Prediabetes is an early stage of the loss of blood sugar control. In people with prediabetes, blood sugar levels are higher than normal, but they aren’t yet high enough for the person to be diagnosed with diabetes. 

Prediabetes is generally considered not to be as serious as diabetes, and it’s much less likely to cause complications. However, prediabetes carries a very high risk of progression to type 2 diabetes if no action is taken. In most cases, it causes few or no symptoms, and is often detected on a routine blood test.

Prediabetes is often reversible. Lifestyle changes make the greatest difference in reducing the risk of progression to diabetes, and medications are also helpful for some people. It’s crucial to learn about prediabetes, because taking the appropriate actions during this stage can prevent the development of type 2 diabetes, which is a serious chronic health condition.

Key Takeaways

• In people with prediabetes, blood sugar levels are higher than normal, but are not yet high enough for the person to be diagnosed with diabetes.

• Most people with prediabetes experience few, if any, symptoms, and many people are unaware that they have this condition. It can be diagnosed with a blood test.

• If no changes are made, the majority of people with prediabetes will progress to type 2 diabetes.

• With lifestyle changes, the likelihood of progression to diabetes can be greatly reduced. Some people also benefit from taking medications to help restore the body’s insulin sensitivity.

What causes prediabetes?

People with prediabetes have insulin resistance. This means that the body’s cells are not responding well to insulin, which is a hormone that’s produced by the pancreas when the blood sugar is high. Insulin normally signals the cells to take up sugar from the blood, and either use it for energy or store it for later. When the body is resistant to insulin, the cells don’t take up sugar from the blood as well as before. This leads to high blood sugar levels.

Type 2 diabetes is also a condition of insulin resistance. The two conditions are very similar. Prediabetes is essentially a milder or earlier form of type 2 diabetes.

Are you at risk for prediabetes?

Anyone can potentially develop prediabetes, but there are some people who are at a higher risk. Some of the risk factors include:

• Excess weight

• Sedentary lifestyle

• Unhealthy diet

• Family history of type 2 diabetes

• History of gestational diabetes (diabetes during pregnancy)

• Smoking

• Older age

The more of these risk factors you have, the greater your likelihood of developing prediabetes. However, even if you have no risk factors, it is still possible that you’ll develop prediabetes. This is why regular medical check-ups are important, so you can be screened for conditions like prediabetes that may not have any apparent symptoms.

Why is it important to identify and treat prediabetes?

The most important reason to take prediabetes seriously is that there’s a high likelihood that it will progress to type 2 diabetes. If the condition is left untreated, about 70% of people with prediabetes will eventually develop diabetes. Some studies have found that this number is even higher – up to 93%. 

Why should you be concerned? Diabetes is associated with serious health complications, which can significantly impact a person’s quality of life and can even be fatal.

With appropriate lifestyle modifications, it’s possible to reverse prediabetes and restore healthy blood sugar control. Some people also benefit from medications to help restore insulin sensitivity in the body. It’s crucial to take prediabetes seriously, because this is the chance to prevent the progression to type 2 diabetes.

What are the symptoms of prediabetes?

In many people, the symptoms of prediabetes are not obvious, and many people don’t notice any symptoms at all. When there are symptoms, they develop gradually over time, making them easy to overlook. As prediabetes develops into type 2 diabetes, then the symptoms will generally become more apparent.

Some potential symptoms that your blood sugar is not under control include:

• Increased thirst. When your blood sugar is high, then sugar enters your urine. The sugar pulls water along with it, which makes you a bit dehydrated. Your body will respond with increased thirst, to replace the lost fluid.

• Frequent urination. As sugar enters the urine and pulls water with it, you’ll generate a larger volume of urine than normal, and you’ll likely find that you need to urinate more often as a result.

• Unexplained weight loss. Because you’re losing sugar in your urine, this means that some of the energy from the foods you eat is being lost. If you eat the same amount, and lose some of the energy as sugar in your urine, then you’ll tend to lose weight.

• Increased hunger. When your body doesn’t have enough energy, this triggers hunger signals. You may find that you’re hungrier than ever, even though you’re also losing weight.

• Fatigue. In people with insulin resistance, even though your blood sugar levels are high, your cells aren’t able to access this sugar and use it for energy. This can make you feel very tired and run-down.

• Dark patches of skin. When your insulin levels are high, this triggers your skin cells to reproduce more rapidly. The new skin cells often have a higher level of melanin, the brown pigment in skin. This can lead to darkening of the skin on some parts of the body, usually on the back of the neck, in the armpits, or in the groin.

As prediabetes develops into diabetes, you’ll likely notice more and more of these signs. When you’re still in the prediabetes stage, you may experience milder versions of these symptoms, or you might not notice any symptoms at all. This is why many people with prediabetes are unaware that they have this condition.

How can you diagnose prediabetes?

Because prediabetes often causes no apparent symptoms, it’s important to get regular check-ups in order to catch it as early as possible. Blood tests can be used to detect prediabetes, including:

• Fasting blood glucose. This test checks your level of blood sugar when you haven’t been eating for several hours (generally first thing in the morning, before you have breakfast). If your blood glucose level is high when you haven’t eaten recently, this is a sign that your body is not processing sugar normally.

