Islets of Hope for persons with diabetes or forms of insulin resistance

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Article disclaimer

Chart created by Lahle Wolfe, 03/25/2006.  For reprint information e-mail Editor@isletsofhope.com

Sources:

American Heart Association

NIH Publication:  Insulin Resistance and Pre-diabetes

Syndrome X Association

NIH: Your Guide to Diabetes: Type 1 and Type 2


More Information about Metabolic Disorders

Prediabetes, previously called Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) and can be classified as part of the larger syndrome, Insulin Resistance Syndrome.

Insulin Resistance and Insulin Resistance Syndrome (IRS)

Metabolic Syndrome (formerly called "Syndrome X" which is now considered outdated) is the same thing as Insulin Resistance Syndrome (IRS)

Confused?  See our Chart Comparison between Insulin Resistance, Insulin Resistance Syndrome (IRS), Prediabetes, Types 1 and 2 Diabetes, and Gestational Diabetes detailing the symptoms, diagnosis, treatment, and prognosis of these major metabolic disorders.

Lifestyle Changes -  Diet, Exercise, Sports, Stress Management


Did You Know?

...That the diabetes drug metformin, a biguanide, reduced the risk of diabetes in those with pre-diabetes was much less successful than losing weight and increasing activity?

(See our section on Exercise to learn how you can improve your health without medication.)

... That pre-diabetes increases your risk of getting type 2 diabetes and of having heart disease or a stroke?

...That pre-diabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This can prevent, or at least delay, onset of type 2 diabetes?

...That An international expert committee of the American Diabetes Association recently redefined the criteria for prediabetes, lowering the blood sugar level cut-off point for pre-diabetes. Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years if they do not exercise or maintain a healthy weight.

 

Important Medical Disclaimer

All material found on this site is intended to be used only as general informational. 

Information and links on this site should not be used for personal diagnosis or as a substitute for professional medical care.  IOH recommends that you seek the advice of a competent health professional for any and all diagnosis and treatment options, as well as before making any changes to your current diabetes care plan.

islets of hope diabetes medical library                                 main Medical Information page
Metabolic Disorders                                                                                        
  main Metabolic Disorders page

A Chart Comparison between Insulin Resistance,
Insulin Resistance Syndrome (IRS), Prediabetes, Types 1 and 2 Diabetes, and Gestational Diabetes

print this Chart


For permission to reprint or use this chart, please contact: Editor@IsletsofHope.com

 

A Chart Comparison of Carbohydrate-Impaired Metabolic Disorders

Disorder

Symptoms

Diagnostic Criteria

Treatment

Prognosis

Insulin Resistance

Other disorders that may also be present include: Hashimoto's Thyroiditis, Polycystic Ovarian Syndrome, Addison's Disease, and Cushing's Syndrome.

Note: A person with insulin resistance may show few signs early on.  Symptoms that may be present include: hypoglycemia (low blood glucose levels), but levels may also be high or normal, mild hyperglycemia (high blood glucose levels), but levels may also be low or normal, food cravings, especially for carbohydrates, weight gain, often rapid, and prone to carry excess weight around the waist, sleep disruption, lethargy, hirsutism in women (excessive facial hair or developing male hair pattern traits), skin tags, acne, acanthosis nigricans, alopecia areata (scalp and/or body hair loss), depression and mood swings, changes in the menstrual cycle, yeast infections, bloating, high LDL (bad) cholesterol and low HDL (good) cholesterol, high levels of triglycerides, high blood pressure (hypotension)

May or may not have elevated fasting blood glucose levels or after meals.  May or may not have elevated blood glucose levels on an oral glucose tolerance test (OGTT).

Will have elevated insulin levels either on morning fasting, during an oral glucose tolerance test, or after meals.

Some physicians believe a disparity in the ratio between blood glucose levels and insulin levels is sufficient to diagnose insulin resistance even if insulin levels are at or near normal levels.

Will have less than 3 symptoms of insulin resistance syndrome (IRS).

Treated with Lifestyle management: weight loss, and exercise.  Usually a diet low in processed carbohydrate and fat.

