Nearly 38% of the U.S. adult population has prediabetes.¹ Of the 96 million U.S. adults with prediabetes, more than 80% are unaware that have an increased risk for type 2 diabetes and other long-term medical conditions associated with it.²
So, how do you know if you are at risk or have prediabetes? That’s the tricky part. Prediabetes doesn’t always produce symptoms and you can remain symptom-free for years. The problem is that nearly every organ system in your body is incrementally harmed by having higher than healthy blood glucose levels. But, there is hope! By making lifestyle changes that lead to overall better health, you can reverse prediabetes and live a longer, healthier life.
What is Prediabetes?
Think of prediabetes like the check engine light that comes on in the dashboard of your car. When the engine is running smoothly, the light stays off. But when the car’s control system recognizes that there is something wrong with the engine, the light comes on. The light is a warning sign that something is off – maybe it's a worn spark plug, a loose gas cap, or a faulty oxygen sensor. Either way, it's a sign that the engine isn’t running as optimally.
Like the check engine light, prediabetes is a warning sign that you are at an increased risk for diabetes and other long-term medical conditions. Prediabetes is when your blood glucose is higher than it should be, but not high enough to meet the criteria for type 2 diabetes.
The American Diabetes Association's expert panel estimates that up to 70% of people with prediabetes will develop type 2 diabetes.³ The progression from normal glucose tolerance to diabetes is a continuous process that can be stopped.⁴ Thankfully, you can reverse this trend.
In healthy people, fasting blood sugar is strictly regulated by insulin and glucagon. After a meal, beta cells in the pancreas release insulin to move glucose from the blood into muscle and liver cells. This lowers the amount of glucose in the blood. Prediabetes is an indication that this regulation is faulty (remember, there’s something wrong with the engine).
Prediabetes is linked to insulin resistance, a condition that results in excessive glucose in the bloodstream. Excess sugar in the bloodstream damages the inner lining of your blood vessels, increasing your risk for cardiovascular disease, high blood pressure, nerve damage, vision problems, and abnormal triglycerides.³ Prediabetes shares risk factors with metabolic syndrome, a group of conditions that further raise your risk for serious chronic diseases. This is why tracking your blood glucose via a continuous glucose monitor (CGM) is a vital tool to help you reverse prediabetes.
Risk factors for type 2 diabetes that you have no control over include:
Some people lose their ability to regulate their blood sugar as they get older. Increased body fat and decreased physical activity are major risk factors for developing prediabetes as you get older. While roughly 37% of U.S. adults have prediabetes, the figure rises to 51% of U.S. adults aged 65 and older.⁵ Growing older increases your risk for insulin resistance, prediabetes, and type 2 diabetes, and having diabetes speeds up the aging process.⁶ In a study evaluating diabetes risk profiles, researchers found that unhealthy sleep was associated with increased diabetes risk for older adults. Surprisingly, obesity and abnormal lipid levels did not increase diabetes risk in adults over age 75.⁷
Family history or a first-degree relative with type 2 diabetes/Ethnicity
Family history is an important risk factor for diabetes. A family history of diabetes can increase your risk of developing it by two to six times. The higher incidence of type 2 diabetes in certain populations suggests a strong genetic component.⁸ Populations with the highest risk of prediabetes include non-Hispanic black people (21.8%), non-Hispanic Asian people (20.6%), and Hispanic people (22.6%), when compared with non-Hispanic white people (11.3%).⁹
The rise of diabetes around the world is related to the rise of its two biggest risk factors: being overweight or obese and a lack of physical activity.¹⁰ Modifiable risk factors for type 2 diabetes that you can change include the following:
Obesity is the strongest modifiable risk factor for prediabetes and type 2 diabetes.¹¹ As shown in a 2020 study, participants who had obesity were eight times more likely to develop type 2 diabetes than participants at a healthy weight, despite having a low genetic risk and favorable lifestyle habits. Participants who were overweight had a 2.4-fold higher risk than individuals at a healthy body weight.¹² Obesity is strongly linked to a higher risk of diabetes in adults under the age of 75, even in people who otherwise choose to live a healthy lifestyle.⁷
Most people spend between half and three-quarters of their day sitting. And as most of us know, sitting for a long time is hazardous for our health. It increases your risk of type 2 diabetes by negatively impacting lipid and glucose metabolism. Based on an analysis of 10 scientific studies, researchers found that there is a 112% greater relative risk for type 2 diabetes in people with sedentary lifestyles.¹³
People who smoke are 30% to 40% more likely to develop type 2 diabetes than people who don't.¹⁴ Smoking increases inflammation, which is a risk factor for insulin resistance and prediabetes. Nicotine and other chemicals in cigarette smoke change glucose homeostasis, which makes it harder for the body to use glucose and respond to insulin. Smoking may also impair beta-cell function in the pancreas, which are the cells that store and secrete insulin.¹⁵
Although cigarette smokers may be less sensitive to insulin while smoking, insulin sensitivity increases within one to two weeks after they stop.¹⁶ Smoking cessation can help reduce your risk of developing prediabetes.¹⁵
Other risk factors for prediabetes include:
Polycystic ovary syndrome (PCOS) is associated with insulin resistance, infertility, obesity, abnormal lipid levels, and high blood pressure.¹⁷ It is a common disorder that affects between 6% and 12% of women.¹⁸ A PCOS diagnosis depends on having at least two of the following:
- Increased androgens
- Irregular menstrual cycles
- Polycystic ovaries
Steroids, antipsychotic medications, and HIV medications
Medications can change your metabolism and make it more difficult to manage your blood sugar. For example, glucocorticoids increase insulin resistance and glucose production in the liver, both of which increase blood glucose levels. Review your medication list with your doctor to see if any of them may increase your risk of prediabetes.
