How to Help Prevent, Manage, and Treat Prediabetes With Diet, Lifestyle Choices, and Medication
Having prediabetes doesn’t destine you for type 2 diabetes. But preventing and treating the condition requires knowing some basic facts first.
Having prediabetes can increase your risk for type 2 diabetes, but you can take steps to keep your blood sugar in a healthy range, and possibly even reverse the disease.
In fact, some patients feel empowered to have been diagnosed early with prediabetes, and are hopeful of preventing type 2 diabetes, says Ann Whelan, RD, CDE, at The Ohio State University Wexner Medical Center in Columbus. “By making some nutritional changes and increasing one’s activity level, those more optimistic individuals may feel confident that they will be able to prevent diabetes while getting healthier,” she says.
But Whelan also notes some people become overwhelmed with the lifestyle changes that living with diabetes requires, or worry about access to good healthcare, resources, education, and social support. They may fear that type 2 diabetes is inevitable and feel the stress of the diagnosis more.
“But in some cases, with the right support, some individuals can learn to work at their own pace to make small, realistic changes in their health over time,” Whelan says.
Does Prediabetes Always Lead to Diabetes?
What Is Prediabetes? Key Facts to Know
Prediabetes is a state in which blood sugar levels are higher than normal but not high enough for a diagnosis of full-blown type 2 diabetes. Prediabetes is also referred to as “impaired fasting glucose” or “impaired glucose tolerance,” depending on the blood test used to make the diagnosis. (1)
“A diagnosis of prediabetes means that an underlying condition called?insulin resistance?is present,” Whelan explains. Insulin a hormone produced by the pancreas that allows sugar in the blood to enter the cells. When you become insulin resistant, insulin can no longer perform this job, and the pancreas ends up producing more and more insulin to compensate, Whelan says. Initially this compensation works, and blood sugar levels remain normal or only slightly elevated, she explains — a condition called prediabetes. (2)
In fact, the Centers for Disease Control and Prevention (CDC) estimates that more than one of every three adults in the United States?—?or 84 million Americans —?have prediabetes. (1)
And the majority of these people, more than 90 percent,?don’t even know they have it. “Left unchecked, insulin resistance usually progresses to type 2 diabetes because the pancreas is no longer able to compensate for the insulin resistance effectively,” Whelan says. (2)
What Are the Risk Factors and Symptoms of Prediabetes?
The risk factors for prediabetes are largely the same as those for type 2 diabetes:
- Being?obese?or overweight
- Not exercising regularly
- Being previously diagnosed with?gestational diabetes?(diabetes during pregnancy)
- Being over age 45
- Having?a family history of type 2 diabetes
- Being African-American, Hispanic and Latino, American Indian, Asian-American, or Pacific Islander
Prediabetes generally has no signs or symptoms. (2) But as the condition progresses toward diabetes, people may experience type 2 diabetes symptoms, such as increased thirst, frequent urination, blurred vision, and fatigue, Whelan says. (3)
One of the few possible signs is acanthosis nigricans, which is a darkening of the skin in places such as the neck, armpits, elbows, knees, and knuckles. (2)
If you notice such skin changes, it’s a good idea to get them checked out by a doctor.
What Causes Prediabetes? Why Experts Aren’t Sure
The exact causes of insulin resistance are still unknown, but experts believe major contributors include excess weight, especially around the middle, and a lack of physical inactivity. Fat around the waist could contribute to chronic inflammation, and has been linked to health problems like high blood pressure and?heart disease. Physical activity helps muscles burn stored glucose, or sugar, and maintain a balance of blood sugar levels in the body. (2)
Other risk factors and potential causes of insulin resistance include ethnicity, steroid use, aging, sleep problems like sleep apnea, and smoking. (2)
Screening for and Diagnosing Prediabetes: How Is It Usually Done?
Or your doctor may discover the condition if you have risk factors for prediabetes and type 2 diabetes and your doctor orders a screening test. (4)
The tests used to screen for prediabetes are the same as those used to screen for type 2 diabetes: the fasting plasma glucose test and the A1C test (also called the HbA1c test or the hemoglobin A1c test). (4)
A1C?is a two- to three-month measure of average blood glucose levels. According to the ADA’s 2018 Standards of Medical Care in Diabetes, adults with no symptoms should begin getting tested for prediabetes at 45 years old, with repeat testing at a minimum of once every 3 years after that, providing the test results were normal. But adults who are overweight or obese and have one or more of the following risk factors should consider getting tested, even if they have not yet reached 45: (5)
- A first-degree relative who has diabetes
- High-risk race or ethnicity, including African-American, Latino, Native American, Asian-American, and Pacific Islander
- History of cardiovascular disease
- Women with polycystic ovarian syndrome (PCOS)
A fasting plasma glucose test result between 100 and 125 milligrams per deciliter (mg/dL) and an HbA1c test result between 5.7 percent and 6.4 percent indicates prediabetes. (4)
The oral glucose tolerance test (OGTT), which involves fasting overnight, then drinking a glucose solution and having blood sugar measured one hour and two hours afterward, is sometimes used to diagnose prediabetes. (4)
But that test is generally used only to screen for gestational diabetes because it’s more time-consuming and expensive than other tests. It can also be used to screen for and diagnose type 2 diabetes, Whelan says.
