Posted On: November 13, 2026
You can feel perfectly well when a routine blood test first raises the possibility of prediabetes, which is why the result may seem to come out of nowhere. You may wonder whether diabetes is inevitable or whether you need medication or a strict diet.
Prediabetes rarely causes noticeable symptoms, so many people have no reason to suspect it. The Centers for Disease Control and Prevention (CDC) estimates that 115.2 million American adults have prediabetes, and most are unaware of it.1 I want you to take the result seriously, and I also want you to know how much you can do about it. The right changes can lower your risk of type 2 diabetes, and for some people, blood sugar returns to the normal range.2 Below, I walk through what your numbers mean, who should be tested and how often, and the steps that make the biggest difference.
Prediabetes means your blood sugar is higher than normal but has not reached the diabetes range. To understand why, it helps to know what insulin does. Your pancreas produces insulin, a hormone that helps glucose move from your blood into your cells for energy. With insulin resistance, your cells respond less effectively, so your pancreas has to work harder to keep blood sugar in range. Over time, it may not be able to meet that demand.3
There are two main types of diabetes. Type 1 is an autoimmune condition in which the body makes little or no insulin. It can run in families, although most people who develop type 1, about 9 in 10, have no known relative with it.4 Type 2, which accounts for about 90% to 95% of diabetes, develops gradually as the body becomes resistant to insulin and the pancreas can no longer keep up.4
Less commonly, diabetes develops after the pancreas itself is damaged, for example by chronic pancreatitis, and heavy alcohol use causes about half of chronic pancreatitis cases in the United States.4,5 Prediabetes sits on that type 2 path: insulin resistance often comes first, blood sugar then rises into the prediabetes range, and without changes, it can eventually reach the diabetes range. Each step along the way is a chance to change course.
Doctors use three laboratory tests to identify prediabetes in adults who are not pregnant, and each provides a different view of glucose control.4,6
| Blood Test | Normal | Prediabetes Range | Diabetes | What the Result Measures |
|---|---|---|---|---|
| Hemoglobin A1C | Below 5.7% | 5.7% to 6.4% | 6.5% or higher | Approximate average blood sugar over the past three months. |
| Fasting Plasma Glucose | Below 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher | Blood sugar after at least eight hours without calories. |
| Oral Glucose Tolerance Test | Below 140 mg/dL | 140 to 199 mg/dL | 200 mg/dL or higher | Blood sugar two hours after a standardized 75-gram glucose drink. |
The unit mg/dL means milligrams per deciliter.
Hemoglobin A1C is a standalone test your physician can order for you. Fasting glucose is part of a basic or comprehensive metabolic panel (BMP or CMP), which many people get with routine blood work, so if your blood was drawn after fasting, you may already have a recent result. The oral glucose tolerance test is used less often outside of pregnancy, usually when other results are unclear. There is no single standard cutoff for insulin resistance, which is one reason it often goes unnoticed until blood sugar starts to rise.
Because A1C does not require fasting and reflects a longer stretch of time than a fasting glucose test, an elevated A1C and a normal fasting result can show up together without either test being wrong. Your physician can decide whether to repeat the test or try a different one. Prediabetes is also associated with greater risk of heart and blood vessel disease, so it is worth checking your blood pressure and cholesterol alongside your blood sugar.7 A result in the diabetes range generally calls for a repeat test to confirm it.4
The American Diabetes Association (ADA) recommends routine diabetes screening from age 35, even if your weight falls within a healthy range. Earlier testing may make sense if you have overweight or obesity plus another risk factor, such as a parent with diabetes. Your medical history also matters.4
Tell your physician if you had gestational diabetes during pregnancy, have polycystic ovary syndrome (PCOS), or take medications such as long-term steroids. Knowing which relatives have diabetes and their age at diagnosis helps, because your family health history provides context that one blood test cannot.4
Once you have prediabetes, the ADA recommends glucose tests at least yearly, although your physician may suggest an earlier check if your results sit close to the diabetes threshold. Adults without prediabetes or diabetes generally repeat screening at least every three years, or sooner if their risk changes.4
Before you leave an appointment, ask which test you will repeat and when. That follow-up will show whether your plan is working.