Many people with high blood pressure (hypertension) also have high blood sugar. Both conditions are associated with inflammation, obesity, increased triglycerides, metabolic disease, and increased insulin levels.¹⁹ Both high blood pressure and prediabetes can be present for years without symptoms, which is why it’s important to monitor your blood pressure and blood sugar.
Over 38% of Americans have high cholesterol. Total cholesterol includes LDL cholesterol, triglycerides, and HDL cholesterol.²⁰ Increases in LDL cholesterol (bad cholesterol) and triglycerides increase fatty deposits on the walls of your blood vessels, increasing your blood pressure. Increases in LDL cholesterol and triglycerides are linked to other risk factors for type 2 diabetes and cardiovascular diseases. Researchers found that people with prediabetes also had unhealthy increases in LDL cholesterol and triglycerides.²¹
These prediabetes risk factors can have a cumulative effect on your diabetes risk. Individuals who have obesity, have a high genetic risk for type 2 diabetes, and make unhealthy lifestyle choices have a 14.5 times higher risk of developing type 2 diabetes than people who do not.¹²
Warning Signs and Symptoms of Prediabetes
The warning signs and symptoms of prediabetes can be very subtle and they aren’t always specific. If you do notice any new or worsening symptoms, it is important to make an appointment with your doctor to check your risks for prediabetes and to determine whether another condition may be causing your symptoms.
Potential warning signs of prediabetes:
- Excessive thirst and hunger
- Blurred vision
- Tiredness and fatigue
- Increased urination
- Slow healing wounds
- Increased numbers of infections
- Numbness in the feet and hands
When your blood sugar is too high, it exceeds your kidney's capacity to filter it out of urine and return it to the body, so more sugar is lost in your urine. Your body needs to dilute this sugar, so it increases water loss in urine as well. As you produce more urine loaded with excess glucose, you are more likely to become dehydrated and hungry, which triggers your body to drink more fluids and eat more.
Increased blood sugar damages the inner lining of small blood vessels throughout the body, resulting in decreased blood flow to the skin. This can lead to things like poor healing and increased skin infections. High blood sugar in the body creates an environment that bacteria thrive in, and it impacts how well immune cells can fight infection.²²
How to Diagnose Prediabetes
Prediabetes is diagnosed by looking at your fasting blood glucose.²,²³ Impaired fasting glucose, or prediabetes, is defined by a fasting blood sugar level between 100 mg/dL and 125 mg/dL.¹⁷ Normal fasting blood glucose levels for people without diabetes are between 70 and 99 mg/dl and less than 140 mg/dl within one to two hours of eating a meal.
Fasting Blood Glucose
- Normal = between 70 and 99 mg per dL
- Prediabetes = between 100 and 125 mg per dL
- Diabetes = 126 mg per dL or higher
If your fasting blood sugar is high, your doctor may suggest a hemoglobin A1C test, which measures your average blood glucose levels over the previous three months.²⁴
- Normal = below 5.7%
- Prediabetes = between 5.7% and 6.4%
- Diabetes = 6.5% or higher
Another test used to determine your blood sugar over several hours is an oral glucose tolerance test. An impaired glucose tolerance is defined by a glucose level between 140 and 199 mg/dL two hours after receiving a 75-g oral glucose tolerance test (OGTT).¹⁷
Glucose Tolerance Test
- Normal: 139 mg/dL or lower
- Prediabetes: 140 to 199 mg/dL
- Diabetes: 200 mg/dL or higher
The Centers for Disease Control and Prevention (CDC) also offers a Prediabetes Risk Test.²⁴ If your risk is high or you are concerned, call your doctor and ask for a diabetes screening blood test.
