Prediabetes

What is prediabetes?

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

Healthy blood sugar (glucose) levels are 70 to 99 milligrams per deciliter (mg/dL). If you have undiagnosed prediabetes, your levels are typically 100 to 125 mg/dL.

According to the American Diabetes Association, for people 45 years old with prediabetes, the 10-year risk of developing Type 2 diabetes is 9% to 14%. The good news is that it’s possible to reverse prediabetes with healthy lifestyle changes.

How common is prediabetes?

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

More than 80% of people with prediabetes don’t know they have it, as it often has no symptoms.

What are the symptoms of prediabetes?

Most people with prediabetes don’t have any symptoms. This is why it’s important to see your primary care provider regularly so they can do screenings, like a basic metabolic panel, to check on your blood sugar levels. This is the only way to know if you have prediabetes.

For the few people who do experience symptoms of prediabetes, they may include:

• Darkened skin in your armpit or back and sides of your neck (acanthosis nigricans).
• Skin tags.
• Eye changes that can lead to diabetes-related retinopathy.

What causes prediabetes?

The cause of prediabetes is the same as the cause of Type 2 diabetes — mainly, insulin resistance.

Insulin resistance happens when cells in your muscles, fat and liver don’t respond as they should to insulin. Insulin is a hormone your pancreas makes that’s essential for life and regulating blood sugar levels. When you don’t have enough insulin or your body doesn’t respond properly to it, you experience elevated blood sugar levels.

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.

What are the risk factors for prediabetes?

Risk factors for prediabetes include:

• Family history of Type 2 diabetes (parent or sibling).
• Having overweight or obesity (a BMI greater than 25).
• Being physically active fewer than three times a week.
• Being 45 or older.
• Smoking.
• Obstructive sleep apnea.
• Having had gestational diabetes.
• Polycystic ovarian syndrome (PCOS).

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

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

Some of these risk factors you can’t change, like your age and family history (genetics). But others, like physical inactivity and smoking, you can help improve. The more of these risk factors you have, the more likely prediabetes is around the corner — or you already have it.

It’s important to talk to your primary care provider about screening for prediabetes. While it might be mentally easier to avoid finding out, knowing and taking action are very valuable to your long-term health.

What are the possible complications of prediabetes?

The main complication of prediabetes is it developing into Type 2 diabetes. Undiagnosed or undermanaged Type 2 diabetes increases your risk of several complications, like:

• Heart attack and stroke.
• Eye issues (diabetes-related retinopathy).
• Kidney issues (diabetes-related nephropathy).
• Nerve damage (diabetes-related neuropathy).

While it’s possible to reverse prediabetes, it’s typically not possible to reverse diabetes complications. This is why prevention and/or proper management are key.

How is prediabetes diagnosed?

Healthcare providers rely on routine blood test screenings to check for prediabetes. If you have risk factors for prediabetes, your provider may recommend these screenings more often.

The following tests can check for prediabetes:

• Fasting plasma glucose test: This tests your blood after you haven’t had anything to eat or drink except water for at least eight hours beforehand (fasted). Basic metabolic panels and comprehensive metabolic panels include a glucose test. Providers routinely order these to get an overall look at your health.
• A1C test: This test provides your average blood glucose level over the past two to three months.

Your provider would diagnose you with prediabetes if your:

• Fasting plasma glucose test result is 100 to 125 mg/dL (normal is less than 100; diabetes is 126 or higher).
• A1C result is 5.7% to 6.4% (normal is less than 5.7%; diabetes is 6.5% or higher).

How can I reverse prediabetes?

The best way to treat — and potentially reverse — prediabetes is through healthy lifestyle changes. Regularly eating nutritious foods and getting regular exercise can help return your blood sugar to healthy levels and prevent or delay Type 2 diabetes.

