Prediabetes and COVID-19

wear a mask

Viruses, including COVID-19, prefer a glucose-rich atmosphere[1] for robust growth.

Prediabetics have elevated blood sugar levels. Our bodies are rich with glucose and are walking bull’s-eyes for COVID-19 looking to take up residence in the nearest fertile host.

We’re not more likely to become infected with COVID-19 if we’re prediabetic, but, once infected, we are at increased risk of harm from the virus.

Another piece of bad news is that infection with COVID-19 might lead to development of type 2 diabetes.[2] If someone is prediabetic, their risk of developing T2D is already elevated. Pile on a COVID-19 infection, and the risk goes up even more.

The good news is there are protective steps that can be taken.

Talk to your healthcare provider about changes you can make in your diet. Cutting back on carbs is probably the first step.

Start now, with a healthy lunch or supper, wherever you are in your meals for the day. No need to wait until next week or next month.

The goal is to reduce the amount of excess glucose floating around in the blood.

You may end up infected with COVID-19, but by reducing your blood sugar levels, you can make it a harder battle for the little parasites.

Remember: wear a mask, clean your hands repeatedly throughout the day, and maintain six feet of separation.

[1] Journal of Metabolic Syndrome, COVID-19 World Tour: Glucose fan-support,, (July 27, 2020).

[2] Nature, Mounting clues suggest the coronavirus might trigger diabetes,, (July 27, 2020).

Understanding Food Choices


Prediabetics come in a variety of shapes.

We’re plump, willowy, healthy heft for our height, bursting out of our clothes—let’s face it, we’re all over the scale when it comes to weight.

Prediabetes is increasing in the population, as is abdominal obesity. But the increase in waist size in this country cannot be blamed for all cases of prediabetes.[1]

Keep that in mind when you’re thinking about your lifestyle and what needs to change. If you’re a person with normal BMI (body mass index) and a healthy waist size, but you’re prediabetic, you still need to look at your diet.

[Check with your healthcare provider and nutritionist before making changes to your way of eating.]

All of us living with prediabetes need to look at our diet. By definition,[2] we’re considered prediabetic because our blood sugar levels are higher than normal, and that sugar comes from the foods we eat.

Don’t waste time looking for the definitive guide to eating healthy and getting out of prediabetes land. We’re individuals with varying genes. What works for one person may not work for another.[3]

That doesn’t mean you give up on adapting your diet. There is a path to healthy eating with your name on it, and you will find it.

What’s On The Menu?

Here are a few rules that apply to all of us:

  • leave sweets (pie, cake, cookies, candy, donuts, etc.) out of the grocery cart, try berries or fresh fruit
  • pass by the white rice, instead pick up brown or wild rice
  • say no to soda pop and fruit juices, drink more water
  • don’t add sweeteners to your foods or drinks, such as white sugar, brown sugar, agave nectar, maple syrup, or honey
  • hold off on eating foods made with white flour, such as bread, pizza crust, and dinner rolls

Other no-nos are out there, but it’s a good starting point.

How many carbs, and how much protein and fat should you eat each day? That depends on how your body handles food.

First, talk to a nutritionist/dietitian who also has experience or training in diabetes education. They’ll create a game plan for you that will get you started on a healthier way of eating.

Second, buy a meter and “eat to your meter.” The nutritionist will give you a guide that applies, in general, to lots of people. It may be adapted somewhat to meet your specific medical needs, if you have any.

But without doing genetic tests on you, and conferring with a geneticist to interpret the results, the pamphlets or info sheets the nutritionist hands you won’t drill down to your body’s specific needs.

We want our blood sugar levels to be normal, not elevated. To get there, we must test the foods we eat to find out what our dietary triggers are . This is why we strongly recommend that for the first six months or so of adapting to your new way of eating, you use a meter to test your blood sugar levels before and after eating and first thing in the morning.

Eventually, you’ll recognize what foods work for you and what foods send your blood sugar bouncing up. It’s going to go up after you eat, but you want it to come back down within a certain range after a couple of hours.

