Being diagnosed with prediabetes can be overwhelming, but it’s also an opportunity to take action. While it’s the earliest stage of type 2 diabetes, lifestyle changes can help improve blood glucose (sugar) levels.
This article covers the symptoms, diagnosis, and treatment options for prediabetes, and explores whether it can be reversed.
Key Points:
- Prediabetes is an early stage of type 2 diabetes, often reversible with lifestyle changes like diet, exercise, and weight loss.
- Symptoms include increased thirst, hunger, frequent urination, and fatigue, but many people are unaware they have it.
- Diagnosis is based on fasting blood sugar and A1c tests, with levels above normal but not yet high enough for type 2 diabetes.
- Risk factors include being overweight, age over 45, family history of diabetes, and lack of regular exercise.
Symptoms of prediabetes
The challenge with prediabetes is that its symptoms can be subtle and easy to overlook for years — until blood sugar levels rise enough to become noticeable.
The best way to catch prediabetes early is by scheduling regular check-ups with your doctor and requesting an A1c test (a measure of glucose management over the previous 2 to 3 months).
Like type 2 diabetes, the symptoms result from gradually rising blood sugar levels, insulin resistance, and insufficient insulin production.
Common symptoms include:
- Increased thirst
- Increased hunger
- Frequent urination
- Dry mouth
- Headaches
- Fatigue after meals
- Unexplained weight gain or loss
- Blurry vision
According to the U.S. Centers for Disease Control and Prevention (CDC), only 10 percent of people with prediabetes are aware of their symptoms, and 98 million Americans — 1 in 3 — have the condition without knowing it.
See more in: Prediabetes Symptoms: Warning Signs and How to Test.
Diagnosing prediabetes
The American Diabetes Association (ADA) defines prediabetes through your A1c, fasting blood sugar, and blood sugar 2 hours after eating:
Prediabetes diagnosis criteria
| Measurement | Range (mg/dL) | Range (mmol/L) |
| Hba1c | 5.7 percent to 6.4 percent | NA |
| Fasting blood sugar | 100 to 125 mg/dL | 5.6 to 6.9 mmol/L |
| 2 hours after a meal | 140 to 199 mg/dL | 7.8 to 11.0 mmol/L |
For comparison, normal blood sugar levels for people without diabetes are:
Normal blood sugar levels (non-diabetic)
| Measurement | Range (mg/dL) | Range (mmol/L) |
| HbA1c | Less than 5.7 percent | NA |
| Fasting blood sugar | 70 to 99 mg/dL | 3.9 to 5.5 mmol/L |
| 1 to 2 hours after a meal | Less than 140 mg/dL | Less than 7.8 mmol/L |
While the diagnosis of prediabetes is straightforward, the challenge lies in recognizing that these elevated blood sugar levels are an early warning of diabetes.
Taking action at this stage is important to prevent progression to type 2 diabetes.
Key blood tests
Fasting blood sugar: Measures blood glucose first thing in the morning, before eating, to show how your body manages glucose without food.
A1c (HbA1c) test: Reflects your average blood sugar levels over the past three months.
Higher HbA1c levels indicate more glucose in the bloodstream, which can lead to long-term damage to nerves and blood vessels, contributing to complications like retinopathy (eye damage), neuropathy (nerve damage), and nephropathy (kidney damage).
Oral glucose tolerance test (OGTT): This test measures your body’s response to sugar by checking blood glucose levels 2 hours after drinking a sugary solution.
It helps identify how efficiently your body processes glucose and is often used to diagnose prediabetes or gestational diabetes.
Learn more in: How Often Should You Test For Prediabetes?
Factors that increase your risk of prediabetes
While being overweight, inactive, or having an unhealthy diet are commonly highlighted risk factors for type 2 diabetes, the causes are more complex. There are two primary pathways that lead to prediabetes and type 2 diabetes:
Insulin resistance
This occurs when your body requires increasing amounts of insulin to manage blood sugar levels. Eventually, the pancreas can’t keep up with this demand, leading to rising blood sugar levels.
Genetic disposition
Some people have a genetic tendency toward beta-cell dysfunction, where the pancreas’ beta cells gradually stop producing adequate insulin.
For those with this genetic background, “reversing” diabetes may not be possible, but taking steps to improve overall health is still beneficial.
Key risk factors for developing prediabetes include:
- Being overweight.
- Age 45 or older.
- Having a family history of type 2 diabetes.
- Exercising less than three times per week.
- Having gestational diabetes or giving birth to a baby weighing over 9 pounds.
