Undiagnosed Type 2 Diabetes or Prediabetes: Are You at Risk?

Dr. Jedha, Host

Hello there, Dr Jedha here and thank you for joining me for episode 50. Episode 50. 

Well, I want to say a big thank you for listening to Type 2 Diabetes Talk and to those people who send in their feedback and let me know how much you enjoy the podcast, I appreciate that. 

I also want to thank those people who have left a rating and review for the podcast on Apple or Spotify or over on our website. If you are a regular listener and enjoy the information, I would appreciate you taking the time to leave us a rating and review, either on Apple or Spotify, which tend to be the most popular listening platforms. Or as I said, you can head to our website and leave a rating and review directly, just head to Type2DiabetesTalk.com/review, or you can find it from the podcast page on our website. 

In episode 43, we highlighted the growing epidemic of diabetes all around the globe. What’s more concerning though is the number of people undiagnosed. Estimates were 8.7 million in the US, 1.2 million in the UK, a million in Canada, and half a million in Australia, not to mention other locations around the world. I’d say these figures are probably underestimated, with many more people going undiagnosed. 

Each year November 14th marks World Diabetes Day and we have a special episode coming on the World Diabetes Day 2024 theme next week. But often during November we focus on sharing information and resources around diabetes awareness, trying to reach more people who may be undiagnosed and might not know it.

That’s why I thought it would be good to have a podcast focused on diabetes risks and symptoms and if you’re listening to this, perhaps you’re concerned that you may be among the millions currently undiagnosed. Or perhaps you’re concerned for a family member, friend or colleague. I encourage you to share this episode widely – with your family members, friends, colleagues, and as many people as possible – as early detection and prevention of prediabetes and type 2 diabetes are key to ensuring your risk of diabetes or more serious complications are minimized.

If you have some of the risk factors you might consider getting proactive to change the modifiable risk factors. And if you’re experiencing any of the symptoms, you might consider getting some bloodwork at your doctor to assess whether you do have diabetes. 

Here’s the thing: it doesn’t help to stick your head in the sand and ignore things, because if your health is in need of an overhaul, then it’s better to do something about it now rather than later, because diabetes-related complications can be serious – not to scare you or anything, but again, it doesn’t help to put your head in the sand when you could put yourself at increased risk of things like heart disease and stroke, vision loss and blindness, nerve damage, and dementia. By taking action, you can avoid and minimize these risks. 

We will put all the information we chat about today on our website, so head down to Type2DiabetesTalk.com and find episode 50.  

So let’s look closer at what diabetes is, why it goes undiagnosed, risk factors, hidden signs and when to see your doctor for that blood test and health check. 

3:21

Let’s start with a simple question: what is diabetes?

There are different types of diabetes but the three main types of diabetes are type 1, type 2 and gestational. For the majority of people type 2 diabetes is the type to be concerned about, and within that we’ll also cover prediabetes because prediabetes often comes before a type 2 diabetes diagnosis. 

Type 2 diabetes and prediabetes are both a condition of altered metabolism where blood sugar levels become higher than usual. The most common cause is insulin resistance. This is where the body cannot effectively use insulin (a hormone that regulates blood sugar). Normally insulin helps push sugar out of the bloodstream by unlocking cells, but in insulin resistance the lock is blocked or the key becomes jammed, insulin can’t unlock the cell and the glucose (or sugar) stays circulating in the bloodstream. In some cases of type 2 diabetes, it may be because the body does not produce enough insulin. Either way, with insulin being ineffective or insufficient, this leads to higher than normal blood sugar levels. 

Diabetes often goes undiagnosed because it tends to develop over time with a gradual onset. Because of this, symptoms can be mild and easily overlooked. In many cases people may simply think their vague symptoms are due to aging, other health conditions or just a transient issue. And of course, it may also be due to lack of awareness of what the risks or symptoms actually are.

5:44

Let’s look at risk factors for diabetes first because certain factors increase the likelihood of developing diabetes and understanding your risk can help you take steps toward early detection and prevention. As we work through some of these risk factors, let’s also chat about what we can do to minimize the risks as well.