Where to start? Carbohydrates, or carbs, are a good starting point. They’re the fuel we use to power our bodies, but we want the good fuel, not the crappy hard-on-the-body fuel.

Generally speaking, complex carbs are good, simple carbs are bad.

The dietitians we’ve interviewed recommend looking at the kind of carbs you’re eating, and cutting back on simple carbs. These are the carbohydrates that break down quickly in the body, sending a rush of sugar into your bloodstream.

Simple carbs include but aren’t limited to:

  • Fruit juice and sweetened beverages such as soda pop
  • Candy
  • Pie, cake, cookies, donuts, and the like
  • Table sugar and syrup
  • White rice
  • White bread
  • White flour

Packaged foods with words that end in “ose” on the nutrition label, particularly if the “ose” words are close to the beginning of the list of ingredients, are a no. The “ose” words are chemical names for sugar and include words such as glucose, maltose, sucrose, dextrose and, well, you get the idea.

Simple carbs can be found occurring naturally in foods such as milk, fruit, and vegetables. They still raise blood sugar levels faster than complex carbs, but they’re better for you, as they have fiber and other things your body needs. They’re not empty calories like candy, which does nothing for the body but add weight.

Complex carbs will send sugar (fuel) into your bloodstream, but at a slower rate, giving your body a chance to use up some of the sugar before it overloads the body.

You don’t want to completely remove carbs from your diet. You want to eat complex carbs and leave as many simple carbs as possible on the table.

Complex carbs include but aren’t limited to:

  • Whole grain breads
  • Quinoa, and brown or wild rice
  • Sweet potatoes, pumpkin, and squash
  • Beans and pulses (the dry edible seed inside a pod, such as chickpeas, lentils, and dry beans)
  • Plain popcorn

What we’re hearing from dietitians is that carbs are OK as long as they’re not simple carbs, and you don’t consume large amounts of any carbs. After all, both simple and complex carbs are sugar.

Your body only needs so much fuel each day. If you constantly overload it, diabetes may be in your future.

The exact number of carbs you should eat will depend on your body. Choose a number and if your meter is showing your fasting blood sugar remains in the prediabetes range, try reducing your daily intake of carbs.

Of course, exercise is part of the lifestyle overhaul, but the key is adapting your way of eating toward healthier choices.

A Healthy Way of Eating: Getting There From Here

The Mediterranean diet, or way or eating, is considered a healthy choice by almost everyone who has an opinion.

It’s more plant-based than meat lovers are used to, but it is healthy and it does include some meat, so not to worry.. The trick is figuring out which Mediterranean diet to follow.[4]

The following food pyramid is from the Mediterranean Diet Foundation.[5] Note that the grains and cereals should be whole grain for prediabetics, and the daily serving (noted as “s”) may be less for those living with prediabetes.

Mediterranean Food Pyramid

You don’t have to put a name to your way of eating. As long as you’re watching your total calories per day and choosing complex carbs over simple carbs, you’ll be ahead of the game.

If you don’t have access to a computer and the Internet, or a smartphone or tablet, then a book will be your best friend when you’re counting carbs, calories, and other nutritional info.

The CalorieKing® publishes a book to accompany its website. We came across the website a few years ago and only recently became aware of the book. [We’re not associated with this company—we just like the tools they offer.]

calorieking book

Thanks to computers and smartphones, there are easy ways to find out how many carbs, calories, proteins, and fats are in whatever you want to eat. Almost.

We’ve used the CalorieKing®, website, although there are lots of similar websites that provide the same information. Choose one that suits you best.

If you use apps, there are loads of them. We like Carb Manager. They have a free version and a premium option, as do most apps. [We’re not associated with this company, either.]

It’s an app we use and like, but please ignore the “keto” and “low carb” slogans they use. This app has all the nutritional information you’ll want to find sensible, healthy choices for yourself and it doesn’t matter if you’re following a specific way of eating or simply sampling foods.

Whether you’re using a book, a website, or an app, the process is the same. Search for the food you want to eat, let’s say apples, and you’ll find out how many carbs and other nutrients are in a serving. You’ll also find out what constitutes a serving size.

