Prediabetes is a condition where blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. It is an important warning sign that action is needed to prevent type 2 diabetes. But the good news is that catching it early can help you reverse it and prevent diabetes.
If you or a loved one has prediabetes or are at risk, it's time to take action. With the help of UPMC's care team, you can stop prediabetes in its tracks.
On this page:
What Is Prediabetes?
Prediabetes is a warning sign that your body isn't metabolizing glucose (sugar) correctly.
Prediabetes glucose levels are higher than normal levels, but not as high as those in someone with diabetes. They approach the borderline diabetic range. Prediabetes increases your risk of developing type 2 diabetes and raises your risk of heart disease and stroke over time.
One in three adults in the United States has prediabetes. More than 80% of those with prediabetes don't know they have it. Without lifestyle changes, many people with prediabetes develop type 2 diabetes within five years.
What causes prediabetes?
Prediabetes forms when your pancreas doesn't make enough insulin or your cells become resistant to insulin (or sometimes both).
Insulin's job is to get sugar from your blood into your cells. Too much sugar stays in your bloodstream when insulin doesn't work well.
Prediabetes risk factors
The risk factors for prediabetes include:
- A history of gestational diabetes — If your baby weighed more than 9 pounds at birth or you had gestational diabetes while pregnant, you're at increased risk.
- A large waist size — The risk increases for men with waists larger than 40 inches and women with waists larger than 35 inches.
- Age — Although you can get diabetes at any age, the risk of prediabetes increases after age 45.
- Diet — Consuming sugar-sweetened drinks, sweets, and desserts, packaged snack foods, and fast foods causes weight gain, which increases your risk.
- Family history of type 2 diabetes — Prediabetes and type 2 diabetes often run in families due to genes or lifestyle.
- Having polycystic ovary syndrome (PCOS) — This common condition increases women's risk of prediabetes.
- Overweight — The more fatty tissue you have, the more resistant your cells become to insulin.
- Poor sleep — Disrupted sleep, as with sleep apnea or shift work, increases the risk of insulin resistance.
- Race — In the United States, prediabetes and type 2 diabetes are more common among African American, Hispanic/Latino, Native American, Asian American, and Pacific Islander populations.
- Sedentary lifestyle — Sitting too much can also cause weight gain and muscle loss. This makes your cells less sensitive to insulin.
Complications of prediabetes
Left undiagnosed or unmanaged, prediabetes increases your risk of getting diabetes, a serious chronic health condition that can lead to:
- Blindness or vision problems.
- Heart attack.
- Kidney failure.
- Loss of your toes, feet, or legs.
- Stroke.
Diabetes is also the eighth leading cause of death in the U.S.
How can I reduce my risks of prediabetes?
If you’re at risk for prediabetes, you can make lifestyle changes to get healthier. And if you’ve already been diagnosed with prediabetes, you may be able to turn things around with diet and exercise.
Research shows that it’s never too late to gain health benefits by making lifestyle changes. The recent Diabetes Prevention Program study showed a 58% overall reduction in diabetes risk after lifestyle changes for people of all ages. In people ages 60 and over, the study showed a 71% risk reduction.
That study also showed that even if you do get diabetes, you can delay its onset. People in the study who made lifestyle changes delayed the onset of diabetes by an average of four years.
There are several lifestyle tweaks that can help reverse the course of prediabetes or at least delay the onset of diabetes. By changing some of your eating habits and getting more exercise, you can bring your blood sugar level back toward normal.
To prevent or delay type 2 diabetes, you can:
- Cut back or eliminate sugary drinks.
- Decrease the amount of processed and fatty foods in your diet.
- Eat fewer refined carbs like white flour and white rice.
- Increase fiber in your diet by eating beans, whole grains, fruits, and vegetables.
- Increase your physical activity to at least 150 minutes per week. That can include walking, jogging, biking, or swimming.
- Lose weight if you need to. Even losing 5% to 7% of your body weight can make a noticeable difference in your blood sugar level.
- Maintain any weight loss through healthy eating and exercise.
- Quit smoking. UPMC offers programs to help you kick the tobacco habit.
