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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
Overcome prediabetes with this comprehensive guide to prevention and wellness
Prediabetes For Dummies is an essential guide for anyone looking to take control of their health and prevent the progression to type 2 diabetes. This updated edition covers the latest research, practical tips, and easy-to-follow advice on diet, exercise, and lifestyle changes. With clear explanations and actionable steps, it empowers you to make informed decisions and optimize your blood sugar for energy, ideal weight, and health. If you’ve been diagnosed or are looking to support a loved one, this book is your go-to resource for managing prediabetes effectively and living a healthier, more vibrant life.
- Understand how prediabetes is diagnosed and how you can delay or prevent the onset of type 2 diabetes
- Learn about new GPL-1 medications and other prediabetes treatment options
- Promote health and wellness with no-cost diet and lifestyle changes that will improve your quality of life
- Get mouthwatering and nutritious recipes to keep blood sugar balanced
You’re not alone—an estimated 91 million people worldwide have prediabetes. Prediabetes For Dummies helps you address this common condition, so you can live a healthy life and prevent long-term complications.
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Seitenzahl: 540
Veröffentlichungsjahr: 2026
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Prediabetes For Dummies®
To view this book's Cheat Sheet, simply go to www.dummies.com and search for “Prediabetes For Dummies Cheat Sheet” in the Search box.
Table of Contents
Cover
Table of Contents
Title Page
Copyright
Introduction
Why Do We Need This Book?
About This Book
Conventions Used in This Book
What You Don’t Have to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Beyond the Book
Part 1: Confronting the Prediabetes Epidemic
Chapter 1: The Origins and Dangers of Prediabetes
Recognizing a Global Problem
Knowing the Recent History of Prediabetes
Understanding the Risks
Realizing Who Is Affected
Considering the Costs
Chapter 2: Suspecting Prediabetes in Yourself or a Loved One
Taking a Risk Quiz
Identifying Key Risk Factors That You Can Control
Understanding How Prediabetes and Diabetes Develop
Seeking a Medical Diagnosis
Chapter 3: Tracking the Transition from Prediabetes to Diabetes
Turning Prediabetes into Diabetes
Recognizing Short-Term Effects of Diabetes
Dealing with Severe, Long-Term Complications
Treating Established Diabetes
Chapter 4: Stopping Prediabetes in Its Tracks
Halting and Reversing Bad Choices
Becoming a Brand New Shopper
Rethinking How You Eat
Putting Your Body in Gear
Adding Medications to Your Daily Routine
Tackling Prediabetes through Surgery
Part 2: Getting a Diagnosis
Chapter 5: Spotting the Metabolic Syndrome
Defining the Metabolic Syndrome
Determining Your Level of Risk
Recognizing Major Signs and Symptoms
Reversing the Causes of the Metabolic Syndrome
Dealing with Uncontrolled Metabolic Syndrome
Chapter 6: The Testing Spectrum: Having Essential Tests and Interpreting Results
Checking Your Blood Glucose Level
Tracking Your Glucose for the Last 90 Days
Knowing Your Cholesterol Levels
Keeping Your Blood Pressure in Check
Looking for Evidence of Inflammation
Hunting for Nutrient Deficiencies
Chapter 7: Children and the Elderly: Special Considerations
Diagnosing and Managing Prediabetes in Children
Paying Close Attention to the Elderly
Part 3: Food and Other Factors: Creating a Healthy Lifestyle
Chapter 8: Setting Yourself Up for Success
Understanding the Evolution of Our Food Supply
Picking on Problem Ingredients
Connecting Problem Foods to Prediabetes
Becoming Aware of the Glycemic Index and Glycemic Load
Analyzing Your Child’s Lunchbox and Lunchroom
Chapter 9: Achieving and Maintaining a Healthy Weight
Benefitting from a Healthy Weight
Becoming Familiar with Your Body Mass Index
Identifying Where You Carry Your Fat
Realizing How You Got Here
Knowing That You Can Lose Weight
Working with an Overweight Child
Chapter 10: Living an Active Lifestyle
Why Exercise Is Essential for Optimal Human Function
Using Exercise to Combat Depression
Planning to Move
Chapter 11: Managing Stress and Seeking Joy
Adopting a Healthy Mentality around Stress and Joy
Considering What Brings You the Most Joy
Recognizing Sources of Stress in Your Life
Assessing Your Attitude toward Your Stressors
Linking Your Stress Level to Your Relationship with Food
Avoiding Exercise Because of Stress
Realizing How Stress Contributes to Prediabetes
Understanding Stress in the Elderly
Perceiving Stress in Kids
Part 4: The Benefits of Following the Mediterranean Diet
Chapter 12: Defining the Mediterranean Diet and How It Can Help
Understanding the Mediterranean Diet
Discovering How the Mediterranean Diet Works