Apps are ideal, because they track all of your food all day and you don’t have to write anything down. But books and websites give you the critical information, and some websites let you set up an account to track your food, the same as apps on your phone.

We’ve been culling through recipes to offer an assortment that lean toward complex carbs rather than simple carbs, and perhaps slant toward the Mediterranean.

Circle back in a week or so and we’ll have started our recipe section.

[1] Annals of Family Medicine, Prevalence of Prediabetes and Abdominal Obesity Among Healthy-Weight Adults: 18-Year Trend,, (February 5, 2020).

[2] MedlinePlus, Prediabetes,, (February 6, 2020).

[3] Diabetes Care, Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report,, (February 6, 2020).

[4] Nutrients, Definition of the Mediterranean Diet: A Literature Review,, (February 7, 2020).

[5] Mediterranean Diet Foundation, Mediterranean Diet Pyramid: a lifestyle for today,, (February 7, 2020).

Exercise Is Our Jam

brisk walking

Eat less, move more, yadda, blah blah, harrumph.

We’ve heard it. We know we should do it. If for no other reason than because it’s a healthy way to live. And, if we’re prediabetic, it helps to reduce our chance of developing full-blown diabetes.[1]

In this post, let’s focus on the “move more” part.

We want to move more, we just want the right to complain about it along the way.

But bonus, they say that once we start exercising, endorphins will race through our bodies and make us happy. Plus they’re supposed to numb the pain. (Looking forward to that.)

A position statement[2] from the American Diabetes Association says that diabetics and prediabetics should participate in physical activity and exercise. So there’s that, for an added bit of motivation.

Before you leap off the couch and start running in place, talk to your healthcare provider to get guidance on what type and how much exercise you should try.

Moderate exercise[3] appears to be more than adequate in combating the elevated blood sugar of prediabetes. Moderate means you have enough breath to chat while exercising, but not enough to sing. No need to practice sprinting when brisk walking will do.

Exercise loosely falls into four categories: aerobic, strength, balance, and flexibility. Ideally, your week will include all of these types of exercise.

Aerobic, or endurance, exercise cranks up our heart rate and breathing. Brisk walking, hopping on the elliptical, dancing (not slow dancing, the other kind), quick marching in place—whatever activity you want to try that gets your heart rate up will be fine.

Strength training is good for all ages, but as we get older, we lose muscle mass. If you’re middle-aged or older, this means you. Resistance training with bands or weights, push-ups against the wall (or floor, if that’s your preference), squats and lunges—they all help rebuild muscle.

Balance exercises are key to preventing falls as we age. Practicing Tai Chi, standing on one foot or walking heel to toe, side-stepping across a room—there are lots of ways to improve balance, but remember, it’s generally safer to work with a partner.

Flexibility exercises keep our body limber. Without flexibility, it gets hard to bend down and pick up money off the floor. Reason enough to stay loose. Stretching each muscle group, yoga, shoulder rolls, using stretch bands—aging muscles get shorter and lose elasticity, but stretching regularly counters the aging effect.

We need to get off our rears and move. If you find that you’re sitting for a few hours each day, make it a habit to get up every 30 minutes and stretch, do a household chore, just move.

Remember, this is for a healthier body and, more specifically, to knock our blood sugar into normal range. In other words, it’s important!

Thirty minutes each day, move at a moderate pace. Get your heart rate up. If you don’t have time to do this for a 30-minute block of time, then break it up into three 10-minute blocks. As long as you get the minutes in and your heart rate is increased for 30 minutes every day, that’s the important bit.

If your lifestyle has been sedentary for a few years, plan a slow but definite path to moderate exercise for 30 minutes each day.

Start out with three minutes of stretching and don’t worry about increasing your heart rate. Do this for four days, then add three minutes of walking as fast as you feel comfortable. And so on.

Keep adding in minutes of activity every few days until you are active for 30 minutes each day. Once you’ve reached that threshold, take a few of those minutes and exercise at a moderate level. Build from there, and within a few weeks, you’ll be exercising at a moderate level for 30 minutes each day.