What Are the Signs and Symptoms of Prediabetes?
Prediabetes rarely causes symptoms, which is why so many people don't know they have it.
If it progresses to diabetes, your symptoms might include:
- Blurred vision.
- Fatigue.
- Frequent urination.
- Increased hunger.
- Increased thirst.
- Unexplained weight loss.
If you have these symptoms, tell your doctor so they can check your blood sugar. Alert them if you have a family history of diabetes so they can assess your risk and screen you.
How Do You Diagnose Prediabetes?
If you’re at risk for prediabetes, your doctor may order one or more tests. The American Diabetes Association (ADA) recommends that screenings for prediabetes begin at age 35. If a person is overweight and has additional risk factors, they should start earlier.
The tests for prediabetes and diabetes include:
Fasting plasma glucose (FPG) test
The fasting plasma glucose screen checks your blood glucose levels. You need to fast (not eat or drink anything other than water) for eight hours before the test. Health care providers record these scores in terms of milligrams per deciliter (mg/dl).
- Normal results are less than 100 mg/dl two hours after drinking the glucose solution.
- Prediabetes is 100 mg/dl to 125 mg/dl.
- Diabetes is equal to or over 126 mg/dl.
Oral glucose tolerance test
The oral glucose tolerance test (OGTT) is a two-hour test that checks your blood glucose. A provider checks the levels before you drink a glucose solution, and again two hours after you drink it. The results of this test show how your body processes sugar.
- Normal is less than 140 mg/dl.
- Prediabetes ranges from 140 to 199 mg/dl.
- The diabetes range is anything higher than 200 mg/dl.
A1C
This test measures your average blood sugar level over the previous two or three months. Health care providers use it to diagnose prediabetes and diabetes. They also use it to see how your treatment plan is working.
The A1C test works by checking the percentage of blood sugar attached to proteins in red blood cells called hemoglobin. The higher your blood sugar levels, the more sugar you’ll have attached to the hemoglobin.
Health care providers give the results of the A1C test in percentages:
- Normal is less than 5.7%.
- Prediabetes is 5.7 % to 6.4%.
- Diabetes is anything equal to or higher than 6.5%.
Unlike other tests, the A1C does not involve fasting from food or drinks.
How Do You Treat Prediabetes?
Prediabetes treatments focus on diet and lifestyle changes. Depending on your health and risk factors, your doctor may also suggest medicines or weight loss surgery.
At UPMC, we have a team-based approach to prediabetes education and care. We aim to provide tailored treatment for prediabetes with the support and tools you need to stay healthy.
Our team includes:
- Exercise therapists.
- Family practice and internal medicine doctors.
- Mental health specialists.
- Nurses.
- Registered dietitians.
- Certified diabetes care and education specialists.
Lifestyle changes to treat prediabetes
Long-term lifestyle changes can help you lose weight and keep it off.
You may reverse prediabetes by losing 5% to 7% of your starting weight with these techniques:
- Eat a healthy diet most of the time — Eat smaller portions to reduce the calories you eat each day and help you lose weight. Add more fruits and veggies to meals and snacks. And drink water instead of sweetened beverages.
- Eat healthy, high-fiber carbohydrates — These include fruits, vegetables, whole grains, beans, nuts, and seeds. Cut back on foods made with white flour or added sugar.
- Get at least 30 minutes of physical activity five days a week — If you have not been active, ask your doctor which activities are best. Start slowly to build up over time.
- Optimize sleep — Aim for eight hours of restful sleep each night. Going to bed and waking at the same time each day can help you sleep better.
Medicine to treat prediabetes
Most people don't need medicines for prediabetes.
But based on your health history and risk factors, your doctor may suggest:
- Pills that improve insulin sensitivity and reduce glucose production by the liver.
- Injectable medications that improve blood sugar control and may support weight loss.
- Shots to help your insulin work better and promote weight loss.
Weight loss surgery for prediabetes
Weight loss or bariatric surgery may reverse prediabetes in people with severe obesity, especially when lifestyle changes alone have not been successful.
This surgery is effective for people who can't lose weight and keep it off with diet and lifestyle.