- Belonging to certain ethnic groups, including African American, Hispanic/Latino American, American Indian, Pacific Islander, or Asian American, all of which show a higher risk of developing type 2 diabetes.
See more in: What Causes Prediabetes?
Prediabetes treatment: how to reduce your risk of prediabetes and type 2 diabetes
Whether your risk stems from insulin resistance or genetic beta-cell dysfunction, there are many steps you can take to improve insulin sensitivity and prevent or delay the progression of diabetes.
Get moving
Regular physical activity helps burn calories and glucose, both during and after exercise.
Even a 15-minute daily walk can be a great start. Walking, although low-intensity, is effective for fat burning without increasing appetite and is gentle on the joints.
Instead of thinking, “I’m too tired to exercise,” commit to just 15 minutes of movement daily.
Make changes to your diet
Improving your diet doesn’t mean cutting out all your favorite foods. Simple changes, like eating a veggie-packed salad instead of a sandwich or reducing soda intake, can make a difference.
Start with small changes, and follow the “80/20 rule” — focus on real, nutritious foods 80 percent of the time, and allow some flexibility for indulgence 20 percent of the time.
Get more information in: Prediabetes Diet: What to Eat & What to Avoid.
“Learning moderation instead of deprivation was the hardest for me. At first, I would deprive myself of things I loved to eat because I thought that would be a quick fix. Just like any diet, it wasn’t sustainable. I learned that balancing what I wanted in moderation worked well and was much easier to maintain long-term.”
Venus Jones (read Venus’ story of reversing prediabetes)
Get more sleep
Lack of sleep negatively affects insulin sensitivity, leading to higher blood sugar levels, weight gain, and increased hunger.
Consistently getting adequate rest helps regulate insulin and blood sugar. Create better sleep habits by setting an evening alarm to remind you when it’s time to wind down.
Lose weight
Reducing excess body fat directly improves insulin sensitivity, as extra fat increases insulin resistance.
While weight loss can be challenging, especially if blood sugar levels are already elevated, steps like improving diet and increasing activity can help.
If needed, speak with your doctor about medications that can help blood sugar management during your weight-loss efforts.
Quit smoking
Nicotine increases insulin resistance, making it harder to manage blood sugar.
By quitting smoking, you can improve insulin sensitivity and lower your risk of diabetes by 30 to 40 percent. This change can have an immediate positive impact on your blood sugars.
Consider medication
For those who cannot manage prediabetes with lifestyle changes alone, medications such as metformin may be recommended.
Metformin helps lower blood sugar levels by improving the body’s response to insulin and reducing glucose production in the liver.
Speak to your doctor about whether medication is a suitable option for you.
Learn more in: Prediabetes Medication: What are the Options? and Metformin for Prediabetes: The Pros & Cons.
Can prediabetes be reversed?
For some, prediabetes can be reversed if it’s primarily due to lifestyle factors like weight gain and unhealthy habits. However, for many, prediabetes stems from the gradual destruction of beta cells, which are vital for insulin production.
Read more in: Is Type 2 Diabetes Reversible?, What is the Most Effective Way to Reverse Prediabetes?, and How Long Does It Take to Reverse Prediabetes?
Research shows that around 60 percent of people with type 2 diabetes experience beta-cell dysfunction, leading to impaired insulin production.
Dr. John E. Gerich, MD, explains in Mayo Clinic Proceedings that both insulin resistance and beta-cell dysfunction play significant roles in the progression from prediabetes to diabetes.
While making healthier lifestyle changes — such as improving your diet, increasing exercise, losing weight, and quitting smoking — can have a big impact, prediabetes for some may not be fully reversible due to genetic factors.
These changes can reduce the need for medications or insulin therapy by improving blood sugar management.
Taking action as early as possible will greatly improve your health outcomes and help manage the progression of the disease.
See more in: 10 Effective Changes You Can Make to Help Reverse Prediabetes Fast.
Did you find this article helpful? Click Yes or No below to let us know!
Peter
Questions:
1)as a pre diabetic 5.8 a1c
I would like to know if there is a table for ranges for a pre diabetic to follow. Example
A)how high a pre diabetic should aim on a post meal after 1 hour and 2 hour
B)before working out with weight, a pre diabetic should have a blood glucose of (#)?
C)should a pre diabetic, as soon as the workout with weights is finished . Should we replenish the glucose by intake of some carbs , and if so how much carbs, example 5 grams or 20 grams ?. Or a glucose number we shouldn aim or only have protein with fat and no carbs at all?.
D)should a pre diabetic before working out with weights, should the pre meal be with carbs if so how much or blood glucose level to aim to have a well plan workout.
