Prediabetes is reversible, and the single most effective thing you can do is lose a modest amount of weight through better eating and regular movement. People who make these lifestyle changes can cut their risk of developing type 2 diabetes in half. An A1C between 5.7% and 6.4% puts you in the prediabetes range, which means your blood sugar is elevated but hasn’t crossed the threshold into diabetes. That’s a window of opportunity, not a diagnosis you’re stuck with.
How Much Weight Loss Actually Matters
You don’t need a dramatic transformation. Losing just 5% to 7% of your body weight is enough to significantly lower your risk. For someone who weighs 200 pounds, that’s 10 to 14 pounds. This modest loss improves how your body responds to insulin and helps bring blood sugar back toward a normal range. The goal isn’t a number on a scale for its own sake. It’s about reducing the fat stored around your liver and pancreas, which directly interferes with blood sugar regulation.
What to Eat (and Why It Works)
A Mediterranean-style eating pattern is one of the best-studied approaches for improving blood sugar control. It centers on non-starchy vegetables (spinach, broccoli, zucchini), whole grains (oats, quinoa, farro), legumes (lentils, chickpeas, black beans), fruits like berries and citrus, healthy fats from olive oil, avocado, and walnuts, and lean proteins like fish, poultry, and tofu. This isn’t a short-term diet. It’s a sustainable way of eating that improves insulin sensitivity and lowers A1C levels over time.
The reason it works comes down to fiber and fat quality. High-fiber foods slow down glucose absorption, which prevents the sharp blood sugar spikes that happen after meals. The antioxidants in berries, leafy greens, and olive oil reduce inflammation at the cellular level, which helps your body use insulin more efficiently. And because meals built around healthy fats and fiber keep you full longer, you’re less likely to reach for sugary snacks between meals.
Aim for 22 to 34 grams of fiber per day, depending on your age and sex. Most people fall well short of this. Practical ways to get there: swap white rice for brown or quinoa, eat beans or lentils a few times a week, snack on an apple with almond butter instead of crackers, and add vegetables to every meal. Insoluble fiber, the kind found in whole grains and vegetable skins, specifically helps increase insulin sensitivity.
Carbs Aren’t the Enemy, but Quality Matters
You don’t need to eliminate carbohydrates. You need to choose ones that break down slowly. White bread, sugary drinks, pastries, and refined cereals cause rapid blood sugar spikes. Whole grains, legumes, and most fruits release glucose gradually. Pairing carbs with protein or fat (like toast with eggs, or fruit with nuts) slows digestion further and keeps your blood sugar more stable.
How Much Exercise You Need
The target is at least 150 minutes of moderate-intensity physical activity per week. That breaks down to about 30 minutes a day, five days a week. “Moderate intensity” means you’re breathing harder than normal but can still hold a conversation: brisk walking, cycling, swimming, or dancing all count. You don’t need to do it all at once. Three 10-minute walks spread through the day give you the same benefit as one 30-minute session.
Adding strength-building exercises helps too. Muscle tissue is one of the biggest consumers of blood glucose in your body, so the more muscle you maintain, the more efficiently your body clears sugar from the bloodstream. Bodyweight exercises like squats, push-ups, and lunges are a fine starting point. Even two sessions per week makes a measurable difference in how your body handles insulin.
If you’re currently sedentary, don’t try to hit 150 minutes in your first week. Start with what you can sustain and build up. The research consistently shows that any increase in activity from a baseline of zero produces real benefits.
Sleep Affects Your Blood Sugar More Than You Think
People with prediabetes who sleep six hours or fewer per night have roughly 25% higher odds of elevated A1C and insulin levels compared to those sleeping seven to eight hours. Short sleep increases inflammation markers and worsens insulin resistance, making it harder for your body to manage blood sugar even if your diet and exercise habits are solid. Sleeping nine hours or more per night is also associated with worse metabolic outcomes, so the sweet spot is between seven and eight hours.
If you struggle with sleep, the basics matter: a consistent bedtime, a cool and dark room, limiting screens before bed, and cutting off caffeine by early afternoon. Poor sleep can also increase hunger hormones that drive cravings for high-sugar foods, creating a cycle that works against your other efforts.
When Medication Enters the Picture
Lifestyle changes are the first-line treatment for prediabetes, and for most people, they’re enough. But medication may be considered in certain situations. Current guidelines suggest it for people under 60 with a BMI over 35, those with fasting blood sugar above 110, an A1C above 6%, or women who had gestational diabetes during pregnancy. If your doctor brings up medication, it’s typically used alongside lifestyle changes, not as a replacement for them.
Tracking Your Progress
Your A1C reflects your average blood sugar over the previous two to three months, which makes it the most useful number for tracking whether your changes are working. After a prediabetes diagnosis, plan to have it rechecked at regular intervals. If your A1C drops below 5.7%, you’ve moved back into the normal range. If it’s holding steady or creeping up, that’s a signal to adjust your approach.
Beyond lab numbers, pay attention to practical signs of progress: clothes fitting differently, more energy during the day, fewer afternoon crashes, and better sleep. These often show up before your A1C changes, and they’re signs that your metabolism is shifting in the right direction.
Making It Stick
The National Diabetes Prevention Program, coordinated by the CDC, is a structured year-long program offered in communities across the country and online. It provides a trained coach and a group of peers working toward the same goals. Participants in the program cut their diabetes risk in half. You can search for a program near you through the CDC’s website.
If a formal program isn’t for you, the core principles are the same: make one or two changes at a time, track what you eat and how you move, and build habits you can maintain for years rather than weeks. Prediabetes doesn’t require perfection. It requires consistency. The gap between where you are now and where you need to be is almost certainly smaller than you think.