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Did you know that over 96 million Americans have prediabetes – and most have no idea? Prediabetes is your body's early warning system that your blood sugar is higher than normal but hasn’t yet reached the level to be considered Type 2 diabetes. The good news? With simple lifestyle changes like diet, exercise, and weight management, prediabetes can often be reversed. The key is knowing the warning signs, causes, and steps to take before it turns into a lifelong condition.

In this blog, we’ll answer the most important questions about prediabetes, from testing and symptoms to providers and prevention.

What Causes Prediabetes?

Prediabetes is a metabolic condition where blood sugar (glucose) levels are higher than normal, but not high enough to be classified as Type 2 diabetes. It develops when your body starts to lose its ability to regulate blood sugar effectively, which may eventually lead to Type 2 diabetes if left unchecked.

In prediabetes, the body’s cells become resistant to insulin (the hormone that helps regulate blood sugar levels), or the pancreas does not produce enough insulin to keep blood sugar levels in check. As a result, glucose builds up in the bloodstream, leading to higher-than-normal blood sugar levels.

Several factors can contribute to insulin resistance:

• Poor diet (especially high in refined carbs and sugar)

• Physical inactivity

• Being overweight or obese

• Hormonal imbalances

• Chronic stress

• Family history of diabetes

• Age (especially over 45)

So, what causes diabetes? In most cases, it begins with prediabetes. If no changes are made, your body may continue to lose insulin function, leading to full-blown Type 2 diabetes.

Testing for Prediabetes

Prediabetes is diagnosed through simple blood tests that measure blood sugar levels. Your provider might order one or more of the following:

• Fasting Blood Glucose Test: This measures your blood sugar after 8 hours without food. These are what the lab values mean:

• • Normal: under 100 mg/dL

• • Prediabetes: 100–125 mg/dL

• • Type 2 diabetes: 126 mg/dL or higher

• Hemoglobin A1C Test: This test measures your average blood sugar levels over the past two to three months.

• • Normal: under 5.7%

• • Prediabetes: 5.7%–6.4%

• • Diabetes: 6.5% or higher

• Oral Glucose Tolerance Test (OGTT): This test measures how your body handles glucose after drinking a sugary drink. After fasting, you’ll drink a sugary solution, and your blood is tested over time. This test is mostly used in pregnancy or special cases. A blood sugar level between 140-199 mg/dL after two hours indicates prediabetes.

If your numbers fall into the prediabetic range, don’t panic – but do take it seriously. This is your opportunity to take back control. Prediabetes is reversible through early intervention, but regular testing is necessary to track blood sugar levels and catch any changes before they become more serious.

Signs and Symptoms of Prediabetes

Prediabetes can develop without noticeable symptoms, which is why it’s often referred to as a “silent” condition.

According to Marcia Carlson, RN, MA, CDCES at Southeast Iowa Regional Medical Center-West Burlington, “Diabetes is very sneaky and can develop with no symptoms in many people. In fact, 20 – 25% of people with diabetes don’t know they have it according to the CDC. Prediabetes is even less likely to cause symptoms. Some people may notice symptoms of increased fatigue, tingling in their toes, or increased thirst.”

Some early warning signs may include:

• Increased thirst: A common symptom of high blood sugar is increased thirst. If your kidneys are working overtime to filter out excess glucose, this can lead to dehydration, causing you to feel thirsty.

• Frequent urination: When blood sugar levels are elevated, the kidneys must work harder to filter and absorb excess glucose, leading to increased urination.

• Fatigue: High blood sugar levels can impair your body’s ability to use glucose for energy, leading to fatigue and tiredness.

• Blurred vision: Elevated blood sugar can cause fluid to be pulled from the lenses of your eyes, affecting your ability to focus.

• Unexplained weight changes.

• Slow-healing wounds or infections: High blood sugar can impair the body's ability to heal wounds or fight infections effectively. This includes frequent yeast infections or skin infections.

• Hair thinning.

• Areas of dark skin: A condition called acanthosis nigricans causes dark, thickened skin in areas such as the neck, armpits, and groin, which can be a sign of insulin resistance.

Since many of these symptoms overlap with other health conditions, it’s important to get tested if you have concerns or are at risk for developing prediabetes.

Why It’s Important to Catch Prediabetes Early

Catching prediabetes early is critical because it allows for lifestyle changes that can prevent the progression to Type 2 diabetes. Without intervention, people with prediabetes have a 5 to 10 times higher risk of developing Type 2 diabetes. Additionally, prediabetes increases the risk of heart disease, stroke, and kidney problems.