Christel Oerum
I don’t know if there are that precise guidelines for prediabetes. This is a link to our prediabetes resources https://diabetesstrong.com/category/diabetes/prediabetes/
Najeeb Safi
Thanks for posting such a great article. I was diagnosed in 2017 as a pre-diabetes. My Ac1 was 5.9. Then i worked so hard to keep it under 5.6. However later on i was diagnosed by fibromyalgia, and I am not able to exercise properly. Now my AC1 is 5.8 . If there is any post or link related to fibromyalgia please share it with us.
Thank
Christel Oerum
We have one post about fibromyalgia that you can find here: https://diabetesstrong.com/diabetic-and-fibromyalgia-staying-active-without-triggering-a-massive-flare-up/ Ginger is a great resource when it comes to fibromyalgia and diabetes
CazT
Thanks for the article. After 2 years of being prediabetic and making no improvement in my numbers despite being very lean and active and changing my diet radically to a very low carb one, I had come to the conclusion that this must be the consequence of beta cell malfunction yet this is the first article I have found (apart from some scientific studies) that has acknowledged this possibility. In the various diabetes forums where I have asked questions, I am invariably told to make sure I’m counting carbs properly (I am), that I might be ‘TOFI’ – thin on the outside, fat on the inside (highly unlikely with a BMI of 18.3) and basically made to feel that it’s something I’m not doing properly when I’ve done my utmost to address the issue and read very widely about it all. It does rather sound from what you say that I’ll either stay prediabetic to my dying day or eventually succumb to diabetes. I’ve wondered about asking to go onto metformin, just to lower the numbers a bit and allow me a bit of leeway with my diet but am reluctant to go onto medication if I can avoid getting my numbers higher. My last A1c was 47 mmol/mol, though, having been 43 two years ago, so it looks dubious. Thanks again – it’s a relief to know that beta cell reduction is a real possibility in my case.
Christel Oerum
I’m glad you found this article and it could help explain what might be going on. An A1c of 47 if fairly low so your doctor might not want to prescribe you any meds. I would recommend having an autoantibody test done, just to verify the type of diabetes you live with (more on that here).
Hang in there and continue doing what you’re doing. Remember, you’re doing everything in your power sometimes that’s just not enough to keep blood sugars in range
CazT
Thank you very much for your reply. I did have an antibodies test, and a CT scan of the pancreas, and they came back negative/normal so I’m assuming I’m on track for T2. I’d really like to find a way to boost beta cells and have been researching a lot into that. I’m wondering about losing even more weight just to test out the fatty liver theory further but I’m pretty skinny and it seems unlikely that taking BMI to below 18 would be very wise; in fact when I contacted Roy Taylor, who has done a lot of research in this area, he thought the same.
Lana
How can I have a 102 glucose fasting result and a 5.6 a1c
Christel Oerum
A1c is an average of your blood sugars over the last 3 months. That includes not just your fasting blood sugars, so your blood sugar is most likely running higher at other time
Ruthie Bennett
I have been a predibetic for the past 3 months alc 5.9 dose tht mean diabetes
Christel Oerum
Your doctor will usually look at your A1c over time but also your fasting blood sugar and blood sugar after meals. Regardless of the diagnosis, you can still start taking some of the actions in this article to help reduce the risk of developing type 2 diabetes.
Julia
Thank you for this article! Will be taking your advice. Question: do all 3 of the numbers (A1C, fasting, after eating) have to be off to be considered preD? Or just 1 off number is considered preD? I have an appt in 3 weeks but in the mean time am panicking! Also, how long with all 3 numbers being in normal range would be considered reversed?
Ginger Vieira
Hi Julia!
First of all: don’t panic. Take a deep breath. I know the potential of a diabetes diagnosis is very overwhelming and scary, but you are not alone in this. And there are so many things you can do to manage, thrive with, and potentially reverse the condition.
Secondly, as far as it’s implied by the ADA, yes, all three of those details need to be high to qualify for prediabetes, which means to consider it “reversed,” all 3 of those numbers would need to be in a healthy range.
I want to make sure you understand though that all three of those numbers are directly linked to each other. It’s very unlikely, for example, that your A1c would go down if your fasting blood sugar and 2-hour post-meal blood sugar didn’t also go down. These numbers are all measuring the same thing: your blood sugar at different points of the day.
Fasting: your morning BG
2-hours post-meal: how your body handles BG after a meal
A1c: how your body is handling your BGs overall, every day
The length of time that qualifies for remission varies depending on who you ask — DiaTribe has a great article on this: https://diatribe.org/type-2-diabetes-remission-what-it-and-how-can-it-be-done.
Between now and your appointment in 3 weeks, maybe one thing you could do is to simply continue reading and studying, without pressure, shame, or fear. Just learn as much as you can so you’re fully prepared when you go to that appointment.
Reema
Hello .. I am just curious to know whether I am diabetic or pre diabetic.
My A1c is 7.0 but my fasting sugar is between 115-124 most of the days. My post meal sugar is between 150-180.
I am not on any medications currently and do not have any symptoms of diabetes mentioned in above article.
Christel Oerum
Diabetes is what we call a “silent” disease since you can’t always feel how much havoc it’s doing to your body. Your doctor will have to evaluate if you should be on medication. Regardless I highly recommend you start taking action to lower your average blood sugars
Carol Maish
I am diagnosed as prediabetic and am trying to bring down my glucose numbers. My fasting glucose is always higher than the numbers I get during the day, an hour or two after eating, why? How can I get a lower fasting number?
Christel Oerum
There are a few things you can do. Increase your movement/exercise amount, reduce carbs at night and if needed reduce your body fat percentage. I think this article will be helpful for you: https://diabetesstrong.com/how-to-lower-your-a1c/
Carol Maish
Thank you for your suggestions; I’ll give those a try. I know I need to introduce more walking into my health routine.
Louise Laba
I get a blood test every six month for a number of reason with the medication I am on. My fasting blood sugar keeps rising from 200 to 217 this last time. My dr. does not seem concerned but my diabetic friends do. . My friends say it might have something to do with the fact I am always so tired and thirsty. I have gained 35 lbs over the last couple of years and I am 65. Should I be concerned? Thank you for any input.
Christel Oerum
With fasting blood sugars at that level I would expect your doctor to run more tests to see if there is a reason for concern. You can tell your doctor that you’d like to have a Hemoglobin A1C test done (that reflects your average blood sugar over the last 3 months) and ask why he/she isn’t concerned. If your doctor isn’t willing to have that discussion with you I would suggest finding another doctor.
It might be nothing, but until you get tested, you don’t know..
Virginia Busch
Good morning. I’ve been diagnosed with pre-diabetes and in my research to figure out how to reverse, I’ve come across your site. What great, clear, informative information. I was wondering if you could recommend any books which are not all scientific that give meal plans, recipes, and how to lose weight. I’m a 68 year old female. Weight loss is difficult. Although I’ve lost 22 pounds in the last seven months. I just starting using a recumbent bike (runner’s knees and arthritis). Any insight you can provide would be most appreciated! In advance, my thanks!
Christel Oerum
I’m glad you found that article useful. There are many weight loss gurus out there, but in a nutshell weight loss comes down to being in a calorie deficit. A calorie deficit means that you burn more calories than you consume. For free resources I’d recommend you start by looking at the following articles:
1. How to calculate your calories: https://diabetesstrong.com/how-to-find-your-daily-calorie-need/
2. Meal plans: https://diabetesstrong.com/category/nutrition/meal-plans/
If you already now know how many calories you consume you can use that as your baseline rather than the calculator and reduce your calories from there or add more activity
Libby F Fife
Hi There,
Thank you for the article. I did have a question about the glucose level chart for people without pre diabetes/diabetes.
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
Could you please tell me the source of those numbers, possibly with a link to the specific page? I wasn’t able to cull all of that information from the American Diabetes link provided. It seems to be a little different from the Joslin and ACCE sites as well. I’d like to take the source info to my doctor when I see her in April.
Thanks so much in advance for any help. I certainly appreciate the info. on the site-it honestly is helpful.
Thanks,
Libby Fife
Ginger Vieira
Hi Libby!
First of all, you’re right — the numbers don’t match exactly, as I rounded 126 up to 130. The inconsistency comes from the translation of the numbers the ADA provides vs. the A1C rates they provide. For example, if you translate a 6.4 A1c like they have listed for prediabetes diagnosis, it translates to 137 mg/dL, not 126. So there’s some wiggle room with all of this data. I chose a middle ground of 130 mg/dL for somewhere between their glucose level versus their listed A1c level.
That being said, the difference between 126 and 130 on a glucometer is nil because there’s a 15% inaccuracy range with every FDA-approved glucometer. You could test now and again 30 seconds later and get a slightly different result like 130 and 126. I hope that helps at your next doctor’s appointment!
Thanks for catching the inconsistencies in our reference vs. the numbers listed.
Libby F Fife
Thanks Ginger! That all makes total sense to me. It’s hard to sort out different sets of numbers isn’t it? When I go to the doctor in April though I will have your information in mind and integrate it with what the doctor says. Thank you again for your help!
Libby