Prediabetes: what your results mean and how to reverse it

Prediabetes is the step before type 2 diabetes: your blood sugar is already high, but not yet at the diabetes level. It is very common. The CDC estimates that about 115 million US adults (more than 2 in 5) have prediabetes, and 8 in 10 of them do not know it.

It matters even more in Puerto Rico: in 2021, 14.4% of adults had diagnosed diabetes, the highest of any US state or territory, according to the CDC. Catching prediabetes early is your chance to stay clear of type 2 diabetes.

Booking a prediabetes visit is simple:

A doctor visit has the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the clinic can’t see you. A doctor's note after your visit is included at no extra charge. See all prices.

If we have already seen you and you only need a lab results review, choose the follow-up visit. A refill of a medicine you already take (non-controlled) is also a follow-up visit, and anyone can book it. If a follow-up or forms visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.

It usually causes no symptoms. Testing is how you find out, especially if you are overweight, have a family history of diabetes or had diabetes during a pregnancy. If prediabetes moves on to diabetes, you may notice great thirst, peeing often, fatigue and blurry vision; see high blood sugar symptoms and what to do if your glucose reads high. Dark, thick patches on the neck or armpits (acanthosis nigricans) can be a sign of insulin resistance.

Prediabetes is found with blood tests, and the doctor gives you a lab order whenever one needs to be done or repeated. These are the ranges:

• A1C: normal, below 5.7%; prediabetes, 5.7% to 6.4%; diabetes, 6.5% or above.
• Fasting blood sugar: normal, 99 mg/dL or below; prediabetes, 100 to 125 mg/dL; diabetes, 126 mg/dL or above.
• Glucose tolerance test (at 2 hours): normal, 139 mg/dL or below; prediabetes, 140 to 199 mg/dL; diabetes, 200 mg/dL or above.

Lifestyle change is almost always the first step. Some people at higher risk may benefit from a medicine; the doctor assesses whether that applies to you.

The CDC says losing around 5% to 7% of your body weight and getting at least 150 minutes a week of brisk walking or similar activity help prevent type 2 diabetes. For a 200-pound person, that is 10 to 14 pounds.

In the National Diabetes Prevention Program, a CDC-recognized lifestyle change program, people with prediabetes lowered their risk of type 2 diabetes by 58% (71% for people over 60). The doctor also reviews the rest of your metabolic health with you: blood pressure, cholesterol and triglycerides.

If losing weight is hard, the doctor does a weight loss evaluation by video. If you have overweight or obesity, she can assess whether a medicine is right for you; read the Ozempic vs Mounjaro vs Zepbound vs Wegovy comparison or the Wegovy guide. For some adults at high risk, the American Diabetes Association (ADA) says metformin may be considered, although the FDA has not approved any medicine to prevent diabetes; the doctor decides whether it is right for you.

• Move more: for example, a 30-minute brisk walk, 5 days a week.
• Eat more vegetables, whole fruit and whole grains, and fewer sugary drinks.
• Sleep well and do not smoke.

We see adults and children of all ages. If your child has been told they have high blood sugar or prediabetes, the doctor evaluates them, gives you any lab order they need and builds a plan with the whole family: eating together, moving together and drinking fewer sodas helps everyone.

For your safety, call 911 or go to the emergency room if you have any of these signs. See also when to go to the ER.

• Great thirst, peeing a lot and unexplained weight loss, with vomiting or fast breathing
• Confusion or extreme drowsiness
• Chest pain, shortness of breath or weakness on one side of the body