“It's important to catch prediabetes early to initiate lifestyle changes with the intent of preventing diabetes and diabetes-related complications. Many diabetes-related complications are a result of high blood sugars, which typically occur with diabetes and not prediabetes, but there are studies that show that the cardiovascular disease associated with diabetes actually starts when someone has prediabetes,” explained Cathy Mehmert, RD, CDCES at Southeast Iowa Regional Medical Center-Fort Madison. “In other words, someone with prediabetes may not have blood sugars high enough to put them at risk for nephropathy, retinopathy, and neuropathy, but their cholesterol could be high enough to cause cardiovascular disease and this needs to be addressed as early as possible.” 

The most compelling reason to address prediabetes early is that Type 2 diabetes can lead to serious complications if left unmanaged, including nerve damage, kidney disease, blindness, and even amputations. However, with lifestyle changes, the risk of developing Type 2 diabetes can be significantly reduced, and in some cases, blood sugar levels can return to normal.

Who is at Risk for Pre-Diabetes?

Several factors increase the likelihood of developing prediabetes. These include:

• Age: As we age, the risk of developing prediabetes increases. People over the age of 45 are more likely to develop prediabetes, especially if they are overweight.

• Obesity: Being overweight or obese is a major risk factor for prediabetes. Fat cells, especially those stored around the abdomen, can contribute to insulin resistance.

• Family history: If you have a parent or sibling with Type 2 diabetes, your risk of developing prediabetes increases.

• Lack of physical activity: Physical inactivity contributes to insulin resistance, which increases the risk of developing prediabetes.

• Unhealthy diet: Diets high in processed foods, sugary drinks, and unhealthy fats increase the risk of developing prediabetes.

• Ethnicity: People of certain ethnicities, including African American, Hispanic, Native American, and Asian American, have a higher risk of developing prediabetes.

When Can Prediabetes Occur? Do Age and Family History Matter?

Age and genetics both increase risk of prediabetes. Prediabetes can develop at any age, but it is more common in adults over 45 years old. However, with the increasing prevalence of obesity and poor lifestyle choices, prediabetes is now being diagnosed in younger individuals, including teenagers and young adults.

If you have a family history of Type 2 diabetes, you’re at higher risk. But having these risks doesn’t guarantee a diagnosis. It just means you should take preventative steps sooner. Early intervention is key to preventing the condition from worsening as people age. Talk to your doctor about earlier and more frequent screening.

How Can You Reverse or Prevent Diabetes?

The good news is that prediabetes is not a life sentence for developing Type 2 diabetes. Lifestyle changes are more powerful than you might think. By making certain changes to your lifestyle, you can reverse or manage the condition and significantly lower your chances of developing diabetes.

“Recommended changes when you have prediabetes focus on healthy eating and being active. In my experience, the greatest challenge people have is moving more consistently,” said Carlson. “Another challenge is that motivated patients sometimes make such drastic eating changes that they cannot maintain them and then become discouraged. Setting a realistic goal is key. It’s true that small changes can make a big difference in your diabetes risk. Things like taking a 10-minute walk after eating each day or replacing sugary drinks with water can help a lot.”

Here are some steps you can take:

1. Lose weight: If you are overweight,losing even7-10% of your body weight can help lower your blood sugar levels and improve insulin sensitivity. For example, if you weigh 200 pounds, losing 10-20 pounds can make a significant difference.
2. Exercise regularly: Physical activity helps your body use insulin more effectively. Aim for at least 150 minutes of moderate-intensity exercise per week, such as walking, swimming, or cycling. Strength training exercises are also beneficial.
3. Eat a balanced diet: Eat a balanced, lower-carb diet focused on whole, unprocessed foods. Focus on eating a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Avoid processed foods and limit your intake of sugary beverages and snacks. Incorporate fiber-rich foods like beans, legumes, and whole grains, which help regulate blood sugar levels.
4. Monitor your blood sugar levels: Regular blood sugar monitoring can help you keep track of your progress and adjust your lifestyle as needed. Work with your healthcare provider to determine how often you should check your blood sugar.
5. Manage stress: Chronic stress can lead to increased blood sugar levels. Practice relaxation techniques like yoga, meditation, deep breathing, or mindfulness to help reduce stress.
6. Get enough sleep: Poor sleep can disrupt your body’s ability to regulate blood sugar levels. Aim for 7-9 hours of quality sleep each night to support overall health and help manage blood sugar levels.
7. Avoid smoking and limit alcohol.
8. Social factors can also play a major role in managing prediabetes. However, there are services available to address some of these factors like access to healthy food, transportation, and health literacy. Explore ways to save money at the grocery store. Resources with easy-to-understand tips are also available if you prefer simple, clear information. 

