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Q: "When do you know that you are borderline diabetic?"

A: "Borderline diabetes" is a term that is no longer medically

recognized, but still too often used. Diabetes educators like to say that being borderline diabetic is like being a little bit pregnant-either you are or you aren't.

Borderline diabetes was meant to refer to a condition in which the blood glucose was not in the normal range, but was not yet in the official diabetic range. The problem with the term over the years was that people didn't consider "borderline diabetes" to be important. It was later discovered, however, that some people with this condition subsequently developed diabetes, and also that they were a group at increased risk for heart attacks and strokes.

In 1997, the borderline term was replaced with two terms, Impaired Glucose Tolerance (IGT) and Impaired Fasting Glucose (IFG). The terms vary depending on whether you are diagnosed by a test 2 hours after a glucose drink, or by a fasting glucose test. The general term encompassing both was usually referred to as Impaired Glucose Tolerance (IGT). However, in 2002, the ADA gave these terms a new name: Pre-Diabetes. The ADA felt that this new term was a clearer way of explaining what it means to have higher than normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the adverse health effects of this serious condition.

Then, in October 2003, the International Expert Committee on the

Diagnosis and Classification of Diabetes revised the guidelines,

lowering the before meal glucose threshold from 110 to 100 mg/dl. The committee stated that this new criteria would increase those with Pre-diabetes to 5 million more, which would help find those people who are at increased risk for developing diabetes. For more information, please review the article "Follow-up Report on the Diagnosis of Diabetes Mellitus", published in the November 2003 issue of Diabetes Care.

What are the numbers?

Non-diabetes: glucose is under 100 mg/dL (<100) before meals, and under 140 mg/dL (<140), 2 hours after a glucose drink. Pre-Diabetes can be diagnosed two ways:

If the fasting glucose is between 100 and 125 mg/dl (greater than

or equal to 100 and <126), this was formerly called impaired fasting glucose, but it is now called Pre-Diabetes.

If the glucose level (measured 2 hours after the person ingests a

glucose-containing solution) is between 140 and 199 mg/dl (greater than or equal to 140 and <200), this was formerly called impaired glucose tolerance, but is now also called Pre-Diabetes.

Diabetes: Fasting glucose is greater than or equal to 126 (126 or

greater) or the glucose level 2 hours after a meal/or glucose drink is greater than or equal to 200 (200 or greater) mg/dl.

More about Pre-Diabetes:

People with Pre-Diabetes often have insulin resistance, in which their body tissues do not respond normally to insulin. Many people have no symptoms, and many never develop diabetes, but at least one-third of all people with Pre-Diabetes do get diabetes. Pre-Diabetes can last for 7-10 years before

diabetes develops. It is rarely diagnosed early, and often it is not

diagnosed at all until full-blown diabetes appears. Even people in the early stages of diabetes may not have symptoms for several years, delaying a diagnosis even more. Pre-Diabetes increases the risk for heart attacks and strokes. Many people who are not diagnosed until they have diabetes may already have significant heart disease.

Who's at risk for Pre-Diabetes?

The risk factors for Pre-Diabetes and type 2 diabetes are the same. People should be screened if they are overweight (>20% above ideal weight) and age 45 or older. They should be screened regularly if they are under age 45 and have one additional risk factor; are Hispanic, African American, American Indian, or Pacific Islander; have a family history of diabetes; have central (waistline) obesity; have a sedentary lifestyle; have had gestational (pregnancy-related) diabetes; have high blood pressure (>130/80); have blood fat problems (such as high triglycerides (>150), high LDL (>100), or low HDL.