What are the Warning Signs of Prediabetes: Are You at Risk?

Despite affecting 1 in 3 American adults, many people can’t say what are the warning signs of prediabetes. Here’s the kicker: most individuals who have prediabetes are unaware of it! 

Understanding your risk is crucial.

In this article, we’ll examine the signs of prediabetes and help you assess your own risk. Read on to take proactive steps towards better health, including how to reverse prediabetes.

Prediabetes: borderline diabetes

People with prediabetes have higher blood glucose (sugar) than normal. But their blood sugar is not high enough for a diabetes diagnosis. 

Prediabetes means your body is showing signs of insulin resistance. It is having a hard time keeping your blood sugar levels stable. This is also known as ‘impaired glucose tolerance’.

If left untreated, prediabetes may progress to type 2 diabetes. In addition, prediabetes can increase your risk of heart disease and stroke.

What causes prediabetes?

Prediabetes can be caused by a combination of genetic, environmental, and lifestyle factors

A decrease in your body’s ability to regulate its blood sugar leads to higher levels than normal. This difficulty regulating blood sugar can be observed first thing in the morning, and after meals. At this stage, prediabetes can be diagnosed.

Several hormones help keep our blood sugar levels within a stable range. When you eat, your body releases insulin to help your cells take up glucose from circulation. Insulin is a hormone produced in the pancreas. Its main job is to make sure your body can use or store the glucose you get from food. 

Sometimes, our body stops responding to insulin properly (insulin resistance). Sometimes our pancreas stops producing enough insulin. As a result of either change, blood sugar levels after a meal will rise higher and take longer to return to pre-meal levels than normal. 

Other hormones related to blood sugar regulation might also contribute to prediabetes. These include hormones such as glucagon, which tells your liver to produce and release glucose into circulation, when your blood sugar is low. The stress hormones cortisol and epinephrine (adrenaline) can also lead to increased blood sugar levels.

Early warning signs of prediabetes

Prediabetes has no early symptoms. Most people (8 in 10) are unaware they have prediabetes. If the condition progresses to type 2 diabetes, you might experience:

  • frequent urination
  • excess thirst
  • blurry vision
  • tingling or numbness in your extremities
  • slow wound healing

The lack of early warning signs of prediabetes makes it more important to be aware of the risk factors. Regular blood tests can detect elevated blood sugar levels before the condition gets worse.

The American Diabetes Association now recommends prediabetes screening for everyone over 35. Earlier, if you have two or more of the risk factors listed below. 

What puts you at risk for prediabetes?

Prediabetes has a combination of risk factors, some modifiable, others not. You are at higher risk for prediabetes and type 2 diabetes if you:

  • Are over 45 years old
  • Have a family history of diabetes (e.g., parent or sibling)
  • Have a history of gestational diabetes, or gave birth to a baby weighing > 9 lbs (4 kg)
  • Are sedentary
  • Have excess body fat, as in:
    • body mass index (BMI) ≥ 25 kg/m2 (≥ 23 kg/m2 for Asian Americans), or
    • waist circumference in men > 40 inches (102 cm) or in women > 35 inches (88 cm)
  • Are African American, Hispanic/Latino, American Indian, Alaska Native, Asian American, or Pacific Islander
  • Have high blood pressure, or are on medication for high blood pressure
  • Have “good” cholesterol (HDL) levels below 35mg/dl (0.90 mmol/L)
  • Have fasting triglyceride (TG) levels over 250 mg/dL (2.82 mmol/L)
  • Have other conditions associated with insulin resistance
    • polycystic ovary syndrome (PCOS)
    • metabolic dysfunction-associated steatotic liver disease (MASLD)
    • acanthosis nigricans
  • Have atherosclerotic cardiovascular disease
  • Are undergoing treatment with atypical antipsychotics or glucocorticoids

The Centers for Disease Control and Prevention have a quick prediabetes quiz to help you find out if you are at risk. Early detection means you can take action sooner!

How to diagnose prediabetes

In the U.S., prediabetes is diagnosed based on the results of one of the following blood tests:

  • Fasting Plasma Glucose (FPG). This is a blood test taken after an overnight fast. A FPG level of 100-125 mg/dL (5.6 – 6.9 mmol/L) indicates impaired fasting glucose, or prediabetes.
  • Hemoglobin A1C (HbA1c). You do not need to be fasting for this blood test. It measures a person’s average blood sugar levels over the past two to three months.  An HbA1c level of 5.7-6.4% is considered prediabetes.
  • Oral Glucose Tolerance Test (OGTT). This blood test is less common than FBG and HbA1c. It involves drinking a glucose solution, then having your blood glucose checked. A two-hour blood glucose level of 140-199 mg/dL (7.8 – 11 mmol/L) is diagnosed as prediabetes.

How to reverse prediabetes

Prediabetes does not mean you will develop type 2 diabetes or heart disease. There is a lot you can do to lower your blood sugar levels and reduce your risk. 

  1. Eat a balanced diet. A diet rich in non-starchy vegetables, whole grains, and lean protein can help regulate blood sugar levels.
  2. Become less sedentary. Aim for at least 30 minutes of moderate-intensity activity on most days of the week. What’s more, avoid prolonged sitting.
  3. Improve sleep hygiene.  Poor sleep quality and quantity can  increase the risk of elevated blood sugar levels. Aim for 7-9 hours of sleep every night. In addition, consider getting assessed for obstructive sleep apnea if sleep problems persist.
  4. Manage stress.  Chronic stress can raise blood sugar levels.  Finding ways to manage stress, such as yoga, meditation, or therapy, can be helpful. 

Prediabetes is considered ‘reversed’ if a blood test indicates normal blood sugar levels. It is important to remember that you cannot change certain risk factors. You might always be at risk of blood sugar problems. 

Staying prediabetes-free requires a long-term commitment to healthy lifestyle changes. In some cases, a health provider may also recommend medication.

Ready to start making some changes today? I have a free habit tracker that can help! Grab your copy below!