If you’ve been told you’re prediabetic, the most effective steps are losing 5% to 7% of your body weight, getting 150 minutes of physical activity per week, and restructuring how you eat. Prediabetes is reversible for many people, and these changes can cut your risk of developing type 2 diabetes significantly.
What Prediabetes Actually Means
Prediabetes means your blood sugar is higher than normal but hasn’t crossed the threshold into type 2 diabetes. It’s diagnosed when your A1C falls between 5.7% and 6.4%, your fasting blood sugar is between 100 and 125 mg/dL, or a two-hour glucose tolerance test comes back between 140 and 199 mg/dL. Any one of those results qualifies.
At this stage, your body is becoming less responsive to insulin, the hormone that moves sugar from your blood into your cells. Your pancreas compensates by producing more insulin, but over time it may not keep up. The good news: this process can be slowed, stopped, or reversed with lifestyle changes.
Lose a Small but Meaningful Amount of Weight
You don’t need to hit an ideal body weight. Losing just 5% to 7% of your current weight makes a measurable difference in how your body handles blood sugar. For someone who weighs 200 pounds, that’s 10 to 14 pounds. The landmark Diabetes Prevention Program trial found that this modest weight loss, combined with regular activity, reduced the progression to type 2 diabetes by 58%.
The pace matters less than the consistency. Losing one to two pounds per week through a combination of eating changes and movement is realistic for most people and easier to sustain than aggressive dieting. Crash diets tend to backfire because the weight comes back, and so does the elevated blood sugar.
Restructure Your Plate
Rather than counting every calorie or gram of carbohydrate, a simple visual method works well for most meals. Start with a 9-inch plate, roughly the length of a business envelope. Fill half with non-starchy vegetables like broccoli, green beans, salad greens, or peppers. Fill one quarter with a lean protein such as chicken, fish, beans, tofu, or eggs. Fill the remaining quarter with carbohydrate foods like whole grains, starchy vegetables, or fruit.
This approach naturally limits portions of the foods that raise blood sugar the most while keeping meals satisfying. It also nudges you toward more fiber, which is one of the most useful nutrients for blood sugar control. Your body doesn’t break down fiber the way it does other carbohydrates, so it doesn’t cause the same blood sugar spike. Soluble fiber (found in oats, beans, apples, and flaxseed) dissolves in your stomach and forms a gel that slows digestion, giving your body more time to process glucose gradually.
The recommended daily fiber intake for adults is 22 to 34 grams, depending on age and sex. Most Americans get about half that. Adding a serving of beans to lunch, swapping white rice for brown, or snacking on vegetables with hummus instead of crackers can close the gap without overhauling your entire diet.
Foods to Prioritize and Limit
- Prioritize: leafy greens, cruciferous vegetables, legumes, whole grains, nuts, fatty fish, berries, and foods naturally high in fiber.
- Limit: sugary drinks (including fruit juice), refined grains like white bread and pasta, processed snacks, and foods with added sugars. These cause rapid blood sugar spikes and offer little satiety.
You don’t need to eliminate carbohydrates entirely. Your body needs them. The goal is choosing carbs that digest slowly and pairing them with protein or fat to blunt the glucose response.
Move for 150 Minutes a Week
The target is 150 minutes of moderate-intensity physical activity per week. That breaks down to about 30 minutes, five days a week. Moderate intensity means you’re breathing harder than normal but can still hold a conversation: brisk walking, cycling, swimming, or even vigorous yard work all count.
Exercise improves blood sugar control through two separate pathways. During activity, your muscles pull glucose from your blood for fuel, which lowers blood sugar immediately. Over weeks and months, regular exercise also makes your cells more responsive to insulin, addressing the core problem behind prediabetes. These benefits are partly independent of weight loss, meaning exercise helps even if the number on the scale doesn’t change much.
Resistance training (bodyweight exercises, resistance bands, or weights) adds further benefit. Building muscle increases your body’s capacity to store and use glucose. Aim for two sessions per week on non-consecutive days, working the major muscle groups. If you’re starting from zero, even 10-minute walks after meals can lower post-meal blood sugar and build a foundation for longer sessions.
Prioritize Sleep
Sleep is an underappreciated factor in blood sugar regulation. The recommended amount for adults is seven to nine hours per night. Research from Columbia University found that even mild sleep reduction increases insulin resistance in women, independent of any changes in body fat. Over time, the added stress on insulin-producing cells from chronic short sleep could accelerate their decline.
If you’re regularly getting six hours or less, improving sleep may be one of the highest-impact changes you can make. Keeping a consistent bedtime, limiting screens before bed, and avoiding caffeine in the afternoon are practical starting points. Sleep disorders like obstructive sleep apnea are also more common in people with prediabetes and can worsen insulin resistance on their own, so persistent daytime fatigue or loud snoring is worth bringing up with your doctor.
Get Retested Every Year
The American Diabetes Association recommends that people with prediabetes have their blood sugar tested at least once a year. Your doctor will typically recheck your A1C or fasting glucose to see whether your numbers are improving, holding steady, or moving toward diabetes. If you’ve made significant changes, you may see your A1C drop below 5.7%, which means you’ve returned to a normal range.
Annual testing also catches progression early. If your numbers are trending upward despite lifestyle changes, your doctor can adjust the plan before you cross into a diabetes diagnosis. Some people benefit from more frequent monitoring, especially in the first year after diagnosis when you’re actively changing habits and want feedback on what’s working.
When Medication Enters the Picture
Lifestyle changes are the first-line treatment for prediabetes, but medication is sometimes considered alongside them. Current ADA guidelines suggest doctors consider metformin for people aged 25 to 59 with a BMI over 35, a fasting glucose above 110 mg/dL, an A1C above 6%, or women who had gestational diabetes. About half of women with gestational diabetes go on to develop type 2 diabetes, which is why screening and early intervention matter for that group.
Metformin works by reducing the amount of glucose your liver releases and making your cells more sensitive to insulin. It’s not a substitute for lifestyle changes, and studies consistently show that diet and exercise outperform metformin alone. But for people with higher-risk profiles, the combination of both provides an extra layer of protection.
Practical Steps That Make It Stick
Knowing what to do is different from actually doing it, and the biggest obstacle for most people is sustaining changes over months and years. A few strategies help. First, pick one or two changes to start with rather than overhauling everything at once. Adding a daily walk and switching from sugary drinks to water is enough to move the needle early on.
Second, track your progress in a way that’s meaningful to you. That might be a step counter, a food journal, or simply noting how your energy levels change after meals. The CDC’s National Diabetes Prevention Program offers a structured, year-long coaching program available in person and online that walks participants through goal-setting, meal planning, and problem-solving. It’s covered by many insurance plans and Medicare.
Third, remember that setbacks are normal and don’t erase your progress. Blood sugar regulation responds to your overall pattern of behavior, not any single meal or missed workout. The trajectory matters more than any individual day.