The timeframe for building a healthy exercise routine will be individual. The only person we need to compare ourselves to is . . . ourself.

How Zen is that?!

[1] Cochrane Library, Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus,, (February 3, 2020).

[2] American Diabetes Association, Diabetes Care, Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association,, (February 3, 2020).

[3] Duke Health, Is Moderate or Vigorous Exercise Best for Glucose Control?,, (February 3, 2020).

Stress? No Thanks, Got Plenty.

Don’t you hate it when you’re stressed and someone tells you to relax? It’s guaranteed to elevate your stress level.

Stress can increase our risk of developing diabetes. If we’re already prediabetic, that’s not good news.

When we are in a stressful situation, our body releases hormones that stir up the fight-or-flight response[1].

The trigger might be someone cutting us off in traffic, or the death of a loved one, or even the unexpected shouts of greeting at a surprise birthday party.

It can also be a long-term stressful situation, such as a high-pressure job, an abusive relationship, or a chronic illness.

When we’re stressed, our body gets ready to fight or flee by releasing hormones that increase our blood sugar. This gives us the boost of energy we need to either punch it out or take to our heels and run. Plus, the liver gets involved by releasing sugar from where it’s stored. Just in case we need it.

Other, more complex changes occur, but the bottom line is, stress, particularly chronic stress, is bad for us. As prediabetics, it’s an additional strain and an increased risk for type 2 diabetes that we do not need.

There’s not a lot we can do to regulate our response to the unexpected. If somebody thinks it’s hilarious to lurk around the corner and jump out yelling “boo,” our heart’s going to jump a bit and those hormones will kick in. Our physical response won’t last long, but it’s irritating.

For chronic or ongoing situational stress, try any of these stress reducers. Find what works for you.

Mindfulness-based stress reduction[2] (MBSR) teaches us how to be in the moment—feel every breath and step, take in every scent and sound. When combined with traditional diabetes prevention programs, practicing MBSR can reduce[3] “perceived stress, BMI, calorie, carbohydrate and fat intake,” and they have the science[4] to support their claims.

Other things we can try that require no special training and are universally accepted as stress reducers include:

Get physical. Any activity will help. Swimming, vacuuming under and behind furniture, walking the dog, cat, or iguana, pulling weeds—they all count. Whatever activity you enjoy, that’s what you should do.

Get a new hobby or finally devote time to an old, beloved hobby. It should grab your focus and engage you mentally, providing escape from the stress source.

Talk it out with a counselor. A trained professional will help you clarify your needs and options. It’s hard to set boundaries and stand up for ourselves. Counselors help us find ways to do this that fit within our individual abilities.

Take care of your body by getting more sleep, eating healthier foods, and cutting out harmful habits like smoking or abusing drugs or alcohol. It’s tough to battle stress or anything else if we’re not physically ready to do so.

Participate in volunteer activities in the community. Getting out of our own heads and doing for others benefits them and us. We do some good and feel better about ourselves. Win-win.

Stress sounds like nothing, but it’s significantly harmful. If there is someone or something in your life causing long-term stress, don’t just carry on. Do something about it!

You’re worth it.

[1] Indian Journal of Endocrinology and Metabolism, Stress and hormones, (January 30, 2020).

[2] UMASS Medical School, Center for Mindfulness in Medicine, Health Care, and Society, (January 31, 2020).

[3] Hindawi, Evidence-Based Complementary and Alternative Medicine, A Mixed-Methods, Randomized Clinical Trial to Examine Feasibility of a Mindfulness-Based Stress Management and Diabetes Risk Reduction Intervention for African Americans with Prediabetes, (January 31, 2020).

[4] UMASS Medical School, Center for Mindfulness in Medicine, Health Care, and Society, History of MBSR, (January 31, 2020).

Macro, Micro, Whatever


How many carbs should you eat each day? (Depends on type of carb, medical history, and so on.)

What, exactly, is the Mediterranean diet? (Depends on who’s talking.)

What, in the name of all that’s healthy, is a “macronutrient?” (Now that we can answer.)