One of the key factors increasing risk of diabetes is age, with those over 40 years having higher rates of diabetes, and those between 55 and 80 being impacted the most. As we age there are changes that can happen in our body composition such as increased body fat, decreased muscle mass and decreased insulin sensitivity in the body’s cells. That’s why as we age we often need to do more to take care of ourselves, eating healthier and being active with particular focus on building muscle. But, we are seeing more and more cases of diabetes in younger people as well, and this can be due to some of the other factors we’re about to discuss, for instance, being overweight. 

Being overweight is a significant risk factor for diabetes, as excess body fat, particularly around the belly area, contributes to insulin resistance and inflammation in the body’s cells. High blood pressure is often linked with diabetes, and the two conditions share common risk factors. Abnormal cholesterol and triglyceride levels are another indicator. 

If you notice your weight is increasing and you now have high blood pressure or high cholesterol, then start doing things to turn this around, as these are key ‘symptoms’ I guess you could call them, these are key symptoms of your metabolism becoming altered. Something is not quite right and your body is trying to tell you that. 

A family history of diabetes, along with a previous history of gestational diabetes both increase your risk. These are obvious risk factors you can’t change, but that doesn’t mean you can’t be proactive to prevent other risk factors that will further increase your risk, such as maintaining a healthy weight, and keeping a close eye on blood pressure and cholesterol levels. 

Primary lifestyle factors that increase risk of diabetes include poor quality nutrition and lack of activity.  Obviously if you’re eating a lot of junk food and sugary foods and drinks, this is not going to lead to a positive outcome. And if you’re always at a desk or sitting around, and do nothing else, this can impact your overall health and risk of health conditions. Clearly some people can’t exercise due to physical limitations, that’s different. Yes, you can still be healthy without exercise by focusing on a healthy diet, quality nutrition. Cut back the sugar and processed foods, eat fresh vegetables, meats, dairy products, nuts, seeds and some fruits, and try to do exercise every single day – that’s going to lower your risk.  

9:01

Then there are lesser-known risk factors that can increase your risk of developing prediabetes and type 2 diabetes, such as inadequate sleep and high stress levels. These factors disrupt hormones in the body, leading to changes in insulin sensitivity and blood sugar regulation. If you are under prolonged stress, try to focus on what you can do to minimize that, and also on getting regular good quality sleep. 

Excessive alcohol intake can lead to weight gain, liver damage, and metabolic disturbances that increase the risk of diabetes. 

There are also a range of medications that can increase risk of diabetes, including glucocorticoids (steroids), thiazide diuretics, beta-blockers, and statins, among others, so be sure to check with your doctor to discuss these risks. 

If you have some of those risk factors presently, think about what you could do to improve your health and minimize those risks. In many cases there are lots of things we can do.

10:36

Now that we’ve covered those risk factors, you might have been thinking, well yes, I am a bit overweight, my blood pressure and cholesterol is high, I haven’t been eating very well and I’ve been stressed. Could I have diabetes?

Great question! Early detection of diabetes is vital for effective management and prevention of complications. But this is where it can get a bit tricky because recognizing the signs and symptoms isn’t easy. Symptoms of prediabetes and type 2 diabetes can be mild and easily overlooked. 

Here’s some common ones to be aware of: 

Frequent Urination: High blood sugar levels cause the kidneys to work harder to filter and absorb the excess glucose, leading to increased urination.

Excessive Thirst: As you lose more water through frequent urination, you may become dehydrated, resulting in an increased need to drink fluids.

Extreme Hunger: Without adequate insulin, cells are deprived of glucose, triggering persistent hunger as your body seeks energy.

Fatigue: When your cells can’t access glucose for energy, you may feel unusually tired and weak.

Blurred Vision: High blood sugar levels can cause the lenses of your eyes to swell, affecting your ability to see clearly.

Unexplained Weight Loss: Even though you may be eating normally, your body can’t use glucose properly for energy, leading to weight loss as your body starts to use fat and muscle for energy instead.