Chapter 13: Making the Mediterranean Diet Work for You
The Lifestyle behind the Mediterranean Diet
Appreciating the Mediterranean Approach to Life
Living Mediterranean Style from Anywhere
Getting a Mediterranean Lifestyle Checklist
Fitting the Mediterranean Diet into Your Life
Chapter 14: Incorporating the Mediterranean Lifestyle into Your Daily Routine
Planning to Start the 7-Day Routine
Part 5: Avoiding or Reversing Prediabetes
Chapter 15: Cooking and Eating for Health and Enjoyment
Learning to Cook for Health and Enjoyment
Chapter 16: Taking Medications or Supplements
Your Prediabetes Management Plan
Drugs Sometimes Used for Prediabetes
Chapter 17: Putting Your Knowledge to Work: A Healthier You in Three Months
Getting Ready to Change
Following the Plan
Applauding Your Accomplishments
Part 6: The Part of Tens
Chapter 18: Ten Myths about Prediabetes
Having Prediabetes Always Leads to Diabetes
Prediabetes Isn’t Reversible
HbA1C Numbers Alone Determine Your Health
A Prediabetes Diagnosis Means that You Can’t Enjoy Good Food
A Good Diet for Prediabetes Is Just about the Carbs
You’re at Fault for Your Prediabetes Diagnosis
A Prediabetes Diagnosis Prevents You from Enjoying Life
Being Thin Is Being Healthy
You Can Never Eat Dessert Again
Prediabetes Needs Medication
Chapter 19: (More Than) Ten Staples to Keep in Your Kitchen
Extra Virgin Olive Oil
Green Leafy Vegetables
Non-Starchy Fruits
Tomatoes
Meat, Fish, and Poultry
Canned Fish
Full-Fat Greek Style Plain Yogurt
Eggs
Beans and Lentils
Nuts and Seeds
Herbs and Spices
Chapter 20: Ten Ways to Stop Prediabetes in Its Tracks
Transforming Unhealthy Patterns
Enjoying the Mediterranean Diet
Focusing on Sleep
Getting Enjoyable Exercise
Spending Time Outdoors
Maintaining a Positive Attitude
Celebrating Your Community
Developing Ways to Cope with Stress
Embracing Meal Planning
Cooking Delicious and Nutritious Foods at Home
Chapter 21: Ten Ways to Help Kids Prevent and Reverse Prediabetes
Revolutionizing Real Food
Good for You Alternatives to Unhealthy Favorites
Hero Foods
Cooking Is Cool
Exercise Gives You Energy
Fun Ways to Feel Great
Happy Baking Times
Playtime with Friends
Fresh Air with Family
Index
About the Authors
Dedication
Authors’ Acknowledgments
Connect with Dummies
End User License Agreement
List of Tables
Chapter 1
TABLE 1-1 Normal, Prediabetic, and Diabetic Glucose Values
Chapter 6
TABLE 6-1 Vitamins You Need
TABLE 6-2 Minerals You Need
Chapter 9
TABLE 9-1 Body Mass Index Chart
Chapter 11
TABLE 11-1 Type A and Type B Personality Traits
Chapter 13
TABLE 13-1 C-1 Polyphenols in Foods and Possible Bioactivity
TABLE 13-2 The ABC’s of the Mediterranean Lifestyle
List of Illustrations
Chapter 4
FIGURE 4-1: The plate on the left shows the appropriate portion size. The one o...
Chapter 12
FIGURE 12-1: The Mediterranean Diet Pyramid.
Chapter 15
FIGURE 15-1: Pitting an avocado the easy way.
FIGURE 15-2: Cleaning and deveining shrimp.
Guide
Cover
Table of Contents
Title Page
Copyright
Begin Reading
Index
About the Authors
Dedication
Authors’ Acknowledgments
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Prediabetes For Dummies®, 2ndEdition
Published by: John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030-5774, www.wiley.com
Copyright © 2026 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies.
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ISBN 978-1-394-36116-8 (pbk); ISBN 978-1-394-36117-5 (ebk); ISBN 978-1-394-36118-2 (epdf)
Introduction
Prediabetes is a medical condition that is rapidly on the rise. It’s expected that over 470 million people will have prediabetes globally in the next five years. It is estimated that 80% of the people who have prediabetes don’t even realize that they have it. Because prediabetes can lead to serious health complications such as the onset of heart disease, diabetes, and stroke, learning how to prevent and reverse it is important. While prediabetes should be taken seriously, a diagnosis doesn’t mean that it’s time to panic. By maintaining a calm, practical, and even enjoyable approach to healthful eating and lifestyle strategies, you and those you love can prevent the onset of diabetes while enjoying yourself in the process.
Why Do We Need This Book?
The growing epidemic of prediabetes and diabetes call for accurate, concise, and helpful information that will help to disrupt the current negative trends. By providing those with prediabetes the information they need to take charge of their health and prevent the onset of diabetes itself, this book can help you and your loved ones to live their best lives.
Having a prediabetes diagnosis means that your blood sugar levels are higher than normal, but they are not high enough to be in the diabetes category. While you may not see drastic warning signs with prediabetes, a doctor’s diagnosis is your warning sign to make the positive changes which will keep you healthy.
