Insulin resistance is usually present for about ten years before blood sugar levels become abnormal. During this period of time, while the person has Prediabetes, he may unknowingly face significantly increased risk of both microvascular and macrovascular disease similar to that of the person with type I diabetes (see above). While the microvascular complications are associated with visual impairment, kidney disease, the macrovascular complications lead to heart attacks, strokes and non-traumatic amputations. In the general population, insulin resistance increases with age, lack of exercise, and increased body fat. There are 79 million Americans or one third of the US population has Prediabetes and many do not know it. If undiagnosed or if no steps are taken to improve health, prediabetes almost always develops into Type II Diabetes. While people with Prediabetes have normal blood sugars, physicians look for several factors to determine who is most like to either have or develop it. These factors are a positive family history of diabetes type 2, a personal or family history of gestational diabetes or babies that were born very large, a large amount of fat above the belt, high blood pressure, elevated cholesterol, gout, and sleep apnea. Physicians often advise prediabetic patients who are overweight to engage in weight loss activities because weight loss often improves insulin resistance. Prediabetic individuals who adapt to a lifestyle involving regular exercise, healthy diet, and maintaining an appropriate weight can lower the chance of developing Type II Diabetes by 60%. Making these healthy lifestyle choices regularly can even make it possible to achieve normal blood sugars naturally, and medication may not be necessary. However, regaining weight, developing a secondary illness, experiencing severe stress, or using medications that negatively influence insulin levels may push prediabetes into Type II Diabetes. Even though the blood sugars are relatively normal, they may still have the microvascular and macrovascular complications from Diabetes. Sometimes, their predilection toward Diabetes is discovered when they present with a heart attack or stroke. Their ophthalmologist may notice an abnormality in their retina upon a routine eye exam or their blood may become abnormal indicating renal failure. They may even develop a sore on their feet that doesn’t heal and evaluation may reveal poor circulation (peripheral vascular disease) or nerve impairment (peripheral neuropathy). Occasionally a male may develop impotence as the first sign of macrovascular disease. For these 79 million Americans, what they do not know can hurt them. As the percentage of people with obesity increases, the number of people with Diabetes type II and Prediabetes will increase as will the complications of this disease.