Prediabetes means your blood sugar is higher than normal but not yet high enough to be diagnosed as type 2 diabetes. It is extremely common, and most people who have it do not know. The important message is that prediabetes is often reversible. Catching it early gives you a real chance to prevent or delay type 2 diabetes and the complications that come with it.
What happens in prediabetes and type 2 diabetes
After you eat, carbohydrates are broken down into glucose (sugar), which enters your bloodstream. The hormone insulin, made by the pancreas, helps move that glucose into your cells for energy.
In insulin resistance, cells respond poorly to insulin. The pancreas makes extra insulin to compensate, but over time it may not keep up. Blood sugar rises, first into the prediabetes range and later, for some people, into the diabetes range.
Blood test numbers explained
Doctors use three main tests. The American Diabetes Association uses these thresholds:
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| A1C | Below 5.7% | 5.7%–6.4% | 6.5% or higher |
| Fasting plasma glucose | Below 100 mg/dL | 100–125 mg/dL | 126 mg/dL or higher |
| 2-hour oral glucose tolerance test | Below 140 mg/dL | 140–199 mg/dL | 200 mg/dL or higher |
- A1C reflects your average blood sugar over roughly the past three months. You do not need to fast.
- Fasting glucose is measured after at least 8 hours without food.
- Oral glucose tolerance test measures blood sugar two hours after a sweet drink.
A diabetes diagnosis normally needs confirmation with a repeat test, unless there are clear symptoms with a very high random glucose level.
Early signs to watch for
Prediabetes usually causes no symptoms. Some people notice darkened, velvety skin in body folds such as the neck or armpits (acanthosis nigricans), which is linked to insulin resistance.
When blood sugar rises into the diabetes range, symptoms may include:
- Feeling very thirsty and urinating often, including at night
- Unusual tiredness
- Blurred vision
- Cuts or sores that heal slowly
- Frequent infections, such as skin, gum or urinary infections
- Tingling or numbness in the hands or feet
- Unexplained weight loss
Many people with type 2 diabetes still have few or no symptoms, which is why screening matters.
Who should get tested
You are more likely to develop prediabetes and type 2 diabetes if you:
- Are 35 or older
- Have overweight or obesity, particularly around the waist
- Have a parent or sibling with type 2 diabetes
- Are physically active fewer than three times a week
- Had diabetes during pregnancy (gestational diabetes) or gave birth to a baby weighing more than 9 pounds
- Have polycystic ovary syndrome (PCOS)
- Have high blood pressure, low HDL cholesterol or high triglycerides
- Are of African American, Hispanic/Latino, American Indian, Alaska Native, Asian American or Pacific Islander background
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If any of these apply, ask your healthcare professional about a simple blood test.
How to reverse prediabetes
The landmark Diabetes Prevention Program study found that a structured lifestyle program cut the risk of developing type 2 diabetes by 58% over about three years, and by 71% in people aged 60 and older. The key ingredients were modest and realistic.
Lose a small amount of weight
Losing 5% to 7% of your body weight can make a major difference. For a person weighing 200 pounds, that is 10 to 14 pounds.
Be active for 150 minutes a week
Brisk walking for 30 minutes on five days a week reaches this goal. Muscle activity helps your body use glucose and improves insulin sensitivity. Adding strength exercises twice a week gives extra benefit.
Improve the quality of your carbohydrates
- Choose whole grains, beans, lentils, vegetables and whole fruit.
- Cut back on sugary drinks, including soda, sweet tea and many coffee drinks.
- Limit white bread, pastries and highly processed snacks.
- Fill half your plate with non-starchy vegetables, a quarter with lean protein and a quarter with whole grains or starchy foods.
Sleep well and manage stress
Short sleep and long-term stress can both worsen insulin resistance. Aim for 7 or more hours of sleep and build in daily ways to unwind.
Stop smoking
Smoking increases the risk of type 2 diabetes as well as heart disease.
The CDC-recognized National Diabetes Prevention Program offers year-long lifestyle programs, in person and online, that follow the approach tested in research.
Is medicine ever used for prediabetes?
For some people at high risk, such as those with a higher BMI, younger age, or a history of gestational diabetes, a clinician may consider metformin alongside lifestyle changes. Lifestyle change remains the foundation.
What if it is already type 2 diabetes?
Type 2 diabetes is a serious condition, but it can be well managed. Treatment usually combines healthy eating, physical activity, weight management and, when needed, medicines. These may include metformin and newer drug classes that also protect the heart and kidneys in some people. Regular checks of A1C, blood pressure, cholesterol, kidney function, eyes and feet help prevent complications.
How often to re-test
If you have prediabetes, your clinician will usually recommend testing at least once a year to see whether your numbers are improving.
Frequently asked questions
Can prediabetes go away?
Yes. Many people bring their blood sugar back to the normal range with weight loss, more activity and better food choices.
Does eating sugar cause diabetes?
Sugar alone does not directly cause type 2 diabetes, but a diet high in sugary drinks and refined carbohydrates contributes to weight gain and insulin resistance, which raise risk.
Is an A1C of 6.0 bad?
An A1C of 6.0% is in the prediabetes range. It is a signal to act now, while changes are most effective.
The bottom line
Prediabetes is a warning light, not a final diagnosis. A simple blood test can find it, and modest weight loss plus regular activity can often turn it around. If you have risk factors, ask to be tested.
This article is for general information and is not a substitute for advice from a qualified healthcare professional.