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My doctor told me I have prediabetes. What do I do now?

The diagnosis is a wake-up call that type 2 diabetes is lurking around the corner. The good news? Making small changes can help you reverse course.
Overweight Woman Standing on a Riverbank at Sunrise
Increasing physical activity to just 30 minutes of brisk walking a day can help improve blood sugar control.Teresa Otto / Getty Images / iStockphoto

There is no shortage of guidance from medical professionals about the risks and management of diabetes. But there is another closely linked condition that is far more prevalent and requires fast action: prediabetes.

About 1 in 3 Americans currently have prediabetes. More alarmingly, 84% don’t know they have it. In fact, a 2018 study found that metabolic markers of prediabetes may occur 20 years before a diagnosis is made. This may be because some of the symptoms associated with a prediabetic state are often not obviously related. (For example, acanthosis nigricans is a related skin condition that involves darkening of the skin in areas such as the groin, neck, elbows and armpits.)

Studies show that up to 170 million Americans could be prediabetic by 2030, which means many people will find themselves sitting in a doctor's office faced with the diagnosis. So what should you do when you hear those words? Here's what you need to know:

What exactly is prediabetes?

To understand the condition, you have to understand the process that occurs in the body to break down and use carbohydrates. When you consume a carbohydrate, the body needs to convert the food into glucose. It does this by relying on the hormone insulin (secreted by the pancreas), which is responsible for chaperoning the sugar to the cells. Insulin essentially knocks on the cell door to allow the cells to let glucose in. Once it gets into the cells, sugar is stored (as glycogen) and can be used as energy. This physiological process is critical to avoid circulating blood sugar in the body.

In a prediabetic state, the cells don’t respond in a normal manner to insulin so the body produces and pumps out even more insulin to try to elicit that response. Eventually, the pancreas becomes exhausted in the process and blood sugar increases.

What causes prediabetes?

Although researchers are not completely certain of the exact cause of prediabetes; being overweight and obese (especially if you carry the weight in the mid-section) appears to be a primary risk factor. Other important indicators include poor diet, sedentary behavior, family history, genetics, history of gestational diabetes or current diagnosis of polycystic ovarian syndrome.

How is prediabetes diagnosed?

Prediabetes is often diagnosed when either your blood sugar or hemoglobin A1C (a three-month marker of blood sugar control) is higher than normal in lab values, but is not high enough to be considered type 2 diabetes. According to the Cleveland Clinic, “the diagnosis of pre-diabetes is made when two blood tests show that your fasting blood sugar level is between 100 and 125 mg/dl, or if two random (anytime) blood sugar tests are greater than or equal to 140, but below 200.” For hemoglobin A1C, a reading of 5.7–6.4% is also associated with prediabetes.

What is happening in my body if I am diagnosed with prediabetes?

When blood sugar is consistently elevated, damage to organs (including the heart, brain and kidneys), as well as the nervous system can occur. This increases the risk for heart disease and stroke, as well as kidney and eye problems. A 2020 study in the British Medical Journal found that prediabetes was linked to an increased risk of both heart disease and death; studies also show an increased risk of Alzheimer’s disease and dementia. Not to mention it leaves you more vulnerable to complications from other illnesses, including COVID-19.

I have been diagnosed with prediabetes. What should I do?

A diagnosis of prediabetes is a wake up call that type 2 diabetes is lurking around the corner, but there’s good news as well. You can avoid turning that corner by making essential lifestyle changes now. The key to reversal can often be found in simple habits:

Lose weight

Studies show that losing just 5-7% of body weight can result in significant benefits to blood sugar control. This accounts for about 10 to 14 pounds for a 200-pound person. In addition to weight, you should also focus on your waist size, aiming for a waist circumference less than 40 inches for men and less than 35 inches for women.

Move more

Physical activity may also help with improvements in blood sugar control. That doesn’t mean you have to set your sights on a marathon, either. Increasing physical activity to just 30 minutes a day may provide benefits. In fact, a study from Duke University School of Medicine found that walking briskly on a regular basis may be more beneficial than jogging for prediabetic patients.

Stress less

Data from the 2015 annual meeting of the Endocrine Society found that mindfulness-based stress reduction methods improved glucose levels in obese women.

Change your diet

Replacing sugar, refined carbohydrates and highly processed foods with a diet rich in plants, healthy fats and lean proteins may help. Studies have indicated that even short exposure to a “standard American diet” (characterized by high intake of saturated fats, refined grains and sugars) increases the risk for prediabetes. That means eat more real food and less junk.

  • Adopt a lower-carbohydrate approach. A 2019 study from the Ohio State University found that 50% of individuals with metabolic syndrome (a condition that includes abnormally high blood sugar) saw reversal after following a low-carb diet.This reversal was evident even when weight loss did not occur.
  • Ditch the diet cola. Don’t turn to artificial sweeteners to satisfy your sweet tooth. Recent studies indicate that they may interfere with normal blood sugar levels. Instead, quench your thirst with water, coffee and tea.
  • Consider fasting. Studies in both humans and animals show that incorporating a time restricted eating approach (a form of intermittent fasting) may help prediabetics avoid type 2 diabetes as well. Simply eating breakfast later and dinner earlier may be a start.

It can be scary to hear, but look at a prediabetes diagnosis as a welcome warning sign, giving you the chance to change course before turning down a dangerous path. Now is the time to take control of your health and work towards reversal.