You can tell with a blood test. An A1C between 5.7% and 6.4% means prediabetes. Below 5.7% is normal, and 6.5% or higher is diabetes. Prediabetes often causes no symptoms at all, so testing is how it gets caught.
Of all the chronic diseases known today, diabetes is the most common. It starts years before it is full-blown and begins to harm one’s health. How can you tell if you are on the path to full-blown diabetes? What can you do to stop and reverse it? Here we cover both the signs to watch for and the remedies.
- What Is Prediabetes?
Prediabetes is a “pre-diagnosis” of diabetes. Think of it as a warning sign. It happens when your blood glucose level (blood sugar level) is higher than normal but not high enough to count as diabetes. Prediabetes is an indication that you could develop type 2 diabetes (T2D) unless you make some lasting lifestyle changes right away. In prediabetes, your pancreas still makes enough insulin when you eat carbohydrates. But the insulin does a poorer job of clearing sugar from the blood, so your blood sugar stays high. This is called insulin resistance.
- What are the symptoms of prediabetes?
Diabetes develops very slowly. It could take up to several years. So when you are in the prediabetes stage, you may have no symptoms at all. You may, however, notice that:
- you’re hungrier than normal
- you’re losing weight, despite eating more
- you’re thirstier than normal
- you have to go to the bathroom more frequently
- you’re more tired than usual
All of these symptoms are typically associated with diabetes. So if you are in the early stages of diabetes, you may notice them.
- What are the risk factors for prediabetes?
It is not very clear what exactly makes insulin stop working right in some people. But several risk factors make it more likely that you will get pre-diabetes. These are the same risk factors linked to type 2 diabetes:
- Weight: Being overweight (having a body mass index, or BMI, higher than 25) raises your risk of prediabetes. This is especially true if you carry a lot of extra weight around your belly. The extra fat cells can make your body more insulin resistant.
- Being inactive: This often goes hand-in-hand with being overweight. If you are not physically active, you are more likely to get prediabetes.
- Having a close family member with type 2 diabetes: Prediabetes runs in families. If someone in your close family has (or had) it, you are more likely to get it.
- Race/ethnicity: Some ethnic groups are more likely to get prediabetes. These include African-Americans, Hispanic Americans, Native Americans, and Asian Americans.
- Age: The older you are, the higher your risk of prediabetes. At age 45, your risk starts to rise. After age 65, your risk climbs very fast.
- Gestational diabetes: If you had diabetes while you were pregnant, your risk of prediabetes later on is higher.
- Other health problems: High blood pressure (hypertension) and high cholesterol (the “bad” LDL cholesterol) increase your risk of getting type 2 diabetes.
- Polycystic ovary syndrome (PCOS) also raises the risk of prediabetes, because it is tied to insulin resistance.
- Hypothyroidism (low thyroid function, or not enough thyroid hormone in the blood): If you have both hypothyroidism and prediabetes, your risk of T2D more than doubles compared with people whose thyroid works normally.
- How is prediabetes diagnosed?
See your doctor if you are overweight (a body mass index, or BMI, over 25) and have one or more of the risk factors above. Your doctor may want to test your blood glucose levels. If your fasting blood test indicates that you have prediabetes, your doctor may want to do an A1C blood test. Or your doctor may skip the fasting blood sugar test and go straight to the A1C blood test. This test shows your average blood sugar levels over a 3 month period. The results are given as a percentage:
- Normal = below 5.7%
- Prediabetes = between 5.7% and 6.4%
- Diabetes = 6.5% or higher.
It is wise to start testing your blood glucose levels every three years from age 45. Do this even if you are not overweight and have none of the risk factors. That way you will catch any problem early, because the risk of prediabetes (and so type 2 diabetes) rises with age.
- What should you do if you have prediabetes?
Serious lifestyle changes work to prevent type 2 diabetes after a pre-diabetes diagnosis. Your doctor will tell you what you need to do. But here are some other things you can do on your own.