Most people with prediabetes have no symptoms, so feeling energetic does not guarantee normal blood sugar. Fatigue is common and has many possible explanations, so a laboratory test gives a clearer answer than fatigue alone.6,8
If your result is described as “borderline,” I encourage you to ask what that means for your own numbers. A number near the top of the range deserves closer attention, particularly if earlier results show a rise. Prediabetes can also occur at a normal weight, so the plan should fit your individual risk, and weight loss may or may not be part of it.2,4
If you develop unusual thirst or begin to urinate much more frequently, contact your clinician promptly. These may be symptoms of diabetes or another problem that needs evaluation.9
Women sometimes ask whether a new glucose result has something to do with menopause. During perimenopause and menopause, shifts in estrogen and body composition can affect how the body responds to insulin, which makes this a useful time to review metabolic health. Hormones are only part of the picture, however, and I would not assume that menopause explains an abnormal test without considering other factors.10
PCOS also raises diabetes risk. A history of gestational diabetes matters long after pregnancy, even if blood sugar returned to normal after delivery. The ADA recommends lifelong tests at least every one to three years after gestational diabetes, and at least annual tests when prediabetes is present. Pregnancy itself requires a separate glucose care plan.4,11
Iron-deficiency anemia can also make A1C appear falsely high. If you have heavy periods or known low iron, tell your physician, particularly when your A1C and fasting glucose do not agree. A plasma glucose test may provide a clearer answer.4
How much prediabetes raises your risk depends on where your numbers fall. According to the ADA, people with an A1C between 6.0% and 6.4% have a 25% to 50% chance of developing diabetes within five years, and the risk climbs as A1C rises.4 There is real reason for hope, too: in a 2025 analysis of 19 studies that followed more than 76,000 adults, nearly three times as many people with prediabetes returned to normal blood sugar within 10 years as went on to develop type 2, and many of the factors that made the difference, like body composition and HDL (“good”) cholesterol, are ones you can work on.12
The landmark Diabetes Prevention Program (DPP) shows what that work can look like: an intensive lifestyle program with ongoing support for food choices and activity reduced the incidence of type 2 diabetes by 58% compared with placebo over about three years. A 2026 follow-up analysis also associated the lifestyle intervention with a lower risk of multiple chronic conditions among some original participants.13,14
For adults with overweight or obesity at high risk, the ADA’s 2026 guidance recommends maintaining a weight reduction of at least 5% to 7% of initial body weight. That goal does not fit everyone, and a separate 2025 study found that some people returned to a normal glucose range without losing weight, so it is worth tracking your blood sugar progress along with any weight goal that makes sense for you.2,15
If you would like support between medical visits, ask your physician about the CDC National Diabetes Prevention Program, since structured support can make a new routine easier to keep.16
Patients often ask me which foods they need to eliminate, but I would rather start with what you normally eat. The ADA supports both Mediterranean-style and lower-carbohydrate dietary approaches, so there is room to choose a pattern that supports your health and suits your preferences.2,17
Consider a familiar lunch. If rice makes up most of the plate, you might keep a smaller portion and add vegetables with a source of protein you enjoy. Whole fruit and whole-grain bread can still fit because the portion and the rest of the meal influence how your body handles the carbohydrate. You do not need to treat one food as the explanation for your entire A1C result.17
Fiber is useful because soluble fiber slows digestion and may temper the rise in glucose after a meal. Oats or beans offer practical ways to add more, and our guide to dietary fiber explains how to increase it without upsetting your stomach.17
If you already eat carefully, a personalized nutrition consultation may be especially worthwhile. A dietitian can suggest changes to meals you enjoy without imposing unnecessary restrictions.
