Prediabetes is a stage between having a normal metabolic state and diabetes. Diabetes occurs when your body does not respond to or cannot produce enough insulin, a hormone made in the pancreas, causing the glucose in your blood to be higher than normal. Glucose is a sugar that all cells in your body need. Prediabetes is when glucose is slightly higher than normal, but not high enough to be diabetes.
Somewhere around 96 million American adults have prediabetes. That's more than one in three people. Prediabetes is considered a serious health condition. It can put you at risk of developing type 2 diabetes, heart disease, and stroke.
While not all of the causes of prediabetes are in your control, the good news is that some of them are. Making the lifestyle choices outlined below may help you reduce your risk of prediabetes or at least delay the onset of type 2 diabetes.
Prediabetes often shows up without any symptoms at all. In fact, more than 80% of people with prediabetes don't even know they have it.
However, a small number of people may notice some symptoms, including:
- Darkened skin in the armpit or on the back and sides of the neck
- Small skin growths in the armpit or on the back and sides of the neck
- High BMI
Body Mass Index
Body mass index, or BMI, is a biased and outdated metric that uses your weight and height to make assumptions about body fat, and by extension, your health. This metric is flawed in many ways and does not factor in your body composition, ethnicity, sex, race, and age. Despite its flaws, the medical community still uses BMI because it’s an inexpensive and quick way to analyze health data.
Prediabetes can happen for different reasons. Some people start to develop insulin resistance, which is when cells in your muscles, fat, and liver don’t respond well to insulin and, therefore, have a hard time using glucose from your blood. Insulin helps lower glucose levels in the blood. When the body doesn't respond well to that insulin, the pancreas produces even more insulin to compensate.
Sometimes the beta cells in the pancreas—the cells that produce insulin—can't make enough insulin to keep up. When insulin isn't working right or there isn't enough being made, more glucose stays in the bloodstream than normal (prediabetes). Over time, this can lead to type 2 diabetes.
Genetic and lifestyle factors can increase your risk of developing prediabetes. Your risk of prediabetes may go up if you:
- Are overweight or obese
- Are aged 45 years or older
- Have a parent or sibling with diabetes
- Are physically inactive
- Have health conditions like high blood pressure or high cholesterol
- Have gestational diabetes (diabetes when you're pregnant)
- Have a history of heart disease or stroke
- Have metabolic syndrome
- Have polycystic ovary syndrome (PCOS)
How Is Prediabetes Diagnosed?
To diagnose prediabetes, healthcare providers need to test your blood. The two most common tests are the fasting plasma glucose (FPG) test and the A1C test.
- Fasting plasma glucose (FPG) test: This test measures blood glucose at a single moment in time. You'll be asked to fast for 8 to 12 hours before taking it (that means no food or drinks other than water). A normal result is 99 milligrams or less per deciliter. Prediabetes is when blood glucose is between 100 and 125 milligrams per deciliter. Type 2 diabetes is anything over 126.
- A1C test: This test can tell what your average blood glucose has been for the past three months. Normal blood glucose in the A1C test is less than 5.7%. Prediabetes is from 5.7% to 6.4%. Type 2 diabetes is 6.5% and above.
Treatments for Prediabetes
Early treatment can help prevent unwanted effects on blood vessels. Injuries to blood vessels can lead to damage to organs like your heart, kidney, and eyes. Treatment is focused on lifestyle changes, like getting 30 minutes of exercise a day, but sometimes medication is needed.
Diabetes and prediabetes are very similar. You can treat prediabetes in the same way as you would prevent it because, ultimately, you're also trying to prevent type 2 diabetes.
Luckily, it's possible to prevent prediabetes. If you have prediabetes, you can follow these same prevention tips to delay type 2 diabetes from starting. Here's how to reduce your chances of prediabetes:
- Maintain a healthy weight: Being overweight or obese tends to increase your chances of developing type 2 diabetes, but it's by far not the only thing that counts. Many people who are an average weight or are somewhat overweight also develop type 2 diabetes.
- Make healthy food choices: This means eating plenty of non-starchy vegetables, limiting added sugar in foods and drinks, choosing whole grains over refined grains, and avoiding highly processed foods when possible.
- Be physically active: It is recommended to get 150 minutes of exercise a week, or 30 minutes five days a week. Exercise makes your cells more sensitive to insulin, meaning they'll be better able to remove glucose from your bloodstream.
- Don't smoke: If you smoke, quitting is one of the best things you can do for your health. If you don't smoke, don't start. Smoking damages blood vessels, the heart, lungs, and so many other organs—it's even harmful to your skin.
By making these adjustments to your lifestyle, you can greatly increase your chance of preventing prediabetes and other health conditions.
However, these changes won't work for everyone. When they don't work, medications can be used to manage prediabetes. The most common medication used is metformin (Fortamet, Glucophage, Glumetza, Riomet).
People who develop prediabetes are more likely to develop not only type 2 diabetes, but also other health conditions. Prediabetes puts people at increased risk of developing cardiovascular disease and stroke. If you are diagnosed with prediabetes, it is recommended to get tested for type 2 diabetes every one to two years.
Living With Prediabetes
If you've already been diagnosed with prediabetes, know that it is possible to reverse it. Following the prevention methods we shared can delay the onset of type 2 diabetes and even prevent it completely. However, keep in mind that this doesn't happen overnight; be patient with yourself and your progress. By exercising regularly, eating a balanced diet, not smoking, and managing your weight, you can live a long, healthy life.
If these are significant lifestyle changes for you, work with your healthcare team to get the support you need. A dietitian can help you find a diet that works with your lifestyle, and a physical therapist or personal trainer can help you with a workout routine. It also doesn't hurt to enlist your loved ones in holding you accountable and joining you in your activities.
Centers for Disease Control and Prevention. Prediabetes – Your chance to prevent type 2 diabetes.
Alvarez S, Coffey R, Algotar AM. Prediabetes. In: StatPearls. StatPearls Publishing; 2022.
National Institute of Diabetes and Digestive and Kidney Diseases. Insulin resistance & prediabetes.
American Diabetes Association. Myths about diabetes.
American Diabetes Association. Fitness.
American Diabetes Association. Quit smoking.