Symptoms and signs of prediabetes

Symptoms and signs of prediabetes

• Prediabetes is caused by insulin resistance.
• Insulin resistance causes a variety of symptoms and signs across the body.
• Symptoms (what you experience) include:
  • Weight gain and an increase in belly fat that can be difficult to lose.
  • Frequent hunger
  • Tiredness, fatigue, and lack of energy
  • Brain fog and trouble concentrating
  • Feeling fed up
  • Skin tags in the armpit and neck regions
• The signs (what a doctor may notice) include:
  • Raised blood pressure
  • An unhealthy blood lipid (fat) profile. High triglycerides and low HDL-cholesterol.
  • Liver tests that indicate fatty liver
  • Pigmentation in skin creases and folds.
• However, some people may have no obvious symptoms or signs at all.

When someone with prediabetes makes lifestyle changes that improve their blood glucose level, they are often surprised at how much better they feel. Often my patients have not realised just how unwell they had been feeling, until they started to feel better!

The onset of prediabetes symptoms can be very gradual. Many people may accept them as simply part of getting older, rather than realising that their body is struggling with how they are living and eating.

Prediabetes is the result of the longer-term problem of insulin resistance. For months or years prior to prediabetes developing, the body becomes increasing insulin resistance. Insulin resistance means the body must release more insulin to try to keep blood glucose levels normal. This insulin resistance and higher blood insulin level (known as hyperinsulinaemia) causes multiple problems across the body.

Insulin encourages the storage of fat on the body, especially belly fat. A waistline that is more than half a person's height can indicate poor health. Even people that are not significantly overweight will notice an increasing waistline as insulin resistance develops. This belly fat can be stubborn and is typically resistant to being lost through exercise.

Insulin is an energy storage hormone. When the insulin level increases glucose and fat are driven out of the blood and into storage. Whilst the insulin level remains high it prevents glucose and fat moving back into the blood to fuel the body. For people with insulin resistance and high insulin levels the body can be considered as being held in fat storage mode. There may be hundreds of thousands of calories of fat stored on the body, but the high insulin level prevents the body from accessing it for energy. Despite plentiful supplies the body is starving.

Insulin resistance can also create hunger throughout the day. This is caused by the blood glucose level swinging from high to low, like a roller-coaster. When sugary or starchy foods are eaten, a rise in blood glucose occurs followed by a rise in insulin in the blood. The insulin then instructs the body to remove glucose from the blood. A high insulin level will cause the blood glucose level to fall too low. The low blood glucose typically happens between one and three hours after eating. This is known as reactive hypoglycaemia. People experience a sudden craving for sugary food with a difficulty in concentrating and feeling shaky.

The insulin resistance, high insulin levels, and blood glucose roller-coaster create feelings of fatigue and brain fog. This is often very notable in the afternoon. People may struggle to stay awake and have difficulty concentrating. In addition, whether through the direct effects of the high insulin, or through the body-wide effects, people often describe feeling fed up.

Skin tags are little bits of excess skin that dangle off the body. They tend to occur on the neck and in the armpits. Research suggests that a high insulin level causes the growth of skin tags.

High blood pressure, or hypertension, is a common problem. Blood pressure is affected by many parts of the body including the heart, blood vessels, and kidneys. Insulin resistance and high blood insulin cause a number of changes that lead to high blood pressure. This includes stiffening of arteries and instructing the kidneys to keep excess salt and water in the blood.

Lipids are fats in the blood. People have typically heard about one blood lipid called cholesterol. However, there are two other important lipids that are commonly measured with a standard cholesterol blood test, triglycerides and HDL-cholesterol. Insulin resistance and a high insulin level typically cause blood triglycerides to become high and HDL-cholesterol to become low. Levels vary between different people, and not everyone will see a change in blood fats when then become insulin resistant. Insulin resistance is indicated if triglycerides are more than 1.7 mmol/L, and if HDL-cholesterol is less than 1 mmol/L in males or less than 1.3mmol/L in females.

Fatty liver, or non-alcoholic fatty liver disease (NAFLD), is associated with insulin resistance. It is a common problem that affects approximately 1 in 3 adults in the UK. A liver blood test, also known as a liver function test, can indicate if someone has fatty liver. A liver function test measures a number of liver markers, including ALT (alanine transaminase). Fatty liver can cause a rise in ALT. However, some people can have fatty liver but have a normal ALT level.

Pigmentation on the neck and in skin folds is known as acanthosis nigricans. It is a darkening and thickening of the skin on the neck, armpits, and groin. It is caused by hyperinsulinaemia (high blood insulin).

• Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management
• The association between depressive symptoms and insulin resistance, inflammation and adiposity in men and women
• Hyperinsulinemia and Its Pivotal Role in Aging, Obesity, Type 2 Diabetes, Cardiovascular Disease and Cancer