What Is Prediabetes?

Prediabetes is a precursor of type 2 diabetes. It does not typically cause symptoms, but without intervention, it can progress to type 2 diabetes.

This condition is diagnosed with blood tests that measure blood sugar and metabolic parameters. There are well-established strategies for treating prediabetes and preventing type 2 diabetes. Dietary management, weight loss, and exercise are often effective—but sometimes medication is needed as an adjunct.

Prediabetes is also known as impaired glucose tolerance or impaired fasting glucose.

prediabetes symptoms
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Symptoms

Prediabetes generally affects adults between 40 and 60. The condition tends to be silent, rarely causing any noticeable symptoms. In fact, according to the Centers for Disease Control and Prevention (CDC), approximately 88 million adults (more than one in three) in the United States have prediabetes. Of those, 84% do not know it.

Because of the lack of symptoms, even after diagnosis, most people do not know exactly when their prediabetes began. The condition can remain stable for years before progressing to diabetes.

In the rare instances when prediabetes does cause symptoms, the effects are usually subtle and can be easily missed or mistaken for other health issues.

Signs of prediabetes include:

  • Excessive hunger or thirst
  • Weight gain
  • Fatigue
  • Polyuria (frequent urination caused in large part by increases in fluid intake to relieve thirst)

Complications

Without treatment, prediabetes progresses to type 2 diabetes, a medical condition that causes a number of health complications, including heart disease, vascular disease, cerebrovascular disease, neuropathy, impaired wound healing, and a predisposition to infections.

Prediabetes is not associated with either type 1 diabetes, a form that usually affects young children, or diabetes insipidis, a condition that affects the kidneys.

Causes

Prediabetes occurs when cells in the body become resistant to insulin, a hormone produced by the pancreas. It keeps blood sugar levels within a healthy range by helping the cells of the body store glucose. Eventually, the cells convert glucose into energy.

If you have prediabetes, you probably make enough insulin, but the cells of your body are resistant to insulin and its effects. This results in a slightly elevated blood glucose level, as well as decreased energy.

Risk Factors

There are several risk factors associated with prediabetes, but the exact cause of the condition is not known. Lack of exercise and a sedentary lifestyle are common among people who have prediabetes.

Hypertension, high cholesterol levels, obesity, and excess body fat, particularly in the abdominal area, are associated with prediabetes. It is not clear whether these health problems cause prediabetes, whether they are caused by prediabetes, or whether they are all caused by another factor.

Associated Conditions

Several metabolic conditions can occur before prediabetes. Insulin resistance is a condition that begins before prediabetes and might not cause high blood sugar. A similar condition described as metabolic syndrome consists of an elevated body mass index (BMI), hypertension, high cholesterol, and insulin resistance.

Diagnosis

Because prediabetes typically does not cause symptoms, it usually is detected during routine screening for diabetes. The American Diabetic Association (ADA) recommends adults begin being screened at age 45.

The ADA also advises testing for adults who:

  • Have a high BMI and one or more other risk factors for diabetes: "High" BMI is defined as 25 kg/m2 for everyone except Asian Americans, for whom a high BMI is defined as 23kg/m2 or lower.
  • Belong to a high-risk race or ethnic population: Specifically, these are African Americans, Hispanic/Latinos, American Indians, Alaska Natives, Asian Americans, and Pacific Islanders.
  • Have a parent or sibling with a history of diabetes
  • Have had gestational diabetes. They should be tested every three years.
  • Are physically inactive
  • Have hypertension or are taking medication to treat hypertension. Hypertension is defined as blood pressure equal to or greater than 140/90 mmHg.
  • Have low levels of high-density lipoprotein (HDL) cholesterol or high levels of triglycerides
  • Have predisposing conditions: These include acanthosis nigricans, non-alcoholic steatohepatitis, polycystic ovary syndrome, atherosclerotic cardiovascular disease, and obesity.
  • Medications: Atypical antipsychotics or glucocorticoids
  • Are HIV-positive

Screening Tests

There are several blood tests that can be used in prediabetes screening. Often, with prediabetes, the blood glucose is mildly elevated, so your results might not be very abnormal. For this reason, you may need to have more than one blood test.

Common blood tests used in prediabetes screening include:

  • Fasting blood sugar test: This test measures your blood sugar after you have gone without food for eight hours. Normal fasting glucose is below 100 mg/dl, the range of 100 to 126 mg/dl suggests prediabetes, and a level above 126 mg/dl suggests diabetes.
  • Glucose tolerance test: This test measures your blood glucose level before and after you drink a carbohydrate drink. A normal glucose level after drinking a 75 gm glucose load is less than 140 mg/dl, it is between 140 to 199 mg/dl for prediabetes, and it is 200 mg/dl or more for diabetes.
  • A1C test: The results of this test reflect average blood sugar levels for the previous two to three months. It works by looking at how much your glucose glycates (sticks) to hemoglobin A, a protein found in red blood cells. Once glucose sticks to a hemoglobin protein, it remains there for the lifespan of the hemoglobin A protein, which can be as long as 120 days. The A1C test measures what percentage of hemoglobin A proteins are glycated. For example, an A1C of 7% means that 7% of hemoglobin A proteins are glycated.

Prediabetes is diagnosed when an A1C test is in the range of 5.7 % to 6.4 %. Anything under 5.7 % is regarded as normal. An A1C of 6.5 % or higher is considered diabetes.

Glucose Monitoring

While it is not required for prediabetes, some people choose to regularly monitor glucose at home. This can help you keep track of how well your treatment plan is working. There are many easy to use glucose monitors, including options that continuously monitor glucose levels.

Treatment

The treatment of prediabetes is focused on taking measures to prevent progression of the condition. Because the mainstay of treatment is lifestyle modification, it can be challenging to maintain consistency.

Regular medical appointments and glucose monitoring can help keep you on track.

Treatment for prediabetes includes:

Weight loss: Even modest weight loss—5% to 10% of body weight—can prevent or delay the progression toward diabetes. For example, someone who weighs 200 pounds, can lower their risk of developing diabetes by losing just 10 pounds.

Reducing carbohydrate intake: Carbohydrates are the nutrient that impacts blood sugar the most. The most important carbohydrates to avoid are those that are refined, such as white bread, pasta, rice, and snack foods. It also is helpful to eliminate juice and other sweetened beverages and to increase your intake of non-starchy vegetables.

Following a Mediterranean diet: This means focusing on fruits, vegetables, and healthy fats such as nuts, seeds, and olive oil.

Medication: If lifestyle changes are not having an effect, your doctor might recommend medication, such as Glucophage (metformin) to help manage your blood sugar. This medication has been shown to help prevent the development of type 2 diabetes.

Increase in physical activity: Exercise not only helps keep weight in check, but it also helps the body better use insulin. Being more physically active (along with losing weight) can actually help cut your risk for diabetes by nearly 60%.

​A Word From Verywell

If you have any risk factors for diabetes, it is important that you get appropriate screening done. When your tests show signs of prediabetes, following medical advice can help you avoid diabetes and its associated complications.

Losing weight, exercising, following a nutrient-rich diet and cutting back on sugar and unhealthy fats will help to keep illness and conditions other than diabetes at bay.

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Article Sources
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