Can Prediabetes Be Reversed Permanently?
Multiple studies provide evidence that type 2 diabetes can be prevented or reversed. Early detection followed by making appropriate lifestyle changes can help you reverse prediabetes and reduce your risk of developing type 2 diabetes. When you slowly make sustainable lifestyle changes, you increase your chances of living a longer, disease-free life.
How to Reverse Prediabetes
Making micro changes in your diet and lifestyle choices can help you reverse prediabetes, but it can take time (and effort) before you notice improvements. Choose multiple ways to measure your progress, like tracking your energy level, mood, how well your clothes fit, and your muscle strength.
Improve your exercise routine
Even minor changes in your activity level can make a big difference. The American College of Sports Medicine (ACSM) and the U.S. Department of Health and Human Services Physical Activity Guidelines² jointly recommend the following:²⁵,²⁶
- Exercise at a moderate intensity for 30 minutes a day, five days a week, for a total of 150 minutes of exercise per week.
- Exercise at a vigorous intensity for a minimum of 20 minutes, three days per week, for a total of 60 to 75 minutes per week.
- Do a combination of moderate and vigorous-intensity walking.
Adults over the age of 65 should follow the same exercise guidelines as younger people, but they would also benefit from muscle strengthening and balance exercises.¹⁰,²⁷ In addition to getting enough exercise, monitor how much you are sitting. The 2017 ADA recommendations state that extended sitting should be avoided. They recommend incorporating short periods of activity into your day after each 30-minute block of sitting time.²⁸
Moderate-intensity activity: defined as between 3 and 6 METs:²⁹
- Walking briskly at 3-4 mph
- Heavy cleaning
- Mowing the lawn
- Home repair
- Raking leaves
Vigorous-intensity activity: defined as 6 METs or more:²⁹
- Walking at 4.5 mph or faster
- Jogging or running
- Hiking at a moderate pace or up a steep grade
- Shoveling snow
- Increases muscle strength
- Increases muscle mass
- Reduces all-cause mortality
- Improves ability to complete daily chores
- Increases resting metabolic rate, which can help with weight management
The U.S. Department of Health and Human Services and the American College of Sports Medicine (ACSM) recommend increasing your exercise to a minimum of 300 minutes per week of moderate-intensity exercise to lose or maintain weight. If possible, try to increase your exercise intensity to vigorous, especially if you have a tight schedule.
Adopt a healthy diet
A healthy diet can reduce blood glucose spikes, increase glucagon secretion, and improve insulin sensitivity. Pair carbohydrates with proteins and healthy fats to help reduce insulin spikes. Try to avoid highly processed foods, added sugars, high glycemic index foods, and excessive alcohol consumption. Instead, prioritize healthy eating and incorporate healthy fats, complex carbs, whole grains, and protein into your meals.
The U.S. Food and Drug Administration declared trans fats as not "generally recognized as safe for use in foods.” Since then, most manufacturers have reformulated their foods and changed their processing methods to remove trans fats.³³ Trans fats can increase inflammation, which is linked to insulin resistance and prediabetes. Avoid trans fats and minimize your consumption of saturated fats.
Ultra-processed or refined foods are convenient, but they contain excess sodium, sugar, and saturated fats. They tend to be low in protein and fiber, two key nutrients for feeling full and avoiding blood sugar spikes. Processing foods removes fiber and essential vitamins, and micronutrients.³⁴ Consuming ultra-processed foods is associated with an increased risk for prediabetes and type 2 diabetes.³⁵ Choose whole foods or minimally processed foods to help reverse prediabetes.
High glycemic foods
The glycemic index assigns a number to a food based on how quickly it raises blood glucose. Glycemic load is determined by multiplying the amount of carbohydrates in a food serving with its glycemic index. Foods containing large amounts of simple carbs, such as candy, potatoes, white rice, and white bread, have a higher glycemic load. Choose foods with a low glycemic index to reduce your risk of blood sugar spikes or pair carbohydrates with proteins and unsaturated fats to reduce their effect on your blood sugar.
Sugars are added to many processed foods to improve palatability and enhance sweetness. Unfortunately, they add calories, cause blood sugar spikes, and make weight management more difficult. Look for added sugars in flavored and sweetened beverages, condiments, candies, and baked goods. Reduce your risk of prediabetes by reading and incorporating suggestions from this ultimate guide to low-sugar foods.
