Telatha Powell, MSN, APRN, AGPCNP-BC 

Diabetes Often Goes Undetected

Diabetes and prediabetes have become increasingly common over the past several decades, making diabetes one of the nation’s most significant and often overlooked public health concerns.

Nearly 12% of Americans have diabetes, and an estimated 30% do not know they have it. Prediabetes, a condition in which blood sugar levels are higher than normal but not yet in the diabetic range, affects approximately one in three adults. Of those, an estimated 80-90% are unaware they have the condition.

Why Early Detection Matters

Prediabetes and Type 2 diabetes typically develop slowly, often without noticeable symptoms. As a result, many individuals are not diagnosed until complications have already begun. Fortunately, routine annual wellness visits and blood sugar screenings can identify these conditions early, allowing treatment to begin before long-term damage occurs.

What is Diabetes?

Diabetes is a condition in which the body cannot properly regulate glucose (blood sugar), its primary source of energy. After carbohydrates such as bread, pasta, rice, fruit, milk, sweets, and sugary drinks are digested, they are broken down into glucose and absorbed into the bloodstream.

The hormone insulin allows glucose to move from the bloodstream into the body’s cells, where it is used for energy. In people with prediabetes and Type 2 diabetes, the body either does not produce enough insulin or cannot use it effectively. As a result, glucose builds up in the bloodstream instead of being used by the body’s cells.

Over time, consistently elevated blood sugar can damage blood vessels and nerves, increasing the risk of heart disease, stroke, kidney disease, vision loss, nerve damage, amputations, and even dementia. Since this damage often occurs silently, many people are unaware that complications are developing until significant harm has already occurred. Maintaining healthy blood sugar levels can reduce these risks while improving energy, overall health, and quality of life.

The Three Main Types of Diabetes: Prediabetes, Type 2 Diabetes, and Type 1 Diabetes

Prediabetes occurs when blood sugar levels are higher than normal and is a precursor to diabetes. Most people with prediabetes have no symptoms. However, possible signs may include skin tags, darkened skin in areas such as the armpits or neck, and symptoms similar to those of diabetes.

Type 2 diabetes accounts for approximately 90-95% of all diabetic cases. Risk factors include a family history of diabetes, being overweight or obese, physical inactivity, being age 45 or older, high blood pressure, prediabetes, and certain racial or ethnic backgrounds, including African Americans, who have a higher risk of developing the disease.

Type 1 diabetes is an autoimmune disease in which the immune system attacks and destroys the insulin-producing cells of the pancreas. The onset of symptoms usually develops quickly. Although type 1 diabetes can develop at any age, it commonly occurs in children, teens, and young adults. Risk factors include genetics and certain environmental triggers. There is currently no known way to prevent or cure Type 1 diabetes.

Some common signs of high blood sugar levels, present with both type 1 and type 2 diabetes, include excessive urination and thirst, weight loss, fatigue, numbness in the hands and feet, and blurry vision.

Why Don’t People Get Screened?

Preventive health screenings save lives, yet millions of recommended screenings go uncompleted. Common barriers include cost, lack of symptoms, transportation challenges, limited access to a primary care provider, and mistrust of the health care system. Others assume feeling tired or unwell is simply a normal part of aging, or avoid testing because they fear receiving a diagnosis.

How Is Diabetes Diagnosed?

Two simple blood tests can help confirm a diagnosis of prediabetes or diabetes:

Fasting Blood Glucose Test

Blood glucose testing is a standard part of annual bloodwork, where prediabetes or diabetes may be diagnosed. Fasting glucose measures blood sugar at a single point in time after you have fasted for at least eight hours. Less than 100 mg/dL is normal. The prediabetes range is 100-125 mg/dL. Diabetes is confirmed when the level is 126 mg/ml or higher on two separate tests.

Hemoglobin A1C Testing

The A1C test measures average blood sugar levels over the previous two to three months and is used both to diagnose and monitor diabetes. A level of 4.7-5.6 is normal, 5.7-6.4 is the prediabetes range, and 6.5 and above is the diabetes range.

Who Should Be Screened?

The American Diabetes Association recommends that all adults age 35 and older be routinely screened for diabetes. Testing is recommended for others at higher risk, including those under 35 who are overweight or obese and have one or more additional risk factors, children who are overweight or obese with family history or risk factors, individuals who are already diagnosed with prediabetes, and women who had diabetes while pregnant, known as gestational diabetes.

Managing Diabetes

Fortunately, prediabetes can often be reversed, reducing the risk of developing Type 2 diabetes. Treatment for prediabetes and Type 2 diabetes focuses on maintaining healthy blood sugar levels through lifestyle changes, regular monitoring, and medications when appropriate. Healthy eating, regular physical activity, adequate sleep, stress management, and maintaining a healthy weight all play important roles in preventing complications and improving long-term health. Even small lifestyle changes can significantly reduce the risk of developing diabetes or help improve blood sugar control in those already living with diabetes.

Take Charge of Your Health

If you are experiencing any symptoms of prediabetes or diabetes, schedule an appointment with your health care provider. If you do not have a primary care provider, taking charge of your health and establishing care with a provider is a great first step toward protecting your health.

The Diabetes Institute at HopeHealth provides comprehensive diabetes care through a multidisciplinary team of endocrinologists, nurses, dietitians, and support staff. Classes for the National Diabetes Prevention Program are also offered through The Diabetes Institute. For more information, visit hope-health.org/services/the-diabetes-institute/.

Regular wellness visits and recommended health screenings remain among the most effective tools for preventing chronic diseases like diabetes. Early detection allows individuals to slow disease progression, reduce complications, and improve their quality of life.