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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.

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Highlights of the Prediabetes Consensus Statement

In 2008, endocrinologists got together and came out with a consensus statement on prediabetes,[1] which seems to be the most current prediabetes consensus statement from this group.

Not much has changed over the years, except for the number of people affected by prediabetes. That figure continues to grow.

You can read the statement online, but who doesn’t love the highlights-only version of pretty much anything that has 33 words in the title?

Here goes:

Introduction

There are hundreds of millions of people around the world with prediabetes.

The scary side of diabetes (stroke, nerve damage, heart disease, and so much more) seems to begin before full-blown diabetes sets in. If you’re prediabetic, you’re at risk for many of the medical complications that affect diabetics.

There are no FDA-approved medications for prediabetes. It was true in 2008, and is still true today.[2]

The Tests

The endocrinologists agree on what the blood work looks like for those who have normal blood sugar, those who have high blood sugar but aren’t yet diabetic (aka prediabetics), and those who are diabetic.

In the statement, they don’t mention using the A1C test as a first measurement of prediabetes, but it’s common to do so now. Therefore, it’s included here.

This 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, or Impaired Fasting Glucose test.

Blood is taken after you’ve been fasting for eight hours or overnight. You should not be active or drink anything, such as coffee, before the test that would affect carb metabolism.

  • 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 called the Oral Glucose Tolerance test, or the Impaired 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. You shouldn’t be active or smoke prior to this test.

Note that the endocrinologists consider this test to be the more important one because it 1) identifies those who have undiagnosed diabetes and 2) indicates those who have a greater risk of becoming diabetic.

Two hours after drinking the sugary concoction:

  • 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.

Another note: The statement suggests the possibility that the higher end of “normal” is actually prediabetic because, in large population studies, physical abnormalities associated with prediabetes/diabetes are cropping up in those with high “normal” numbers.

And one more note: the endocrinologists say that prediabetes is diagnosed by either the fasting blood sugar test, the oral glucose tolerance test, or diagnosed metabolic syndrome, which is considered to be the same as prediabetes.

Get tested for prediabetes if you have one or more of these risk factors, as listed in the statement:

  • Family history of diabetes
  • Cardiovascular Disease
  • Being overweight or obese
  • Sedentary lifestyle
  • Non-white ancestry
  • Previously identified IGT, IFG, and/or metabolic syndrome
  • Hypertension
  • Increased levels of triglycerides, low concentrations of high-density lipoprotein cholesterol, or both
  • History of gestational diabetes
  • Delivery of a baby weighing more than 9 lb (4 kg)
  • Polycystic ovary syndrome
  • Receiving antipsychotic therapy for schizophrenia and severe bipolar disease

Treatment

The goal is to get blood sugar back to the normal range and treat high blood pressure and excess lipids (cholesterol and other fats in the blood) through medication. Controlling the blood sugar alone won’t automatically prevent heart disease or stroke associated with prediabetes and diabetes.

Meet with your healthcare provider to talk about where you are and where you want to be. Agree on the lifestyle changes you need to make to get you off the path to diabetes.

It boils down to:

Eat less, move more.

Cut calories, eat more fiber, go for healthy choices rather than simple carbs, which include fries, donuts, bread . . . and the list goes on. A nutritionist will lay it all out for you and help you figure out the crazy world of carbs.

You and your healthcare provider should decide if, in addition to cutting calories, drug therapy or other medical treatment is needed to help with weight loss.

Exercise, but don’t start out thinking you have to run a marathon. Your provider will suggest a safe level of exercise for you.

There is no FDA-approved drug therapy to prevent type 2 diabetes or to treat prediabetes, but your provider may decide to try some drugs off-label, depending on your risk factors. That’s another conversation you’ll need to have as you’re working on changing your lifestyle.

There’s more information in the consensus statement. A lot more, for those who love tackling sciencey jargon.

For those who prefer the CliffsNotes® version, we’re done!

[1] American Association of Clinical Endocrinologists, Diagnosis and Management of Prediabetes in the Continuum of Hyperglycemia—When Do the Risks of Diabetes Begin? A Consensus Statement From the American College of Endocrinology and the American Association of Clinical Endocrinologists, https://www.aace.com/files/prediabetesconsensus.pdf, (April 25, 2019).

[2] Medscape, What are the FDA-approved drugs for treatment of prediabetes or prevention of type 2 diabetes mellitus (DM)?, https://www.medscape.com/answers/117853-6619/what-are-the-fda-approved-drugs-for-treatment-of-prediabetes-or-prevention-of-type-2-diabetes-mellitus-dm, (April 29, 2019).