More than 1 in 3 American adults have prediabetes — and nearly 85% of them don’t know it yet. An estimated 3 in 4 people with prediabetes will develop type 2 diabetes. And, this serious metabolic condition is also linked to heart disease and stroke. Fortunately, being proactive with your health can make a difference: With diet and lifestyle changes, you have the power to completely reverse a prediabetic prognosis. In this guide, we'll educate you on the warning signs of prediabetes, as well as how to reverse prediabetes if you discover you're at risk.

What is prediabetes?

Prediabetes is a metabolic condition characterized by higher-than-normal blood sugar levels, but not high enough to be categorized as diabetes. Prediabetes is caused when your body’s insulin response doesn’t function properly. (Read more: What Is A High Glucose Level.) Although not full-blown diabetes, prediabetes can still damage your organs and it is important to reverse it as soon as possible.

What are the warning signs of prediabetes?

Prediabetes often rises undetected because there are no symptoms unique to the condition. The most common symptoms, listed below, have been linked to prediabetes  — but also are linked to a number of other unrelated conditions. If you are experiencing any of these symptoms or are at higher risk for developing prediabetes, talk to your health provider. 

• Unusual fatigue
• Weight loss
• Blurred vision
• Excessive thirst
• Frequent urination or increase in urinary tract infections
• Cold hands and feet
• Dry mouth
• Increased irritability, nervousness or anxiety
• Skin issues: itchy skin or experiencing thick, dark, velvety patches near your armpits, elbows and neck
• Slow-healing wounds 

Risk factors for prediabetes

The top risk factors for prediabetes are:

• Being overweight or obese
• Having high blood pressure or high cholesterol
• Being over the age of 45
• Having a parent or sibling with type 2 diabetes
• Having cardiovascular disease
• Living a sedentary lifestyle (being physically active fewer than 3 times per week)
• Having experienced gestational diabetes or giving birth to a baby over 9 lbs
• Having polycystic ovary syndrome
• Race: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders are at higher risk than Caucasians. 

If you’re unsure about your risk level for developing prediabetes, the American Diabetes Association offers a free 60-second online test. 

How do I know if I have prediabetes?

Prediabetes is diagnosed with the same blood tests as diabetes. Learn more about such tests in What To Do About High Glucose Levels.

How to reverse prediabetes

Prediabetes can be reversed with several important lifestyle changes. 

1. Monitor your blood sugar levels. Once you’ve been diagnosed as prediabetic, talk to your doctor to make sure you’re getting tested routinely with blood tests or a wearable device (CGM), even after your levels return to normal. 
2. Be active. Get your heart rate up for at least 30 minutes per day, which helps with weight loss or maintenance and overall metabolic functioning. 
3. Stick to a healthy diet incorporating high-fiber whole fruits and vegetables, legumes and lean meats; and avoid processed foods. 
4. Maintain a healthy weight. If you’re slightly overweight, losing a small amount over time (5-7% of your bodyweight) and keeping those extra pounds off makes a significant difference in your body’s ability to manage its blood glucose levels.
5. Hydrate. Drinking water has benefits for every single function of your body and also helps lower your blood sugar levels. 
6. Manage your stress levels and get adequate amounts of sleep.

What is a good prediabetes diet?

There is no single diet that works well for everyone. A good prediabetes diet is full of nutrient-dense, colorful foods. The American Diabetes Association recommends portioning your meals by categories: nonstarchy vegetables, carbohydrate foods and protein foods.

Source: American Diabetes Association

Carbohydrates break down into glucose and are the predominant source of your blood glucose levels. They’re also your main source of energy so it is very important to eat enough of them. The three main types of carbohydrates in food are sugar, starches and fiber.

Sugars, whether naturally occurring or added, break down into glucose and immediately enter your bloodstream. Your body will need this shot of energy if you’re about to be very active. If you’re eating candy while watching TV, that sugar sits in your bloodstream for hours. Repeated blood sugar spikes like this lead to a lower insulin response and, over time, a higher blood glucose level.

Starches are a type of complex carb, meaning they take a longer time to break down into glucose and don’t overwhelm your body with energy all at once. High-starch foods include corn, winter squash, potatoes, legumes and peas as well as whole grains.

Fiber comes from plant-based foods and has a whole host of benefits, including lowering cholesterol levels, keeping your digestive tract healthy and bowel movements regular. Foods high in fiber include fruits, nuts and seeds, vegetables and whole grains like quinoa, oats and brown rice. 

Nonstarchy vegetables should make up about half of your meals. These vegetables are high in fiber but low in starch and include green vegetables (brussels sprouts, asparagus, collards, lettuces, broccoli, celery), eggplant, zucchini and yellow squash, tomatoes, onions, mushrooms, carrots and peppers. 

Protein should make up ¼ of your plate and include the leanest proteins (chicken, lean ground beef, turkey bacon, greek yogurt or beans). 

Key takeaways

Prediabetes is a serious condition and may progress to type 2 diabetes, heart disease or stroke if unaddressed. However, prediabetes is reversible, so the diagnosis should act as a wakeup call to slowly shift your daily behaviors. Through weight management, physical activity, healthy eating, hydration and taking care of your emotional health, you have the power to better manage your metabolic health. Over time, these steps can readjust your body’s insulin responses to decrease your risk of long-term health issues and diseases.