD, Family and Consumer Sciences Educator, OSU Extension, Union County

REVIEWED BY: Daniel Remley, Associate Professor, Field Specialist, Food and Nutrition and Wellness, OSU Extension

 

SOURCES:

American Diabetes Association. Diabetes Care 2018; 41 (Supplement 1): S13-S27.  https://doiorg10/10.2337/dc 18-S002

American Diabetes Association (2018) Diabetes Risk Test.  http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/

American Diabetes Association (2017) Prediabetes Risk Test. https://doihaveprediabetes.org/prediabetes-risk-test.html

Mayo Clinic (2018) Diabetes. https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444

MedlinePlus National Institutes of Health (2018) Diabetes. https://medlineplus.gov/diabetes.html

National Diabetes Education Program (2018) Guiding Principles for the Care of People with or at Risk for Diabetes.  https://www.niddk.nih.gov/health-information/communication-programs/ndep/health-professionals/guiding-principles-care-people-risk-diabetes

National Institute of Diabetes and Digestive and Kidney Disease (2016) Diabetes Tests & Diagnosis.   https://www.niddk.nih.gov/health-information/diabetes

WebMD (2016) Diagnosis of Diabetes.  https://www.webmd.com/diabetes/guide/diagnosis-diabetes#1

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