Macronutrients are substances that our body needs in large amounts (hence ‘macro’). They help us grow and thrive. Macronutrients include fats, carbohydrates, and proteins.

They provide the energy our body needs. Whether we’re sleeping, singing, or skiing, our body needs fuel. Our fuel is measured in calories. The macros provide our calories, but important to note that they’re not all the same:

  • There are 4 calories in a gram of carb or protein.
  • There are 9 calories in a gram of fat.

Once we consume and digest the macros, they break down in our bodies:

  • carbs into sugars
  • fats into fatty acids and glycerol
  • proteins into amino acids

For prediabetics, it’s primarily the sugar from the carbs that our bodies are having a hard time using properly.

It doesn’t matter if we eat candy or quinoa, they both turn into sugar, which fuels our body. But, quinoa take longer to break down and makes our bodies work harder in the digestion process. The candy barely says hi before it breaks down into sugar and dumps into our bloodstream.

Examples of fat-containing foods:

  • Butter
  • Ice cream
  • Potato chips
  • Fried foods
  • Cream
  • Pastries

Examples of carbohydrate-containing foods:

  • Bread
  • Rice
  • Grains (quinoa, oats)
  • Crackers
  • Bananas
  • Candy

Examples of protein-containing foods:

  • Fish
  • Beef
  • Poultry
  • Beans
  • Eggs
  • Cheese

We need fats, carbs, and proteins. But we can choose healthy versions of each.

For instance, olive oil is better than butter as a fat. Nuts are better than chips, and a lean pork chop is better than fatty sausage.

Whole grains like quinoa and steel cut oats are better than donuts or pancakes. Berries are a good choice—soda and fruit juice are not.

Red meats with lots of fat and whole milk products are not the healthiest protein choices. Free-range chicken, wild salmon, or beans are better for us.

Micronutrients are minerals and vitamins required in our diets, but in small amounts, such as iron, vitamin A, and zinc (the list is long).

Our bodies require quite a bit of some minerals, including calcium, potassium, sodium, and a few others. They’re actually considered macronutrients, due to the amount we should take in each day. Because they’re minerals, they often get tossed into the micronutrient section for discussion.

We take in micronutrients, or micros, through the food and liquids we consume. If our diet isn’t providing what we need, a nutritionist may recommend meeting our daily goal through supplements.

Ask your healthcare provider to refer you to a registered dietitian/nutritionist. Your body’s requirements are specific to, well, your body.

We can chat about healthy choices in general, but percentage of this and amount of that will be found through recommendations by an expert and trial-and-error by you as you change your way of eating.

We usually cite sources in posts as we go, but since the information is found in multiple publications it didn’t make sense. Instead, we’re recommending the Merck Manual for further reading.

Relationships: Insulin and Blood Sugar

Who cares about insulin? Or blood sugar? And what are they, anyway?

Most of us have heard the words, but we’re not clear on the roles that insulin and blood sugar play in our bodies.

We need to learn, because they matter. Especially if we’re prediabetic and have too much blood sugar (glucose) floating around inside.

Here’s how the insulin/blood sugar relationship works:

Let’s say we’re having shrimp, some white rice, and an avocado for lunch. We’ll skip the green vegetable because we don’t need it for this example.

Once eaten, all three food items will break down and provide energy (food) to our body.

The shrimp provides proteins, which become amino acids.

The rice provides carbohydrates, which become sugars (also known as blood sugar, or glucose).

The avocado provides fats, which become fatty acids and glycerol.

Because we’re prediabetic, we’ll focus on the carbohydrates.

The cells in our body are clamoring for their lunch. And since we’re made up of cells, it’s important to feed the little guys. They want a boost to get them through a long afternoon. They want a sugar boost because that’s what most of the cells prefer for energy. Come on, carbs!

The sugar, which is what the rice became after it was digested, is floating around in the blood and the body notices that there’s extra sugar (food) ready to be transported to the hungry cells.

An alert is sent to the pancreas, a gland which is tucked down behind the tummy and next to the spine.[i] The alert goes to the islets of Langerhans – which sounds straight out of Lord of the Rings – and these little floating islands of cells in the pancreas start squirting out hormones called insulin.