May benefit from low glycemic diet.

Sometimes oral medications are prescribed.

It should be noted that weight loss and exercise have been shown to be overall more effective at stopping the progression of, and reversing insulin resistance.

Insulin resistance can often be completely reversed or halted from further progression.

Insulin resistance may be an indication of poor lifestyle habits or another underlying disorder that requires additional treatment.

Insulin Resistance Syndrome

Also called Metabolic Syndrome, or Metabolic Syndrome X, and was formerly called Syndrome X

 

Mild hyperglycemia (high blood glucose levels), but levels may also be low or normal at times, food cravings, especially for carbohydrates, weight gain, often rapid, and prone to carry excess weight around the waist, sleep disruption, lethargy, hirsutism in women (excessive facial hair or developing male hair pattern traits), skin tags, acne, acanthosis nigricans, alopecia areata (scalp and/or body hair loss), depression and mood swings, changes in the menstrual cycle, yeast infections, bloating, high LDL (bad) cholesterol and low HDL (good) cholesterol, high levels of triglycerides, high blood pressure (hypotension).

Other disorders that may also be present include: Hashimoto's Thyroiditis, Polycystic Ovarian Syndrome, Addison's Disease, and Cushing's Syndrome.

IRS is diagnosed when any 3 of the following symptoms are present, but a diagnosis of diabetes cannot be made:(1)

Prediabetes

Elevated Fasting Glucose of > 112 mg/dL or current use of diabetic medication

Abdominal obesity (especially apple shaped body) when:

Waist Circumference
Woman: is >35 inches
Men: is > 40 inches

High Blood Pressure:
Systolic is
> 130 mm HG or  Diastolic is > 85 mm HG, or current use of blood pressure medication

Low HDL Cholesterol
Woman: < 50
Men: < 40

Elevated Triglycerides
>150 mg/dL

Treated with Lifestyle management: weight loss, and exercise.  Usually a diet low in processed carbohydrate and fat.

May benefit from low glycemic diet.

Sometimes oral medications are prescribed for insulin sensitizing, or for other symptoms like high cholesterol or blood pressure.

It should be noted that weight loss and exercise have been shown to be over all,  more effective at stopping the progression of, and reversing insulin resistance which is at the heart of other problems associated with IRS.

Insulin resistance, one aspect of IRS can often be completely reversed or halted from further progression.

If untreated IRS can lead to the onset of type 2 diabetes and may result in compli- cations and health problems due to poor lipid profile.

Women that have PCOS may also experience worsening of symptoms of PCOS when insulin resistance is not addressed medically and through lifestyle changes.

IRS can also worsen the symptoms and increase the liklihood of complications from other disorders sometimes associated with IRS, including Hashimoto's Thyroiditis, Polycystic Ovarian Syndrome, Addison's Disease, and Cushing's Syndrome.

Prediabetes

Prediabetes used to be called impaired fasting glucose (IFG) or Impaired Glucose Tolerance (IGT), but in 2005, federal and diabetes experts renamed it prediabetes to help patients better appreciate the serious nature of this metabolic condition and urgency involved in making healthy lifestyle changes in order to avoid the full onset of type 2 diabetes.

 

hypoglycemia (low blood glucose levels), but levels may also be high or normal, mild hyperglycemia (high blood glucose levels), but levels may also be low or normal, food cravings, especially for carbohydrates, weight gain, often rapid, and prone to carry excess weight around the waist, sleep disruption, lethargy, hirsutism in women (excessive facial hair or developing male hair pattern traits), skin tags, acne, acanthosis nigricans, alopecia areata (scalp and/or body hair loss), depression and mood swings, changes in the menstrual cycle, yeast infections, bloating, often have high LDL (bad) cholesterol and low HDL (good) cholesterol, high levels of triglycerides, high blood pressure (hypotension)

Morning Fasting Glucose: From 100 to 125 mg/dL, or
5.6 to 6.9 mmol/L indicates Impaired Fasting Glucose (IGF) or
Prediabetes and an Oral Glucose Tolerance Test (OGTT) may be given.

