Prediabetes is reversible, and the steps to reverse it are well established. An A1C between 5.7% and 6.4%, or a fasting blood sugar between 100 and 125 mg/dL, puts you in the prediabetes range. Without changes, many people with prediabetes develop type 2 diabetes within five years. The good news: a combination of modest weight loss, regular movement, and dietary shifts can dramatically lower that risk.
Lose 7% of Your Body Weight
The single most impactful thing you can do is lose a moderate amount of weight. The landmark Diabetes Prevention Program, which forms the basis of most current guidelines, set the target at 7% of your starting body weight. For someone who weighs 200 pounds, that’s 14 pounds. For someone at 170 pounds, it’s about 12 pounds. That level of weight loss reduced the rate of progression to type 2 diabetes by 58% in the trial, outperforming medication.
The recommended pace is one to two pounds per week. Crash dieting isn’t the goal. Slow, steady loss that you can maintain over months and years matters far more than a dramatic drop followed by regain. Even if you don’t hit 7%, any sustained weight loss improves your insulin sensitivity and lowers your blood sugar.
Get 150 Minutes of Activity Per Week
The CDC recommends at least 150 minutes of moderate-intensity physical activity each week. Brisk walking counts. So does cycling, swimming, dancing, or any activity that raises your heart rate enough that you can talk but not sing. That breaks down to about 30 minutes on five days, though you can split it however works for your schedule.
Adding strength training, like bodyweight exercises, resistance bands, or weights, helps your muscles absorb glucose more efficiently. Even short walks after meals can blunt the blood sugar spike that follows eating. If you’re currently sedentary, start with 10-minute walks and build up. Consistency matters more than intensity.
Shift What You Eat
You don’t need a rigid meal plan, but the pattern of your eating matters. A Mediterranean-style diet, built around vegetables, whole grains, legumes, nuts, olive oil, and fish, is one of the best-studied approaches for prediabetes. Research on people with overweight or obesity found that those who closely followed a Mediterranean diet had significantly better insulin sensitivity than those who didn’t, even when their weight was similar. Fish consumption in particular showed a strong association with improved insulin function.
The core principles are straightforward:
- Prioritize fiber. Fiber slows the absorption of sugar into your bloodstream, smoothing out post-meal glucose spikes. Studies on glycemic control have used supplemental fiber doses of 10 to 20 grams daily with positive results, but you can reach that through food: beans, lentils, oats, berries, broccoli, and whole grains are all rich sources. Aim for at least 25 to 30 grams of total fiber per day.
- Reduce refined carbohydrates. White bread, sugary drinks, pastries, and white rice cause rapid blood sugar spikes. Swap them for whole grain versions, and pair carbs with protein or fat to slow digestion.
- Watch portions of starchy foods. You don’t have to eliminate potatoes, rice, or pasta. But filling half your plate with non-starchy vegetables and keeping starches to a quarter of the plate makes a measurable difference.
- Limit sugary beverages. Soda, fruit juice, sweetened coffee drinks, and energy drinks are some of the fastest routes to a blood sugar spike. Water, unsweetened tea, and black coffee are better defaults.
Stay Hydrated
Plain water plays a more direct role in blood sugar regulation than most people realize. When you’re dehydrated, your blood becomes more concentrated, which raises the concentration of glucose in your plasma. Dehydration also triggers hormonal changes that prompt your liver to produce more glucose. A large UK dietary survey found that each additional cup of water per day was associated with a small but meaningful reduction in A1C levels in men, with a 22% reduced odds of elevated blood sugar per cup of daily water. Drinking enough water won’t reverse prediabetes on its own, but it supports every other change you’re making.
Protect Your Sleep
Sleep deprivation directly impairs your body’s ability to use insulin. In controlled studies, just 24 hours without sleep produced a significant drop in insulin sensitivity in otherwise healthy people. You don’t have to pull an all-nighter to feel the effects. Chronically getting fewer than six or seven hours a night creates a similar pattern over time, pushing your blood sugar higher regardless of what you eat.
Most adults need seven to nine hours per night. If you’re consistently falling short, improving your sleep may be one of the easier wins available to you. Keep a consistent bedtime, limit screens before bed, and keep your room cool and dark.
When Medication Enters the Picture
Lifestyle changes are the first-line treatment for prediabetes, and for most people, they’re enough. But the American Diabetes Association recommends considering metformin for people at especially high risk. That typically means adults between 25 and 59 with a BMI of 35 or higher, a fasting blood sugar of 110 mg/dL or above, an A1C of 6.0% or higher, or a history of gestational diabetes. If you fit that profile and lifestyle changes alone aren’t bringing your numbers down, medication can provide additional protection while you continue working on diet and exercise.
Get Tested Every Year
Once you’ve been diagnosed with prediabetes, major guidelines recommend annual testing. Your doctor will likely recheck your A1C or fasting glucose once a year to see whether your numbers are improving, holding steady, or creeping toward the diabetes range. This is important even if you feel fine, because prediabetes and early type 2 diabetes rarely cause noticeable symptoms.
If your numbers are trending in the right direction, annual testing confirms that what you’re doing is working. If they’re rising, it gives you and your doctor a chance to adjust your approach before you cross the threshold into type 2 diabetes. Prediabetes is not a waiting room for diabetes. It’s a window where the trajectory can still change.