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What is Prediabetes?

July 24, 2018
What is Prediabetes?

Prediabetes is a condition that 1 out of 3 American adults have, according to the Centers for Disease Control and Prevention (CDC). You, yourself, may have prediabetes, even if you have no signs or symptoms.

But what is prediabetes? How do you know if you have prediabetes? Does having prediabetes mean that you need to inject yourself with insulin and to prick your fingers to check blood sugar? How can you take care of high blood sugar if you have it? Here are the prediabetes basics to know, and how Lark Diabetes Prevention Program can provide unlimited coaching to lower blood sugar if you have prediabetes.

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Normal (Healthy) Blood Sugar Regulation and Insulin Action


Prediabetes is a condition that falls between normal, healthy blood sugar levels, and high blood sugar levels in diabetes. Blood sugar, or blood glucose, levels are higher in prediabetes than in healthy people, but lower than in diabetes. The same is true for insulin resistance: insulin resistance is lowest in healthy people, higher in people with prediabetes, and highest in people with diabetes. Blood sugar levels and insulin resistance are related to how your body uses carbohydrates.

Normal Carbohydrate Metabolism

You may have heard that a low-carb diet can help lower blood sugar, but how exactly are carbohydrates, blood sugar, and prediabetes and diabetes related? Let us start with normal carbohydrate metabolism and the relationship to blood sugar levels, as the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) explains.

Carbohydrates from Food and Your Body

The focus here is on two specific types of carbohydrates, called sugars and starches, that are in foods. Sugars and starches can be in foods that are healthy or that are less healthy. These are some examples of high-carbohydrate foods, as listed by the CDC.

  • Fruit
  • Starchy vegetables (think potatoes, sweet potatoes, peas, corn, and winter squash)
  • Grains and grain products (think cereal, bread, pasta, rice, and pretzels)
  • Legumes (think beans, peas, and lentils)
  • Dairy products (think milk and yogurt)
  • Sugary foods (think sodas, ice cream, candy, cookies, pie, and cake).

When you eat foods with sugars and starches, your body breaks down those carbohydrates into a specific type of simple sugar called glucose. The glucose enters your bloodstream, causing your blood sugar or blood glucose levels to rise. This happens after a meal.

Another source of blood glucose is the liver. Your liver makes and stores glucose so that you can use the glucose when your cells need it. This can happen when you have not eaten recently, so there is no available glucose from food, or while you are exercising.

Blood Sugar Levels, Insulin, and Your Body’s Cells

What happens to all that glucose that is now floating around in your bloodstream? Many cells, such as your muscle and brain cells, need it for energy. If you take in more energy than you need, your body can convert the excess glucose to fat and store it in fat cells.

Here is where insulin enters the picture. Insulin is a hormone that is produced by beta cells in your pancreas. Your fat, muscle, and liver cells all need insulin to be able to take in the glucose from your blood. When blood sugar levels rise, an organ called the pancreas release insulin to help cells in your body take glucose from the bloodstream. Once blood glucose levels are back down to normal, your insulin levels drop, too.

When Blood Glucose Regulation Goes Haywire: Insulin resistance and the development of prediabetes and diabetes


Prediabetes and type 2 diabetes are conditions that develop when insulin does not work properly anymore. They develop gradually, often over years or decades, and are usually as least partially related to lifestyle factors that you have some control over.

Changes in Insulin Demands and Blood Glucose Regulation

Insulin is released in response to an increase in blood sugar. When you are healthy, the system works like this when you eat a meal that contains carbohydrates.

  1. You eat the meal. 
  2. During digestion, your body breaks down carbohydrates from the meal into glucose.
  3. Blood sugar (blood glucose) levels rise.
  4. The pancreas releases insulin into the bloodstream.
  5. Cells in your body take advantage of insulin so they can take up glucose.
  6. Insulin and blood glucose levels return down to baseline levels.

This carefully controlled system can go awry, though. Here is how the scenario can change if you continually challenge your blood glucose regulation system. A common way this can happen is if you are gaining weight. With weight gain, you are consistently eating more than your body needs.

  1. You eat a meal. You eat more than you need.
  2. During digestion, your body breaks down carbohydrates from the meal into glucose.
  3. Blood sugar (blood glucose) levels rise. They rise to higher-than-normal post-meal levels.
  4. The pancreas releases insulin into your bloodstream. Your pancreas needs to produce and release more insulin than normal.
  5. Cells in your body take advantage of insulin to take up glucose. Cells need more insulin than normal to get the job done.
  6. Insulin and blood glucose levels return down to baseline levels. But the system was strained to take care of the extra demands.

Age, genetics, being overweight or obese, having a poor diet, being physically inactive, and other risk factors can also cause an increase in insulin demands or changes similar to those outlined above. Since prediabetes does not usually cause symptoms, it is important to get tested. If you have prediabetes, Lark Diabetes Prevention Program (DPP) can provide coaching on a healthy lifestyle to reverse it.

The Start of Insulin Resistance

Repeatedly demanding that your body produce more insulin eventually has negative consequences. It can lead to a condition called insulin resistance. That means that the cells in your body are no longer highly sensitive, or responsive, to insulin. With insulin resistance, cells require more insulin to do the same job of clearing excess glucose from your blood to get blood sugar levels back to normal.

