Prediabetes

Prediabetes happens when you have elevated blood sugar levels, but they’re not high enough to be considered Type 2 diabetes.

A healthy fasting blood sugar (glucose) range is 70 to 99 milligrams per deciliter (mg/dL). If you have prediabetes, your fasting levels are typically 100 to 125 mg/dL.

Prediabetes is very common. Researchers estimate that 84 million adults in the U.S. have it. It affects more than 1 in 3 adults under age 65 and half of the people over 65 in the U.S.

This condition may turn into Type 2 diabetes (T2D), which can lead to damage in many parts of your body if left untreated. The good news is that you may be able to prevent or delay Type 2 diabetes with healthy lifestyle changes. This includes upping your physical activity and choosing more whole foods.

Talk to your primary care provider about screening for this condition. It might be mentally easier to avoid finding out. But knowing and taking action are very valuable to your long-term health.

Symptoms of prediabetes

Prediabetes often has no symptoms. More than 8 in 10 people with it don’t know they have it. One possible sign of prediabetes is darkened skin in your armpit or on the back and sides of your neck.

Early signs that it may be turning into Type 2 diabetes include:

• Peeing often, which may be most noticeable at night
• Intense thirst
• Intense hunger, even though you eat regularly
• Fatigue

Because of the lack of symptoms, it’s important to see your healthcare provider regularly so they can do screenings. This is the only way to know if you have it.

Prediabetes causes

The main cause of prediabetes is insulin resistance.

Insulin resistance happens when cells in your muscles, fat and liver don’t respond as they should to insulin. This hormone is essential for controlling your blood glucose. When you don’t have enough insulin or your body doesn’t use it properly, you get high blood sugar.

Several factors can contribute to insulin resistance, including:

• Genetics
• Excess body fat, especially in your belly and around your organs (visceral fat)
• Physical inactivity
• Eating highly processed, high-carbohydrate foods and saturated fats frequently
• Certain medications, like long-term steroid use
• Hormonal disorders, like hypothyroidism and Cushing syndrome
• Chronic stress and a lack of quality sleep

Risk factors

Risk factors for prediabetes include:

• Biological family history of Type 2 diabetes
• Overweight or obesity (a BMI greater than 25)
• Exercising less than three times a week
• Being 45 or older
• Smoking
• History of gestational diabetes
• Obstructive sleep apnea
• Polycystic ovarian syndrome (PCOS)

Race and ethnicity are also factors. You’re at increased risk if you’re:

• Black
• Hispanic/Latino American
• Native American
• Pacific Islander
• Asian American

Complications of this condition

The main complication of prediabetes is its development into Type 2 diabetes. This increases your risk of several complications, like:

• Heart attack and stroke
• Eye issues
• Kidney issues
• Nerve damage

How doctors diagnose this condition

Healthcare providers rely on routine blood test screenings to check for prediabetes. These tests include:

• Fasting blood sugar: This tests your blood after you haven’t had anything to eat or drink except water for at least eight hours. Basic and comprehensive metabolic panels include this test.
• A1C: This test measures your average blood glucose level over the past two to three months.

Your provider diagnoses you with prediabetes if your:

• Fasting blood sugar result is 100 to 125 mg/dL (no diabetes is less than 100; diabetes is 126 or higher)
• A1C result is 5.7% to 6.4% (no diabetes is less than 5.7%; diabetes is 6.5% or higher)

How can I prevent or delay Type 2 diabetes?

The best way to treat prediabetes and prevent or delay the onset of Type 2 diabetes is through healthy lifestyle changes. Eating nutritious foods and exercising can help regulate your blood sugar levels.

Even small changes can greatly lower your risk for developing Type 2 diabetes, like:

• Weight loss: Studies show that losing 7% of your total body weight can reduce the onset of T2D by more than half.
• Regular activity: Movement and exercise make your body more sensitive to insulin. Exercise also builds muscle that can absorb blood glucose. Aim for 30 minutes a day, five days a week, for a total of 150 minutes a week.
• Eating changes: Try to cut out added sugars, swap simple carbs for complex carbs and eat more veggies. A dietitian can help you plan healthy eating patterns you can stick with long-term.

Lowering your risk factors also helps. Steps you can take include:

• Finding ways to reduce or manage stress
• Quitting smoking
• Managing any sleep disorders
• Managing related conditions, like high cholesterol and high blood pressure

Many programs are available to help you live a healthy life and prevent or delay Type 2 diabetes. To find a plan that works for you, talk to your provider. You can also find resources through the National Diabetes Prevention Program.

Can you take medication for prediabetes?

In some cases, your healthcare provider may recommend taking certain oral diabetes medications. The most common medication is metformin.

This is more likely if you:

• Have a BMI of 35 or greater
• Are younger than 60
• Have a history of gestational diabetes
• Have a fasting blood sugar level of 110 mg/dL or higher or an A1C level of 6.0% or higher

But, in general, making changes to your lifestyle has a greater benefit in curbing prediabetes than metformin.

Researchers are currently studying the use of GLP-1 agonists for this condition.

When should I see my healthcare provider?

See your healthcare provider regularly if you have prediabetes or are at increased risk for it. Even if your management plan is currently working, your needs and body may change. So, check in with your provider consistently. They’ll let you know how often to have appointments.

What can I expect if I have this condition?

If you receive a prediabetes diagnosis, your provider will recommend making changes to manage it. This can be overwhelming. But taking it one step at a time can lead you closer to better health.

Without taking action, many people eventually develop Type 2 diabetes. This is often because they don’t know they have prediabetes.

If you still develop diabetes despite making healthy changes, try not to be hard on yourself. It isn’t a disease of a lack of willpower. It involves many complex mechanisms. And the healthy changes you’ve made are still helping protect your well-being.

Is there anything I can do to feel better?

Other things you can do to help make life with prediabetes a little easier include:

• Educating yourself and loved ones: Diabetes is complex, and many things affect blood sugar levels. Do your best to learn about prediabetes from reliable sources. The more your loved ones know about the changes you’re making to help your health, the more they can support you.
• Taking care of your mental health: This diagnosis can make you feel all sorts of emotions, especially because of the widespread stigma about diabetes. Consider seeing a mental health professional.
• Joining support groups: Talking with people going through the same challenges can help you feel part of a community.
• Making a plan: Focus on one goal or healthy change at a time. Too many changes at once can be overwhelming.
• Being kind to yourself: Changing habits is difficult. It likely won’t be a straightforward path to healthier habits. This is OK and expected. Value progress over perfection. Any positive change is helpful.

Can prediabetes be prevented?

The strategies for preventing prediabetes are the same as for preventing or delaying Type 2 diabetes:

• Exercising regularly
• Maintaining a weight that’s healthy for you
• Eating nutritious food
• Not smoking

You may have such strong genetic risk factors that even healthy changes aren’t enough to prevent prediabetes.