What is prediabetes?
Prediabetes is the term used to describe elevated blood sugar (glucose) that has not yet reached the threshold of a type 2 diabetes diagnosis. Consider pre-diabetes a warning sign that it is time to take your health more seriously. Prediabetes typically has no symptoms or signs; however, it has been associated with being overweight. Prediabetes is reversible by getting healthier.
What is the difference between prediabetes and type 2 diabetes?
Prediabetes occurs when there is too much sugar (glucose) in the blood. It is an early warning sign that the body has more sugar in the blood than it can use.
Type 2 diabetes is a condition that occurs slowly over time. The pancreas cannot produce enough insulin to keep up with the increased need to move sugar into the cells for energy. Medication and lifestyle changes are necessary to manage blood sugar levels and avoid diabetes complications.
Type 1 diabetes is different, and results from auto-immune attacks on the pancreas.
What are the signs and symptoms of type 2 diabetes?
Without reversing prediabetes, blood sugar continues to rise and signs and symptoms of diabetes may develop. The most common symptoms and early signs are thirst and excess urination. Sometimes people will notice unexplained weight loss.
Later signs of type 2 diabetes include:
What causes prediabetes, and what are the risk factors for prediabetes?
Pre-diabetes is a warning sign that metabolism is getting out of balance. Humans are designed to be physically active hunters and gatherers who move a lot and eat only occasionally. This isn't what most of us do. Essentially, the underlying cause of prediabetes is that there is more fuel (glucose) available than can be used up. This can be because of excess intake of dietary carbs and sugars, because of insulin resistance, or because the liver is making too much glucose. The easiest causes of prediabetes to manage are insulin resistance and excess dietary intake. For many people with prediabetes, it can be reversed with exercise in combination with eating a low-carb diet (low-glycemic index diet).
Some of the risk factors for prediabetes include:
- Family history (having a family member with diabetes or prediabetes)
- Ethnic heritage (Hispanics, Latinos, and African-Americans are at highest risk)
- Having had gestational diabetes
- Having PCOS or polycystic ovarian syndrome
- Being overweight or obese
- Smoking
- Having heart disease, high blood pressure, or high cholesterol
- Eating too much-processed food, sugar, or soda
- Not being physically active every day
- Being under high stress and not releasing it in healthy ways like exercise

QUESTION
Diabetes is defined best as... See AnswerWhat are the signs and symptoms of prediabetes?
Unfortunately, there are no symptoms or signs of prediabetes. It almost always is diagnosed by chance during a medical screening or routine bloodwork. This is why it is important to get screened, especially if you are overweight or have family members with diabetes or pre-diabetes. However, the most common sign associated with prediabetes is being overweight.
It is common for a person with prediabetes to only have slightly elevated blood sugar levels, but the body continues to require increased insulin to maintain it. Hyperinsulinemia or high insulin, has signs and symptoms of the following:
- Sleepiness (after a meal)
- Lethargy
- Weight gain around the abdomen
Occasionally, people may notice they are thirstier than normal or are urinating more frequently.
What kind of doctors diagnose and treat prediabetes?
Prediabetes is typically diagnosed and managed by your primary care practitioner, including internists and family medicine specialists, or pediatricians in the case of children or adolescents. Other specialists who may be consulted include physicians who specialize in endocrine glands and hormones including diabetes management (Endocrinologists). A nutritionist can be consulted to help you review your diet and suggest dietary and lifestyle changes. A personal trainer can be helpful if you are having a hard time putting together an exercise plan for yourself. There are a lot of self-care resources too. Eating healthier, exercising, and losing weight are ways to improve your health, and are key to prediabetes treatment.
Health News
- Surgery Doesn't Get Safer When Patient, Surgeon Are Same Gender
- Got GERD? Eat This Way to Help Avoid Symptoms
- Want to Avoid Knee Replacement? Build Up Your Thighs
- Breathing in Coal-Based Pollution Could Be Especially Deadly: Study
- Scans Show Brain Changes in People With Long COVID
More Health News ยป
Is there a test to diagnose prediabetes (HbA1c and prediabetes chart)?