Aim to build toward at least 150 minutes of moderate physical activity each week. A brisk walk counts, and you can divide the time into shorter sessions if that fits your schedule. A short walk after dinner is a good place to start, especially if it is something you can keep up.2
Strength exercises matter too, because muscle uses glucose and helps you stay capable in everyday life. Resistance bands or light weights may be suitable, although your clinician can help you adjust the routine if pain or another medical condition limits you. Easier walks or stairs may be your first sign of progress.17
Poor sleep can affect glucose regulation and your energy for change. Try to protect a consistent sleep schedule, and tell your physician if you snore loudly or wake up exhausted, because sleep apnea deserves its own assessment. The ADA recommends attention to sleep health in people with prediabetes.17
Stress can also make regular meals or activity harder to maintain. Choose support you can manage without adding another demanding task. If persistent anxiety or low mood interferes with daily life, it deserves a separate conversation. Alcohol is worth reviewing as well, particularly if it disrupts your sleep; if you do not drink, there is no health reason to start.17
Some people at higher risk may benefit from medication. Metformin is one option, particularly for selected patients with higher glucose levels or a history of gestational diabetes. Some people also qualify for obesity treatment with glucagon-like peptide-1 (GLP-1) medications, which mimic a hormone involved in appetite and blood sugar regulation. Our article on metabolic health and GLP-1 medications discusses that broader decision; prediabetes alone does not mean you need one of these drugs.2
At Eileen West, MD and Associates, our 90-minute comprehensive annual health assessments make room to review blood sugar alongside the rest of your health. We look at whether a result has changed over time, whether diabetes runs in your family, and whether blood pressure or cholesterol need attention too. Looking at the pattern helps us make decisions that one number alone cannot support.
As a board-certified internist, I consider hormonal changes when they matter, but I also want to understand your daily routine because advice about food or exercise must fit your life. Together, we can agree on priorities and decide what deserves further evaluation.
Our members receive one 45-minute nutrition consultation each year with Mary Hunt, MS, RDN, a registered dietitian nutritionist with experience in diabetes care. Mary shares the goals from that visit with our team, so we can connect your food choices with your larger medical plan.
For some patients, we may also discuss a continuous glucose monitor, a small wearable sensor that shows glucose patterns across the day. It can be useful when we have a specific question to answer, but it does not replace the laboratory tests that diagnose prediabetes. We use the data only when it can help us choose the best next step.4
Yes. Some people return to a normal glucose range through lifestyle changes, sometimes with medication. You may hear the word “remission,” but a normal result does not guarantee that your risk has disappeared, which is why follow-up tests still matter.2,15
A1C is an accepted diagnostic test, although your physician may repeat it or use a different blood test if the result conflicts with your history or other glucose results. Iron deficiency and pregnancy are two situations that can affect its interpretation.4
Yes. Family history and the way your body responds to insulin affect your risk, so a healthy weight does not rule out prediabetes. If weight loss is not appropriate for you, the plan can focus on nutrition and activity that support glucose control.4,17
No. Nutrition and physical activity provide the foundation for most prevention plans, while medication may help selected patients whose risk is higher. Your medical history and your glucose trend should guide that discussion.2
The ADA recommends glucose tests at least yearly after prediabetes. Your physician may suggest a check in three to six months if your result is close to the diabetes threshold or you have made changes you want to evaluate. A1C reflects several months, so a test after only a few days rarely answers that question.4
A prediabetes result comes with time to change course, and the everyday steps that help most, like a walk after dinner or a little more fiber at lunch, tend to add up. With the right support, you can lower your risk of type 2 diabetes, and you may be able to lower your blood sugar back into the normal range along the way.
Leading the way in women's healthcare is renowned board-certified internal medicine doctor Dr. Eileen West. She has over 20 years of experience and is recognized for her expertise in menopause, osteoporosis, and cardiovascular disease prevention. Her excellence-driven compassionate approach, which is associated with the American College of Physicians, improves the lives of her patients by putting a strong emphasis on their overall well-being.
Location: Fairfax, Virginia
Areas of Expertise: Women's Health, Menopause Management, Cardiovascular Disease Prevention, Osteoporosis Diagnosis and Treatment.
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