How Does Food Affect Prediabetes?

One of the biggest contributors to prediabetes is your diet, specifically, your carbohydrate intake. But what is a carb?

Carbohydrates are one of the body’s main sources of energy, found in:

• Bread, pasta, rice

• Potatoes

• Fruit

• Sugar and sweets

• Processed foods

When you eat carbs, your body turns them into glucose (sugar). Too many carbs, especially refined carbs and sugars, can spike your blood sugar and wear down your body’s insulin response.

“Carbohydrates raise blood sugars the most, so it's important to focus on the amount eaten at meals and snacks. I recommend eating at least three meals daily with similar amounts of carbohydrates,” said Mehmert. “For prediabetes, a 7% to 10% weight loss is recommended to prevent diabetes. I review what the patient eats and work with them to develop simple but sustainable changes in their diet to promote weight loss. Exercise and smoking cessation also play a role in preventing diabetes.”

Smart Food Swaps for Prediabetes:

• Choose whole grains (brown rice, oats) over white rice and white bread.

• Opt for non-starchy vegetables like leafy greens, broccoli, and peppers.

• Add lean proteins and healthy fats (like nuts, olive oil, avocado) to balance your meals.

• Limit sugary drinks, snacks, and processed foods.

The goal is to stabilize your blood sugar and improve your insulin sensitivity.

“Blood sugars are affected by food, exercise, medications, alcohol, stress, and illness. Many people don't realize that their liver produces sugar or glucose, and puts glucose into the bloodstream which increases blood sugar levels,” explained Mehmert. “ If someone is sick or stressed, their liver can make extra glucose and cause an increase in blood sugar levels. This is why someone with diabetes can have high blood sugars without eating anything...the extra sugar comes from their liver.”

Which Providers Can Help?

Knowing who to see and when is crucial for catching and reversing prediabetes.

• Primary Care Provider (PCP): Your first point of contact. Ask them for regular blood tests if you have risk factors.

• Registered Dietitian or Nutritionist: Can help you design a realistic, sustainable eating plan.

• Certified Diabetes Educator (CDE): Offers practical tools to manage blood sugar and prevent diabetes.

• Mental Health Counselor: Stress, emotional eating, and burnout are real. Don’t ignore the emotional side of lifestyle changes.

Whether or not an endocrinologist is needed depends on if your condition progresses to diabetes or involves complex hormonal issues.

What Questions Should You Ask Your Doctor?

Being informed and asking the right questions can help you catch prediabetes early and stay on top of your health.

Following are questions to ask at your annual checkup or if you have risk factors:

• “Should I be tested for prediabetes?”

• “Do I have any signs of insulin resistance?”

• “What lifestyle changes should I make now to avoid diabetes?”

If You’re Feeling Symptoms:

• “Could my fatigue, thirst, or blurred vision be related to blood sugar?”

• “Can we check my A1C or fasting glucose levels?”

If You've Been Diagnosed with Prediabetes:

• “How often should I monitor my blood sugar?”

• “What are realistic weight and exercise goals?”

• “Can I work with a dietitian?”

• “Is medication necessary now, or can I try lifestyle changes first?”

Remember, early detection is key – the earlier you act, the better your chances of preventing diabetes.

Finding Help

Prediabetes doesn’t mean you’re destined to get diabetes – but it is a wake-up call. With awareness, support, and lifestyle changes, it is possible to prevent or even reverse prediabetes. Early detection and intervention are crucial to avoid long-term complications of diabetes. If you are at risk, or suspect you may have prediabetes, talk to your PCP about getting tested and taking the necessary steps to protect your health. Click here for a full list of primary care providers accepting new patients at our Great River Health locations.

In addition, Southeast Iowa Regional Medical Center dietitians are a valuable resource for those diagnosed with prediabetes. PCPs and the Diabetes Education Programs at Great River Health locations can assist patients in connecting with a dietitian. They can also provide resources from the American Diabetes Association and from the Centers for Disease Control and Prevention (CDC). Henry County Health Center Diabetes Education does offer a free prediabetes class. Find out more by calling 319-385-6518.

For individuals diagnosed with Type 1, Type 2, and gestational diabetes, our Diabetes Education Programs provide personalized care. Learn more about Great River Health’s Diabetes Education Programs.

For more information about prediabetes, visit our Health Library.