There are three blood tests that can diagnose prediabetes and type 2 diabetes.
Hemoglobin A1c (HbA1c)
- Hemoglobin A1c (HbA1c) measures the average blood sugar (glucose) over the last 3 months. It is a measure of how much sugar is attached to your red blood cells.
- A pre-diabetes level is 5.7% and 6.4%.
- An HbA1c > 6.5% is considered a diabetes glucose level.
Fasting blood sugar levels (serum glucose)
- Fasting blood sugar or serum glucose is a measure of your blood sugar first thing in the morning before you have eaten anything.
- Prediabetes also can be identified with serum glucose or blood sugar level. A fasting blood sugar test of 100-125 mg/dl indicates prediabetes.
Oral glucose tolerance test
- Prediabetes and diabetes also can be diagnosed with an oral glucose tolerance test. This test measures how high blood sugar levels get at fixed time intervals after consuming a high-sugar-content beverage. This test is most commonly used to diagnose diabetes related to pregnancy (gestational diabetes).
Prediabetes glucose levels are shown here in a chart of normal, prediabetes, and diabetes lab test numbers so you can make comparisons.
Normal | Prediabetes | Diabetes | |
HbA1c | 5.6% or less | 5.7%-6.4% | 6.5% or more |
Fasting blood glucose | 99mg/dl or less | 100-125mg/dl | 126mg/dl or more |
Oral glucose tolerance | 140mg/dl or less | 140-199mg/dl | 200mg/dl or more |
What is the treatment for prediabetes?
Prediabetes is best treated with a proactive, renewed commitment to getting healthier and making healthier choices every day. It can, and usually is, be treated with diet and exercise alone. However, some people with prediabetes are treated with a medication called metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet). Research published in the New England Journal of Medicine showed that lifestyle changes reduced diabetes incidence by 58% compared to metformin, which reduced the incidence by only 31%.1
If you have been diagnosed with prediabetes, discuss a treatment plan with your healthcare professional.
What medications or supplements treat prediabetes?
Metformin is the only medication approved by the FDA to treat prediabetes. It works by stopping the liver from producing excess glucose. For some people, metformin also helps them lose weight. It can be an option for people who aren't ready or able to make lifestyle changes right away. Metformin also is a medication that can be discontinued as soon as blood sugar levels are at goal, and healthy lifestyle habits have become routine.
Some dietary supplements have good evidence of helping reverse prediabetes. For example, most people with prediabetes are deficient in vitamin D and magnesium. Both of these are necessary to keep cells properly sensitive to insulin. A healthcare professional can order a blood test to check and see if you're deficient in these and other nutrients, for example, chromium, biotin, and N-acetyl cysteine. These also are nutrients that have research supporting their role in improving insulin sensitivity.3 Check with a healthcare professional before taking supplements. You may need to find one with this specialized knowledge such as a naturopathic doctor, nutritionist, or integrative medicine doctor.
Subscribe to MedicineNet's Diabetes Newsletter
By clicking "Submit," I agree to the MedicineNet Terms and Conditions and Privacy Policy. I also agree to receive emails from MedicineNet and I understand that I may opt out of MedicineNet subscriptions at any time.
What about a low carb diet for prediabetes?
A low-carb diet is a great option for prediabetes because it will improve blood sugar, help you lose weight, and help you feel more energetic. Carbohydrates are digested into glucose very easily. A person with prediabetes already has too much sugar in the blood so you don’t want to add any more.
To feel satisfied on a low-carb diet you have to eat healthy amounts of protein and fat. Many people continue to try to follow a low-fat or fat-free diet while also trying to make low-carb choices, and understandably, feel hungry and frustrated because there is nothing tasty to eat. Recent research published in the British Medical Journal debunked the low-fat hypothesis (that people on a low-fat diet have a lower risk of developing prediabetes).2 People are not at a lower risk of prediabetes.
What is the glycemic index?