During the OGTT, blood glucose levels are checked 2 hours after being given 75 grams of a glucose solution to drink.

2 Hours after drinking 75 grams of glucose: From 140 to 200 mg/dL, or 7.8 to 11.1 mmol/L indicates Impaired glucose tolerance (IGT), or Pre-diabetes

See chart note(2)

Treated with Lifestyle management: weight loss, and exercise. Persons with pre- diabetes may benefit from a diet low in processed carbohy- drates and fat, or from following a low glycemic diet.

Sometimes oral medications are prescribed for insulin sensitization, however, studies show that weight loss and exercise are more effective at stopping and reversing prediabetes than oral medications.

People with prediabetes belong to a larger group of individuals with a condition known as insulin resistance syndrome (IRS), in which the body gradually loses sensitivity to insulin.

Prediabetes can be completely reversed or halted from further progression.  If not treated, type 2 diabetes can onset.

Type 2 Diabetes

Formerly called non-insulin dependent diabetes mellitus (NIDDM), and adult onset diabetes.

Onset is usually slow over months or years. Symptoms include hyperglycemia (high blood glucose levels), weight gain, or weight loss depending upon how early type 2 is diagnosed and high blood glucose levels are any of the following may also be present: dry mouth, increased thirst, increased urination (volume and frequency), abdomen pain, headaches, increased appetite, changes in temperament or behavior, blurred vision, poor wound healing, yeast infections, erectile problems in men.

Can occur at any age and may be diagnosed in young children, teens, adults, and seniors.

Morning Fasting Glucose: 126 mg/dL or higher, or 7.0 mmol/L or higher

2 Hours after drinking 75 grams of glucose: Over 200 mg/dL, or 11.1 mmol/L or higher on more than one occasion

See chart note(2)

Treated with Lifestyle management: weight loss, exercise, and stress management. Persons with type 2 diabetes tend to benefit from a diet low in processed carbohydrates and fat, or from following a low glycemic diet.

Oral medications are prescribed when lifestyle cannot control blood glucose levels, and in some cases injected insulin becomes necessary.

Once type 2 diabetes onsets there is no cure. It cannot be reversed, but it can be managed.

With good control, complications can be avoided or minimized.  

With poor control complications are likely.

Type 1 Diabetes (sometimes called Juvenile Diabetes, formerly called Insulin Dependent Diabetes Mellitus, or IDDM)

There is more than one form or cause of type 1 diabetes including LADA, MODY, Bronze Diabetes

Type 1A - will be diagnosed when there are certain antibodies present (about 85% of all type 1 diagnosis).

Type 1B - is also called idiopathic type 1 diabetes when there are no antibodies present. May be more commonly diagnosed in African Americans.

Surgical removal or damage to the pancreas can also cause type 1 diabetes.

Type 1 diabetes mellitus is characterized by beta cell destruction caused by an autoimmune process, usually leading to absolute insulin deficiency (the pancreas makes no insulin).  Onset is rapid, usually occurring over a period of days or weeks.

Onset is usually in children or young adults with over 95 percent of persons with type 1 develop the disease before the age of 25. Sometimes occurs from birth.

Hyperglycemia (high blood glucose), weight loss, dry mouth, increased thirst, increased urination (volume and frequency), abdomen pain, headaches, breath may smell sweet or fruity, ketones may be present in urine. increased appetite, changes in temperament or behavior, blurred vision, poor wound healing, general body aches, yeast infections, erectile problems in men.

Many diagnosed with type 1 diabetes are in a state called diabetic ketoacidosis which may cause loss of consciousness, coma, or death.

Morning Fasting Glucose: 126 mg/dL or higher, or 7.0 mmol/L or higher

2 Hours after drinking 75 grams of glucose: Over 200 mg/dL, or 11.1 mmol/L or higher on more than one occasion

Type 1 diabetes is not diagnosed in persons 40 years of age or older (sometimes not after age 25).  Latent Autoimmune Diabetes in Adults (LADA) is the form that occurs in later adulthood.