Excessive alcohol intake can increase blood sugar and blood pressure. Alcoholic beverages are usually high in calories and sugar, which means they can cause blood sugar spikes and lead to weight gain. Alcohol consumption can also disrupt sleep and increase inflammation. When the quality of your sleep declines, you are at an increased risk of prediabetes. If you consume alcohol, try to limit how much you drink and how often.³⁶ Try to aim for no more than one drink per day for women and no more than two drinks per day for men.
Improve your sleep routine
Your brain does not shut down when you go to sleep. During sleep, the brain and body get rid of waste, release hormones, recharge cells, and work on learning and memory. Disrupted or insufficient sleep increases your risk of insulin resistance, prediabetes, type 2 diabetes, metabolic syndrome, obesity, high blood pressure, abnormal blood lipids, and heart disease. Even one night of sleep deprivation can increase insulin resistance and the risk of developing prediabetes.³⁷ Aim for 7 to 8 hours of restful sleep each night.
Your body's stress response floods it with chemicals and hormones to cause a surge of glucose into your bloodstream to provide your muscles with enough energy to face or flee from your stressor. In the modern world, this response isn’t very helpful. Managing stress effectively can stabilize and even reduce your blood pressure and blood sugar. Too much chronic stress can increase your risk of prediabetes and other serious health conditions.
Lose excess weight
Weight loss is associated with decreased insulin resistance, decreased fasting glucose levels, and increased insulin sensitivity.¹¹ A conservative weight loss goal of 5% to 10% is often enough to normalize blood sugar. Try for a minimum of 5% weight loss because research shows that less than 5% weight loss does not help improve blood sugar control.²⁷,³⁸ Even when the average amount of weight loss is not high, researchers noted that there was a substantial difference in the incidence of diabetes between the group that lost weight and the group that did not.³⁸
Maintaining weight loss is challenging but essential to reducing type 2 diabetes risk. Weight regain increases diabetes risk. When postmenopausal women regained 50% of their lost weight within a year after completing a five-month intentional weight loss program, their insulin levels were higher and they had more insulin resistance than at their baseline. Even partial weight regain can increase diabetes and cardiovascular disease risk.³⁹ Researchers caution that more studies are needed in more diverse populations to fully understand the risk of weight regain.
Address other medical conditions
If you have obesity, high blood pressure, high cholesterol, polycystic ovary syndrome (PCOS), or sleep apnea, see your doctor for help in developing a treatment plan. These medical conditions may increase risk factors that are associated with prediabetes. Managing these conditions can improve your overall health and reduce your risk of diabetes.
Keep track of your health
Know your numbers. Do you know your blood pressure, cholesterol, triglyceride, and blood sugar numbers? Keep track of these numbers using your online medical record. If you see trends such as increased blood pressure, total cholesterol, low-density lipoprotein (LDL), triglycerides, or fasting blood sugar, talk to your doctor about steps you can take to improve these numbers.
Reach out to a pro for help
If you have prediabetes, ask for help. Make an appointment with a dietitian or nutritionist who specializes in diabetes to create a dietary plan that incorporates your favorite foods while taking steps towards a healthier and more nutritious diet.
Talk to your doctor or healthcare provider about your weight if you are concerned. This conversation is hard to open, but once you do, you may find that your doctor has advice, referrals, and medication that can help you lose weight. See if they can refer you to a diabetes prevention program.
How Long Does It Take to Reverse Prediabetes?
It takes time to develop prediabetes, and it also takes time to reverse it. Your risk factors and your ability to make significant lifestyle changes will determine how long it takes to reverse prediabetes. There is no set timeline. Prediabetes is reversible. No matter how long it takes, don't get discouraged. Every lifestyle change you make improves your health and reduces your risk of developing type 2 diabetes and its associated chronic diseases.
When You Should Consult A Pro
The earlier you identify and diagnose prediabetes, the better. If you have symptoms that concern you, see your doctor. Talk to your doctor about your weight and blood sugar. Obesity and type 2 diabetes are both chronic diseases. Over the last decade or so, research into obesity management and drug development has increased, expanding treatment options for both conditions.
Tracking Your Health
Metabolic changes leading to prediabetes and, eventually, type 2 diabetes, start 10 to 13 years before receiving a diabetes diagnosis. However, a diabetes diagnosis is not inevitable. You can make lifestyle changes now that reduce your risk of developing type 2 diabetes.
While diabetes screening tests may help identify people at high risk, a single screening test misses many people who develop type 2 diabetes.⁶ By tracking your blood sugar and looking for patterns, you can increase your chances of identifying insulin resistance early, thus avoiding prediabetes and, ultimately, type 2 diabetes. A CGM and the Signos app provide real-time data to help you make decisions about how to optimize lifestyle factors that affect your health and reduce your risk of prediabetes.
Get more information about weight loss, glucose monitors, and living a healthier life
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