Slow-Healing Sores: Elevated blood sugar levels can impair circulation and affect your body’s ability to heal wounds efficiently.

Can you see how some of these are quite vague? For instance, you might not think going to the bathroom more to pee, being a bit thirstier or feeling tired are diabetes symptoms. You could put these things down to nothing or you might not even take notice of them at all. 

But, if you do notice them, it’s certainly time to consider visiting the doctor for a health check and blood test. 

Sometimes people can be diagnosed with prediabetes but due to the fact that many symptoms go unrecognized, many people live with prediabetes or even type 2 diabetes for a number of years before knowing their blood sugar levels are rising or have risen to alarming levels. It’s not uncommon for people to discover their A1c levels are up at 11% when diagnosed, sometimes higher, which is not good at all, considering normal levels are below 5.7%.

So again, if you have any of the risk factors for diabetes or suspect any symptoms, it is time to visit your doctor for a health check. 

14:31

To assess whether you have diabetes, your doctor will send you to have your blood tests at the pathology center. They will often test fasting blood sugar and A1c levels, and usually they do two consecutive tests at different timepoints to confirm the diagnosis.

A fasting blood sugar test measures your blood sugar after an overnight fast.

• A fasting blood sugar level of 100 to 125 mg/dL or 5.6 to 6.9 mmol/L indicates prediabetes.
• A fasting level of 126 mg/dL or 7.0 mmol/L or higher on two separate tests indicates diabetes.

A HbA1c test also known as A1c or the glycated hemoglobin test measures your average blood sugar level over the past few months.

• A HbA1c level between 5.7% and 6.4% indicates prediabetes, that’s if you’re in the US. Most other places the prediabetes A1c is set at 6.0% to 6.4%. 
• A HbA1c level of 6.5% or higher on two separate tests indicates diabetes.

Sometimes they will do an Oral Glucose Tolerance Test. This test measures your blood sugar before and two hours after you drink a sugary drink. It shows how well your body handles glucose.

Another important test to request that can detect early issues in blood sugar regulation is the fasting insulin test. This test is not one that is routinely done for diabetes screening but it can be requested and is a highly valuable test to get. It measures the level of insulin in your blood after an overnight fast. Elevated fasting insulin levels can indicate insulin resistance, which is a key factor in the development of pre and T2Diabetes. For people with normal blood sugar but high fasting insulin, it’s a red flag that the body is struggling with insulin resistance, even if full-blown diabetes hasn’t developed and can’t be detected yet. By detecting insulin resistance early, you can get proactive with nutrition and lifestyle changes, so you can prevent a prediabetes diagnosis altogether. 

So ask your doctor to add a fasting insulin test so you can get a more comprehensive assessment of your metabolic health. And when you’re at the doctor, get your blood pressure and cholesterol checked as well. 

16:39

If you do receive a diagnosis, it can be confronting and overwhelming, but it’s important to remember that this is the first step towards better health. It’s a valuable opportunity and by taking steps to eat better, exercise regularly, sleep, and stress less, you can reverse your diabetes in the opposite direction. All is not lost, don’t panic, just take positive steps forward each day. And there are lots of resources and support to help you too, such as all the podcast episodes we have and the resources and programs we have on our website too. 

The thing is, early detection of health issues through regular screenings can prevent health conditions and more importantly prevent more serious complications from developing. The sooner you can take action on risk factors, or even after a diagnosis, the healthier you will be, so don’t stick your head in the sand thinking symptoms will disappear. If you’re concerned about your risk of diabetes, have any of the risk factors we’ve mentioned today or are experiencing any of those vague symptoms, don’t hesitate to visit your doctor for that health check, okay? 

Find all this information on our website at Type2DiabetesTalk.com alongside episode 50. And please, help others by sharing this episode far and wide. Support your family members, friends and colleagues to understand the risks so they can identify symptoms early and make sure their health is looked after. 

That’s all from me this week. Take care of you.

Dr Jedha, over and out.