We define prediabetes clearly in Chapter 1. Prediabetes is not usually associated with all the bad complications of diabetes, which we discuss in Chapter 3, but it alone may be associated with some heart problems. And prediabetes is not only the stage before diabetes. It may also be the stage before high blood pressure (prehypertension) or high cholesterol. All the abnormalities that lead to prediabetes (that can go on to diabetes) are also to blame for the development of prehypertension (that can go on to high blood pressure) and mildly elevated cholesterol (that can go on to hypercholesterolemia). By helping you to reverse prediabetes, we’re also helping you to reverse the other two conditions. So, you are basically getting three books for the price of one. What a deal!
Approaching this book with the knowledge that you can reverse prediabetes is important. If there is one point that we want to make clear, it’s that you are not doomed to develop diabetes just because you have prediabetes. You can still enjoy optimal health and using this book as a guide enables you to do so. If you reverse prediabetes, you will probably reverse prehypertension and mildly elevated cholesterol as well. Chapters 8 through 21 provide everything you need to know to do this.
About This Book
This book is an excellent resource for what you need to know about prediabetes — and a lot about diabetes as well. (You can find everything you need to know about diabetes in an excellent book called Diabetes For Dummies, the 6th edition of which we wrote a few years ago.)
You don’t have to read this book from start to finish (but it wouldn’t hurt). You can pick up the book and start reading anywhere you want. If you want to know what prediabetes is, start with Chapter 1. If you want to know what factors lead to prediabetes, Part 1 provides the answers. Getting a diagnosis is taken up in Part 2, while Part 3 discusses creating a healthy lifestyle. Part 4 teaches you the ways that the Mediterranean diet can work for you. Part 5 tells you how to avoid or reverse prediabetes.
Our aim, with this book, is to empower you to embrace science-based approaches to creating a healthy lifestyle. Developing a healthy relationship with food, achieving and maintaining a healthy weight, living an active lifestyle, and managing stress and seeking joy, are important factors which we illustrate throughout this guide to help prevent you from developing diabetes.
Conventions Used in This Book
The sugar in your blood is called glucose, and too-high glucose leads to many of the complications of diabetes. But the white sugar you eat is not glucose; it’s sucrose. And many other sugars exist, such as fructose, maltose, and galactose. So we don’t use just the word sugar in this book; we call the particular sugar by its proper name.
When we mention a level of blood sugar (glucose), it is shown in units called milligrams per deciliter (mg/dL). I don’t mean to confuse you, but the rest of the world uses the International System of units called, in this case, millimoles per liter (mmol/L). You can convert mg/dL to mmol/L as you cross the border of the United States into Canada simply by dividing the mg/dL by 18. For example, a blood glucose of 100 mg/dL is 5.5 mmol/L.
Two major types of diabetes exist: Type 1 diabetes mellitus and Type 2 diabetes mellitus. We refer to them as Type 1 and Type 2 diabetes in this book.
We discuss nutrition, exercise, and lifestyle frequently in this book because of how they affect your overall health, which in turn affects your susceptibility to prediabetes and diabetes.
Finally, in Chapter 15, Chef Amy Riolo (one of the authors) includes more than 25 complete meal recipes to try. Each of these recipes is packed not only with flavor, but with balanced micronutrients and powerful plant compounds which can reduce inflammation and help balance blood sugar. If you’re a vegetarian, look for the tomato next to the recipe name that indicates the recipe does not contain meat, poultry, or fish.
What You Don’t Have to Read
Everyone is different. You may have received a thorough explanation of what prediabetes is from your doctor already, and you’re just here to discover how to manage it. In that case, you can skip to Part 3. If you’re unfamiliar with what prediabetes is, how to help a loved one, how to prevent children from being diagnosed, and so forth, however, reading Part 4 in its entirety is a good idea. The Part of Tens section offers four chapters that are full of concise, helpful information that are great to reference from time to time on your wellness journey.
Foolish Assumptions
We assume that your mind is a blank when it comes to the actual scientific differences between prediabetes and diabetes. Therefore, you won’t suddenly come up against a term that you have never seen before without finding an immediate definition of that term. On the other hand, if you already know something about the subject, you can expect to find much greater detail. Throughout the book, the most important points are clearly marked using tools such as icons (which we explain in a moment).
We also assume that you’d like to know as much as possible, and as many ways as possible in which you can help yourself or others reverse diabetes. For this reason, we explain each of the tips and strategies that are available currently to help you do so.
How This Book Is Organized
This book has six parts, and you don’t have to start at Part 1. Each part is self-contained. In fact, each chapter is self-contained, so if you see a chapter title that really excites you such as “Cooking and Eating for Health and Enjoyment,” feel free to jump right in there. Here is a brief synopsis of what you can find in each part of this book.
Part 1: Confronting the Prediabetes Epidemic
This introductory part gives you a foundation of understanding as to what prediabetes is all about. Dr. Simon Poole starts with a discussion of how prediabetes originates. From there, he moves on to talk about when you should suspect that you have developed prediabetes. What are the elements of your family history, your personal history, and your current lifestyle that suggest this diagnosis? Moving right along, he traces the factors that convert prediabetes to diabetes. Then he offers a general discussion about stopping this conversion before it happens.
