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10 Differences Between Prediabetes and Diabetes

Natalie Stein
February 5, 2021
10 Differences Between Prediabetes and Diabetes

Prediabetes and type 2 diabetes are both conditions with higher than normal blood sugar due to insulin resistance, but they are not the same condition. Prediabetes can progress to type 2 diabetes. One study, cited in an article in Diabetes Care, found that 8.1 to 24.3% of people with prediabetes develop diabetes within 29 months, or less than 2 and ½ years. These are 10 differences between prediabetes and type 2 diabetes.

1. Blood sugar levels


Blood sugar is higher in prediabetes than in diabetes. A healthcare provider can order a blood test to check for prediabetes and diabetes, and it can be done in a normal laboratory.The National Institute for Diabetes and Digestive and Kidney Diseases notes the following cutoffs and ranges for prediabetes and diabetes.

Diagnosis A1C (percent) Fasting plasma glucose (mg/dl) Oral glucose tolerance test (mg/dl)
Normal
below 5.7
99 or below
139 or below
Prediabetes
5.7 to 6.4
100 to 125
140 to 199
Diabetes
6.5 or above
126 or above
200 or above

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2. Insulin production and levels


Both prediabetes and type 2 diabetes result from a condition called insulin resistance. That means that the body is resistant, or less responsive, to the effects of a hormone called insulin. Insulin lowers blood sugar levels. As insulin resistance progresses, or your body becomes less responsive to the effects of insulin, beta cells in the pancreas produce more insulin to keep blood sugar down. 

Prediabetes, or high blood sugar, finally develops years after this progression starts, according to a review article in the journal Diabetes Care. At that time, insulin levels in the body are likely very high. That is also true when diabetes is first diagnosed. However, soon after, beta-cell exhaustion can occur, and the beta cells no longer produce much insulin. So, although insulin levels are high in prediabetes, they are often low in diabetes that has been present for a few years.

3. Number of people with the condition


Data from the Centers for Disease Control and Prevention show that 34.2 million, or nearly 1 in 10, American adults have diabetes. An additional 88 million, or 1 in 3, have prediabetes. The numbers are higher in adults 65 years and older, with 1 in 4 having diabetes and 1 in 2 having prediabetes.

4. Symptoms


Most people with prediabetes do not have symptoms, and some people with diabetes do not have symptoms until complications begin to develop, according to the American Diabetes Association in Diabetes Care. However, uncontrolled diabetes can cause these symptoms.

  • Excessive thirst.
  • Frequent urination.
  • Excessive hunger.
  • Sudden weight loss.
  • Excessive fatigue.
  • Numb or tingling feet or fingers.
  • Frequent infections, such as colds.
  • Wounds that heal slowly.

It is important to get tested for prediabetes or diabetes even without these symptoms, since complications can occur before any symptoms appear.

5. Medications


Although the American Diabetes Association guidelines in Diabetes Care mentions that metformin could help prevent the progression of prediabetes to diabetes, the Food and Drug Administration has not approved it or any other drug for this purpose. Furthermore, an estimated 0.7% to 3.1% of patients with prediabetes use metformin, according to research published in Diabetes Spectrum.

In contrast, research in Diabetes Care shows that the vast majority of patients with diabetes use medication, such as metformin, insulin, and sulfonylureas. Injectable insulin may need to be administered multiple times a day, on a strict schedule.

6. Weight loss


If you are overweight, losing a few pounds can lower blood sugar if you have prediabetes or diabetes. Small changes that can lead to weight loss include taking smaller portions, eating more vegetables, trimming fat from meat and poultry before cooking it, and choosing water instead of sugar-sweetened beverages.

If you have diabetes, though, the American Diabetes Association reminds that there is something to be aware of when it comes to weight loss. If it is unintentional, it could be because your body is eliminating it in urine instead of storing it as fat. That could be a sign that blood sugar is very high, and it is time to talk to your healthcare provider.

7. Carbohydrate consumption


The type and amount of carbohydrates are important in prediabetes and diabetes. In general, high-fiber, less-processed carbohydrates, in small amounts, are better choices. These include whole grains, fruit, beans, and starchy vegetables. Serving sizes are about 1 to 2 slices of whole-grain bread, ½ cup of oatmeal or cooked brown rice, or 1 cup of fruit. Less-healthy choices include refined grains such as refined cereals and white bread and rice, desserts, fried foods, and sugar-sweetened beverages.

With diabetes, the timing of carbohydrate consumption is also important. A change in the amount of carbohydrates compared to the usual amount at that time of day can mean that the dose of medication may need to be changed. In general, it is best to stick to a consistent meal and snack schedule with a predetermined, moderate amount of carbohydrates at each occasion.

8. Physical activity


Physical activity reduces insulin resistance, according to the American Diabetes Association guidelines in Diabetes Care. Both patients with prediabetes and patients with diabetes are encouraged to increase physical activity to at least 150 minutes per week. 

Exercise can be trickier for patients with diabetes who are taking insulin, since physical activity can cause hypoglycemia or lead to the need for adjustments in carbohydrate intake or insulin dosing. Patients with diabetes need to monitor their blood sugar before, during, and after exercising to be safe.

9. Reversibility


In many cases, prediabetes is reversible with lifestyle changes, such as losing weight and increasing physical activity. Diabetes can be reversible with intensive medication and other therapies, but reversal is more difficult. Later on in diabetes, if beta cell exhaustion occurs, diabetes is irreversible.

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10. Blood sugar monitoring


Patients with prediabetes may get their blood sugar tested in a lab once or twice a year, but patients with diabetes may need to get their blood sugar tested more often than that. In addition, patients with prediabetes may need to check blood sugar at home multiple times a day, according to the National Institute for Diabetes and Digestive and Kidney Diseases.

Blood sugar levels are high in both prediabetes and diabetes, but there are many differences between the two. While a healthy lifestyle can help lower blood sugar in individuals with diabetes or prediabetes, patients with diabetes likely need medications, may experience symptoms, and are at higher risk for complications. Lark Diabetes Prevention Program offers coaching based on proven techniques to lower blood sugar and reduce the risk for diabetes, and you may be eligible through your healthcare plan or your employer!

Written by Natalie Stein on February 5, 2021
Exercise, Fitness & Nutrition Expert | Lark Health
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