Prediabetes, also called borderline diabetes, is a health condition in which blood sugar (or glucose) levels are high but not high enough to be classified as type 2 diabetes. It will lead to type 2 diabetes and other complications such as kidney damage, nerve damage, eye damage, heart attack, or stroke if not treated.  Not everyone with prediabetes eventually develops diabetes. About 5-10% of people with prediabetes develop type 2 diabetes annually and about 25% eventually develop type 2 diabetes within 5 years. However, with lifestyle changes it can be reversed or treated.


Many risk factors will cause prediabetes. So, the exact cause is not known. But continuous high levels of blood glucose (or sugar) is the determining factor. Insulin is a hormone secreted by the β-cells of the pancreas which helps to regulate blood sugar (or glucose) levels. Insulin helps regulate blood sugar by promoting its absorption into cells or tissues. Prediabetes occurs when the cells of your body are resistant (or not responding) to insulin. Because of this, the amount of glucose which stays in the blood is higher than normal since it’s not absorbed. High level of blood sugar is called hyperglycemia. If this persist and it is not treated, then it will lead to type 2 diabetes which can be termed as “persistent hyperglycemia”.

Risk factors

Risk factors for prediabetes are the same as those for type 2 diabetes and includes:

  • Being physically inactive.
  • Overweight, or obese.
  • Fat distribution. Individuals with fat around their waist and upper body are more susceptible than those with fat on their hips and lower body.
  • Age above 45.
  • Unhealthy diet. This includes eating processed food, red meat, or drinking sugar sweetened beverages.
  • Men are more susceptible to prediabetes than women.
  • Family history of diabetes.
  • History of gestational diabetes. mellitus. That is diabetes developed during pregnancy.
  • High blood pressure.
  • Smoking.
  • High cholesterol (non-high-density lipoprotein cholesterol or non-HDL cholesterol) levels.
  • High triglyceride levels.
  • Non-alcoholic liver disease.
  • Race or ethnicity. That is being of African, Native American, Latino, Asian, or Pacific Islander descent.
  • Genetic make-up.
  • Socio-economic status.
  • Geographical location.
  • Polycystic Ovary Syndrome (PCOS). PCOS is a fertility disorder in women which increases insulin resistance. Insulin resistance will lead to increase blood sugar.
  • Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts during sleep. Individuals with sleep apnea have an increase resistance to insulin and can develop type 2 diabetes.

Warning signs and symptoms

Just like type 2 diabetes, signs and symptoms of prediabetes develop very slowly over many years and can usually go undetected. Most people with prediabetes hardly develop any signs and symptoms. However, signs and symptoms may only become apparent when serious complications such as type 2 diabetes are already arising. It is therefore important to regularly go for a blood sugar test especially if you have prediabetic risk factors.

Warning signs and symptoms include:

  • Increase hunger.
  • Excessive thirst.
  • Frequent urination.
  • Dry mouth.
  • Unexplained wight loss.
  • Unusual fatigue or tiredness.
  • Numbness, tingling, burning or pain in your extremities such as hands or feet.
  • Cold hands or feet.
  • Wound or sore takes longer to heal.
  • Thick, dark, or velvety patches in certain areas of your skin especially near armpits, neck and elbows, and knees.
  • Genital itching or thrush.
  • Increase (or recurrent) urinary tract infection
  • Blurred vision.

Having any of these signs or symptoms does not mean you have prediabetes. However, a visit to a doctor and testing blood sugar levels will help confirm.


It is recommended to get tested for prediabetes at the age of 35 according to the American diabetes association. However, if you are overweight, obese, or have any prediabetic risk factor then you should be tested earlier. Prediabetes is diagnosed using any of the following 4 tests: fasting blood sugar (FBS) test, glucose tolerance test (GTT), Hemoglobin A1C (HA1C) test, and random blood sugar (RBS) test.

A FBS level between 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicates prediabetes (or impaired faster glucose). Using a fasting GTT with 75 g of glucose, people with fasting blood glucose levels less than 100 mg/dL (5.6 mmol/L) and a glucose tolerance value between 140 and 199 mg/dL (7.8 to 11.0 mmol/L) at 2 hours are said to have prediabetes. An HA1C level between 5.7% to 6.4% indicates prediabetes. A random blood glucose value between 140 mg/dL to 180 mg/dl (7.8 to 10 mmol/L) may indicate diagnosis.

How to prevent prediabetes?

Prediabetes can be delayed or completely prevented through healthy diet, staying physically active, maintaining a healthy weight, and avoiding stress. Staying physically active can involve cycling, exercising regularly for at least 30 minutes every day, brisk walking, or doing housework. If you are overweight or obese, then try to maintain a healthy weight by aiming for a BMI of 18.5 to 24.9 kg/m2. For a healthy diet, avoid junk food, processed food, or meat, and too much sweets but eat lots of vegetables, fruits, whole grains, and foods high in nutrition and fiber.

How to reverse or treat prediabetes?

Prediabetes can be completely and permanently reversed or treated naturally through modification of diet, lifestyle, and fitness. This can take about three years. People diagnosed with prediabetes usually take about 10 years to fully develop type 2 diabetes. So, there is enough time to act and reverse prediabetes upon diagnosis. Below are steps you can take:

  1. Drink enough water (at least 2 liters per day).
  2. Exercise regularly or brisk walk for at least 150 minutes per week or 30 minutes per day.
  3. Eat a clean, healthy, and balanced diet. You can seek a dietitian nutritionist for help or assistance. A dietitian nutritionist will help develop a meal plan specific to your condition in addition to other practical strategies to maintain a healthy diet.
  4. Stop smoking.
  5. Seek treatment if you have sleep apnea as it leads to increase insulin resistance.
  6. Eat fewer carbs.
  7. Try to lose excess weight as much as possible and avoid being obese.

Although prediabetes can be reversed naturally, natural does not work for everybody. Your doctor might need to prescribe some medications to help you lose weight and appetite.

Prediabetes can be associated to both type 1 and type 2 diabetes

Most diagnosis or research always link prediabetes to type 2 diabetes and not type 1 diabetes. However, according to a study published by the American Diabetes Association (ADA), 5 % to 10 % of all adults diagnosed with type 2 diabetes may actually have type 1 diabetes (latent autoimmune diabetes of adulthood [LADA]). This suggests that these individuals had signs and symptoms of prediabetes prior to diagnosis. Therefore, the association or link between prediabetes and type 1 diabetes should not be overlooked.