It struck me as a fairly remarkable coincidence that inside of a single week three separate women told me they’d been diagnosed with prediabetes.  More interesting was that none fit what I considered the typical profile for diagnosis: they weren’t overweight, were fairly active, and conscientious about their diets. I figure if this is happening in my community, perhaps it’s happening in yours too, which is why I turned to registered dietitian and diabetes nutrition coach Mary Ellen Phipps for advice. Mary Ellen, who has type 1 diabetes herself, knows first hand the power of food in long-term health. I asked her to shed some light on prediabetes prevention, diagnosis, and treatment:

1. What is prediabetes and how is it diagnosed?

Prediabetes is what you might have heard described as borderline diabetes or insulin resistance. Your blood sugars are elevated, but not enough for a diabetes diagnosis. Technically, prediabetes is when you have one of the following test results:

  • a fasting glucose of 100-125 mg/dL
  • 2 hour post glucose tolerance test blood sugar of 141-199 mg/dL
  • hbA1c 5.7%-6.4%

2. Are there symptoms?

Most people will not feel symptoms at this stage, which is why it’s important to have a yearly physical to check for it. Your doctor will always run a fasting glucose test as part of a normal well-check. But, some people may experience:

  • Lethargy
  • Increased thirst
  • Minor unexplained weight loss
  • Minor unexplained weight gain
  • Increased appetite

3. Does eating too much sugar lead to prediabetes? 

For some people yes, for some people no. Prediabetes is largely dependent on genetic factors, but lifestyle does play a part. It’s hard to say if eating too much sugar will give you prediabetes because just like with other diseases, the same exposure will effect two different people differently. The best defense against developing prediabetes is knowing your risks, eating a balanced sensible diet, and being physically active.

4. What are the risk factors for prediabetes?

The most common risk factors are:

  • Being 45 years of age or older
  • Family history of type 2 diabetes
  • Being overweight or obese
  • Prior history of gestational diabetes
  • You’ll find various other risk favors here

4. What is the prediabetes treatment? Is  full-blown diabetes inevitable?

Things can absolutely improve at this stage with lifestyle modifications, notably weight management (if applicable), diet, and exercise. At this stage, your pancreas is struggling to keep up as your body becomes more and more resistant to the insulin it is producing. However, there usually is little or no actual damage to the pancreas at this point. It’s important to know that things are almost always “reversible” in the prediabetes phase, and most people can achieve normal blood sugar levels with diet and exercise modifications.

6. How do you prevent prediabetes?

Unfortunately, for some people prevention is a challenge. A strong family history can be a big uphill  battle, but knowing you are at a higher risk means you can take action early to ensure you don’t develop diabetes. The biggest steps you can take for your health are:

  • Stay active…find something that brings you joy
  • Eat a balanced, realistic diet: high in fiber, protein, and fat
  • Do NOT succumb to the low-carb trend as this can further exacerbate blood sugar levels
  • Focus on quality, higher fiber carbohydrates
  • Be responsible, intentional, and realistic with your food choices
  • Tune into your emotional health, since stress also play a role in diabetes/prediabetes management

If you think you might be at risk for prediabetes, talk to your doctor. A fasting glucose test is standard for your annual check up. You can also request a HbA1c test, which can be particularly informative. 

And if you do get a prediabetes diagnosis, consider seeing a registered dietitian for counseling. Mary Ellen Phipps sees patients one-on-one in the Houston area and is available for virtual counseling as well. She also writes the Milk & Honey Nutrition Blog, which features gluten-free and diabetes-friendly recipes. Feel free to email her questions or to inquire about her nutrition coaching: