Prediabetes is one of the most common and underdiagnosed conditions in the United States. It means your blood sugar is higher than normal, but not yet high enough to be classified as type 2 diabetes. The catch: most people with prediabetes have no symptoms at all and do not know they have it.
Here is the important part: prediabetes does not have to become diabetes. With the right lifestyle changes, many people can bring their blood sugar back to a healthy range and significantly reduce their risk of developing type 2 diabetes. This guide covers everything you need to know.
What Is Prediabetes?
Prediabetes occurs when the body does not process glucose (blood sugar) as efficiently as it should. Glucose comes primarily from the food you eat. After digestion, it enters the bloodstream, where insulin (a hormone produced by the pancreas) helps move it into cells for energy.
In prediabetes, one or both of the following problems occur: the pancreas does not produce enough insulin, or cells have become resistant to insulin and do not absorb glucose as well. The result is blood sugar that runs higher than normal, but not yet in the diabetes range.
While prediabetes itself may not cause obvious symptoms, it can already begin to cause damage to the heart, blood vessels, and kidneys, even before a diabetes diagnosis is made.
Note: Prediabetes is reversible. Unlike type 2 diabetes, it can often be fully corrected through lifestyle changes alone.
Prediabetes Symptoms: What to Watch For
Prediabetes typically has no clear symptoms, which is why so many cases go undetected. One possible physical sign is darkened skin in areas such as the neck, armpits, or groin, a condition called acanthosis nigricans.
If prediabetes has progressed closer to type 2 diabetes, you may begin to notice these type 2 diabetes symptoms:
- Increased thirst
- Frequent urination
- Increased hunger
- Fatigue
- Blurred vision
- Numbness or tingling in the hands or feet
- Slow-healing cuts or sores
- Frequent infections
- Unexplained weight loss
Note: If you notice any of these symptoms, do not wait. See a provider and ask for a blood sugar test. These symptoms can indicate that prediabetes has already progressed to type 2 diabetes.
Risk Factors for Prediabetes
Several factors increase the likelihood of developing prediabetes. Many are the same as those for type 2 diabetes:
- Being overweight, especially with excess fat around the abdomen
- Waist size above 40 inches for men or 35 inches for women
- Physical inactivity or a largely sedentary lifestyle
- Eating a diet high in red meat, processed meat, or sugary beverages
- Age 35 or older (though risk exists at any age)
- Family history: a parent or sibling with type 2 diabetes
- Certain racial and ethnic backgrounds including Black, Hispanic, Native American, and Asian American populations
- History of gestational diabetes during pregnancy
- Polycystic ovary syndrome (PCOS)
- Obstructive sleep apnea
- Smoking or tobacco use
- High blood pressure, low HDL cholesterol, or high triglycerides
Note: Having three or more of the conditions listed above (high blood pressure, low HDL, high triglycerides, high blood sugar, large waist size) together is known as metabolic syndrome, which significantly raises the risk of both diabetes and heart disease.
How Is Prediabetes Diagnosed?
Prediabetes is diagnosed through blood tests. There are no symptoms to rely on, which is why screening is so important. The most common tests are:
A1C Test: Measures your average blood sugar over the past 2 to 3 months. – Below 5.7% is normal – 5.7% to 6.4% indicates prediabetes – 6.5% or higher on two separate tests indicates diabetes
Fasting Blood Sugar Test: Taken after at least 8 hours of not eating. – Below 100 mg/dL is normal – 100 to 125 mg/dL indicates prediabetes – 126 mg/dL or higher on two tests indicates diabetes
Oral Glucose Tolerance Test: You drink a sugary liquid and blood sugar is tested over two hours. – Below 140 mg/dL after two hours is normal – 140 to 199 mg/dL indicates prediabetes – 200 mg/dL or higher suggests diabetes
Note: The American Diabetes Association recommends blood sugar screening starting at age 35 for most adults, and earlier for people who are overweight and have additional risk factors.
Prediabetes in Children
Type 2 diabetes and prediabetes are increasingly common in children and teenagers, largely due to rising rates of childhood obesity. The same blood sugar ranges that apply to adults apply to children as well.
The American Diabetes Association recommends testing children who are overweight or obese and have at least one additional risk factor, such as a family history of type 2 diabetes, being born to a mother who had gestational diabetes, or belonging to a higher-risk racial or ethnic group.
Children diagnosed with prediabetes should be tested annually for type 2 diabetes, or sooner if they experience significant weight gain or develop symptoms such as increased thirst, frequent urination, or fatigue.
Complications of Untreated Prediabetes
Many people think prediabetes is harmless since it is not yet full diabetes. That is not accurate. Even at the prediabetes stage, elevated blood sugar can begin to cause long-term damage, including:
- Heart disease and increased risk of silent (unrecognized) heart attacks
- Stroke
- High blood pressure
- Kidney damage
- Nerve damage
- Fatty liver disease
- Eye damage that can affect vision
Note: If prediabetes progresses to type 2 diabetes, the risk of all of these complications increases significantly.
How to Reverse Prediabetes
The most effective treatment for prediabetes is lifestyle change. Research shows that modest, consistent changes can bring blood sugar back to a healthy range and prevent or significantly delay type 2 diabetes.
Key steps include:
Eat a Healthier Diet: Focus on fruits, vegetables, whole grains, nuts, and healthy fats like olive oil. Cut back on red meat, processed foods, sugary drinks, and refined carbohydrates. Reducing portion sizes and eating on a consistent schedule also helps stabilize blood sugar.
Get More Active: Aim for at least 150 minutes of moderate aerobic activity per week (brisk walking, swimming, or cycling) or 75 minutes of vigorous activity. Breaking up long periods of sitting with short walks every 30 minutes also makes a meaningful difference.
Lose Excess Weight: Losing just 5 to 7 percent of your body weight (roughly 10 to 14 pounds for someone weighing 200 pounds) can cut the risk of developing type 2 diabetes by more than half.
Stop Smoking: Quitting smoking improves how insulin works in the body and directly lowers diabetes risk.
Manage Blood Pressure and Cholesterol: High blood pressure and cholesterol often accompany prediabetes and compound cardiovascular risk. Diet, exercise, and medication if prescribed can help keep these in check.
Note: These changes do not need to be drastic to be effective. Small, sustainable habits over time produce real results.
Medications for Prediabetes
Lifestyle change is the first-line treatment for prediabetes. However, for adults at high risk who are not able to achieve results through lifestyle changes alone, a provider may prescribe metformin (Glumetza, Fortamet) or other diabetes medications. Metformin helps the body use insulin more effectively and reduces the amount of glucose the liver releases into the blood.
For children with prediabetes, medication is generally not recommended unless lifestyle changes have not improved blood sugar levels over time.
Alternative supplements like cinnamon, ginseng, magnesium, and flaxseed have been discussed in some studies, but there is no definitive evidence that any of them reliably reverse prediabetes. Always talk to your provider before adding any supplement, as some can interact with medications.
Note: Medication is a support tool, not a substitute for lifestyle change. The two work best together.
Questions to Ask Your Doctor About Prediabetes
If you have been told you have prediabetes or are concerned about your blood sugar, our primary care services team can help — here are helpful questions to bring to your appointment:
- How can I prevent prediabetes from turning into type 2 diabetes?
- Do I need medication, or can I manage this with lifestyle changes?
- How much weight do I need to lose to make a difference?
- How many minutes of exercise do I need each week?
- Should I avoid certain foods or limit sugar?
- Do I need to see a dietitian or diabetes educator?
- How often should I come in for blood sugar testing?
Are there local programs or resources to help me make these changes?