Infants through age 35-40, when diagnosed with type 1 diabetes are generally considered to have Juvenile Diabetes with the exception of when another specific form such as MODY is diagnosed

See chart note(2)

Lifestyle management includes following a healthy diet consisting of about 50% of calories from healthy carbohydrates, low in fat, and often low in protein.

Injected insulin is always required except in the case of some patients with MODY, or in those newly diagnosed with LADA (who will likely end up on insulin).

Sometimes oral diabetes medications are also necessary when persons with type 1 diabetes also have type 2 insulin resistance.

Once type 1 diabetes onsets there is no cure. It cannot be reversed, but it can be managed.

With good control, complications can be avoided or minimized.  

With poor control complications are likely.

Keeping HbA1c levels at or below 7% can reduce the risk of many complications to that of a person without diabetes.  Since HbA1c tests are not entirely accurate predictors  it is important to also keep daily blood glucose levels under control.

Gestational Diabetes (GD)

GD is a similar to type 2 diabetes and occurs only during pregnancy. However, it can develop into full onset of type 2 diabetes.

Because women are routinely tested for GD an early diagnosis is likely.

Normal symptoms of pregnancy may be confused with GD symptoms which may include weight gain or loss, hyperglycemia (high blood glucose levels), dry mouth, increased thirst, increased urination (volume and frequency), abdomen pain, headaches, increased appetite, changes in temperament or behavior, blurred vision, poor wound healing, yeast or bladder infections, and fatigue.

GD usually develops during the 5th or 6th month of pregnancy (between 24 and 28 weeks) when certain hormones produced by the placenta can cause insulin resistance to develop.

Fasting Glucose: a level  higher than 95 mg/dL (5.3 mmol/L) may indicate GD and a Glucose Challenge Test may be given.

1 Hour after drinking
50 grams of glucose on a GCT:
(3)  140 mg/dL or, 7.8 mmol/L or higher is abnormally elevated, and an Oral Glucose Tolerance Test (OGTT) will be given.

OGTT(4)(5) results in the following ranges may indicate GD:

At 1 hour: higher than 180 mg/dL (10.0 mmol/L)

At 2 hours: higher than 155 mg/dL (8.6 mmol/L)

At 3 hours: higher than 140 mg/dL (7.8 mmol/L)

Treated with Lifestyle management: weight control, light exercise, and stress manage- ment.

Persons with GD tend to benefit from a diet low in processed carbohydrates and fat, or from following a low glycemic diet.

When lifestyle cannot control blood glucose levels, injected insulin becomes necessary.

It is still somewhat controversial as to whether or not it is safe to take the insulin sensitizing drug Glucophage during pregnancy. Some doctors offer this treatment, others do not.

After delivery, symptoms usually disappear or become more manageable.  Some women will develop type 2 diabetes.  Any woman that has had GD is at greater risk of GD in subsequent pregnancies, and for developing type 2 diabetes later in life.

GD can contribute to complications during pregnancy and at birth for both baby and mother and should be taken as a serious medical condition that requires advice and care of a physician.

 Chart Notes

(1) the symbol < means less than, and the symbol > means greater than, when underlined it means "or equal to.")

(2) For more complete information and charts on normal and abnormal blood glucose levels, including those used to diagnose diabetes, see:

Normal and Target Blood Glucose Ranges for Diabetics
Morning Fasting Blood
Oral Glucose Tolerance Test Ranges (non-pregnant)
Oral Glucose Tolerance Test (pregnancy)

Gestational Diabetes Screening:  Glucose Challenge Test (during pregnancy)

(3) Some physicians use a lower cutoff and may recommend that a woman undergo an OGTT if she is 130 mg/dL (7.2 mmol/L) or higher.

(4) If two or more tests show blood glucose higher than the normal ranges above, gestational diabetes will be diagnosed.

(5) A 75-gram glucose load may be used but may not be as reliable as the 100-gram glucose test.  If your doctor has you take the 75-gram test, you will not have blood drawn at the 3-hour mark.

 

         

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 Page Updated 04/02/2006