Understand The 10 Stages of Developing Diabetes For Early Prevention
Prevention is always better than cure.
More than half of the people with type 2 diabetes are unaware that they are living with diabetes.
Most of the time, the symptoms don’t follow the textbook. This is because diabetes develops in a slow and step-wise manner. The typical diabetes picture reveals itself only when it is full-blown. But this doesn’t mean we should wait until the drum roll moment before its revelation.
We can sense it way early, during the initial stages. For this, you need to know how you develop type 2 diabetes.
Why is it important now to understand how you develop diabetes?
There is no sign of this diabetes pandemic getting better anytime in the near future.
The International Diabetes Federation (IDF) has reported that, as of 2021, 540 million adults aged 20 to 79 years have diabetes. Also, the total number of people with diabetes is projected to rise to 643 by 2030 and 783 by 2045. Given the risk, it becomes important to learn how you develop diabetes to prevent it earlier. Prevention lets you protect your quality of life. This saves you from distressing complications. This saves you money. This saves your peace of mind.
Diabetes develops in stages. There are specific symptoms and methods to investigate each stage. Taking the best preventive action in the initial stages can help you revert to normalcy. Moreover, it saves you from this common and burdensome disease.
Diabetes develops in ten stages:
- The first stage is the presence of risk factors.
Type 2 diabetes, unlike type 1, follows the risk factors.
There are certain factors that increase the risk of type 2 diabetes. The risk factors are either modifiable or non-modifiable.
Modifiable risk factors: obesity or overweight, sedentary lifestyle, smoking, alcohol, and high blood pressure.
Non-modifiable risk factors: increasing age, gestational diabetes, family history of diabetes.
If you are at risk, you must start taking action the day you find it. For both groups, adopting a healthy lifestyle is a preventive strategy. A healthy lifestyle means adopting a healthy diet, adequate physical activity, stopping smoking, and managing stress effectively.
2. The second stage is the one where you start gaining weight.
These people are in the 20–30 age range. These are the ones who had risk factors yet couldn’t adopt a healthy lifestyle. In this stage, the weight gain is slower and, to a lesser extent, around 2 to 4 kilograms. The weight gain is usually around the waist and upper part of the body. This type of weight distribution gives the appearance of an “apple-shaped” body.
In this stage, weight gain is the only symptom. The preventive strategy is to lose that extra weight as soon as possible.
3. The third stage is the stage of frequent glucose spikes.
You have repeated episodes of rises in glucose levels. This means your body needs a higher amount of insulin to keep glucose levels in check. This, in turn, leaves your pancreas, which is pumping out insulin, overworked. As a result, the pancreas can become enlarged in some people.
This is when symptoms like fatigue, cravings, brain fog, and frequent headaches start. At this stage, the fasting and postprandial blood glucose and HbA1C would be normal. A continuous glucose monitor (CGM) can help you notice the spikes. I wouldn’t recommend getting a CGM for the sole purpose of knowing your glucose spikes. Because there are several people who are actually in need of it. Instead, you can check your fasting insulin levels, which most likely will be high and can give you a clue. Even if it is not high, if you have the symptoms, you have to start taking action for prevention.
The preventive action is to manage the glucose spikes. The good thing about this stage is that your body is still sensitive to insulin. It means it is easier for us to lose weight and revert to normal levels. The strategies you can follow are: increasing your physical activity to lose weight; cutting down on sugar and highly processed foods; and consuming whole foods.
I recommend reading The Glucose Goddess Method by Jessie Inchauspe. Her hacks to manage glucose spikes are science-backed and effective.
4. The fourth stage is the stage of obesity.
This obesity is due to all the excess sugar that is being converted and stored as fat. The fat cells surrounding your internal organs in the waist area store this fat. It is called the visceral fat. The weight gain at this stage can be as quick as 5 to 10 kilograms in 6 months. In the initial stages, you are still insulin-sensitive. But this is a strong indicator that you are progressing towards insulin resistance.
You will have all the symptoms of glucose spikes as in the previous stage. Also, your insulin levels can be higher. You need to take immediate action to lose weight at this stage.