The Development of Prediabetes and Diabetes

The body can successfully produce enough insulin for quite a while, but not forever. Eventually, the pancreas becomes unable to produce enough insulin to keep blood sugar levels normal. This point, when insulin is no longer sufficient, is the point when blood sugar levels begin to rise. There will not be symptoms immediately and possibly not for years, but you can get a blood test, and your doctor can diagnose you with prediabetes or diabetes based on the result. 

Blood Sugar Levels in Prediabetes


There are a few tests you can get to check for prediabetes. They are all related to your blood sugar. Prediabetes values are higher than the values that are considered normal, but lower than the values in diabetes. The following table is adapted from an article published in Clinical Diabetes and Endocrinology.

Test What It Measures How It Works Prediabetes Value
Glycated hemoglobin (A1C)
Longer-term (3-month) estimate of blood sugar values
Simple blood test – does not need to be fasting
5.7 to 6.4%
Fasting plasma glucose (FPG)
The amount of glucose in your bloodstream
Blood test after an overnight fast (at least 8 hours)
100-125 mg/dl
Oral glucose tolerance test (OGTT)
How well your body metabolizes glucose (sugar)
Blood test 1 hour after you drink a solution with 75 grams of glucose
140-199 mg/dl

Prediabetes Symptoms


You may notice some symptoms with diabetes, especially with type 1 diabetes or poorly controlled type 2 diabetes. They can include the following.

  • Increased thirst and more frequent urination.
  • Tingling or numbness in your fingers or feet.
  • Increased hunger.
  • Unexplained low energy levels.
  • Poorer vision.
  • Slower healing of cuts and minor wounds.

Still, it is important to know that some people do not get symptoms with diabetes. Furthermore, most people with prediabetes do not get symptoms. That is why you should know your risk and test your blood sugar if you have risk factors.

Prediabetes Risk Factors


The risk factors for prediabetes include both lifestyle factors, which you can change, and genetic factors, which you cannot change. Knowing which risk factors you have can give you an idea of whether you are likely to have prediabetes or be at risk for insulin resistance. The ADA identifies several risk factors for prediabetes.

These are some of the lifestyle, or modifiable, risk factors for prediabetes.

  • Being overweight or obese
  • Not getting regular physical activity or exercise
  • Eating high amounts of sugar, refined carbohydrates, or fried foods
  • Having a diet low in fiber

These are some of the genetic, or non-modifiable, risk factors for prediabetes.

  • Having a family history of type 2 diabetes
  • Being 45 years of age or older
  • Being of African American, Native American, Asian American, or Hispanic American ethnicity
  • Having a personal history of gestational diabetes or having given birth to a baby weighing at least 9 lb
  • Having polycystic ovarian syndrome, or PCOS

“Can I get prediabetes if I am thin?” You may wonder if you can get prediabetes or diabetes if you are not overweight or obese, or if you do not have all of the above risk factors. Yes! Again, it is safest to get tested if you are unsure. If you do have prediabetes, Lark DPP can help you make healthy choices to manage blood sugar.

Time to Get Tested for Prediabetes?

The CDC reports that a full one-third of American adults have prediabetes. A shocking 6 out of every 7 of them (85%) of them do not know that they have it! That means nearly 3 in 10 American adults are walking around with prediabetes and have no idea. Are you one of them?

It may seem intuitive to wait until you have symptoms of prediabetes or diabetes before getting tested, but symptoms of prediabetes are unlikely to happen. In diabetes, symptoms may not become noticeable unless blood sugar levels are at dangerously high levels.

Instead, your doctor may order a prediabetes screening test or a diabetes screening test for you, or you can ask for one. 

It is best to be on the safe side and get tested for prediabetes even if you do not have symptoms or do not think you have many risk factors. The NIDDK recommends getting tested regularly if you fall into one of the following categories.

  • Are overweight or obese
  • Have one or more risk factors
  • Are at least 45 years old
  • Had gestational diabetes

You might want to ask your healthcare provider to order a prediabetes test if you have symptoms or risk factors.

Take the Prediabetes Test

Prediabetes versus Diabetes


Since both prediabetes and type 2 diabetes are characterized by insulin resistance and high blood sugar, it is not surprising that they have some similarities. 

  • They share risk factors, such as older age, certain ethnic and racial groups, obesity, and lack of adequate physical activity.
  • They are both responsive to a healthy diet and exercise program.
  • Most people with prediabetes will get type 2 diabetes sooner or later.

Still, prediabetes is different from diabetes in important ways, including symptoms, complications, and treatment plan. Lark DPP offers coaching to prevent diabetes, while the treatment plan in Lark for Diabetes is geared towards managing diabetes and blood sugar.

Diabetes Complications

If blood sugar is not within goal ranges, diabetes can lead to complications. These can include loss of vision, neuropathy in your hands and feet, and poor wound healing. Diabetes also raises the risk for heart disease, kidney disease, hypertension, and stroke, according to the ADA.