The easiest way to choose quality carbohydrates is by following a low glycemic index diet. With a low glycemic index diet, you balance the carbohydrate/sugar content of a meal with enough fiber, fat, and protein so that the meal is digested and absorbed slowly. This gradually releases glucose into the bloodstream, and thus the body does not require a large amount of insulin. It also provides the body with good, steady energy over many hours.
Is there prediabetes diet?
The best foods for prediabetes include the following:
- healthy proteins and fats
- Lots of vegetables
- Some fruits
- Some low glycemic index carbohydrates like quinoa, oatmeal, and brown rice
The foods to eat for prediabetes are real foods in their natural or whole form. There needs to be a balance of fat, protein, and carbohydrate. Drinking lots of water or unsweetened tea also is important.
Food to Avoid for Prediabetes Management
An easy way to identify the most important foods to avoid is to avoid any white food, which includes:
- Sugar (and anything made with sugar)
- White flour (and anything made with flour)
- White bread
- White rice
- White pasta
- White potato, etc.
Cauliflower is white, but it is a good food for prediabetes because it is a whole, real vegetable.
It also is best to avoid highly processed foods (like foods that come in boxes or packages already prepared). These foods are high in calories, carbs, and chemicals, and low in nutrients and vitamins. Other foods to avoid include:
- Fried foods
- Fatty meat such as prime rib, burgers, bacon, and fatty cuts of pork, sausages, greasy burgers, hydrogenated fats.
- Blackened or burned foods (these cause inflammation)
- Snack foods like pretzels, chips, or cookies
- Many “energy bars” (compare nutrition labels - a bar that is friendly for prediabetes will have less than 5 grams of sugars and at least 2 grams of fiber)
- Meals without any vegetables
- Sodas, sweetened tea, fruit juice, juice-like sweetened beverages
The take-home message is to pay close attention to the quality of all foods - fats, proteins, and carbohydrates – and choose less processed ones.
What are examples of good food choices for a prediabetes diet?
Choosing quality fats and proteins means choosing real food rather than processed versions. Believe it or not, a serving of organic full-fat Greek yogurt with real raspberries will be much more satisfying, and better for your blood sugar and weight, than the fat-free fruity version.
Good protein choices include:
- Organic poultry (chicken or turkey)
- Grass-fed red meat (beef or buffalo)
- Organic lean pork
- Wild fish and seafood
- Whole eggs
- Plant-based proteins such as:
- Beans
- Lentils
- Nuts
- Seeds
- Tofu
- Peas
- Protein powders for smoothies
Organic and grass-fed choices are important because what an animal eats changes the nutrition of the meat. Non-organic and factory-fed animal meats increase inflammation. In prediabetes, this means an increased risk for heart disease and complications.
Make at least some of your meals vegetarian because plant-based fats are associated with lower oxidized LDL and less inflammation. Good fat choices include:
- Avocado
- Olive oil
- Coconut oil and coconut milk
- Organic full-fat dairy products
- Wild, cold water fish
- Grass-fed red meat
- Dark meat from pastured poultry
Check labels because hydrogenated fats are often used in packaged bakery products.
What about exercise and prediabetes?
All exercise helps reverse prediabetes by using up sugar in the bloodstream and improving insulin sensitivity. An exercise plan should focus on two things:
- Be physically active every day. This could be a walk after dinner, doing yard work or gardening, playing with the kids, swimming, biking, dancing, etc. Tracking the number of steps you take each day with a smartphone or fitness tracker can be very helpful.
- Focus on building more muscle a few times a week.
Increasing muscle strength makes the cells of the muscle "hungrier (more insulin sensitive), and that equals a healthier metabolism. You can build muscle by using weights, your body weight, or resistance bands. If you choose weight training start slowly, and ask for help using the equipment safely and properly. Begin with low weights, and gradually work up to heavier weights. Lifting one round of heavy weights for only 6-8 repetitions has more benefit than one round of light weights for 10 or more repetitions. If you can do more than 10 repetitions, add more weight.
