⚠️ Prediabetes: The Warning Sign You Can Reverse

If your doctor tells you that your blood sugar is “a little high” — but not high enough to be called diabetes — you are standing at a crossroads. This in‑between zone is prediabetes. It’s not a disease in itself, but a powerful warning that your body is struggling with insulin and that Type 2 diabetes is on the horizon. The good news: prediabetes is reversible. With the right changes, you can bring your blood sugar back to normal and avoid diabetes altogether. Dr. Ravi Sishir Reddy explains what prediabetes is, how to know if you have it, and the proven steps to turn it around.

1. What Is Prediabetes?

Prediabetes is a condition where your blood glucose levels are higher than normal, but not yet in the diabetic range. It means your body’s insulin response is beginning to falter — your cells are becoming resistant, and your pancreas is working overtime to keep your sugar in check. Without intervention, prediabetes frequently progresses to full‑blown Type 2 diabetes within 5‑10 years.

The diagnostic criteria for prediabetes are:

• Fasting plasma glucose: 100–125 mg/dL (5.6–6.9 mmol/L) — also called impaired fasting glucose (IFG).
• 2‑hour OGTT (oral glucose tolerance test): 140–199 mg/dL (7.8–11.0 mmol/L) — also called impaired glucose tolerance (IGT).
• HbA1c: 5.7%–6.4% (39–47 mmol/mol).

If you fall into any one of these categories, you have prediabetes. Dr. Reddy emphasises that this is not a “maybe” or “borderline” situation to be ignored — it’s a call to action.

👉 Read more: HbA1c Test Explained →

2. Are There Any Symptoms of Prediabetes?

For most people, prediabetes is completely silent. You may feel perfectly fine. However, some subtle signs can appear, especially as insulin resistance worsens. These include:

• Darkened skin patches (acanthosis nigricans) — velvety, dark areas, usually on the neck, armpits, or groin. This is a classic skin marker of insulin resistance.
• Unexplained fatigue — the cells are not efficiently absorbing glucose for energy.
• Increased hunger — despite eating, your body feels starved because glucose isn't entering the cells properly.
• Difficulty losing weight — especially around the abdomen.
• Skin tags — small, benign growths often associated with insulin resistance.

Because symptoms are so subtle, screening is essential. The American Diabetes Association recommends testing for prediabetes in all adults aged 35 or older, and earlier if you are overweight and have additional risk factors like family history, sedentary lifestyle, or high blood pressure.

3. Who Is at Risk?

• Being overweight or obese (especially abdominal obesity).
• Age over 35 (though prediabetes is increasingly seen in younger adults).
• Family history of Type 2 diabetes.
• Physical inactivity.
• History of gestational diabetes or delivering a baby over 4 kg.
• Polycystic ovary syndrome (PCOS).
• High blood pressure or high cholesterol.
• South Asian, African, or Hispanic ethnicity — higher genetic susceptibility.

👉 Read more: Controllable Risk Factors →

4. What Happens If You Ignore Prediabetes?

Without lifestyle change, approximately 5‑10% of people with prediabetes progress to Type 2 diabetes each year, and up to 70% will eventually develop diabetes. Even before that, prediabetes carries an increased risk of heart attack, stroke, and kidney disease, because the same metabolic dysfunction that raises blood sugar also damages blood vessels. The elevated insulin levels (hyperinsulinemia) can promote weight gain and inflammation. So, prediabetes is not a “safe” zone — it’s already causing harm.

5. How to Reverse Prediabetes: The Evidence‑Based Approach

Reversal — meaning your blood sugar returns to the normal range without medication — is entirely possible. The landmark Diabetes Prevention Program (DPP) trial showed that intensive lifestyle intervention reduced the risk of progressing from prediabetes to diabetes by 58% — a result far superior to the drug metformin (which reduced risk by 31%).

Dr. Reddy outlines the key strategies:

• Lose 5‑7% of your body weight: If you weigh 80 kg, that’s just 4‑5.6 kg. Weight loss is the single most powerful predictor of reversal. It reduces visceral fat, lowers inflammation, and restores insulin sensitivity.
• Adopt a lower‑carbohydrate, whole‑food diet: Prioritise non‑starchy vegetables, lean protein, legumes, whole grains in moderation, and healthy fats. Cut down on refined flour, white rice, sugary drinks, and processed snacks. A Mediterranean or DASH‑style diet is strongly protective.
• Exercise at least 150 minutes per week: A combination of aerobic (brisk walking, cycling) and resistance training (weights, bodyweight exercises) improves glucose uptake by muscles and increases insulin sensitivity for 24‑48 hours after each session.
• Increase fibre intake: Soluble fibre (oats, legumes, vegetables, flaxseed) slows glucose absorption and improves gut health.
• Prioritise sleep and manage stress: Sleep deprivation and chronic stress raise cortisol, which directly worsens insulin resistance. Aim for 7‑8 hours of quality sleep and incorporate relaxation techniques.
• Consider metformin in selected cases: For those at very high risk (e.g., previous gestational diabetes, severe obesity, or young age with multiple risk factors), metformin can be added to lifestyle changes to further reduce the risk of progression.

6. How to Track Your Success

Repeat your fasting glucose and HbA1c at least once a year — or every 3‑6 months if your levels were very close to the diabetic threshold. You should see a drop within weeks of starting lifestyle changes. Even if you don’t hit “perfect” numbers immediately, every 1% drop in HbA1c reduces your future risk of complications substantially.