Prediabetes

What is prediabetes?

Prediabetes means that your blood glucose, or blood sugar, levels are higher than normal but not high enough to be called diabetes. Glucose comes from the foods you eat. Too much glucose in your blood can damage your body over time.

If you have prediabetes, you are more likely to develop type 2 diabetes, heart disease, and stroke. But if you make some lifestyle changes now, you may be able to delay or prevent type 2 diabetes.

What causes prediabetes?

Prediabetes usually happens when your body has a problem with insulin. Insulin is a hormone that helps the glucose get into your cells to give them energy. A problem with insulin could be:

• Insulin resistance, a condition in which the body can't use its insulin properly. It makes it hard for your cells to get glucose from your blood. This can cause your blood sugar levels to rise.
• Your body can't make enough insulin to keep your blood sugar levels at a healthy level

Researchers think that being overweight and not getting regular physical activity are major factors in causing prediabetes.

Who is at risk for prediabetes?

About 1 out of every 3 adults has prediabetes. It is more common in people who:

• Are overweight or have obesity
• Are age 45 or older
• Have a parent, brother, or sister with diabetes
• Are African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American
• Are not physically active
• Have health conditions such as high blood pressure and high cholesterol
• Have had gestational diabetes (diabetes in pregnancy)
• Have a history of heart disease or stroke
• Have metabolic syndrome
• Have polycystic ovary syndrome (PCOS)

What are the symptoms of prediabetes?

Most people don't know they have prediabetes because usually there are no symptoms.

Some people with prediabetes may have darkened skin in the armpit or on the back and sides of the neck. They may also have many small skin growths in those same areas.

How is prediabetes diagnosed?

There are a few different blood tests that can diagnose prediabetes. The most common ones are:

• Fasting plasma glucose (FPG) test, which measures your blood sugar at a single point in time. You need to fast (not eat or drink) for at least 8 hours before the test. The results of the test are given in mg/dL (milligrams per deciliter):
  • A normal level is 99 or below
  • Prediabetes is 100 to 125
  • Type 2 diabetes is 126 and above
• A1C test, which measures your average blood sugar over the past 3 months. The results of an A1C test are given as a percentage. The higher the percentage, the higher your blood sugar levels have been.
  • A normal level is below 5.7%
  • Prediabetes is between 5.7 to 6.4%
  • Type 2 diabetes is above 6.5%

If I have prediabetes, will I get diabetes?

If you have prediabetes, you may be able to delay or prevent type 2 diabetes through lifestyle changes:

• Losing weight, if you are overweight
• Getting regular physical activity
• Following a healthy, reduced-calorie eating plan

In some cases, your health care provider may also recommend taking diabetes medicines.

Can prediabetes be prevented?

If you are at risk for prediabetes, those same lifestyle changes (losing weight, regular physical activity, and a healthy eating plan) may prevent you from getting it.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Tremor

What is a tremor?

A tremor is a neurological condition that includes shaking or trembling movements in one or more parts of your body. It most often affects the hands. But it can also affect the arms, legs, head, vocal cords, and torso (trunk). A tremor is involuntary, meaning that you cannot control it. It happens because of muscle contractions.

A tremor may come and go, or it may be constant. It can happen on its own or be caused by another disorder. It is not life threatening, but it may cause challenges. It can make it hard to do daily life tasks such as writing, typing, eating, and dressing. In some cases, a tremor can even lead to disabilities.

What are the types of tremor?

There are several types of tremor, including:

• Essential tremor, sometimes called benign essential tremor or familial tremor. This is the most common type. It usually affects both your hands and arms while you are moving them. It can also affect your head, voice, or legs.
• Parkinsonian tremor, which is a common symptom in people who have Parkinson's disease. It usually affects one or both hands when they are at rest, but it can affect the chin, lips, face, and legs.
• Dystonic tremor, which happens in people who have dystonia. Dystonia is a movement disorder in which you have involuntary muscle contractions. The contractions cause you to have twisting and repetitive movements. It can affect any muscle in the body.