Part 2: Getting a Diagnosis
The second part of the book defines the Metabolic Syndrome and how to spot it. It also teaches how essential tests are performed and how to interpret results. In this part, Dr. Simon Poole also discusses special conditions including children, the elderly, and other life stages in which prediabetes is prevalent. Getting the proper diagnosis is the first step to transforming your health.
Part 3: Food and Other Factors: Creating a Healthy Lifestyle
What you discover in these chapters should make it clear to you that prediabetes, as well as Type 2 diabetes, is promoted by unhealthy lifestyle habits, which means both conditions can be reversed by adopting healthier lifestyle habits.
The first lifestyle habit to consider is the food you eat. Next, you want to deal with your weight by maintaining an active lifestyle. Exercise is an important component of a healthy lifestyle, which can help you burn calories and gain muscle. Finally, taking steps toward minimizing stress can help you manage prediabetes successfully.
Part 4: The Benefits of the Mediterranean Diet
Untreated or poorly managed diabetes can cause low blood glucose (hypoglycemia) and very high blood glucose (hyperglycemia). These conditions have a very definite effect on your quality of life and need to be prevented.
Next are the long-term complications that take ten or more years of diabetes to develop but can be devastating. Blindness, kidney failure, nerve disease, and heart disease are the factors to fear in this regard. But you are never going to have any of these complications because you are going to reverse your prediabetes, so it never gets to diabetes!
A special category of long-term complications are sexual complications and the complications of pregnancy. These situations warrant their own chapter. (It’s not X-rated, so feel free to read it even when the kids are around.)
The Mediterranean diet has been selected as the best overall diet in the world and one of its strengths is being efficient in helping those who follow it reverse and prevent diabetes. This section teaches how to make the Mediterranean diet work for you. From adapting a healthful approach towards food to discovering which types of foods are best for diabetes, this part enables you to power-charge your meal plan with ingredients that have stood the test of time and continue to help people live better and longer.
Part 5: Avoiding or Reversing Prediabetes
Now it’s time to head to the kitchen! Creating homemade meals, no matter how simple, for yourself or others is one of the best ways to take charge of your diet. In Chapter 15, we cook together and enjoy the healthful and delicious food we make. You unearth delicious and nutritious recipes to enjoy at breakfast snack-time, lunch, dinner, and for dessert. In this chapter, Chef and coauthor Amy Riolo provides you with recipes that feature nutritious yet inexpensive ingredients in a variety of ways that can be enjoyed by a wide range of palettes.
Can medications help to reverse prediabetes? You find out in Chapter 16, and you also find out whether any vitamins or supplements may make a difference.
To put all your new knowledge together, we created Chapter 17, which features a complete plan for a three-month health makeover. Sometimes you need structure in order to succeed. This chapter tells you what to eat, what exercise to do, and everything else you need to know to create the healthy habits which can help you for life.
Part 6: The Part of Tens
No For Dummies book is complete without this part. You can read ten myths about prediabetes, ten staples to keep in your kitchen, ten ways to stop prediabetes in its tracks, and ten ways to help kids prevent and reverse diabetes.
Icons Used in This Book
The icons alert you to information you must know, information you should know, and information you may find interesting but can live without.
When you see this icon, it means the information is essential and you should be aware of it.
This icon informs you of information that may be useful but not extremely important.
This icon marks important information that can save you time and energy.
This icon alerts you to important information that can assist you with managing prediabetes.
Beyond the Book
In addition to the abundance of information and guidance related to prediabetes that we provide in this book, you get access to even more help and information online at Dummies.com. Check out this book’s online Cheat Sheet. Just go to www.dummies.com and search for “Prediabetes For Dummies Cheat Sheet.”
Part 1
Confronting the Prediabetes Epidemic
IN THIS PART …
Understanding the origins of prediabetes
Managing prediabetes in yourself or a loved one
Stopping prediabetes in its tracks
Chapter 1
The Origins and Dangers of Prediabetes
IN THIS CHAPTER
Crossing the line from health to prediabetes to diabetes
Noting the recent origin of prediabetes
Figuring out who is affected
Calculating the costs
Prediabetes is a condition in which blood sugar (in the form of glucose) levels are higher than normal but not yet high enough to be diagnosed as Type 2 diabetes. It signals that the body is starting to have trouble managing blood glucose effectively.
While prediabetes itself may not cause noticeable symptoms, high blood glucose increases the risk of developing Type 2 diabetes, heart disease, and other medical problems if left unaddressed. Even if blood glucose levels don’t rise progressively to a diagnosis of Type 2 diabetes, having higher than normal average blood glucose levels does increase the risk of some of the same health complications that are associated with Type 2 diabetes including heart disease and strokes, kidney and eyes diseases as well as in increased risk of neurological problems including dementia.
Although the prefix “pre” may suggest that prediabetes inevitably leads to diabetes, this is certainly not the case and there are many people who would not be predestined to develop Type 2 diabetes.
