There's a particular feeling that comes with hearing "your blood sugar is a little high" or "you have prediabetes." Some people feel scared. Some feel ashamed. And quite a few feel nothing much at all, because they feel fine and the word "pre" makes it sound like something for later.
I'd like to offer a different way to hear it: prediabetes is a wake-up call, not a life sentence. It's your body giving you advance notice, while there's still plenty of room to change direction.
What prediabetes actually means
With prediabetes, your blood sugar is higher than normal but not yet high enough to be diagnosed as type 2 diabetes. Your doctor will usually find it with one of these blood tests (ranges from the NIDDK):
A1C: 5.7% to 6.4% (this reflects your average blood sugar over about 3 months)
Fasting plasma glucose: 100 to 125 mg/dL
Oral glucose tolerance test: 140 to 199 mg/dL (two hours after a sugary drink)
Underneath those numbers is usually insulin resistance: your cells aren't responding to insulin as well as they should, so your pancreas works harder to keep up. Over time, it may not be able to.
Why it deserves your attention
I'm not going to sugarcoat this (pun intended). Researchers have found that prediabetes is linked to a higher risk of heart disease and stroke. The NIDDK notes that people with prediabetes have a high chance of developing type 2 diabetes within 5 to 10 years if nothing changes.
It's also incredibly common. Researchers estimate that nearly 4 in 10 US adults have prediabetes, and that about 8 in 10 of them don't know it.
And because prediabetes usually has no symptoms, many people go years without knowing. If you've found out, you're actually ahead of the game.
Why it's not a life sentence
Here's the part I really want you to hear: not everyone with prediabetes develops type 2 diabetes. The NIDDK says so directly, and it describes healthy living as a way to prevent or even reverse prediabetes.
We know this because of one of the most important studies in modern prevention research: the Diabetes Prevention Program (DPP). More than 3,000 adults at high risk for type 2 diabetes were randomly assigned to a lifestyle program, a medication (metformin), or a placebo. The lifestyle group aimed for modest weight loss (7% of body weight) and at least 150 minutes of physical activity a week.
The results, published in the New England Journal of Medicine:
The lifestyle program reduced the risk of developing type 2 diabetes by 58% compared with placebo.
For people aged 60 and older, the reduction was 71%.
Lifestyle change worked better than the medication, which reduced risk by 31%.
The researchers kept following participants for years in a follow-up study. At 10 years, the lifestyle group was still developing diabetes at a lower rate (34% lower than placebo, and 49% lower for those 60 and older), and those who did develop it did so about four years later. At 15 years, the lifestyle group's risk was still 27% lower.
I share those long-term numbers honestly, because they show two things. First, lifestyle change has a real and lasting effect. Second, it isn't a one-time fix. Habits need to keep going for the benefits to keep going.
What to do after a prediabetes diagnosis
1. Take a breath, then take one step
Shame is a terrible motivator. Prediabetes is not a character flaw. Age, genetics, family history, and many other factors play a role. What matters now is what you do next, and the next step can be small.
2. Move most days
The DPP goal was 150 minutes a week of moderate activity like brisk walking, which is about 30 minutes, 5 days a week. Researchers summarizing the US Physical Activity Guidelines also recommend muscle-strengthening activities at least 2 days a week for older adults. Interestingly, a follow-up analysis of the DPP found that getting at least 150 minutes of activity a week reduced diabetes risk by 44% even in people who didn't reach their weight-loss goal. Movement matters on its own.
3. Aim for modest, muscle-friendly weight loss (if you need it)
If you have extra weight, a 5% to 7% loss is a common target (the DPP lifestyle group aimed for 7%). That's about 10 to 14 pounds for someone who weighs 200 pounds. After 50, aim to lose fat, not muscle: keep your protein up and keep doing strength work.
