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Increasing attention is being placed on a condition identified as prediabetes where blood glucose levels are higher than normal but not yet at the level of diabetes - i.e. between 140-200 mg/dL by an oral glucose tolerance test (OGTT) or between 100 and 126 mg/dL by a fasting plasma glucose test (FPG). Prediabetes is indicative of a condition called insulin resistance where the cells of the body do not use insulin properly to help absorb glucose that they need for energy. As a result, they continually send out a signal for more insulin. The pancreas produces more insulin to keep up with demand, but the levels of glucose in the blood continue to rise (hyperglycemia) which results in impaired glucose tolerance (IGT), another term for prediabetes.

There is increasing evidence that hyperglycemia resulting from insulin resistance is enough to damage or injure the very distal (toes and feet) long axons of unmyelinated or slightly myelinated small fibers that causes the first symptoms of peripheral neuropathy. It appears that the neuropathy of prediabetics is the same type as that of diabetics and causes the same symptoms, such tingling, paresthesia, pain, autonomic dysfunction just perhaps not as intensely or as widespread. There is also data to indicate that impaired glucose tolerance is more common among people with idiopathic peripheral neuropathy than commonly thought (up to 45% or more in one study) vs. impaired glucose tolerance in the general population (up to 14%).

In addition, IGT is one of a group of conditions that make up the metabolic syndrome, also found in prediabetics. The metabolic syndrome includes:

• Excess weight around the waist
• High triglycerides
• Low HDL (high-density lipoproteins) the "good" cholesterol (dyslipidemia)
• High blood pressure
• High fasting blood glucose levels.

Researchers are investigating the possibility that peripheral neuropathy of prediabetes may be also related to the presence of these other features of metabolic syndrome in addition to high glucose, specifically dyslipidemia.

The most effective management of prediabetes, advocated by the Diabetes Prevention Program, is dietary changes and exercise. Evidence points to improvement of symptoms of peripheral neuropathy following these steps.

To read more about prediabetes and peripheral neuropathy, please click on the following link: http://www.medifocus.com/abstracts.php?gid=NR021&ID=18255003