- Assess Your Food Choices: A healthy food plan aims to keep your blood glucose level in a healthy, normal range. A registered dietitian (RD) or certified diabetes educator (CDE) can help you build a meal plan. It should include foods you like and foods that are good for your blood glucose level. Adjust your meal plan so it feels comfortable and satisfying to you. It should take into account your overall health, physical activity, and what you like to eat.
- Exercise regularly: When you exercise, your body burns more glucose, which lowers your blood glucose level. Exercise also means your body needs less insulin to move glucose, so your body becomes less insulin resistant. With prediabetes, your body is not using insulin well, so lower insulin resistance is a very good thing. Aim for at least 150 minutes of moderate activity a week. That is 30 minutes five days a week. You can get it by walking, bike riding, or swimming.
- Lose weight. If you are overweight, losing just 7 percent of your starting weight can help delay or prevent diabetes. So if you weigh 200 pounds, losing 14 pounds can make a difference. Weight loss also helps lower your blood pressure and cholesterol levels.
- Metformin: Medicine might be recommended for people with prediabetes who are at very high risk of type 2 diabetes. According to the American Diabetes Association, metformin should be the only medicine used to prevent T2D. It works by stopping the liver from making more glucose when you do not need it. That keeps your blood glucose level in a better range.
- Some good news
If you have prediabetes, you are definitely not alone. In 2015, an estimated 84.1 million Americans age 18 and older had this condition. That is a whopping 1 in 3 Americans! Having prediabetes does not mean you will surely get diabetes. It is, however, a warning of what could lie ahead. People with prediabetes have a higher risk of type 2 diabetes than people with normal blood sugar levels. Those chances rise if you make no healthy changes to your diet or activity habits. But it is not all bleak. It can be reversed, and you can stop the slide into diabetes. You can take control of your health by making the right choices. Keep a close watch on your blood sugar so you do not slip into prediabetes or full diabetes.
Frequently asked questions
What is the prediabetes range?
The A1C blood test shows your average blood sugar over about three months. Below 5.7% is normal. 5.7% to 6.4% is prediabetes. 6.5% or higher is diabetes. Your doctor may start with a fasting blood sugar test and follow it with an A1C. Or your doctor may go straight to the A1C.
Does exercise lower prediabetes?
Yes. Exercise makes your body burn more glucose, which lowers your blood sugar. Your body also needs less insulin to move glucose into cells, so insulin resistance drops. Aim for at least 150 minutes of moderate activity a week. For example, walk, ride a bike or swim for 30 minutes five days a week.
What is the fastest way to fix prediabetes?
Change the habits that raised your blood sugar, and start now. Build a meal plan that keeps your blood glucose in a normal range. Get at least 150 minutes of moderate exercise a week. If you are overweight, lose 7 percent of your starting weight: 14 pounds if you weigh 200. For people at very high risk, a doctor may add metformin.
Can prediabetes be reversed?
Yes. Prediabetes is a warning, not a sentence. It can be reversed. You can stop the slide into type 2 diabetes by changing your diet and activity habits, losing weight if you carry extra, and tracking your blood sugar. The risk of diabetes climbs when nothing changes.
Related reading
References:
- Healthline (2018): Understanding Borderline Diabetes: Signs, Symptoms, and More. Retrieved from https://www.healthline.com/health/diabetes/borderline-diabetes-know-the-signs
- Endocrineweb (2008): Prediabetes- How to prevent prediabetes from becoming type 2 diabetes. Retrieved from https://www.endocrineweb.com/conditions/pre-diabetes/pre-diabetes
- WebMD: Prediabetes (Borderline Diabetes). Retrieved from https://www.webmd.com/diabetes/type-2-diabetes-guide/what-is-prediabetes#1
- FamilyDoctor.org (2019): Prediabetes. Retrieved from https://familydoctor.org/condition/prediabetes/
Sources
- Tabák AG, Herder C, Rathmann W, et al. Prediabetes: a high-risk state for diabetes development. Lancet. 2012. PMID 22683128
- Tabák AG, Jokela M, Akbaraly TN, et al. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet. 2009. PMID 19515410
- Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002. PMID 11832527
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP
Interventional pain physician, addiction medicine specialist and obesity medicine diplomate.
Licensed in Missouri and Illinois.
Last reviewed June 18, 2026
