Prediabetes: Everything You Should Know

Prediabetes means your blood sugar numbers are beginning to rise, and you’re at risk for type 2 diabetes. While many people with prediabetes do progress to full diabetes, it’s not a certainty. There are several lifestyle modifications you can make to reverse your prediabetes and reduce your risk for developing type 2 diabetes.

Key takeaways:

Prediabetes is a condition where your blood sugar numbers are higher than normal, but not high enough to be classified as type 2 diabetes. Prediabetes often has no symptoms, so you may not know you have it. According to the Centers for Disease Control and Prevention (CDC), nearly 100 million Americans have prediabetes and 80% of them are unaware that they have it.

Studies demonstrate that 70% of people with prediabetes go on to develop type 2 diabetes, but you can stop or slow that process with careful lifestyle modifications. Learn about prediabetes and what to do if you’ve been diagnosed.

What is prediabetes?

Prediabetes means your blood sugar numbers are higher than normal, and you are at risk for developing type 2 diabetes. Prediabetes is a serious health condition that can also increase your risk for heart attack and stroke. You can have prediabetes for years and not know it because it often has no symptoms.

The common symptoms of type 2 diabetes, such as increased thirst, more frequent urination, and slow-healing wounds aren’t usually seen in prediabetes. One possible symptom of prediabetes is acanthosis nigricans, darkened skin around the neck, groin, or armpits. This is related to insulin resistance, which precedes prediabetes.

Dr. Jeff Stanley, diabetes doctor and medical director at Virta Health explains how prediabetes develops.

When glucose (sugar) levels in the blood start to rise, the body produces insulin, a hormone that helps glucose enter the cells to be used as energy. In the development of prediabetes, your cells don’t respond to insulin as they should (this is called insulin resistance) and the pancreas responds by making even more insulin. Once the pancreas is unable to keep up, glucose levels continue to rise above normal levels and prediabetes develops.

Dr. Jeff Stanley

Who is at risk?

According to the CDC, about one-third of all American adults have prediabetes. The cause of prediabetes is complex, but genetics appear to play a large role because it tends to run in families. Dr. Stanley says, “There are no symptoms for prediabetes, so it’s important to get tested if you’re at risk.”

Prediabetes is most common in people who:

  • Had gestational diabetes (diabetes during pregnancy)
  • Have a parent or sibling with prediabetes or diabetes
  • Have polycystic ovarian syndrome (PCOS)
  • Have high blood pressure
  • Are overweight or obese
  • Have high cholesterol
  • Live a sedentary life
  • Are over 35

Does prediabetes always progress to diabetes?

A diagnosis of prediabetes can be viewed as a warning sign to make changes to your lifestyle before your condition progresses to type 2 diabetes. Many people with prediabetes do go on to develop type 2 diabetes, but there are changes you can make to avoid or delay that outcome.

Dr. Stanley said, “Prediabetes does not always progress to diabetes. In fact, just like type 2 diabetes, prediabetes is reversible. With the right diet and lifestyle changes, many people with prediabetes can lower their blood sugar to normal levels. Without lifestyle changes, prediabetes can, in many cases, progress to type 2 diabetes.”

Recent research conducted by Stanley’s team at Virta Health has shown that by following a carbohydrate-restricted eating pattern, 97% of people with prediabetes were able to avoid progression to type 2 diabetes. Over half of the patients in the trial were able to completely reverse their prediabetes by significantly reducing their carbohydrate intake.

How is prediabetes diagnosed?

The American Diabetes Association recommends prediabetes screening tests for anyone over age 35, and even earlier for people with a family history of diabetes. If you had gestational diabetes during a past pregnancy, you are highly encouraged to get tested for prediabetes. There are three common types of tests for diabetes or prediabetes:

Fasting blood sugar test

A fasting blood sugar test looks at the amount of sugar in your blood at one point in time. It is taken after an overnight fast, or after at least eight hours of not eating or drinking anything but water. Here is what the numbers mean:

NormalLess than 100 mg/dL.
Prediabetes100–125 mg/dL.
DiabetesGreater than 125 mg/dL.

Hemoglobin A1c test

Often shortened to just A1c, this test shows your average blood sugar level over the past three months. The sugar in your blood sticks to a protein called hemoglobin. The A1c test measures how much of your hemoglobin is coated in sugar. This test gives a better overview than one fasting blood sugar reading can. Here is what the numbers mean:

NormalBelow 5.7%
Prediabetes5.7% to 6.4%
DiabetesOver 6.4%

Oral glucose tolerance test

This test determines how well your body uses glucose and moves it into your cells for energy. The test involves checking your blood sugar when you arrive and then giving you a special sugary drink they have there at the doctor's office. Usually two hours after drinking the glucose beverage, your blood glucose is tested again. This is similar to how they test for gestational diabetes in pregnant women. Here is what the numbers mean:

NormalLess than 140 mg/dL.
Prediabetes140-199 mg/dL.
DiabetesGreater than 200 mg/dL.

How to prevent type 2 diabetes

Your healthcare provider will give you information about how to manage your prediabetes. There are several lifestyle modifications you can do to prevent your prediabetes from becoming type 2 diabetes. These include:

Stop smoking

According to the CDC, people who smoke have up to a 40% higher risk of developing diabetes. People with diabetes who smoke need more insulin and have more diabetes complications than people with diabetes who don’t smoke.

Cut your carbs

Foods with carbohydrates, like pasta, bread, sweets, and most junk foods, can impact your blood sugar, making it more likely to progress to type 2 diabetes. For stable blood sugar numbers, focus more on protein and healthy fats.

Dr. Stanley said, “If you find out you have prediabetes, you’ll likely want to change your diet to prevent it from progressing to type 2 diabetes. One of the most studied diets for reversing diabetes and prediabetes is a low-carbohydrate diet. Trying a carb-restricted diet can be very successful in reversing prediabetes and preventing its progression to type 2. You’ll also want to continue to visit your doctor regularly to check your blood sugar levels and make sure the condition is not worsening.”


According to the American Diabetes Association, regular exercise makes your body’s cells more sensitive to insulin, which can lower the glucose circulating in your blood. Exercise can help your blood sugar numbers to be more stable.

Prediabetes and type 1 diabetes

According to the CDC, less than 10% of people with diabetes have type 1, but that still includes over nine million people worldwide. Most of the time, prediabetes is talked about in the context of type 2 diabetes. We spoke with Dr. Matthias von Herrath, Scientific Director of the Diabetes Research Institute. He studies type 1 diabetes and explained that there are signs of prediabetes for type 1 as well.

He says, "What many don't know is that prediabetes can be associated with a case of type 1 or type 2 diabetes or a mix of both. People normally think that prediabetes is found in patients that are at high risk for developing type 2 diabetes since it is more common, but similarly, there is also now a detectable type 1 prediabetes, that can be screened for by autoantibodies.”

He explains that the screening for type 1 prediabetes, which checks for specific autoantibodies in your blood, allows physicians to help you take steps to delay developing symptoms of type 1 diabetes.

It's important for the public to be educated on prediabetes symptoms for both type 1 and type 2 to receive necessary medical advice, interventions, and care.

Dr. Matthias von Herrath

The autoantibodies signal that your immune system is attacking your pancreas' insulin-making cells. People who have a blood relative with type 1 diabetes are at an increased risk of developing the disease and are encouraged to get screened.

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