5. The fifth stage is the stage of becoming resistant to insulin.
Insulin stores glucose in the liver cells. The cells must be accepting of insulin to complete this process. Due to the constant exposure to excess glucose and insulin, these cells get tired. They finally decide to stonewall insulin. Besides liver cells, your muscle and fat tissues also become resistant to insulin.
This leads to symptoms of insulin resistance:
- Erratic blood glucose levels with alternating spikes and crashes
- More cravings for sugary and starchy foods
- Skin hyperpigmentation called acanthosis nigricans.
- High blood pressure.
- Blood workups can show high triglycerides, fasting blood glucose greater than 100 mg/dl, and an increased waist-to-hip circumference ratio.
This entire picture is called cardiometabolic syndrome. Most of these patients quickly progress to prediabetic conditions.
The good news is that you can reverse insulin resistance through intensive lifestyle changes. This includes:
- A calorie-restricted diet with low carbs, high protein, and adequate healthy fats.
- Cutting down on salt and highly processed foods.
- At least 150 minutes per week of moderate-intensity workouts or 75 minutes per week of high-intensity workouts.
- Some patients may need oral hypoglycemic agents.
6. The next stage is the stage of inflammation that is not clinically visible.
Insulin suppresses the breakdown of fat in the fat cells. When the fat cells become resistant to insulin, there is an unchecked breakdown of fat. This is called lipolysis. This releases fatty acids into the blood, which triggers an inflammatory response.
The substances released as a response speed up the deposition of the fat on the blood vessel walls. This lays the foundation for developing diseases like heart attack and stroke.
This stage manifests the same symptoms as above but with greater intensity. Thus, the preventive strategies are the same, viz., intensive lifestyle modification with oral hypoglycemic agents if prescribed.
7. At this stage, your weight gain slows down.
The fat around your waist is continuously broken down and pumped into the blood. Thus, the central visceral fat around your belly starts to melt. But still, peripheral weight gain persists.
Many people at this stage relax into their old habits, thinking that they are losing or maintaining their weight. This is the calm before the storm.
Thus, you need to act wisely, consult your doctor, and start taking action. By now, you might know the drill for preventing diabetes-losing weight, dietary changes, and medicines if necessary.
8. The next stage is the stage of lipotoxicity, which means our body is flooded with free fatty acids.
The fat now travels to accumulate in the liver and pancreas. This can present as fatty liver and pancreatic beta cell damage. The beta cells in the pancreas are the ones supposed to secrete insulin. When it gets damaged, there is no insulin production to maintain glucose levels.
Now you might start getting the symptoms of diabetes. This is a critical stage where you need medical help. You might need drugs to reduce the fat and high sugar along with lifestyle changes.
9. The next stage is the stage of high blood glucose and glucotoxicity.
Remember, there is less or no insulin to keep the glucose in check. The manifestations of diabetes start affecting the quality of your life. You might have increased appetite, increased thirst, increased urination, headaches, muscle aches, and vision problems. Your fasting and post-meal glucose levels will be high.
Get medical attention at this stage. Your doctor will start you on blood glucose-lowering agents. Most of the people who develop diabetes meet their doctors at this stage. This is the stage where your diabetes becomes treatable but not curable. Though studies show that reversal is possible with weight loss, the sustainability of remission over a prolonged period is low.
10. The final stage is the full-blown picture of diabetes.
This is the stage where you will be deficient in insulin. This is the stage where one develops complications affecting the kidneys, eyes, or nerves. At this stage, oral medicines become insufficient to control blood glucose. The patients will need insulin replacements.
It is hard to reverse diabetes when you get to this stage.
To summarize:
- Diabetes develops in stages.
- In 2045, one in eight adults will have diabetes.
- But it is easier to prevent it than to treat it.
- The best preventive strategy is weight loss of at least 7 to 10% of current weight.
- The recommended strategies for weight loss are a calorie-restricted diet, adequate physical activity, time-restricted eating, and bariatric surgery for obese individuals who meet the indicated criteria.
- Test yourself and know where you are to take the necessary actions so that you don’t develop diabetes.
- Always consult a doctor when in doubt.
Reference: Lecture by Dr. Osama Hamdy from Harvard Medical School.
You may check out some ideas to prevent and reverse diabetes written by Dr Mehmet Yildiz.