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

• Weight loss: Your healthcare provider may recommend trying to lose excess weight to combat insulin resistance and prediabetes. One study revealed that losing 7% of weight can reduce the onset of Type 2 diabetes by 58%.
• Regular activity: Getting regular amounts of moderate-intensity physical activity helps increase glucose usage and improve muscle insulin sensitivity. A single session of moderate-intensity exercise can increase glucose uptake from your blood and into your muscles by at least 40%. This helps lower blood sugar levels. Aim for 30 minutes a day, five days a week, for a total of 150 minutes a week. Try walking or another activity you enjoy.
• Eating changes: Cutting out added sugars, swapping simple carbohydrates for complex carbohydrates and eating more veggies can help your blood sugar return to healthy levels. Your provider will help you find which long-term diet for prediabetes is best for you.

Lowering your risk factors for prediabetes can often get your blood sugar levels back to healthy levels. You might:

• Work with a nutritionist or dietitian to plan healthy eating patterns you can stick with long-term, like the Mediterranean diet.
• Find ways to reduce or manage stress.
• Quit smoking.
• Get a diagnosis for and/or treat any sleep disorders.
• Manage related conditions, like high cholesterol and high blood pressure.
• Find support groups where you can meet other people going through the same challenges.

There are many programs available to help people live healthy lives and reverse prediabetes. To find a plan that works for you, talk to your provider or 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. This is more likely if lifestyle changes haven’t helped improve your blood sugar levels and/or you have multiple risk factors for Type 2 diabetes.

The most common medications providers prescribe for prediabetes are metformin and acarbose.

Can I prevent prediabetes?

The strategies for preventing prediabetes are the same as for reversing it and preventing Type 2 diabetes:

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

Unfortunately, some people have such strong genetic risk factors that even lifestyle changes aren’t enough to prevent developing prediabetes.

What can I expect if I have prediabetes?

If you receive a prediabetes diagnosis, you’ll need to make lifestyle changes to manage or reverse 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 with prediabetes eventually develop Type 2 diabetes. This is often because people don’t know they have prediabetes.

How do I take care of myself if I have prediabetes?

Aside from following your healthcare team’s medical guidance for treating prediabetes, there are other things you can do to help make life with prediabetes a little easier, including:

• Educate yourself: Diabetes is complex, and many things affect blood sugar levels. Do your best to educate yourself on prediabetes and diabetes from reliable sources. And don’t hesitate to ask your healthcare provider questions.
• Educate family and friends: The more your loved ones know about prediabetes and the changes you’re making to help your health, the more they can support you in this journey.
• Take care of your mental health: A prediabetes diagnosis can make you feel all sorts of emotions, especially because of the widespread stigma and misunderstanding about diabetes. If prediabetes is causing you distress, consider seeing a mental health professional, like a psychologist.

It’s also important to remember:

• Changing habits is difficult. It likely won’t be a straightforward path to healthier habits. This is OK and expected.
• Focus on one goal or healthy change at a time. Too many changes at once can be overwhelming.
• Value progress over perfection. Any positive change is helpful change.
• Be kind to yourself.

If you still develop prediabetes or Type 2 diabetes despite making healthy changes, try not to be hard on yourself. Type 2 diabetes 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 health.

When should I see my healthcare provider?

It’s important to 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, it’s important to check in with your provider consistently. They’ll let you know how frequently to have appointments.

What questions should I ask my healthcare provider about prediabetes?

It can be helpful to ask these questions:

• How can I lower my risk for prediabetes and Type 2 diabetes?
• What are the symptoms of Type 2 diabetes?
• What’s a healthy and realistic weight for me to aim for?
• What are some healthy ways to lose weight and keep it off?
• How much physical activity should I do and what kind is best for me?
• What changes can I make to my eating patterns to help prevent or delay Type 2 diabetes?
• Should I see a registered dietitian? If so, who do you recommend?
• Can you refer me to a diabetes prevention program nearby or online?
• Are there any local support groups for people with prediabetes or diabetes?