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Patients that develop type 2 diabetes go through a period of time in which they are prediabetic or have borderline diabetes. This article outlines the symptoms, diagnosis and treatment of prediabetes.

Prediabetes is, as the name suggests, a condition in which you have blood sugar levels that are higher than normal, but not yet high enough to receive a diagnosis of diabetes.

Unfortunately, unless you get treatment in this prediabetic stage, you have a higher risk:

  • Type 2 diabetes
  • Heart disease
  • Stroke

Prediabetes can be broken down into different types — including impaired glucose tolerance (in which your blood sugar levels are higher than normal after a meal), impaired fasting glucose (in which your blood sugar is higher in the morning before you eat) and if your hemoglobin Ac levels are between 5.7 and 6.4 percent.

What causes prediabetes?

Prediabetes develops because the cells of your body become resistant to the effects of insulin, which is a hormone that helps metabolize sugar. Since your body is no longer able to metabolize sugar, the primary source of energy, your cells, in essence, become starved. The higher than normal blood sugar levels cause prediabetes, which can eventually become type 2 diabetes. While it is not known why prediabetes develops, there are certain risk factors that increase your risk of getting the disease. These include:

  • Age. If you are over 45 years of age then you are more likely to get the disease.
  • Obesity. People that have a body mass index higher than 25 are more likely to get prediabetes.
  • Fat distribution. If you have more fat around your waist than your hips then you are more likely to get prediabetes.
  • Sedentary lifestyle. A lack of physical activity predisposes you to developing prediabetes.

Symptoms of prediabetes?

Unfortunately, there are no clear or overt symptoms for prediabetes. However, symptoms associated with insulin resistance may start to emerge. These include:

  • Dark, velvety skin
  • Discoloration around your elbows, knees, neck, armpits and knuckles
  • Excessive thirst
  • Excessive urination
  • Fatigue or feeling tired
  • Sores or wounds that don’t heal properly

These are symptoms that are more suggestive of type 2 diabetes but can start to present at an earlier stage. Having these symptoms can also mean that your prediabetes has progressed to type 2 diabetes. Therefore, if you feel any of these symptoms coming up, please consult your doctor right away.

Diagnosis: How is prediabetes diagnosed?

When you present with symptoms that suggest prediabetes, your doctor will send you for blood testing. These are the tests that can help diagnose prediabetes:

  1. Hemoglobin A1c test. This test, which is also called the A1c test, measures your average blood sugar levels over a period of 2-3 months. This test can be done at any time. Generally, a value of A1c for prediabetes is between 5.7 and 6.4 percent. If your results are in this range, then a second test will be conducted just to make sure. Generally, the higher your A1c levels are, the higher the risk is that your prediabetes will turn into type 2 diabetes.
  2. Fasting plasma glucose (FPG) test. During this test, you will have to fast for a period of eight hours or overnight. Then, your blood sample will be taken in order to determine your fasting blood sugar level. If your results come back between 100-125 mg/dL, that it indicates that you have prediabetes.
  3. Oral glucose tolerance test (OGTT). During this test, your blood sugar levels will be tested two times. First, your blood sugar will be tested at the beginning of your appointment and then you will be given a sugary drink. Two hours after you drink the sugary drink, they will take another blood sample. If your blood sugar levels are between 140-199 mg/dL after the two hours, then that indicates that you have prediabetes.

Treatment: How can prediabetes be managed?

The good news is that prediabetes is reversible with long-term lifestyle changes. Generally, prediabetes is treated as a way of preventing type 2 diabetes. Therefore, treatment for type 2 diabetes also includes lifestyle changes. We'll have a look at the most common lifestyle changes recommended for prediabetics.

Changes in diet and weight loss

Having a low-carbohydrate diet leads to an improvement in blood glucose levels, as well as a reduction in insulin resistance and weight. While there is no standard definition for how many carbohydrates you should consume if you are on a low-carbohydrate diet, many people use 21 to 70 grams as a guideline.

Some studies have shown that low-carbohydrate diet can lead to an improvement in type 2 diabetes. However, not many studies have explored this in patients with prediabetes. It is also important to keep in mind that patients who have high cholesterol, kidney, or heart disease should not be a low-carbohydrate diet. Make sure to consult with your doctor before you make any major changes. Studies have also shown that eating foods high in fiber such as fruits, vegetables and grain, can help treat your diabetes.


It is well known that patients that are regularly active and exercise have a reduction in the risk of developing diabetes. In fact, just 30 minutes of any activity can help raise your heart rate. You can even try to incorporate your physical activity into your schedule such as walking or riding a bike to work or taking part in a sports team.

  • Ford, Earl S., Guixiang Zhao, and Chaoyang Li. "Pre-diabetes and the risk for cardiovascular disease: a systematic review of the evidence." Journal of the American College of Cardiology 55.13 (2010): 1310-1317.
  • Bansal, Nidhi. "Prediabetes diagnosis and treatment: A review." World journal of diabetes 6.2 (2015): 296.
  • Guasch-Ferré, Marta, et al. "Metabolomics in prediabetes and diabetes: a systematic review and meta-analysis." Diabetes care 39.5 (2016): 833-846.
  • Photo courtesy of SteadyHealth

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