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How To Reverse Prediabetes

With a few key lifestyle changes, you can avoid a type 2 diabetes diagnosis.

With Trisha Best MPH, RD, LD

Photo of fish swimming upstream.

Prediabetes is a health condition marked by increased levels of blood sugar. While your blood sugar levels in prediabetes are not high enough to be considered type 2 diabetes (hence the ‘pre-’) yet, it's important to take your diagnosis seriously to prevent other complications that can occur if it is left to progress unchecked. The good news is that it is completely reversible if caught in time!

Prediabetes is also extremely common, so you're in good company. More than 1 in 3 Americans, or about 88 million of us have it. However, almost 85% of people who are affected aren't even aware of it. Unfortunately, there are often no obvious symptoms until further health problems arise down the road. 

What is prediabetes?

Insulin problems are at the root of prediabetes, and here’s why: 

Insulin is an all-important hormone made inside your pancreas. Its purpose is to help your body effectively use blood sugar (which you get from the food you eat) by turning it into energy. 

According to Trista Best MPH, RD, LD, "People with prediabetes do not process glucose efficiently, which leads to frequently high blood sugar build up due to a lack of insulin. The body makes insulin to carry glucose into the cells and prevent this buildup, but when your body either isn't making enough or the cells become resistant to insulin, high glucose ensues.”

Without prompt intervention, prediabetes (and later, type 2 diabetes) can cause a slew of other health issues, ranging from nerve damage to increased risk of cardiovascular illness. Nearly 70 percent of people with prediabetes develop diabetes, according to the American Diabetes Association, which means you have an over 30% of reversing it if you take action right away.

The risk factors for prediabetes include:

  • Being over 45
  • A sedentary lifestyle
  • Obesity
  • High blood pressure
  • Gestational diabetes
  • An unhealthy diet
  • Smoking cigarettes
  • Genetics and race can increase your risk of developing prediabetes and diabetes, however, most research points to this being a combination of environment, socioeconomic factors, and shared habits rather than a genetic predisposition or destiny.

What are the warning signs of prediabetes?

  • Increased thirst and hunger
  • Blurred vision
  • Fatigue
  • Constant urination
  • Wounds that are slow to heal
  • Infections occurring more frequently
  • Numbness or tingly sensations in the feet or hands

Some people with prediabetes can notice skin darkening in certain areas, including their neck, knuckles, elbows, or knees. When left to progress untreated, prediabetes can be also associated with silent heart attacks (which are heart attacks without symptoms) and kidney damage. 

What is the CDC prediabetes screening test?

The Centers for Disease Control (CDC) offers a one-minute prediabetes risk assessment test online, which you can take here. If you find that you have one or more of the symptoms or risk factors, make an appointment with your doctor to discuss what to do next. A helpful first step is a blood sugar test, which will let you know if you’re at risk for diabetes. 

What is fasting blood sugar?

A fasting blood sugar test can help you understand your risk of diabetes. Your doctor will take test a blood sample after you have fasted for eight hours.

What should your fasting blood sugar be?

  • Typical: 100 mg/dL or 5.6 mmol/L
  • Prediabetes: 100 to 125 mg/dL or 5.6 to 7.0 mmol/L 
  • Type 2 diabetes: 126 mg/dL or 7.0 mmol/L or higher 

Your doctor may also run an A1C test, which helps to reveal your blood sugar level average over three months, and can eliminate the possiblity that your blood sugar may have been elevated on that particular day, but not consistently overtime.

What is A1C?

A1C refers to glycated hemoglobin, and the percentage of A1C indicates how much sugar is attached to the hemoglobin protein in your blood. 

What is a good A1C level?

  • Typical: 5.7%
  • Prediabetes: 5.7% - 6.4% 
  • Type 2 diabetes: 6.5% or higher, when confirmed on two different tests

How to prevent prediabetes from becoming diabetes?

Fortunately, prediabetes is entirely reversible. Ask your doctor to connect you with a certified diabetes educator and other support. Remember, you don't have to try to make changes alone. Most health plans cover diabetes education, and many even cover nutritionists and physical therapists if you have diabetes or prediabetes. If you're concerned about the cost of treatment, many nonprofit organizations also provide the same services and more. See our recent special report for a complete list of these resources and how to find them even without health coverage. The CDC also offers a Lifestyle Change Program, which can help you begin to prevent diabetes through education, working with a health coach, and support groups both online and in-person.

How to prevent diabetes with diet and exercise

Exercise can be one of the most important tools for preventing prediabetes from becoming type 2 diabetes. It not only benefits your health by aiding in weight management, it has been shown in multiple recent studies to lower blood sugar and improve glucose tolerance, as well as A1C levels, maximum oxygen uptake, and body composition. 

How to start exercising

  • Start small. For example, even walking can make a huge difference. The World Journal of Diabetes found that walking for at least 30 minutes per day was shown to reduce the risk of type 2 diabetes by approximately 50 percent. 
  • Don’t sit still. You can set a time or alarm to remind yourself to get up and move around every half an hour if you are used to sitting all day for work. Stand up, stretch, and try taking the long route when walking from your parked car, or choosing the stairs instead of the elevator. If your job requires you to stay in one place all day, you can try setting up a DIY standing desk that allows you to stand part of the time.
  • Get into nature. Spend time tending to your garden, join a local community garden, do yard work, or hike a local trail.
  • Make downtime active. Watch your favorite TV show while you walk in place or lift light weights.
  • Keep movement fun. Find something you love to do — whether that be dancing, swimming, working out with a video game or YouTube tutorial, or jogging with friends — and slowly incorporate it into your regular routine. Studies show that you you’ll be more likely to stick to a type of fitness if you enjoy doing it.

What is a healthy diet for prediabetes?

After a diagnosis of prediabetes, ask your doctor to connect you with a certified diabetes educator and or nutritionist to help you develop a customized diet and meal plan that allows you to eat the foods you're accostomed to with alterations that lower the amount of sugar and refined carbohydrates you are consuming to help lower your blood sugar.

Studies show that developing a plan around the foods you like and adding in new healthy alternatives for simple carbohydrates, such as substituting cauliflower rice or zoodles for white rice and pasta, is much more effective than simply trying to cut out all foods that have carbohydrates and sugar without healthy alternatives to substitute in their place. You don't have to give up all of the foods your love or grew up cooking. In fact, research shows that a diet plan that allows you to incorporate those foods into your diet will be more sustainable and effective longterm.

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Prediabetes—Time to Treat to Preempt Diabetes and Related Complications
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