Diagnosing prediabetes is crucial because it may be the critical step before developing diabetes. As you find out in this book, diabetes is associated with complications that may cause considerable physical and mental discomfort at best and be life-threatening at worst. So you don’t want to go there.
Even if you go on to develop diabetes, all is not lost. You can use the suggestions found here to avoid further complications. You can’t get rid of the diagnosis, but you can get rid of the problems.
In this chapter, you discover how to differentiate among three physical states: normal health, prediabetes, and diabetes. We explain that prediabetes is a recent phenomenon, which parallels the epidemic of obesity and lack of exercise in countries around the world.
Next, you discover who is affected by prediabetes and which groups of people are at the highest risk. We also touch on special considerations for children and the elderly at risk for prediabetes.
Finally, we focus on the costs of prediabetes, which are not only monetary. We explain that even though prediabetes is often considered a benign condition and not a disease, changes occur in the body of a person with prediabetes that may not be benign after all.
Recognizing a Global Problem
Prediabetes is increasingly recognized as a major public health concern in the United States, Europe, and around the world. What makes prediabetes particularly worrying is its silent nature and a vast majority of those who have it are unaware. In the United States, for example, the Centers for Disease Control and Prevention (CDC) estimates that about 96 million adults, or nearly 38 percent of the adult population, have prediabetes. Yet over 80 percent of these people don’t know they’re affected. The situation is similarly concerning in Europe. According to the International Diabetes Federation, over 36 million people in Europe are thought to have prediabetes. In the UK, National Health Service figures suggest that around 5 million people may be living with prediabetes, sometimes referred to as “non-diabetic hyperglycemia.”
Globally, the International Diabetes Federation estimates that more than 540 million adults may be affected by prediabetes. While high-income countries still bear much of the burden, the problem is accelerating in low- and middle-income nations due to rapid urbanization, changes in diet, and increasingly sedentary lifestyles. What is especially concerning is the strong association between prediabetes and the eventual development of Type 2 diabetes. Without intervention, as many as 70 percent of people with prediabetes will go on to develop diabetes, often within five to ten years.
Taking control of prediabetes
The good news is that prediabetes is being identified more frequently with increased screening and can often be reversed or managed through the lifestyle changes described throughout this book. In this chapter, you discover some of the basics about prediabetes and its impact on health.
Here are some encouraging facts about managing prediabetes:
Without intervention, about 15–30 percent of people with prediabetes will develop Type 2 diabetes within five years. This means that while a substantial proportion do progress, it is not inevitable. Many do not develop diabetes, especially with lifestyle changes.
Up to 50 percent of Type 2 diabetes cases can be prevented or delayed with appropriate lifestyle modifications, such as weight loss, healthy eating, and increased physical activity.
A substantial number of people with prediabetes can reverse the condition through lifestyle changes such as losing a modest amount of weight, eating more healthfully, and becoming more physically active.
With the right changes, many people are able to bring their blood glucose levels back into the normal range, often avoiding the progression to Type 2 diabetes altogether.
Even if blood glucose doesn’t return fully to normal, lifestyle improvements can still make a big difference — slowing or stopping the progression to diabetes and lowering the risk of serious complications.
While not everyone may fully reverse prediabetes, the majority of people who make and sustain these changes can significantly improve how their body handles glucose and reduce their long-term health risks.
Embodying the Spectrum
Every cell in the human body needs energy to function, and one of the body’s primary sources of this energy is glucose — a simple sugar derived from the food we eat. When we consume carbohydrates such as bread, fruit, rice, or pasta, our digestive system breaks them down into glucose, which is then absorbed into the bloodstream. Protein and fat can also be converted into glucose by the body, particularly when carbohydrate intake is low. This blood glucose is then transported around the body and taken up by cells, where it’s either used immediately for energy or stored for later use.
To ensure that blood glucose levels remain within a healthy range, our bodies rely on a carefully balanced system of regulation. A key player in this process is the hormone insulin, which is produced by the pancreas. When glucose enters the bloodstream after a meal, insulin is released to help move the glucose from the blood into the cells. This keeps blood glucose levels from rising too high. Between meals or during periods of physical activity, the body taps into its glucose stores to keep energy levels stable.
However, this finely tuned system can be disrupted by various aspects of lifestyle. Dietary habits, portion sizes, levels of physical activity, the presence of excess body fat, and the quality of sleep can all influence how efficiently the body regulates blood glucose. Genetic factors also play an important role. When the balance tips, either because the body doesn’t respond properly to insulin or because insulin production declines, glucose can start to build up in the bloodstream. Over time, chronically elevated blood glucose levels can damage blood vessels and organs, contributing to serious complications such as heart disease, kidney problems, and vision loss.
This risk doesn’t appear overnight; it increases gradually. There is a spectrum of blood glucose regulation that ranges from healthy and optimal, through intermediate stages where glucose levels are mildly elevated in prediabetes, to persistently high levels that meet the criteria for diabetes. Everyone, whether they are aware of it or not, is somewhere on this spectrum. Some people manage their blood glucose levels very efficiently, while others may struggle due to lifestyle factors, genetics, or a combination of both.