What causes tremor?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. For most types, the cause is unknown. Some types are inherited and run in families. There can also be other causes, such as:

• Neurologic disorders, including multiple sclerosis, Parkinson's disease, stroke, and traumatic brain injury
• Certain medicines, such as asthma medicines, chemotherapy, corticosteroids, and medicines used for certain psychiatric and neurological disorders
• Alcohol use disorder (AUD) or alcohol withdrawal
• Poisoning from certain toxic substances, including pesticides and heavy metals such as mercury and lead
• Hyperthyroidism (overactive thyroid)
• Liver or kidney failure
• Anxiety or panic
• Too much caffeine

Who is at risk for tremor?

Anyone can get tremor, but it is most common in middle-aged and older adults. For certain types of tremor, having a family history raises your risk of getting it.

What are the symptoms of tremor?

Symptoms of tremor may include:

• Rhythmic shaking in the hands, arms, head, legs, or torso
• Shaky voice
• Difficulty writing or drawing
• Problems holding and controlling utensils, such as a spoon

How is tremor diagnosed?

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, which includes checking:
  • Whether the tremor happens when the muscles are at rest or in action
  • The location of the tremor
  • How often you have the tremor and how strong it is
• A neurological exam, including checking for:
  • Problems with balance
  • Problems with speech
  • Increased muscle stiffness
• Blood or urine tests to look for the cause
• Imaging tests to help figure out if the cause is damage to your brain
• Tests that check your abilities to do daily tasks such as handwriting and holding a fork or cup
• An electromyogram, a test that measures involuntary muscle activity and how your muscles respond to nerve stimulation

What are the treatments for tremor?

There is no cure for most forms of tremor, but there are treatments to help manage symptoms. In some cases, the symptoms may be so mild that you do not need treatment.

Finding the right treatment depends on getting the right diagnosis of the cause. Tremor caused by another medical condition may get better or go away when you treat that condition. If your tremor is caused by a certain medicine, stopping that medicine usually makes the tremor go away.

Treatments for tremor can include:

• Medicines. There are different medicines for the specific types of tremor. Another option is Botox injections, which can treat several different types of tremor.
• Surgery may be used for severe cases that do not get better with medicines. The most common type is deep brain stimulation (DBS). DBS uses electrodes that are implanted in the brain. The electrodes send electrical pulses to the parts of the brain that are causing the tremor.
• Physical, speech-language, and occupational therapy, which may help to control tremor and deal with the daily challenges caused by the tremor.

If you find that caffeine and other stimulants trigger your tremors, it may be helpful to cut them from your diet.

NIH: National Institute of Neurological Disorders and Stroke

Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is a nervous system disease that attacks nerve cells called neurons in your brain and spinal cord. These neurons transmit messages from your brain and spinal cord to your voluntary muscles - the ones you can control, like in your arms and legs. At first, this causes mild muscle problems. Some people notice:

• Trouble walking or running
• Trouble writing
• Speech problems

Eventually, you lose your strength and cannot move. When muscles in your chest fail, you cannot breathe. A breathing machine can help, but most people with ALS die from respiratory failure.

The disease usually strikes between age 40 and 60. More men than women get it. No one knows what causes ALS. It can run in families, but usually it strikes at random. There is no cure. Medicines can relieve symptoms and, sometimes, prolong survival.

NIH: National Institute of Neurological Disorders and Stroke

Aphasia

Ataxia Telangiectasia

Ataxia-telangiectasia (A-T) is a rare, inherited disease. It affects the nervous system, immune system, and other body systems. Symptoms appear in young children, usually before age 5. They include:

• Ataxia - trouble coordinating movements
• Poor balance
• Slurred speech
• Tiny, red spider veins, called telangiectasias, on the skin and eyes
• Lung infections
• Delayed physical and sexual development

People with A-T have an increased risk of developing diabetes and cancers, especially lymphoma and leukemia. Although it affects the brain, people with A-T usually have normal or high intelligence.

A-T has no cure. Treatments might improve some symptoms. They include injections to strengthen the immune system, physical and speech therapy, and high-dose vitamins.

NIH: National Institute of Neurological Disorders and Stroke