Prediabetes: Symptoms, Diagnosis & Treatment

The day you’re diagnosed with prediabetes can feel like a remarkably scary day. It can also be a day that motivates you to take action. While type 2 diabetes is a progressive disease (more on that later), there are still many things you can do to improve your blood sugars right away.

In fact, prediabetes is type 2 diabetes in its earliest stages — which is why it shouldn’t be dismissed or taken lightly. You’ve earned the “pre” in front of “diabetes” because while your blood sugar levels are higher than normal, they simply aren’t high enough to qualify for full-fledged type 2 diabetes.

For some, prediabetes and type 2 diabetes is “reversible.” For others, it may not be.

In this article, we’ll look at the symptoms of prediabetes, how it’s diagnosed, how it’s treated, and whether or not it can be “reversed.”

Symptoms of prediabetes

The trickiest part of prediabetes is that the symptoms can be very subtle and easy to ignore for years — until blood sugar levels are high enough to catch your attention.

The surest way to catch prediabetes in its tracks is by scheduling annual check-ups with your primary care doctor and requesting that your HbA1c level be tested. More on A1c’s later….

Like type 2 diabetes, the symptoms of prediabetes are the result of gradually increasing blood sugar levels, insulin resistance, and inadequate levels of insulin.

The most common prediabetes symptoms are:

• increased thirst
• increased hunger
• frequent urination
• dry mouth
• headaches
• feeling tired after meals
• inexplicable weight-gain or weight-loss
• blurry vision

The Centers for Disease Prevention and Control (CDC) report that as few as 10 percent of people with prediabetes are actually aware of their increasing symptoms.

The CDC also estimates that 84 million American — 1 out of every 3 people — has prediabetes, most of whom don’t know it.

Diagnosing prediabetes

The American Diabetes Association qualifies a diagnosis of prediabetes based on your HbA1c and your “fasting” blood sugar level (when you first wake up in the morning) and 2 hours after eating a meal:

• HbA1c: 5.7 to 6.4 percent
• Fasting blood sugar: 100 to 125 mg/dL
• 2 hours after a meal: 140 mg/dL to 199 mg/dL

You can compare those numbers to the blood sugar levels in a non-diabetic:

• Fasting blood sugar (in the morning, before eating): 70 to 90 mg/dL
• 1 hour after a meal: 90 to 130 mg/dL
• 2 hours after a meal: 90 to 110 mg/dL
• 5 or more hours after eating: 70 to 90 mg/dL

Diagnosing prediabetes or type 2 diabetes is actually fairly straight-forward, but the problem is that both you and your doctor may not see an A1c or blood sugar level in the “prediabetes” zone as the red-flag that it truly is.

This is diabetes. It’s just the earlier stages of the disease. You should take action. You should treat it with as much concern as you would if it was diagnosed as “type 2 diabetes.”

To be tested for prediabetes or type 2 diabetes, you’ll need to schedule a check-up with your primary care doctor and ask for these two blood tests: your fasting blood sugar and your HbA1c.

What is your fasting blood sugar?

Simply put, your fasting blood sugar is your blood sugar first thing in the morning before you eat breakfast. Since it’s been typically has been more than 8 hours since your last meal, the fasting blood sugar indicates how your body has managed its blood sugar levels when variables like food are not present.

What is the HbA1c test?

Your HbA1c — also known as A1c — is a blood test that measures the amount of “leftover” glucose (also known as “advance glycogenated end-products or “AGEs”) that have accumulated in your bloodstream during the prior 3 months. The higher your A1c is, the more damage is occurring to your body’s nerve endings and blood vessels in areas like your eyes, your fingers, and toes, and your kidneys.

The more AGEs are present in your blood, the more damage is occurring that can develop into diabetes complications like retinopathy, neuropathy, hair-loss, gastroparesis, dermopathy, and nephropathy.

The higher your blood sugars are each day, the higher your next A1c result will be!

Factors that increase your risk of prediabetes

While mainstream media often depicts type 2 diabetes as the result of being overweight, not exercising, and eating unhealthy food, it is significantly more complex.

There are actually two pathways that lead to prediabetes and type 2 diabetes.

The first is basic insulin resistance, which means your body needs more and more insulin in order to maintain healthy blood sugar levels. At a certain point, the pancreas can’t keep up with the demand, and blood sugars begin to rise.

The second is a genetic disposition that results in the gradual dysfunction and destruction of your pancreas’ beta-cells. Beta-cells play the leading role in insulin production, and many people with type 2 diabetes struggle to actually produce normal amounts of insulin.

Determining which group you are in isn’t easy, or even possible for the average patient.

For patients in this second group, “reversing” diabetes isn’t likely possible, but that doesn’t mean you can’t take steps towards improving your health isn’t worthwhile.