Understanding where you fall on this spectrum is important, and fortunately there are reliable ways to measure how well your body is handling glucose over time. These measurements — such as fasting glucose, HbA1c, or glucose tolerance tests — are explored in more detail later in this chapter. For now, it’s worth remembering that blood glucose regulation is something that affects everyone, and that the way each of us live our daily lives has a powerful influence on how well our bodies manage this essential energy source.
Going from normal to prediabetes
The diagnosis of prediabetes is made the same way that a diagnosis of diabetes is made: by doing a blood glucose test in the laboratory.
Many countries, including the United States, report blood glucose levels in milligrams per deciliter (mg/dL), while many other regions such as Europe and the UK use millimoles per liter (mmol/L). Both units measure the same thing, but the values differ due to the conversion factor between the two systems.
The critical values (numbers) in the test results are as follows:
A normal fasting blood glucose result is less than 100 mg/dL (5.6 mmol/L).
Prediabetes is diagnosed when the fasting blood glucose is between 100 and 125 mg/dL (5.6–6.9 mmol/L) on more than one occasion.
Diabetes is diagnosed when the fasting blood glucose is 126 mg/dL (7 mmol/L) or greater on more than one occasion.
A normal blood glucose level two hours after eating 75 grams of glucose is less than 140 mg/dL (7.8 mmol/L).
Prediabetes is diagnosed when the glucose two hours after eating 75 grams of glucose is between 140 and 199 mg/dL (7.8–11.1 mmol/L) on more than one occasion.
Diabetes is diagnosed when the glucose two hours after eating 75 grams of glucose is 200 mg/dL (11.1 mmol/L) or greater on more than one occasion.
Table 1-1 is a summary of these values using mg/dL units.
TABLE 1-1 Normal, Prediabetic, and Diabetic Glucose Values
Type of Test
Normal
Prediabetes
Diabetes
Fasting blood glucose
Less than 100 mg/dL
100–125 mg/dL
126 mg/dL or greater
Blood glucose two hours after eating 75 grams of glucose
Less than 140 mg/dL
140–199 mg/dL
200 mg/dL or greater
In recent years, another laboratory test called HbA1c has become a widely used way of diagnosing and monitoring both prediabetes and diabetes. HbA1c stands for glycated hemoglobin, which refers to the percentage of red blood cells that have glucose attached to them. Because red blood cells live for, and are replaced in, a cycle of around three months, this test reflects a person’s average blood glucose level over the previous two to three months — rather than just at the moment of testing, such as a fasting glucose or glucose tolerance test does.
The use of HbA1c in diagnosing diabetes became more common after it was endorsed by major organizations such as the American Diabetes Association (ADA) and the World Health Organization (WHO) around 2009–2011. One of the main reasons for its popularity is practicality. Unlike glucose tests, HbA1c doesn’t require fasting, and it isn’t affected by short-term factors such as recent meals, stress, or illness. That makes it more convenient for both patients and healthcare providers.
According to current guidelines:
An HbA1c below 5.7 percent (which is below 39 mmol/mol) is considered normal.
A level between 5.7 percent and 6.4 percent (39–47 mmol/mol) indicates prediabetes.
A level of 6.5 percent or higher (48 mmol/mol or above), confirmed by a repeat test, signals diabetes.
While HbA1c is now frequently used to diagnose prediabetes because of its reliability and convenience, with a single blood test without the need for fasting, it is also useful for monitoring how well prediabetes is managed over time. However, it’s worth noting that HbA1c results can be less reliable in certain individuals, for example, those with anemia, certain blood disorders, or recent blood loss, so healthcare professionals may choose alternative tests when needed.
These definitions are arbitrary. They have changed in the past, and they may do so again depending on scientific studies. For example, a fasting glucose result of greater than 140 mg/dL (7.8 mmol/L) used to be the cutoff point for a diagnosis of diabetes. Then doctors discovered that people who had fasting glucose levels below 140 mg/dL suffered from the complications of diabetes without having a diagnosis of diabetes. So, they lowered the level for the diagnosis to 126 mg/dL (7 mmol/L). Unfortunately, even some people with fasting blood glucose levels below 126 have shown up with complications of diabetes.
You should be familiar with some other terms for these levels of blood glucose, because you likely can read or hear about them:
Impaired fasting glucose
(IFG) is another name for the condition where the fasting blood glucose is between 100 and 125 mg/dL (5.6–6.9 mmol/L) after an overnight fast.
Impaired glucose tolerance
(IGT) is another name for the condition where the blood glucose is between 140 and 199 mg/dL (7.8–11.1 mmol/L) two hours after eating 75 grams of glucose.
Some people have impaired fasting glucose, while others have impaired glucose tolerance. Still others have both conditions combined, so the total number of people with prediabetes is not the sum of the people with IFG plus the people with IGT.