The majority of the body’s cells aren’t going to let the sugar just walk in. Our cells are like hotel rooms requiring a key to open.

This is where the insulin shines. The insulin is the key. It attaches to the cell and unlocks it, letting the sugar in to feed the cell. You’d think the cell wouldn’t require coaxing to be fed, but that’s how it works.

Insulin also shepherds extra blood sugar into the liver where it’s stored until the body needs it. Maybe it’ll get called out if you haven’t eaten for several hours, or you’re exercising and need the extra food for your cells.

All of this happens when the body is working as it should, but what happens if your body isn’t cranking out enough insulin? Or what if your cells don’t want to open up when insulin comes knocking?

If your body can’t control the amount of sugar (glucose) floating around in your blood, that’s when trouble starts.

Too much blood sugar floating around and not doing its job of feeding cells, or simply sitting in storage until it’s needed, can cause damage to the body.

There’s a window of time where our body’s in trouble but not yet in full type 2 diabetes. That’s where we are – in prediabetes land.

If we don’t do something about the insulin problem, we’ll cross the border into type 2 diabetes land.

Once we’re living with type 2 diabetes, we’re at a much higher risk of stroke, heart disease, kidney failure, nerve damage and vision loss.[ii] For starters.

But, if we’re lucky enough to find out we’re prediabetic, and that’s a big if since 90% of those living with prediabetes don’t know it[iii], we have a good chance of successfully making the changes necessary to avoid type 2 diabetes, leave prediabetes behind, and get our bodies back to being efficient at the whole insulin/blood sugar relationship.

[i] Johns Hopkins Medicine/Pathology, The Pancreas, (March 5, 2019).

[ii] Centers for Disease Control and Prevention, Diabetes Quick Facts, (March 5, 2019).

[iii] Centers for Disease Control and Prevention, Prediabetes: Your Chance to Prevent Type 2 Diabetes, (March 5, 2019).

Prediabetes: Are You at Risk?

Wondering what your chances are of being prediabetic?

The Centers for Disease Control and Prevention reports that “approximately 84 million American adults—more than 1 out of 3 . . . “[i] are prediabetic. We don’t love those odds.

Most specialists agree that these are the primary risk factors:

Age 45 and older: Prediabetes can come on at any age, but the older you get the more at risk you are.

Affected family members: If your parents or siblings have type 2 diabetes, that increases your chance of becoming prediabetic.

Weight: Are you chubby, obese, fat? Do you carry that extra weight around the middle? This is one of the biggest risks for prediabetes.

Exercise: Actually, the lack of exercise. If you’re not active at least three times a week, this puts you at risk.

Ethnicity/Race: Although it’s not clear why, if you’re Latinx, African American, Native American, Asian American, or Pacific Islander, you may be at higher risk of developing prediabetes.

PCOS: Polycystic Ovary Syndrome. If you have it, it is a risk factor.

Gestational Diabetes: Developing this during pregnancy, or giving birth to a baby weighing more than nine pounds, increases your risk of developing prediabetes.

Sleep: If your sleep is interrupted or just not good, this is a risk factor.

Feels sort of random, but there it is.

If any risk factor listed above is ringing your bell, check with your provider about getting tested. Have the conversation.

You can’t solve the problem if you don’t know about it. And there is a solution – you don’t have to end up with type 2 diabetes.

[i] Centers for Disease Control and Prevention, Prediabetes: Your Chance to Prevent Type 2 Diabetes, (March 6, 2019).

Medications and Blood Sugar

As prediabetics, the number we look at on a daily basis is our fasting blood sugar level.

We can do that at home with a monitor. Knowing that number, as well as the numbers pre- and post-meal, helps us to track our prediabetes. These numbers give us the information we need to not eat this or eat more of that, with the end result (we hope) of reducing our blood sugar levels.

A sneaky enemy of blood sugar levels that most of us don’t think about is medicine.

Some of the prescription or over-the-counter medications we take raise our blood sugar. This can blow a big hole in our how-to-beat-prediabetes game plan.