The most important factors that increase your risk of prediabetes are:

• If you are overweight
• If you are age 45 years or older
• If you have a parent or sibling with type 2 diabetes
• If you exercise less than 3 times a week
• If you had gestational diabetes during pregnancy
• If you gave birth to a baby that weighed over 9 pounds
• If you are African American, Hispanic/Latino American, American Indian, Pacific Islander, or Asian Americans. These ethnicities have all shown a higher risk of developing type 2 diabetes.

How to reduce your risk of prediabetes & type 2 diabetes

Whether your diabetes is the result of insulin resistance or genetic beta-cell dysfunction, there are still many things you can do to improve your body’s sensitivity to insulin and prevent or delay the further progression of the condition.

Get moving

The more you exercise, the more calories and glucose your body burns over the course of 24 hours, and the more it burns even afterward when you’re at rest.

Even going for a 15-minute walk every day at lunch is a worthwhile start. Walking is often dismissed as not being intense enough to provide many benefits, but walking is actually a great way to burn fat and calories without increasing your appetite. It’s also very easy on the joints, can be done on a treadmill or outside, and you can set your own comfortable pace.

The next time you come home from work and think, “I’m too tired to exercise,” stop that pattern of thinking and commit to just 15 minutes of movement.

Make a few changes to your diet

Eating a healthier diet doesn’t mean you have to cut out all the things you love. Even making changes to one or two meals a day can have benefits.

For example, maybe you start eating a very green salad loaded with fresh veggies for lunch instead of that footlong sub-sandwich. Or perhaps you start limiting your soda consumption to one can per day instead of 4 cans per day.

Pick a couple of places to make changes so it isn’t quite so overwhelming. Over time, you may find that you want to keep making improvements to other food choices, too. And remember, the goal doesn’t have to be 100 percent perfection. The “80/20 Rule” is great: choosing healthy, real food 80 percent of the time, with 20 percent left for less-than-perfect treats.

Get more sleep

Getting too little sleep has been linked directly to a variety of issues that impact your blood sugars, hunger levels, weight-gain, mood, and cravings.

A lack of sleep — especially a consistent lack of sleep — can take a tremendous toll on your insulin sensitivity, too, which means you’ll need more insulin to regulate your blood sugars than normal. This can easily lead to weight gain, reduced energy, and higher blood sugars over time.

There’s no way around it — your body needs more sleep. Start improving your own sleep habits by setting an alarm or reminder in the evening to ding when you need to begin getting ready for bed.

Lose weight

Easier said than done, certainly, but all of the aforementioned steps towards reducing your risk of diabetes should also help you lose weight.

Extra body fat, quite simply, increases your body’s resistance to insulin. The more extra body fat you have, the more insulin it will take to help your body achieve healthy blood sugar levels. Losing weight also decreases inflammation levels, which decreases insulin resistance, too.

*Do keep in mind: for some, losing weight may be challenging if your diabetes has progressed to type 2 diabetes already, and blood sugars are already significantly elevated. Talk to your doctor about medications that will help bring your blood sugars down while you continue to work on your weight-loss goals.

Quit smoking. Nicotine has proven in research to actually make insulin less effective. Which means, as a smoker, you’re creating higher levels of insulin resistance even if you’re doing other healthy things like exercising and eating a healthy diet.

Smoking actually increases your risk of diabetes by 30 to 40 percent. Quit smoking and instantly increase your sensitivity to insulin, thus improving your blood sugars without making any other changes.

Can prediabetes be reversed?

For some, prediabetes is reversible if it is the “simple” result of weight gain and unhealthy habits. For many, however, prediabetes is the result of the body’s gradual destruction of beta-cells.

Beta-cells play a critical role in insulin production. More and more research today regarding type 2 diabetes demonstrates that approximately 60 percent of people with type 2 diabetes are experiencing a lack of insulin production through “beta cell dysfunction and destruction.”

“It is now well recognized that 2 factors are involved: impaired [beta-cell] function and insulin resistance,” explains John E. Gerich, MD, in a study published by the Mayo Clinic Proceedings. “Prospective studies of high-risk populations have shown insulin-resistance and/or insulin-secretory defects before the onset of impaired glucose tolerance.”

This means that while you should absolutely still pursue healthier habits around nutrition, exercise, weight-loss, sleep, quitting smoking, the gradual progression of your disease means your diagnosis is here to stay.

That being said, making any changes you can in your habits can play a tremendous role in whether or not you need to start taking diabetes medications or if you need to start insulin injections to help bring your blood sugars down to a healthy level.

Read more on “reversing” diabetes: Is Type 2 Diabetes Reversible?

Living well as a person facing a diagnosis of prediabetes or type 2 diabetes is very possible. The first step is to take action and do whatever is in your power to improve your body’s sensitivity to insulin, improve your diet, get more exercise, get more sleep, and say goodbye to detrimental habits like smoking.

Prediabetes is diabetes. The sooner you take action, the sooner you improve your health.