• Hemoglobin A1c (HbA1c). This test looks for a certain type of hemoglobin, which is the protein in your blood that carries oxygen. When your blood sugar level is high, some of the sugar will react with hemoglobin and alter it. Because the hemoglobin in your blood is replaced every three to four months, this test provides a measure of your average blood sugar over that period of time. If your HbA1c is high, then you’ve been regularly experiencing episodes of high blood sugar.

• Oral glucose tolerance test (OGTT). For this test, your blood sugar is first measured when you haven’t been eating. You then drink a beverage that contains a specific amount of glucose, and your blood sugar is measured again two hours later.

Prediabetes is diagnosed when your fasting blood sugar is 100 to 125 mg/dL (5.6 to 6.9 mmol/L), your HbA1c is 5.7 to 6.4, or your blood sugar on the OGTT is 140 to 199 mg/dL (7.8 to 11.0 mmol/L) two hours after drinking the glucose beverage. Levels higher than these indicate that you have diabetes, while lower levels are considered to be within the normal range.

In general, at least one of these tests should be performed to screen for prediabetes or diabetes. It’s recommended that all adults be screened at least once every three years starting at age 40, or sooner in those who have risk factors for developing diabetes (such as a family history of diabetes, being overweight and/or physically inactive, or a history of gestational diabetes).

Complications of prediabetes

In itself, prediabetes doesn’t generally cause complications. However, if you don’t take any action, then prediabetes is likely to develop into type 2 diabetes. If this happens, then you’re at risk for the complications of diabetes, some of which can be severe or even life-threatening. Some of these complications include:

• Kidney problems

• Heart disease

• High blood pressure

• Stroke

• Nerve damage

• Damage to the eye

• Infections of the skin and other tissues

• Loss of limbs (usually lower limbs)

For people with diabetes, there are ways to reduce the likelihood of these complications. However, people with prediabetes can take steps to reverse this condition, and reduce the chances that they’ll develop type 2 diabetes.

How can you stop prediabetes from escalating into type 2 diabetes? Can you reverse this?

Although prediabetes can escalate into type 2 diabetes, this doesn’t happen to every single person. If you have prediabetes, it’s important to keep in mind that it’s possible to reduce the likelihood of progression to type 2 diabetes. In some cases, prediabetes can also be reversed.

However, if you don’t make any changes in your life, then the chances of developing diabetes are fairly high. Although you aren’t necessarily doomed to develop diabetes, you will need to take steps to address the problem.

The first step is to take prediabetes seriously. You should monitor your blood glucose regularly, and should also have a periodic hemoglobin A1c test to determine your average blood sugar levels. This allows you to stay on top of the problem, and adjust your lifestyle and any other treatments as necessary.

The best way to prevent progression of prediabetes is through a program of lifestyle changes. This includes healthy and sustainable weight loss, a healthier diet, and an exercise program. A program of lifestyle changes has been shown to reduce the risk of progression to diabetes by 58%. It can be challenging for many people to make the necessary changes, but support can be helpful.

Some people with prediabetes also take metformin. This is a medication that helps to increase the body’s insulin sensitivity. It’s commonly used to treat type 2 diabetes, but some studies have shown that it reduces the risk of progression to diabetes. The risk is reduced by 31% over the course of three years, and by 18% over the course of 15 years. In addition, metformin may help to prevent complications like heart disease, even in those who don’t progress to diabetes. 

Those who are most likely to benefit from taking metformin for prediabetes are people at the highest risk for progression to diabetes, including those who:

• Are younger

• Are more overweight

• Have a history of gestational diabetes (diabetes during pregnancy)

• Have a higher fasting blood glucose level

If you have prediabetes, you should have a discussion with your doctor about the best options for you to help reduce your risk of developing diabetes. You can take control of your blood glucose levels with the NOVI Glucose Optimization Program. The program includes an initial online health consultation, 2 weeks of digital health coaching and monitoring, 1 continuous glucose monitor (CGM), and an end-of-program review.

Prevention is always better than cure 

If you have prediabetes, then now is your chance to prevent yourself from developing diabetes. If your lifestyle stays the same, then there’s a very good chance that you’ll end up with diabetes in the future. 

This could result in significant complications that reduce the quality and even the length of your life. However, you have a chance to prevent this from happening, by making significant changes to your lifestyle now.

Although the importance of lifestyle change is clear, it’s not always easy to create and stick to a healthy lifestyle plan. It can be helpful to have professional support in doing this. 

NOVI Health has a care team of experienced dietitians, specialist doctors and professional fitness instructors who all specialize in glucose management to help you get into the best health possible. We can help you take the first step and build habits that last through our NOVI Glucose Optimization Program. This package includes:

• 1 Initial online consultation (in-clinic or through video consultation) with your dietitian to better understand your health status, background, and health goals to get you started.

• 1 FreeStyle Libre sensor with free shipping to help log your glucose data that will be analyzed by your coach and translated into actionable steps towards a healthier you.

• 2 weeks of digital health coaching and monitoring to help you make sense of your readings, keep you motivated, on-track.

• End-of-program review by coach so you’ll have a better understanding of your body and how it responds to your personalized diet and exercise program.