It’s tricky if the medication that raises our blood sugar is one we absolutely must take!

Some blood pressure medications, like beta-blockers or thiazide diuretics[i], raise our blood sugar.

Steroids in oral (pill) form can bump our blood sugar level up, but if used in the form of a cream or inhaler, they’re generally not an issue[ii].

Other drugs can also affect blood sugar levels, such as niacin, which is a B vitamin, some antipsychotic drugs, and a sprinkling of others.

Because you’re prediabetic, you should have a quick conversation with your pharmacist about any prescription or over-the-counter drugs you’re taking, to see which might have an effect on your blood sugar. Then work with your provider to decide if the trade-off is worth it.

Sometimes, medications are the reason we’re prediabetic, which puts us in a real pickle if we can’t get off the meds.

We can’t ignore anything that affects our blood sugar. If we do our homework and make changes where we can, it will help us stay on the road that leads out of prediabetes land!

[i] Diabetes Self-Management, Drugs That Can Worsen Diabetes Control, (March 7, 2019).

[ii] WedMD, What Medicines Can Make Your Blood Sugar Spike?, (March 7, 2019).

Prediabetes: FAQ

What is prediabetes?

You have prediabetes when your blood sugar is higher than normal, but not high enough to be in the type 2 diabetes range. This condition puts you at increased risk of developing type 2 diabetes or other health problems, such as heart disease and stroke. Prediabetes should be taken seriously, but it’s not necessarily permanent, as it can be reversed in many cases.

What causes prediabetes?

Many cells in our body like to eat sugar for energy. Carbohydrates turn into sugar when we eat them. In response, the pancreas produces a hormone called insulin, which goes to the cells wanting energy and “unlocks” them, allowing the sugar to enter. If there’s more sugar than insulin, the sugar has nowhere to go and builds up in your blood.

Will I develop type 2 diabetes if I am prediabetic?

You have an excellent chance of stopping the progression to type 2 diabetes. It is not a one-way path, although if you do nothing to combat it, you may develop type 2 diabetes at some point.

What are the risk factors for prediabetes?

Most specialists agree that these are the primary risk factors:

Age 45 and older: Prediabetes can come on at any age, but the older you get the more at risk you are.

Affected family members: If your parents or siblings have type 2 diabetes, that increases your chance of becoming prediabetic.

Weight: Are you chubby, obese, fat? Do you carry that extra weight around the middle? This is one of the biggest risks for prediabetes.

Exercise: Actually, the lack of exercise. If you’re not active at least three times a week, this puts you at risk.

Ethnicity/Race: Although it’s not clear why, if you’re Latinx, African American, Native American, Asian American, or Pacific Islander, you may be at higher risk of developing prediabetes.

PCOS: Polycystic Ovary Syndrome. If you have it, it is a risk factor.

Gestational Diabetes: Developing this during pregnancy, or giving birth to a baby weighing more than nine pounds, increases your risk of developing prediabetes.

Sleep: If your sleep is interrupted or just not good, this is a risk factor.

How do I know if I have prediabetes?

Not everyone has symptoms. The best way to determine if you’re prediabetic is to get a blood test done. There are exceptions to how blood test results are interpreted. Your provider will let you know what they mean for you, but the following is a general picture of what testing is done, and what the results indicate.

The first test snaps a picture of what your blood sugar has been doing for the last two or three months. It’s called the Hemoglobin (A1C) test and is usually the first one providers use when diagnosing prediabetes.

A1C below 5.7 percent is normal

A1C between 5.7 and 6.4 percent is prediabetes

A1C 6.5 percent or higher in tests done on two different days is type 2 diabetes

Next is the Fasting Blood Sugar test. Blood is taken after you’ve been fasting for eight hours or overnight.

Fasting blood sugar below 100 mg/dL is normal

Fasting blood sugar between 100 and 125 mg/dL is prediabetes

Fasting blood sugar 126 mg/dL or higher (in tests done on two different days) is type 2 diabetes

The third test is not used for everyone. It’s called the Oral Glucose Tolerance test. After fasting for eight hours or overnight your blood is tested. You then drink a sugary concoction and two hours later your blood is tested again.

