If your doctor tells you you have prediabetes, a lot of questions might start racing through your head. How did I get here? Is it serious? And when does prediabetes become full-on type 2 diabetes? The first thing to know if you find yourself in this situation is that you’re not alone. Prediabetes is surprisingly common—more than 1 in 3 American adults has the condition, according to the Centers for Disease Control and Prevention (CDC). Yet eight out of ten of them don’t know it because there aren’t a lot of obvious symptoms.
In simple terms, prediabetes is just what it sounds like; It’s a precursor to diabetes when a person has elevated blood sugar levels. It’s not something to ignore. Being prediabetic raises your risk of developing type 2 diabetes—often within five years if left untreated, according to the CDC—as well as heart disease and stroke. But you don’t have to become part of those statistics. If it’s caught early and addressed, prediabetes is often reversible.
Here we’ll break down how to identify your risk factors, get tested, and steps you can take to reduce the chance that it progresses.
Of several available blood tests, the one that’s most often used to diagnose and manage prediabetes and diabetes is an A1C or hemoglobin A1C.
This test gives your doctor a glimpse of your average blood sugar levels over the past 2 to 3 months. The good thing about an A1C test is that you can take it anytime without fasting beforehand.
It specifically measures the percentage of glycated hemoglobin in your blood cells. When blood sugar levels are elevated, some sugar sticks to hemoglobin—a protein in red blood cells responsible for carrying oxygen to your body’s tissues. That’s known as glycated hemoglobin. A glycated hemoglobin level between 5.7 percent and 6.4 percent generally indicates prediabetes:
Normal: Below 5.7%
Prediabetes: 5.7% to 6.4%
Diabetes: 6.5% or above
A complicated mix of genetic and lifestyle factors plays a role in the development of both prediabetes and diabetes. Ultimately, the former advances into the latter when the body doesn’t make enough insulin to maintain normal blood sugar levels.
It’s worth noting that, though the two are related, prediabetes is different from insulin resistance. To recap: Prediabetes is when blood sugar levels are higher than normal but not yet high enough to classify as type 2 diabetes.
Insulin is a hormone that’s naturally produced in the pancreas to help regulate blood sugar and keep it within a normal range. When the body doesn’t respond to the effects of insulin in the usual way—and the pancreas has to crank out more of it to maintain blood sugar—that’s known as insulin resistance.
Insulin resistance alone may not have any symptoms at first, according to the American Diabetes Association. But it often worsens over time, and the pancreas cells that produce insulin start to wear out. The resulting spike in blood sugar levels can lead to prediabetes and, eventually, full-fledged type 2 diabetes. And there are some symptoms that could indicate that the condition has progressed, including:
Numbness in the feet
Excess body weight is one of many risk factors associated with an increased risk of developing insulin resistance, prediabetes, and diabetes. They include:
Family history with a first-degree relative with type 2 diabetes
Age: 45 years or older
History of gestational diabetes
Physical inactivity/sedentary lifestyle
Eating a diet high in processed foods
Certain ethnicities: African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander American
Polycystic ovary syndrome (PCOS)
The biological mechanisms that actually cause diabetes are still being studied. But we do know that obesity is a risk factor for insulin resistance and that insulin resistance is a risk factor for developing diabetes. Here are some other key points about the connection between body weight and diabetes:
The big picture matters. Obesity has been linked to a variety of health problems, including heart disease, stroke, and certain cancers. People with diabetes are at higher risk for cardiovascular disease.
Fat distribution may play an important role. Abdominal fat—also known as visceral fat—in both men and women appears to be linked to low-grade inflammation and related to the development of cardiovascular disease and type 2 diabetes, according to one 2019 review.
Losing even a small amount of weight has an impact. Dropping just 5 to 7 percent of your body weight can improve insulin sensitivity and reduce your risk of developing diabetes. For a 200-pound person, that’s about 10 to 14 pounds.
Being overweight doesn’t cause diabetes. Even people who don’t have obesity or excess overweight can have insulin resistance and develop prediabetes and type 2 diabetes.
Now for the good news. Certain risk factors (like age and family history) are completely out of your control. But you can take action when it comes to lifestyle risk factors, including what you eat and how much you move your body, which can, in turn, help lower your risk of developing insulin resistance, prediabetes, and diabetes.
1. Get tested
If you think you’re at risk, ask your doctor to test your hemoglobin A1C level. If you’re over 35, this screening should be part of your yearly exam anyway. Not sure where you stand? Assess your risk with the American Diabetes Association’s quick online test.
2. Maintain a healthy weight
As mentioned above, losing a modest amount of weight can help keep blood sugar levels in check and reduce your risk of developing diabetes. Those who are at high risk for type 2 diabetes can prevent or delay the onset by losing just five to seven percent of their body weight, according to the Diabetes Prevention Program (DPP), a national study with thousands of participants.
3. Move more
Aside from excess body weight, researchers from the DPP concluded that sedentary behavior is the other biggest lifestyle risk factor for diabetes. So start with the goal of reducing sedentary activities, like sitting in front of the TV, and moving more. Work toward at least 30 minutes of physical activity five days a week. If you haven’t been active, talk to your doctor about how to get started safely.
4. Eat a healthy diet
The dietary advice you hear again and again for overall health applies here, too. Eating more fiber, whole grains, fruits, and vegetables, aiming for smaller portions, and choosing water over sweetened beverages can help lower your risk of diabetes.
5. Manage stress
Even if you eat right and move more, chronic stress can trigger certain hormonal changes in the body that increase your appetite and lead to weight gain. While stress will always be a part of life, you can take steps to cope with it. Finding what works for you—rest, practicing good sleep hygiene, meditation, stretching, journaling, and movement—can go a long way toward keeping stress in check, promoting overall wellness, and helping you maintain a healthy weight.
6. Prioritize sleep
You probably already know that prioritizing sleep is good for mental and physical health. It turns out sleep also impacts your blood sugar levels: A 2017 meta-analysis found that poor sleep quality is associated with higher A1C and impaired metabolic function in people with type 2 diabetes.
7. Take medication if you need it
In some cases, your doctor will prescribe medication like metformin—which can lower blood sugar—to help prevent prediabetes from progressing into diabetes. A follow-up of the DPP study showed that people who made lifestyle changes (including moving more and eating healthy foods) or who take metformin could prevent or delay the onset of type 2 diabetes for at least 15 years.
Prediabetes is a common but complex condition. We recommend working closely with your doctor to monitor your blood sugar levels and build a treatment plan tailored to your specific needs. While prediabetes might progress into type 2 diabetes, many people can help keep the condition in check with lifestyle changes like moving their body more and losing a small amount of body weight.
Found is among the largest medically-supported weight care clinics in the country, serving more than 200,000 members to date. To start your journey with Found, take our quiz.