A prediabetes diagnosis means your blood sugar is higher than normal but not yet in the diabetes range. The good news: losing just 5 to 7% of your body weight through diet and exercise cuts your risk of developing type 2 diabetes by 58%. That’s roughly 10 to 14 pounds for someone who weighs 200 pounds. Prediabetes is one of the most reversible health conditions you can have, but it requires consistent changes.
What Your Numbers Mean
Prediabetes is diagnosed when your A1C falls between 5.7% and 6.4%, or your fasting blood sugar reads between 100 and 125 mg/dL. An A1C below 5.7% is normal; 6.5% or higher is diabetes. Your doctor will likely recommend retesting your A1C every one to two years to track whether your numbers are moving in the right direction or creeping upward.
These numbers reflect how well your body handles insulin, the hormone that moves sugar from your blood into your cells. In prediabetes, your cells are becoming resistant to insulin’s signal, so sugar builds up in your bloodstream instead. Everything below, from exercise to sleep, targets this underlying problem.
Physical Signs Worth Watching
Most people with prediabetes feel perfectly fine, which is why blood tests catch it more reliably than symptoms. But there’s one visible clue worth knowing about: dark, velvety patches of skin in body creases like the neck, armpits, or groin. This condition, called acanthosis nigricans, is a direct sign of insulin resistance. It can also appear on the hands, elbows, or knees. If you notice these patches, mention them to your doctor even if you haven’t had bloodwork recently.
Move More, and Be Specific About It
The target is at least 150 minutes of moderate-intensity aerobic activity per week. That’s 30 minutes a day, five days a week. “Moderate intensity” means you’re breathing harder than usual but can still hold a conversation: brisk walking, cycling, swimming, even energetic yard work all count. You don’t need to do it all at once. Three 10-minute walks throughout the day add up the same way.
Strength training matters too. Building muscle increases the number of cells actively pulling sugar out of your blood, which directly improves insulin sensitivity. Bodyweight exercises like squats, lunges, and push-ups work if you don’t have access to a gym. Aim for at least two sessions per week on non-consecutive days.
Exercise lowers blood sugar both immediately (your muscles burn glucose for fuel) and over time (regular activity makes your cells more responsive to insulin for 24 to 48 hours after each session). This is why consistency matters more than intensity. A daily walk does more for your blood sugar than an occasional intense workout.
Rethink Your Plate
You don’t need to follow a rigid diet plan. The core principle is reducing how fast sugar enters your bloodstream after meals. Two strategies do most of the work: increasing fiber and paying attention to the quality and quantity of carbohydrates you eat.
Fiber slows digestion, which prevents the sharp blood sugar spikes that stress your insulin system. The recommended intake for adults is 22 to 34 grams per day depending on age and sex, but most Americans fall well short of that. Practical ways to close the gap include swapping white rice for brown rice or quinoa, snacking on apples, pears, or almonds instead of processed snacks, adding beans or lentils to soups and salads, and starting your morning with oatmeal topped with nuts and berries. Broccoli, spinach, Brussels sprouts, and avocados are also high in fiber.
When it comes to carbohydrates, both the type and the amount matter. A food’s glycemic index tells you how quickly it raises blood sugar, but what’s more useful is the glycemic load, which accounts for how much carbohydrate you’re actually eating in a typical serving. A small portion of a high-glycemic food might affect your blood sugar less than a large portion of a medium-glycemic food. In practice, this means portion size is just as important as food choice. A bowl of white pasta will spike your blood sugar far more than a half-cup serving of the same pasta alongside vegetables and protein.
Pairing carbohydrates with protein, fat, or fiber at every meal slows absorption. Instead of toast alone for breakfast, add eggs or avocado. Instead of fruit by itself as a snack, pair it with a handful of nuts.
Losing a Small Amount of Weight Has Outsized Effects
The landmark Diabetes Prevention Program study found that losing 5 to 7% of body weight reduced diabetes incidence by 58% compared to people who made no changes. That result came from a combination of calorie reduction and 150 minutes of weekly activity. Notably, the lifestyle approach outperformed medication: metformin, the most commonly prescribed drug for blood sugar management, reduced risk by 23 to 49% depending on the study group.
You don’t need to reach an “ideal” weight. Even modest, sustained weight loss of 10 to 15 pounds produces meaningful improvements in insulin sensitivity. Crash diets tend to backfire because the weight returns. Slow, steady changes you can maintain for years matter far more than dramatic short-term results.
Sleep and Stress Are Not Optional Factors
Sleep deprivation directly worsens insulin resistance through several overlapping pathways. When you don’t sleep enough, your body produces more cortisol (a stress hormone that triggers the liver to release extra sugar into your blood), ramps up inflammation, and shifts your nervous system into a fight-or-flight state that further impairs how your cells respond to insulin. Fat cells also malfunction under sleep restriction, releasing more fatty acids into your bloodstream, which compounds the problem.
Adults need a minimum of seven hours per night. If you’re getting six or fewer, improving your sleep may move your blood sugar numbers almost as effectively as changing your diet. Basic strategies include keeping a consistent bedtime, limiting screens in the hour before sleep, and keeping your bedroom cool and dark.
Chronic stress works through many of the same hormonal pathways as sleep deprivation, particularly the sustained elevation of cortisol. Finding a reliable way to manage stress, whether that’s walking, meditation, social connection, or simply protecting your schedule from constant overload, supports everything else you’re doing.
When Medication Enters the Picture
Lifestyle changes are the first-line treatment for prediabetes, and they work better than medication for most people. But your doctor may discuss metformin if you’re under 60 with a BMI of 35 or higher, if your fasting blood sugar is above 110 mg/dL, if your A1C is 6.0% or above, or if you had gestational diabetes during pregnancy. In these higher-risk groups, metformin offers meaningful additional protection alongside lifestyle changes, not as a replacement for them.
Building a Monitoring Routine
After your initial diagnosis, expect to repeat your A1C test every one to two years. If you’re making active changes, testing at the 12-month mark gives you a clear picture of whether your efforts are working. An A1C that drops below 5.7% means you’ve moved back into the normal range. A number that holds steady means you’re preventing progression. A number that climbs toward 6.5% signals the need for more aggressive intervention.
Some people find it helpful to use a home glucose meter occasionally, particularly after meals, to learn which foods spike their blood sugar most. You don’t need to test daily the way someone with diabetes might, but a few weeks of post-meal testing can be genuinely educational. You’ll quickly discover which meals your body handles well and which ones cause sharp rises.