Blood sugar below 140 mg/dL is normal

Blood sugar between 140 and 199 mg/dL is prediabetes

Blood sugar 200 mg/dL or higher is type 2 diabetes

Is prediabetes reversible?

The answer is yes, prediabetes is reversible for some. Three factors play a big part for the majority who reverse their prediabetes diagnosis: weight loss, exercise, and a change in eating habits. Work with your provider and a nutritionist to develop a common-sense plan of action.

Is there treatment for prediabetes?

In addition to weight loss, exercise, and a change of eating habits, healthcare professionals will sometimes recommend metformin, a drug that helps your body control its high blood sugar levels. If you are able to reverse your prediabetes, you’re typically taken off of metformin.

Exercise and Blood Sugar Levels

As prediabetics, our goal is to stay far away from type 2 diabetes, and to eventually get out of prediabetes land.

We’re working on our weight and changing what we eat. Do we really need to exercise, too?

It’s worth taking a look. If we can’t reach our goal without adding exercise to our lives, we need to know that so we can make an informed choice.

Cochrane[i] published an update[ii] in December 2017 of an earlier Cochrane Review from 2008. The review searches for an answer to our question: Is exercise necessary to lower blood sugar levels?

Here’s how they set up their review:

For their search methods, they, “searched the CENTRAL, MEDLINE, Embase,, ICTRP Search Portal and reference lists of systematic reviews, articles and health technology assessment reports. The date of the last search of all databases was January 2017.”

And for their selection criteria they, “included randomised controlled trials (RCTs) with a duration of two years or more.”

OK, sounds good. Let’s see what they found.

Although they make it clear that more research needs to be done, at this time there doesn’t appear to be a definitive answer as to whether just changing one’s diet and not exercising, or just exercising and not changing one’s diet, affects the chances of developing type 2 diabetes.

But, there is some evidence that for prediabetics, changing one’s diet and increasing physical activity may reduce the chance of developing type 2 diabetes.

What kind of exercise are we talking about?

Before we get into that, be aware that exercise can change blood sugar levels. The direction isn’t always down. Under the right conditions, blood sugar levels will rise with exercise. Or the levels might go too low. They’re fickle.

Check with your healthcare provider before starting any exercise regime to determine what’s safe for you.

There are multiple studies about exercise and the reduction of blood sugar levels. It isn’t yet clear how vigorous that exercise must be to show a benefit, although low intensity exercise doesn’t seem to do much to lower blood sugar levels.

Basically, we’re talking about low, moderate, and high intensity exercise.

Low intensity: walking, stretching, housework – if you can talk and sing without running out of breath, you’re exercising at a low intensity.

Moderate intensity: jogging, cycling uphill, lifting weights – if you can talk, but you can’t sing more than a few notes without running out of breath, you’re exercising at a moderate intensity.

High intensity: running, a rapid set of jump squats, jumping rope as fast as you can – if you can’t say more than a handful of words without becoming breathless, you’re exercising at a high intensity.

Another way to measure the intensity of a workout is to monitor your maximum heart rate (MHR). Low intensity gets you to 40 to 50 percent of your MHR, moderate intensity gets you to 50 to 70 percent of your MHR, and high intensity gets you to 70 to 85 percent of your MHR.[iii]

There’s quite a formula to finding your MHR and personal percentages. The talk method is an easier way to monitor exercise intensity.

Looking at some of the various studies completed so far, it seems that short bursts of high intensity exercise may do more to lower blood sugar levels than longer sessions of moderate intensity exercise.

There is no certain answer yet as to level of exercise needed to do the job, but it’s pretty clear that changing eating habits and exercising is the way to go.

Check with your healthcare provider before making any changes to your eating or exercise habits. It’s important to get healthy, but we don’t want to accidently harm ourselves along the way.

[i] Cochrane,, (March 9, 2019).

[ii] Cochrane Library, Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus, (March 9, 2019).

[iii] Mayo Clinic, Exercise intensity: How to measure it, (March 10, 2019).