This plan also is great if you are in a hurry. You can complete a full workout in just 20 minutes twice a week. Work up to this gradually to avoid injury.
If you like cardiovascular exercise, focus on short bursts of high-intensity activity. Research studies show that few people lose weight by spending an hour on a treadmill or elliptical machine. Lifting heavy weights, and short sprints that make you breathless helps you lose weight best. For most people, this is less than 90 seconds, after which, you should walk until you catch your breath and do it again! You'll be done in 20 minutes.
And, as always check with your health-care professional before starting any exercise program and get help using equipment properly to avoid injury.
What is the prognosis for a person with prediabetes?
Unfortunately, most Americans with prediabetes don't make healthy changes or aren't empowered to take control of their health. Because of this, most people with prediabetes do progress to diabetes. But the good news is, and what research proves, is that with physical activity and healthier foods 58% of new cases of diabetes can be prevented.
Can prediabetes be reversed?
Prediabetes can be reversed with lifestyle changes. This includes being more physically active and following a healthy diet plan such as a low glycemic index diet, rich in quality, real foods. Quitting smoking, stress management, and keeping alcohol intake moderate all help too. If lifestyle is not changed, prediabetes usually progresses to diabetes.
How do I monitor my efforts to reverse prediabetes?
When you are working to reverse prediabetes, your healthcare professional will advise you on how often you should have your blood tests checked – usually every 3 months.
Having your home glucose monitor (finger stick test) gets you involved in managing your prediabetes, and also can help you track your progress. Write down the numbers and what was consumed to learn how you respond to different meals. This is a great way to test different prediabetes meal plans to find out what foods cause your blood sugar levels to go up the least, and the most!
Do the following to track your meals and foods.
- Check your blood sugar and write it down.
- Enjoy your meal and write down what you ate and the portion sizes.
- In two hours, check your blood sugar and write it down. Did that meal treat your body well? How much did your blood sugar go up? How did you feel?
- Keep a log of these readings to discuss them with your healthcare professional or nutritionist to problem-solve ways to make better diet choices. This will help you find foods to eat and foods to avoid for your situation.
Can prediabetes be prevented?
Absolutely! The best way to prevent prediabetes includes the following:
- Stay active
- Eat a healthy low glycemic index diet
- Handle stress in healthy ways
If you had gestational diabetes, you may want to pay special attention to adopting the habits discussed in this article.
Most importantly, for people with prediabetes, diabetes can be prevented by taking action now.
Health Solutions From Our Sponsors
<http://www.nejm.org/doi/full/10.1056/NEJMoa012512>
2. Ramsden, C. E. et al., "Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73)." BMJ 2016;353:i1246.
<http://www.bmj.com/content/353/bmj.i1246>
3. Mwiti, K. C., et al. "The Biochemical Role of Macro and Micro-Minerals in the Management of Diabetes Mellitus and its Associated Complications: A Review." Int J Vitam Nutr Res. 2015;85(1-2):88-103.
Top Prediabetes Related Articles
Heart Healthy Diet: 25 Foods You Should Eat
What foods are heart healthy? Learn what foods help protect your cardiovascular system from heart attack, coronary heart disease, stroke, and cardiovascular disease. Plus, find easy meal recipes and menu ideas for more everyday heart benefit.Blood Pressure Picture
The blood pressure is the pressure of the blood within the arteries. See a picture of Blood Pressure and learn more about the health topic.Diabetes (Type 1 and Type 2)
Diabetes is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.Diabetes Quiz
Take the Diabetes Quiz and learn the causes, signs, symptoms, and types of this growing epidemic. What does diabetes have to do with obesity and diet? Learn about life as a diabetic.Type 2 Diabetes Diet Plan
A type 2 diabetes diet or a type 2 diabetic diet is important for blood sugar (glucose) control in people with diabetes to prevent complications of diabetes. There are a variety of type 2 diabetes diet eating plans such as the Mediterranean diet, Paleo diet, ADA Diabetes Diet, and vegetarian diets.Learn about low and high glycemic index foods, what foods to eat, and what foods to avoid if you have type 2 diabetes.Heart Disease: Causes of a Heart Attack
Heart disease prevention includes controlling risk factors like diet, exercise, and stress. Heart disease symptoms in women may differ from men. Use a heart disease risk calculator to determine your heart attack risk.Heart Disease Quiz
Take our Heart Disease Quiz to get answers and facts about high cholesterol, atherosclerosis prevention, and the causes, symptoms, treatments, testing, and procedures for medically broken hearts.How the Heart Works
The heart is a very important organ in the body. It is responsible for continuously pumping oxygen and nutrient-rich blood throughout your body to sustain life. It is a fist-sized muscle that beats (expands and contracts) 100,000 times per day, pumping a total of five or six quarts of blood each minute, or about 2,000 gallons per day.High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms.
Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure.
The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater.
If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.
REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
What Is High Blood Pressure (Hypertension)? Symptoms, Treatments
What causes high blood pressure (hypertension)? What is normal blood pressure? Know the warning signs and symptoms of high blood pressure. Read about high blood pressure medications, diet, and long-term treatments.High Blood Sugar (Hyperglycemia)
Hyperglycemia or high blood sugar is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes.Symptoms of high blood sugar may include increased thirst, headaches, blurred vision, and frequent urination.Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
Low Blood Sugar (Hypoglycemia)
Low blood sugar or hypoglycemia occurs when blood sugar is dangerously low and is often complication of type 1 and type 2 diabetes. Learn about symptoms, dangers, and treatment.Normal Blood Sugar Levels In Adults with Diabetes
People with diabetes can manage and prevent low or high blood sugar levels (hyperglycemia or hypoglycemia) by keeping a log of your blood sugar levels when you are eating and fasting and eat foods that are high in carbohydrates and sugar, for example, buttered potatoes, candy, sugary desserts, and fatty foods.
Blood tests, for example, the hemoglobin A1c test (A1c test) and urinalysis can diagnose the type of diabetes the person has. Diabetes during pregnancy, called gestational diabetes, should be managed by you and your OB/GYN or another healthcare professional.
Extremely high levels of blood glucose in the blood can be dangerous and life threatening if you have type 1, type 2, or gestational diabetes.
If you or someone that you are with has extremely high blood glucose levels, call 911 or go to your nearest Urgent Care or Emergency Department immediately.
To prevent and manage high blood glucose levels in people with diabetes keep a log of your blood sugar levels, eat foods that are high in carbohydrates sugar, for example, buttered potatoes, candy, sugary deserts, and fatty foods that you can share with your doctor and other healthcare professionals.
Obesity and Overweight
Get the facts on obesity and being overweight, including the health risks, causes, reviews of weight-loss diet plans, BMI chart, symptoms, causes, surgical and nonsurgical treatments, and medications.Stress
Stress is a normal part of life, but chronic or severe stress can be harmful to your health. Learn what happens in your body when you are stressed and how you can manage your response.Stress Quiz
Stress creeps into everyone's life at one time or another, while some people will suffer from poorly managed chronic stress. If you're suffering, there are things you can do. Take the Stress Quiz to learn what you can do to beat the long-term effects of chronic stress.Type 2 Diabetes Signs
Learn about type 2 diabetes warning signs, symptoms, diagnosis, and treatment options. Find out why thirst, headaches, and infections could be signs of diabetes. Discover the treatment options for people with type 2 diabetes, including medicines and lifestyle improvements.When Are Wrist and Forearm Amputations Performed?
Surgical removal of the wrist and forearm is performed in patients with conditions such as severe injury with irreplaceable loss of blood supply to the wrist or/and forearm; diseases such as peripheral vascular disease [PVD] (blood vessel disease), diabetes, blood clots, or sepsis (severe infection); burns, thermal injuries, and injury secondary to extreme cold exposure to the wrist or/and forearm; surgery to remove tumors or infected area from the bones and muscle, ulcers, and pathological fractures.