Dealing With the Emotional Toll of a Prediabetes Diagnosis
When you are first diagnosed with prediabetes, you might want to check your local hospital or YMCA for any in-person support programs, Whelan says. “Sometimes knowing that you are not alone and learning all you can about the disease is enough,” she says.
Whelan also notes that people with prediabetes can find many online?support groups?and blogs that provide educational information and emotional support. Family members and healthcare professionals can offer support and encouragement, while?mental health professionals?can help you when you feel like you’re dealing with more problems than you can cope with on your own, Whelan says.
Is Reversing Prediabetes Possible Through Dieting, Weight Loss, and Lifestyle Changes?
Luckily, you can take steps to help reverse prediabetes and prevent the onset of type 2 diabetes.
Data and research back up this notion. In fact, the CDC points out losing just 5 to 7 percent of your body weight can help prevent prediabetes from progressing into full-blown type 2 diabetes. (1)
One study notes that lifestyle intervention may decrease the percentage of people with prediabetes who develop type 2 diabetes from 37 to 20 percent within four years of those individuals’ prediabetes diagnoses. (6)
Also, the landmark Diabetes Prevention Program (DPP) study, which examined the effects of weight loss through?dietary changes?and increased physical activity in people who have prediabetes, found the disease is reversible. (7)
The DPP study enrolled 3,234 overweight adults from 27 clinical centers around the United States; 45 percent of participants were members of racial or ethnic minority groups.
Participants who received intensive counseling and motivational support for improving their diets and being physically active reduced their risk of developing diabetes by 58 percent.
The methodology of the DPP has been adopted by the YMCA’s Diabetes Prevention Program, which is currently being implemented at participating Ys across the United States, as well as other sites. The CDC maintains a list of local DPP programs, including ones run by the YMCA. And, in 2018, National DPP programs will become eligible for Medicare coverage, according to the U.S. Department of Health and Human Services. (8)
That means many of the 84 million Americans with prediabetes now have access to an affordable?—?and proven?—?way of managing their prediabetes and preventing or delaying type 2 diabetes.
How to Follow a Prediabetes Diet: What to Eat and Avoid
A healthy diet for people with prediabetes is the same as any healthy diet, Whelan says. Generally, she notes, you’ll want to reach for the following foods:
- More fruits and vegetables, including at least 1 cup of vegetables at both lunch and dinner
- Fish at least twice a week
- Lean meats and proteins, such as the round or loin cuts of meat and chicken without the skin
- Plant-based proteins like beans, instead of meat and chicken more often
- Food that is roasted, broiled, grilled, steamed, or baked instead of deep-fried or pan-fried
- Oil for cooking instead of butter, lard, or shortening
- Water and other calorie-free drinks
In addition, Whelan says, you’ll want to cut back on:
- Regular soft drinks and juice
- Refined?carbohydrates, such as white bread, rice, and potatoes
- High-fat desserts like ice cream, cakes, pies, and cookies — reach for fruit instead
- High-fat and processed meats, like hot dogs, sausage, and bacon
- Foods with?trans fat, like certain margarines, packaged baked goods, and certain peanut butters (check the label)
- Alcohol. Limit your drinking to a moderate amount, which means no more than one drink per day for women, and no more than two drinks per day for men. A drink is about 12 fluid ounces (oz) beer, 5 oz of wine, or 1.5 oz of liquor. (9)
The Importance of Portion Control for Reversing Prediabetes
Whelan notes that if you are overweight, losing weight can decrease your odds of developing type 2 diabetes. (10) Cutting back portions is one way to lose weight. In addition, the Joslin Diabetes Center notes that portions are closely related to blood glucose control: If you eat more than recommended, your blood sugar will go up. (11)
Whelan offers the following tips for portion control:
- Use a smaller plate and skip second helpings.
- Write down what you eat and drink for a week, which will make you more aware of how much you’re consuming.
- Try to avoid snacking between meals.
- When dining out, share your main course with a friend or family member, or try taking half of it home in a to-go box.