Other terms that you may hear should be disregarded because they have no clear meaning and are no longer used scientifically. These include:
Borderline diabetes
Touch of sugar
Understanding diabetes
Two major types of diabetes are called Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM). (If you want to find out exactly what distinguishes them, pick up our book Diabetes For Dummies, which is also published by Wiley.) Here’s a grossly oversimplified overview:
Type 1 is an autoimmune disease that usually occurs in children.
Type 2 may occur in either children or adults and is often associated with risk factors such as being overweight and having high blood pressure.
When diabetes develops in Type 2, the body still has plenty of insulin but not enough to keep the blood glucose in the normal range because the body resists the action of insulin.
The word prediabetes in this book refers to the period between normal blood glucose control and Type 2 diabetes.
Knowing the Recent History of Prediabetes
In this section, we discuss the reason for the development of the term prediabetes, as well as the fact that prediabetes is not an entirely benign condition.
Needing new language
The term prediabetes hasn’t been around long. In fact, it was first used in 2002. It was introduced by the American Diabetes Association (ADA) and by Tommy G. Thompson, the health and human services secretary at the time.
A number of reasons for the introduction of this term were:
The terms
impaired fasting glucose
and
impaired glucose tolerance
were meaningless to patients and required a lot of explaining.
Other terms, such as
touch of sugar
and
borderline diabetes,
were generally meaningless.
Studies such as the Diabetes Prevention Program showed that diet and exercise resulting in a weight loss as little as 5 to 7 percent of someone’s initial weight would lower the incidence of Type 2 diabetes by up to 58 percent.
A broadly understandable term was needed so that patients could know where they were and where they had to go with respect to diabetes. These people stood to benefit from lifestyle modification and other treatments.
Studies at the time showed that most people with prediabetes would go on to develop diabetes within ten years unless they made relatively modest changes in diet and exercise. Therefore, the ADA and Thompson put together an expert panel of doctors and other diabetes experts. The panel report stated that intervention in prediabetes is critical for three reasons:
Just having glucose levels in the prediabetic range puts a person at a 50 percent greater risk of a heart attack or stroke.
The development of Type 2 diabetes can be delayed or prevented by modest lifestyle change.
For many people, modest changes in lifestyle can turn back the clock and return elevated blood glucose levels to normal.
Along with the new term, the ADA recommended that physicians begin to screen their patients for prediabetes at age 45. Screening was especially important for people who answered yes to these questions:
Do you have a relative with Type 2 diabetes or heart disease?
Are you overweight or obese?
Do you have high blood pressure?
Do you have a sedentary lifestyle?
Do you have high levels of triglycerides and/or low levels of HDL cholesterol (both being types of fats measured in a blood test)?
Do you belong to a higher-risk ethnic group, such as African American, Latino, or Asian American/Pacific Islander?
Do you have apple-shaped rather than pear-shaped weight distribution? This means your excess weight is around your stomach rather than your hips.
For women who have had children, did you develop diabetes during the pregnancy or have a baby who weighed more than 9 pounds at birth?
For women, is there a history of
polycystic ovarian syndrome,
a condition that may include lack of periods, infertility, and increased hair on the body?
Understanding the Risks
Prediabetes may not be associated with all the problems of diabetes, but your body may be developing some reversible damage if you have this condition. We discuss the most important issues here.
Heart attacks and strokes
People with blood sugar levels above the healthy range in the prediabetes zone face a significantly increased risk of heart disease and stroke. Research shows the relative risk of these cardiovascular events can be up to twice as high compared to those with consistently healthy blood sugar. If blood sugar rises further into the diabetes range, the risk increases even more. These relationships are strongly supported by large, long-term studies, though it is important to note that other factors such as blood pressure, cholesterol, and lifestyle habits also play a role.
Eye health: Retinopathy
Damage to the small blood vessels in the eye, known as retinopathy, is a well-known complication of diabetes, but it can also occur when blood sugar is only moderately elevated. Studies have shown that the risk of developing eye problems rises steadily as glucose levels increase, even before reaching the diabetes threshold. There is no clear cut-off below which risk disappears, but the closer blood sugar is to the normal range, the lower the risk of vision-related complications.
Brain health and dementia
Higher blood sugar levels are associated with an increased risk of cognitive decline and dementia, including Alzheimer’s disease. Research indicates that individuals with elevated blood glucose in the prediabetes range tend to perform worse on memory and thinking tests than those with lower, healthier glucose levels. The risk of developing Alzheimer’s disease is about twice as high for people with diabetes, and those with prediabetes also show measurable declines in brain function. While these findings show strong associations, it is not yet clear if high blood sugar directly causes dementia or if shared risk factors are involved.
Quality of life and daily function
Living with prediabetes can impact daily life. Studies have found that people with elevated glucose levels report lower quality of life, including more fatigue, reduced work productivity, and increased absenteeism. On average, individuals in this group lose several weeks of productive time each year compared to those with healthy blood sugar.