Extra Aspects of Diabetes Management

Prediabetes management can center around lifestyle changes, such as eating better and exercising more. Diabetes management includes those changes, but has other requirements, too. The CDC identifies some possible components of a diabetes management plan.

  • You may be on one or more prescription medications, possibly including insulin that requires injections.
  • You will need to test your blood sugar at least twice per day, and possibly more, such as before or after meals and exercise, or when you drink alcohol.
  • You will need to carry blood glucose tablets or another high-sugar snack all the time, just in case you get hypoglycemia (low blood sugar).
  • You may need to modify your planned exercise session if your blood sugar goes awry.

Fighting Prediabetes with Lifestyle and Medical Care


Since most people with prediabetes do not know that they have it, most people with prediabetes do not know they should be treating it. The result can be progression to type 2 diabetes. An article in Lancet says an estimated 5 to 10% of people with prediabetes get diabetes each year. About 25% of people with prediabetes develop diabetes within 3 to 5 years, according to an article published in Clinical Diabetes and Endocrinology. In total, up to 7 in 10 patients with prediabetes will eventually develop diabetes. 

These numbers can be lower with a few healthy lifestyle changes, such as those in Lark DPP. In fact, a famous clinical trial tested the effects of the Centers for Disease Control and Prevention (CDC)-approved Diabetes Prevention Program (DPP) in people with prediabetes.

The study found that:

  • Participants in the DPP group had a 58% lower risk of developing diabetes.
  • Participants who were at least 60 years old or who were Asian American had a 71% lower risk.
  • Participants in the DPP group had more weight loss and increased activity levels than those in other groups.

The Prediabetes Lifestyle and DPP


There are some steps that can lower blood sugar if you have prediabetes. Adopting a healthier lifestyle can prevent or delay the onset of type 2 diabetes. Goals might include:

  • Losing weight if you are overweight. Losing just a few pounds can help improve insulin sensitivity and lower blood sugar. Even preventing weight gain can keep your risk of diabetes lower, according to a review article published in Diabetes Care.
  • Increasing your physical activity, with your doctor’s permission. A good goal is to work up to at least 150 minutes per week of moderate to vigorous-intensity exercises, such as brisk walking, swimming, aerobics, and playing tennis. Cycling, playing basketball, circuit training, gardening, and dancing also count!
  • Improving your diet. Limiting sugary foods and sugar-sweetened beverages, fried foods, and processed and fatty and processed red meat, while increasing vegetables, fish, and whole grains, and lean protein, may improve insulin sensitivity.

The DPP has a curriculum designed to help you lose weight and implement the other lifestyle behaviors that can help you prevent or delay type 2 diabetes. The program takes a year to complete and may be covered by your insurance. You can enroll in an in-person DPP with weekly meetings, or opt for a program such as Lark DPP, which provides unlimited coaching, anytime, via smartphone.

Prediabetes and Your Doctor

As you would with any health condition, you should work alongside your doctor to manage prediabetes. Along with supporting healthy lifestyle changes, your doctor can order blood sugar tests to monitor your progress, and let you know if there is anything more you should do for your prediabetes. You may even get a prescription for metformin to increase insulin sensitivity.

Staying Positive with Prediabetes

It is normal to feel confused or frustrated any time you get news that you have a health condition, but you can think of your prediabetes diagnosis as a positive thing. It gives you a chance to make effective and meaningful changes that can prevent or delay diabetes or its complications.

The lifestyle changes you make now can be challenging, but here is extra motivation. These changes can help your health in other ways, plus give you benefits that you feel immediately in your daily life. When you eat right and get active, you can:

  • Lower blood pressure and cholesterol.
  • Have more energy.
  • Sleep better.
  • Improve your confidence.
  • Enjoy a better mood.

Talk to your doctor if you think you may have prediabetes or you want to start monitoring your blood sugar. It could be one of the best steps you take for your health.

No Cost Health Kit to Lower Your Risk of Diabetes

Weight 160lbs
Height 64
low Risk

Signs and symptoms are unlikely to appear during prediabetes, so don’t wait for them! Instead, it is time to take action if you have prediabetes or have other risk factors for developing diabetes. You could be at risk for type 2 diabetes and eligible for a Diabetes Prevention Program (DPP) if you have one or more risk factors such as being overweight or obese, being over 45 years old, being physically inactive, or having a family history of type 2 diabetes. 

Lark Diabetes Prevention Program (DPP) offers coaching through your smartphone to help manage prediabetes and lower the risk of developing type 2 diabetes. Your Lark coach is always available to help with lifestyle choices that can prevent or delay the onset of diabetes. Lark is designed to help you establish healthy habits around areas, such as weight loss, nutrition, physical activity, and even sleep and stress management, that can effectively lower blood sugar and help avoid symptoms of diabetes. Plus, you may even get a scale or Fitbit without any cost to you!

The entire program is available to you for no cost if your health insurer participates. Click here to find out if you may be eligible for Lark! Lark is completely convenient and ready to chat whenever you are. You could be minutes away from taking the first steps to managing prediabetes and improving health.

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Written by Natalie Stein on July 24, 2018
Exercise, Fitness & Nutrition Expert | Lark Health
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