Your Guide to Understanding and Managing Prediabetes

Last updated November 13, 2018.

When your blood sugar climbs higher than normal, but not so high that you fit the definition of diabetes, we say that you have prediabetes. It’s very common — an estimated 86 million Americans have prediabetes and another 120 million have actual or frank diabetes.

So prediabetes isn’t an actual disease so much as a warning sign. Getting a prediabetes diagnosis doesn’t mean you’re guaranteed to progress to full on Type 2 diabetes, which brings heightened risks of heart disease, kidney disease, nerve damage and more.

The good news is if you’re motivated now to make some simple lifestyle adjustments, you can reverse prediabetes and live a healthy life.

Your Guide to Understanding and Managing Prediabetes
How is prediabetes diagnosed?
What causes prediabetes?
What is the treatment for prediabetes?
What medications are used to treat prediabetes?
What are some easy ways to make better food choices?
How can I get more exercise in my day?

Prediabetes is a laboratory diagnosis. Most commonly it’s detected when a routine blood test shows that your fasting blood sugar is elevated. Other tests that may detect prediabetes are a hemoglobin A1c, which measures your average blood sugar over the preceding several weeks, and a glucose tolerance test, in which your blood sugars are sampled at various times after consuming a large quantity of sugar. Most patients do not have any of the typical symptoms we associate with diabetes, such as increased thirst, increased urination or blurry vision.

Why is high blood sugar bad for you? The answer to this question still isn’t fully understood, but we do know that a high blood sugar can itself be harmful and is associated with many other metabolic abnormalities — such as resistance to the hormone insulin and elevated blood lipids — that together can damage your blood vessels, nerves and pretty much every organ in your body. Patients with prediabetes are at risk for these complications, but less so than those with actual diabetes.

Prediabetes results from a combination of genetic and environmental factors. You can’t do much about the former, such as a family history of diabetes, or being a member of an ethnic or racial groups (Black, Hispanic, Native American, Pacific Islander or Asian American) who is diagnosed with diabetes at a higher rate than the rest of the population.

But you can dramatically alter the latter. The main lifestyle habits that can set you up for prediabetes include:

• Becoming overweight
• Physical inactivity
• Inadequate or poor quality sleep
• Smoking

Women with a history of gestational diabetes are also at increased risk for prediabetes, as are women with polycystic ovarian syndrome (PCOS) and anyone with sleep apnea.

The goal of treating prediabetes is to return the blood sugar to normal and prevent the development of actual diabetes. This can be accomplished with a combination of lifestyle changes, and medication, if necessary. As you can see from the list of causes, achieving this goal is largely in your hands, and your health care provider can help!

Losing weight, even a few pounds, can make a huge difference. This is best achieved through a healthy diet that includes lots of leafy green vegetables, fruit and lean proteins diet and regular exercise. If you’re getting enough sleep but still feeling tired every day, you may have a sleep disorder that can be diagnosed in a sleep lab. And finally, of course, if you’re a smoker you must stop. Your health care provider can help you achieve all of these goals.

For certain patients, primarily those who are significantly overweight and in whom lifestyle changes have not successfully lowered the blood sugar, medication can be considered. The one used most often is metformin, which helps lower blood sugar levels.. There is as yet no compelling evidence that any alternative supplements — e.g. herbs or vitamins — are effective.

Prediabetes is a risk factor for developing actual diabetes, but it’s one that can almost always be successfully managed through lifestyle adjustments. Look at it not as a disease but as a warning sign, one that if addressed can lead to a healthier, happier and longer life.

If you need medication to manage your prediabetes, your doctor may prescribe metformin, commonly known by the brand name Glucophage. This medication, which is only approved for people with actual diabetes, helps regulate the amount of sugar in your blood and it can help lower insulin resistance. Some providers will recommend it to help lower blood sugar and weight. Your doctor may also prescribe medications to help control your cholesterol and blood pressure — these won’t prevent prediabetes from progressing, but can help manage conditions that may accompany it.

• Benefits: Controlling the amount of sugar in your blood and increasing your body’s response to insulin can help prevent prediabetes from developing into type 2 diabetes.
• Harms: Your provider can help tailor your medication to your individual needs. Common side effects of metformin include diarrhea, bloating, stomach pain, gas, indigestion, constipation, heartburn, a metallic taste in the mouth, and more.

Shifting your diet to one built around green vegetables, lean proteins and natural fats and getting regular exercise a few times a week will reduce your blood sugar. For many people, a prediabetes diagnosis is just a wake-up call that inspires them to embrace a healthier approach to life.

There are many ways for you to help manage and even reverse your prediabetes. But two healthy habits can make the biggest difference: Making healthy food choices and getting regular exercise.

You’re more likely to develop prediabetes if you’re overweight and/or eat a diet that contains too many calories from refined carbohydrates and processed foods. Excess weight — especially around the abdomen — and poor food choices can contribute to insulin resistance, a condition that affects your body’s ability to regulate blood sugar (glucose). Insulin resistance is also one of the hallmarks of type 2 diabetes. The good news is, you can keep insulin resistance at bay by improving your diet and managing your weight.

Try these small steps that will help you start eating a diet that prevents disease:

• Fill half your plate with leafy greens at every meal and cut back on refined carbs like cookies, french fries, chips, and pastas. These kinds of carbohydrates can cause your blood sugar levels to rise tounhealthy levels and increase your odds of developing insulin resistance. Instead, eat whole grains, such as steel-cut oatmeal, brown rice, popcorn, and quinoa, plus fresh produce. These foods are low in fat and packed with fiber to keep your blood sugar stable.
• Replace sodas, fruit juices, alcohol, and sweetened drinks with water. Make your water more interesting by adding a slice of fresh orange, strawberry, watermelon or cucumber.
• Choose natural fats that are good for your body such as avocados, walnuts, virgin coconut oil, grass-fed meat and salmon.  

You don’t have to be a world-class athlete in order to reap the benefits of exercise: incorporating small amounts of movement throughout the day can be just as effective as one sustained workout. Aim for a total of 30 to 60 minutes of moderate-intensity exercise every day, combining cardio and resistance training. Here are some ideas for how to get started:

• Try a try a brisk 30-minute walk after work
• Take the stairs instead of the elevator
• Get off the train or bus one stop early and walk the rest of the way
• Schedule walking breaks on your calendar, just like you do with meetings
• Invest in a pedometer or fitness tracker and set goals
• Find a friend or coworker to walk with — having a partner helps you stick to it
• Walk to pick up your lunch instead of having it delivered

Exercise is an important part of managing and potentially reversing prediabetes. Not only can it aid in weight loss, but moving more causes your muscles to use up blood sugar and increase your body’s sensitivity to insulin. If you’re overweight, losing about 5 to 10 percent of your body weight (that’s 10 to 20 pounds if you’re 200 pounds) can also help.