What is prediabetes?
Prediabetes is a condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. It is considered a precursor to developing full blown diabetes. With prediabetes, the pancreas is still able to produce enough insulin to prevent extremely high blood sugar levels. However, the body’s cells have become somewhat resistant to the effects of insulin and cannot properly regulate glucose levels like they used to. This results in moderately elevated blood sugar. Prediabetes is sometimes referred to as impaired glucose tolerance or impaired fasting glucose, depending on which test showed abnormal results.
Around 88 million American adults have prediabetes, which is over 1 in 3. The majority of people with prediabetes are unaware they have it. Without making lifestyle changes to improve blood sugar control, 15-30% of people with prediabetes will develop type 2 diabetes within 5 years. However with early detection and intervention, the onset of diabetes can be delayed or prevented.
Some risk factors that increase the likelihood of developing prediabetes include:
- Being overweight or obese
- Family history of type 2 diabetes
- Physical inactivity
- Advancing age (risk increases after age 45)
- Gestational diabetes during pregnancy
- Polycystic ovary syndrome (PCOS)
- High blood pressure
- Abnormal cholesterol – high triglycerides and low HDL (“good”) cholesterol
- Sleep apnea
- Fatty liver
- Ethnic background – greater risk for African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans
Common symptoms
In the early stages, prediabetes usually has no obvious physical symptoms. As it progresses, the following may be experienced:
- Increased thirst and need to urinate frequently
- Blurry vision
- Fatigue
- Increased hunger
- Frequent infections
- Slow healing of cuts or wounds
- Tingling, pain, or numbness in hands or feet
- Itching skin
- Darkening of skin in folds and creases of the body
However, many people with prediabetes can go years without noticing any signs or symptoms at all. The only way to detect it is through blood tests for blood sugar and A1C levels.
Diagnosis and testing
Prediabetes is diagnosed through blood tests that measure current blood sugar levels and average blood sugar over the past 2-3 months.
The main tests are:
- Fasting blood glucose – blood sugar measured after fasting for at least 8 hours. Prediabetes range is 100-125 mg/dL.
- Oral glucose tolerance test – blood sugar measured 2 hours after drinking a sugar solution. Prediabetes range is 140-199 mg/dL.
- A1C – reflects average blood sugars over 2-3 months. Prediabetes range is 5.7-6.4%.
Meeting the range for any one of these tests confirms a diagnosis of prediabetes. The higher the results, the greater the risk of eventually developing type 2 diabetes.
Some other blood tests may include:
- Cholesterol levels
- Kidney function
- Liver enzymes
- C-reactive protein (inflammation marker)
These help identify any potential diabetes-related complications earlier so they can be treated promptly.
Complications of prediabetes
Although prediabetes is still a milder condition compared to full blown diabetes, it can already lead to damage to the body after 5-10 years if left uncontrolled. Potential complications include:
- Heart disease and stroke – Chronic high blood sugar levels stiffen the arteries and make clots more likely to form. This increases risk of heart attack and stroke.
- Nerve damage (neuropathy) – Excess sugar can injure the walls of the tiny blood vessels that supply the nerves, especially in the legs and feet.
- Kidney disease (nephropathy) – The kidneys contain millions of tiny blood vessel clusters that filter waste. High blood sugar can damage this delicate filtering system.
- Eye damage (retinopathy) – Similar to the kidneys, the eyes have a dense network of tiny blood vessels that are affected by prolonged high blood sugar.
- Foot damage – Nerve injury combined with reduced circulation can lead to foot ulcers, deformities, and amputations.
That’s why it’s crucial to treat prediabetes early. The progression to diabetes and related problems can be delayed or avoided altogether.
Treatment
Reversing prediabetes and restoring normal blood sugar levels is very achievable, especially when caught early. Treatment focuses on lifestyle changes rather than medications:
- Weight loss – Losing just 5-10% of body weight can lower blood sugar significantly.
- Healthy diet – Focus on whole, unprocessed foods. Choose lean proteins, fiber-rich produce, and healthy fats.
- Exercise – Aim for 30 minutes of moderate activity most days. This helps with weight loss and improves insulin sensitivity.
- Stress management – Chronic stress promotes high cortisol levels, which raise blood sugar.
- Sleep – Getting adequate sleep normalizes metabolic hormones and blood sugar control.
Checking blood sugar periodically helps monitor if lifestyle interventions are working. Medications like metformin may be added if blood sugars remain very elevated despite following medical nutrition therapy and increasing physical activity.
Reversal is possible
With diligent lifestyle changes and weight loss of 5-10%, prediabetes can be reversed in over 50% of cases. Blood sugars can be restored to normal, or at least kept from progressing to diabetes. Even small amounts of weight loss and exercise have big impacts for improving insulin resistance and blood sugar regulation.