Using the Glycemic Index and the Glycemic Load to Monitor Your Carb Intake
The glycemic index rates foods on a scale of 0 to 100, based on how much those foods affect your blood sugar. The lower the ranking, the slower your blood sugar rises after eating that food. More cooked and processed foods tend to have higher GI numbers, while more fiber-filled and fat-filled foods tend to have lower GI numbers. (12)
The glycemic load, meanwhile, is an additional measure that tells you not only how quickly the glucose enters the bloodstream, but how much glucose it can deliver. For example, watermelon has a glycemic index of 80, but a serving of watermelon has so few carbohydrates that its glycemic load is only 5. (12)
Counting your carbohydrates?is not required for people with prediabetes, Whelan says, but it can be a useful tool that can help you regulate portion sizes and eat healthier.
Why Smoking and Prediabetes Are a Deadly Combination
Smoking?can increase your risk of developing type 2 diabetes, especially if you’ve already been diagnosed with prediabetes. In fact, it can decrease blood from flowing to your muscles and elevate stress levels — all of which increases your risk of insulin resistance. Preliminary research also suggests nicotine may affect blood sugar control. (13)
Here are some proven ways you can quit smoking: (14)
- Individual, group, or telephone counseling
- Treatment delivered via a mobile phone
- Nicotine replacement products, like over-the-counter nicotine patches, gum, or lozenges, or prescription inhalers or nasal sprays
Why Exercise Is Crucial to Help Manage Well or Reverse Prediabetes
“Being active is one of the best ways to delay or prevent type 2 diabetes,” Whelan says. (15) Regular physical activity can help lower your weight and?blood pressure, and improve?cholesterol levels, she explains. Try walking for half an hour five days a week to start, Whelan recommends.
In fact, a 2016 study looked at whether exercise alone could affect oral glucose tolerance, and found that it was actually fairly comparable to the results of the exercise-plus-diet group. In the research, participants who adjusted their diet and exercise habits saw an 8.2 percent improvement in glucose tolerance, and participants who adjusted only their exercise habits saw just a 6.4 percent improvement in glucose tolerance. (16)
Common Medication That Can Help Treat Prediabetes
If you need medication to help manage your prediabetes, your doctor will most likely prescribe?Glucophage (metformin), Whelan explains. Metformin reduces how much glucose your liver makes and can also lower insulin resistance. (17) Also, people with prediabetes are often prescribed medication to help them manage their?hypertension, if applicable, Whelan says.
Possible Complications of Unmanaged Prediabetes
Above all, it’s important to take steps to prevent type 2 diabetes after you receive a prediabetes diagnosis. “Diabetes is a serious disease that causes several long-term complications, like heart disease, kidney disease, eye disease, nerve disease, and more,” Whelan says. “If you delay or prevent it, you’ll prevent long-term complications and enjoy better health in the long run.” (18)
Why Prediabetes Isn’t an Early-Death Sentence
It’s important to know that you will not automatically develop type 2 diabetes if you have prediabetes, Whelan says. Early treatment can help return blood glucose levels to the normal range, she explains. By being proactive about your health, you can avoid developing type 2 diabetes and take steps towards a more active, healthy life.
Additional reporting by Stephanie Bucklin
Editorial Sources and Fact-Checking
- Prediabetes.?Centers for Disease Control and Prevention. July 2017.
- Prediabetes and Insulin Resistance.?National Institute of Diabetes and Digestive and Kidney Diseases. August 2009.
- Diabetes Symptoms: When Diabetes Symptoms are a Concern.?Mayo Clinic. April 2016.
- Prediabetes.?Mayo Clinic. August 2017.
- Standards of Medical Care in Diabetes.?American Diabetes Association. 2018.
- Tuso, P. Prediabetes and Lifestyle Modification: Time to Prevent a Preventable Disease.?The?Permanente?Journal. Summer 2014.
- The Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP).?Diabetes?Care. December 2002.
- Medicare Diabetes Prevention Program (MDPP) Expanded Model.?The Centers for Medicare and Medicaid Services.
- What’s a “Standard” Drink??National Institute on Alcohol Abuse and Alcoholism.
- Hamman R, Wing R, Edelstein S, et al. Effect of Weight Loss with Lifestyle Intervention on Risk of Diabetes.?Diabetes?Care. September 2006.
- Key to Success: Portion Control.?Joslin Diabetes Center.
- The Lowdown on Glycemic Index and Glycemic Load.?Harvard Health Publishing.
- First Identification of Nicotine as Main Culprit in Diabetes Complications Among Smokers.?American Chemical Society. March 2011.
- Quitting Smoking.?Centers for Disease Control and Prevention. December 2017.
- Colberg S, Sigal R, Fernhall B. Exercise and Type 2 Diabetes.?Diabetes?Care. December 2010.
- Slentz C, Bateman L, Willis L. Effects of Exercise Training Alone vs. a Combined Exercise and Nutritional Lifestyle Intervention on Glucose Homeostasis in Prediabetic Individuals: A Randomized Controlled Trial.?Diabetologia. October 2016.
- Metformin.?National Health Service.
- Type 2 Diabetes.?Mayo Clinic. January 2018.