4. Change the plate, not your whole life
Research supports eating patterns such as Mediterranean or lower-carbohydrate eating. In a Spanish trial of adults aged 55 to 80 at high risk for heart disease, researchers found that a Mediterranean diet rich in extra-virgin olive oil, with no calorie counting, lowered the risk of developing type 2 diabetes by about 40% compared with a lower-fat control diet. In another trial of adults with an A1C between 6.0% and 6.9%, a lower-carbohydrate eating plan modestly lowered A1C over six months compared with usual eating. In practice, that might mean filling half your plate with vegetables, adding a palm-sized portion of protein (fish, beans, eggs, poultry, or tofu), swapping sweetened drinks for water or unsweetened tea, and building meals around protein and fiber rather than refined starches.
5. Look at sleep and stress
These don't get as much airtime, but they matter. Researchers have found that people who regularly sleep less than about 7 hours a night have a higher risk of type 2 diabetes, and in a small lab study, less than a week of short sleep made the body handle sugar less well. Managing stress deserves a place in your plan, too.
6. Find your people
Change is easier with company. Invite a friend to walk with you after dinner, cook a healthy meal together, or join a local walking group, cooking class, or faith community. A functional medicine practitioner or health coach can also help you build a plan and stay on track.
Changing the story
When I talk with people over 50 about prediabetes, I often see their shoulders drop a little when they realize this isn't the end of the story. It's the beginning of a different one: more walks, more vegetables from the garden, more strength, better sleep, and more time with people they love.
That's not a sentence. That's a life worth building.
Ready for a plan?
My free course, Insulin Resistance & Prediabetes 101, walks you through it step by step: what your numbers mean, how to build steadier meals, how to move in ways that fit your body, and how to put it together into habits you'll keep.
You've got this. One step at a time. Dr. LaVera
Sources
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
Huang Y, Cai X, Mai W, et al. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016;355:i5953. https://pubmed.ncbi.nlm.nih.gov/27881363/
Xia PF, Tian YX, Geng TT, et al. Trends in prevalence and awareness of prediabetes among adults in the U.S., 2005–2020. Diabetes Care. 2022;45(2):e21–e23. https://pubmed.ncbi.nlm.nih.gov/34872984/
Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine. 2002;346:393–403. https://www.nejm.org/doi/full/10.1056/NEJMoa012512
NIDDK. Diabetes Prevention Program (DPP), including 10- and 15-year DPP Outcomes Study findings. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
Hamman RF, Wing RR, Edelstein SL, et al. Effect of weight loss with lifestyle intervention on risk of diabetes. Diabetes Care. 2006;29(9):2102–2107. https://pubmed.ncbi.nlm.nih.gov/16936160/
Piercy KL, Troiano RP, Ballard RM, et al. The Physical Activity Guidelines for Americans. JAMA. 2018;320(19):2020–2028. https://pubmed.ncbi.nlm.nih.gov/30418471/
Salas-Salvadó J, Bulló M, Estruch R, et al. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med. 2014;160(1):1–10. https://pubmed.ncbi.nlm.nih.gov/24573661/
Dorans KS, Bazzano LA, Qi L, et al. Effects of a low-carbohydrate dietary intervention on hemoglobin A1c: a randomized clinical trial. JAMA Netw Open. 2022;5(10):e2238645. https://pubmed.ncbi.nlm.nih.gov/36287562/
Shan Z, Ma H, Xie M, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care. 2015;38(3):529–537. https://pubmed.ncbi.nlm.nih.gov/25715415/
Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435–1439. https://pubmed.ncbi.nlm.nih.gov/10543671/
All content is educational and not a substitute for personalized medical care. Please talk with your doctor or health care provider before changing your diet, physical activity, or medications.
LaVera J. Forbes, PhD, MS, CHN, is the founder of Dr. LaVera’s Healthy Aging, LLC. Find free healthy aging resources at drlavera.com.
© 2026 Dr. LaVera’s Healthy Aging, LLC. All rights reserved.