Don’t wait until it turns into full type 2 diabetes to take action. The most powerful time to intervene is during the early prediabetes stage, where progression can often be halted or reversed. Lifestyle habits established now will continue paying off for the rest of your life.
Making lifestyle changes
Turning prediabetes around requires reevaluating daily habits:
Nutrition:
- Reduce sugar, refined grains, fast food, and processed foods
- Eat more vegetables, fruits, nuts, beans, whole grains, fish, and lean poultry
- Choose healthy fats like olive oil, avocados, nuts, and salmon
- Limit carbohydrates to about 45% of daily calories
- Spread meals out – eat smaller portions about every 4-5 hours
- Drink water instead of sugary beverages
Exercise:
- Get at least 150 minutes per week of moderate activity like brisk walking
- Incorporate 2-3 days of strength training for muscle development
- Take more steps each day by parking farther away, taking stairs, pacing during phone calls, etc.
- Try higher intensity interval training a few times a week
- Sit less – take breaks to walk around every 30-60 minutes
Other:
- Aim for 7-9 hours of sleep per night
- Manage stress with meditation, yoga, deep breathing, etc.
- Stay connected socially with friends and family
- See your healthcare provider regularly to monitor blood sugar changes
Making even small steps toward these habits creates positive momentum. Over time, prediabetes can be reversed and the threat of diabetes minimized.
Sample meal plan
Here is a sample 1-day meal plan following a prediabetes-friendly diet:
| Meal | Foods |
|---|---|
| Breakfast | Oatmeal made with low-fat milk, walnuts, and berries |
| Snack | Hard boiled egg and apple slices |
| Lunch | Grilled chicken sandwich on whole grain bread with lettuce, tomato, and mustard + side salad |
| Snack | Low-fat Greek yogurt with almonds |
| Dinner | Baked fish, brown rice, and steamed broccoli |
| Snack | Baby carrots and hummus |
This provides balanced protein, fiber-rich grains, produce, and healthy fats for optimal blood sugar control. The meal spacing helps prevent energy crashes or cravings. Staying hydrated with water and unsweetened drinks is also key.
Supplements that may help
Certain supplements may help improve insulin sensitivity and blood sugar management in prediabetes. However, lifestyle interventions should still be the foundation. Potential beneficial supplements include:
- Chromium – Improves insulin efficiency and glucose metabolism
- Alpha lipoic acid – Potent antioxidant that protects insulin-producing cells
- Berberine – Reduces production of glucose in the liver
- Cinnamon – Helps glucose enter cells more readily
- Curcumin – Anti-inflammatory that may improve insulin resistance
- Magnesium – Supports healthy blood sugar regulation
Consult a doctor before taking supplements to ensure safety and correct dosing.
Tracking progress
To monitor the effectiveness lifestyle changes and treatments, regular testing of the following biomarkers is recommended:
| Test | Frequency |
|---|---|
| Fasting glucose or A1C | Every 3-6 months |
| Blood pressure | Every doctor visit |
| Kidney function | Every 6-12 months |
| Eye exam | Annually |
| Foot exam | Annually |
| Weight | Weekly |
Tracking blood sugar levels, kidney function markers, blood pressure, and body weight helps assess if interventions are keeping prediabetes under control or if treatment needs to be adjusted. Regular eye and foot exams look for early signs of diabetic complications.
When to see your doctor
Contact your doctor promptly if you experience:
- Blurred vision
- Numbness or tingling in hands or feet
- Increased thirst and urination
- Unexplained weight loss
- Sores or cuts that won’t heal
- Recurrent infections
These could indicate your blood sugar management needs adjustment. Monitoring and managing prediabetes early on with your healthcare provider gives you the best chance of preventing progression to type 2 diabetes.
Long term outlook
By making lifestyle modifications and keeping up with recommended testing, people with prediabetes have an excellent chance of halting disease progression and reducing diabetes risk.
One study found that over a 10 year period, 50% of people with prediabetes were able to revert back to normal blood sugars through diet, exercise and modest weight loss. Only 5-10% went on to develop diabetes.
With diligent lifestyle interventions, the long term outlook for prediabetes is very promising. Risk of eventual kidney failure, blindness, amputations and cardiovascular disease can be significantly lowered. Committing to healthy daily habits leads to big rewards down the road.
The takeaway
Prediabetes is a common but reversible condition where blood sugar is elevated, but not yet high enough for a diabetes diagnosis. Without lifestyle changes, many people with prediabetes will advance to type 2 diabetes within 10 years. But the good news is diabetes prevention is very achievable with modest weight loss, nutrition improvements, more activity, and other healthy habits. These not only help normalize blood sugars, but lower future risk of complications like heart disease, nerve problems, and kidney damage. With proper prevention and management strategies, prediabetes can be overcome. Don’t wait – start optimizing your daily habits today and take control of your health.