Chronic kidney disease
Growing evidence shows that people with moderately elevated blood sugar have a higher risk of developing chronic kidney disease (CKD). A large meta-analysis found that those with higher-than-normal glucose had about a 12 percent increased risk of CKD compared to those with normal blood sugar, after accounting for other risk factors. Recent studies have found that the prevalence of CKD in this group can be as high as 16.5 percent, compared to 15.3 percent in the general population and nearly 30 percent in those with diabetes. Other research has shown that more than one third of people with elevated glucose show early signs of kidney damage, such as protein in the urine or reduced kidney function. While these studies demonstrate a clear association, it is not yet certain that higher blood sugar directly causes kidney disease, as other factors such as high blood pressure and cholesterol often coexist.
Overall mortality
Elevated blood sugar, even if not in the diabetes range, has been linked to a higher risk of premature death from all causes. Large population studies find that people with higher-than-normal glucose have an increased risk of dying from heart disease, stroke, kidney failure, and some cancers compared to those with normal blood sugar. While these associations are consistent, it is important to recognize that other lifestyle factors, such as obesity, smoking, and lack of physical activity, may also contribute to the increased risk.
Risk of cancer
Recent research suggests that people with moderately elevated blood sugar may have a higher risk of developing certain cancers, including pancreatic, liver, endometrial, stomach, colorectal, breast, and gallbladder cancers. For example, a 2024 meta-analysis found a 42 percent higher risk of pancreatic cancer among people with elevated glucose compared to those with normal levels. However, the relationship between blood sugar and cancer is complex and may be influenced by other factors such as excess weight, poor diet, and physical inactivity, which often accompany higher glucose levels. Therefore, while there is a clear association, it is not certain that elevated blood sugar directly causes cancer.
Even though prediabetes is not as serious as diabetes, it does involve medical deterioration. The longer you allow yourself to have prediabetes, the greater the damage. Start to reverse it now!
Realizing Who Is Affected
Some groups of people are affected by prediabetes more than others, and they may even be affected when their blood glucose levels are lower than the levels that currently define prediabetes. (In the earlier section “Going from normal to prediabetes,” We spell out those levels.)
Prediabetes rates of about 38 percent in the adult US population are now considered similar across major racial and ethnic groups when age-adjusted. While earlier studies suggested some differences, current research shows that non-Hispanic White, non-Hispanic Black, Hispanic or Latino, Asian American, and American Indian and Alaska Native adults all experience prediabetes at comparable rates. This means that elevated blood sugar before the onset of diabetes is a shared challenge for many Americans, regardless of background.
However, disparities remain in the progression from prediabetes to diabetes. Adults from non-Hispanic Black, Hispanic or Latino, Asian American, and American Indian and Alaska Native backgrounds are more likely to develop diabetes compared to non-Hispanic White adults. For example, the CDC reports that the age-adjusted prevalence of diagnosed diabetes is 12.1 percent in non-Hispanic Black adults, 11.7 percent in Hispanic or Latino adults, 13.6 percent in American Indian and Alaska Native adults, and 9.1 percent in non-Hispanic Asian adults, compared to 6.9 percent in non-Hispanic White adults. These differences are influenced by a variety of factors, including genetics, access to healthcare, socioeconomic status, and the impact of social determinants of health.
Approaching these statistics with respect and sensitivity is important. Differences in health outcomes among racial and ethnic groups are shaped by a complex mix of factors, including historical and ongoing inequities in healthcare access, neighborhood resources, and opportunities for healthy living.
These numbers reflect patterns seen in large populations and should never be used to make assumptions about individuals or communities. Addressing these disparities and inequalities is a moral imperative and requires culturally sensitive prevention and care, as well as efforts to improve access to healthy food, safe places to be active, and high-quality health care for everyone.
Ensuring that proper education on healthful diets, lifestyle, and the strategies for being able to implement them is available to all communities (especially those which are underserved) is integral to transform the historical patterns that evidence suggests. Whether it’s teaching nutrition classes, offering educational programming on fitness, cooking classes, or giving people tips to fit the lifestyle habits into their daily life with ease, every amount of time and money spent on education offers enormous benefit.
Considering children and adolescents
By 2023, the Centers for Disease Control and Prevention (CDC) estimated that 8.4 million US adolescents aged 12 to 17, about 32.7 percent, have prediabetes, a dramatic increase from earlier years. This rise in prediabetes among young people is closely linked to the ongoing epidemic of childhood obesity which is closely associated with the development of prediabetes.
The prevalence of obesity among children ages 6 to 11 in the United States has remained a serious concern. According to the CDC, as of 2017–2020, approximately 20.7 percent of children ages 6 to 11 were classified as having obesity. Among adolescents aged 12 to 19, the rate was even higher, with 22.2 percent affected by obesity. These figures reflect a continued rise from previous decades and underscore how high rates of childhood and adolescent obesity are contributing to the increasing prevalence of prediabetes in young people.
Not only are children with obesity at greater risk for prediabetes and diabetes, but they may suffer bone and joint problems, sleep apnea (periods of stopping breathing during sleep that lead to extreme fatigue during the day), and social and psychological problems. In Chapter 11, we offer specific advice about prediabetes and obesity in children and adolescents.
Prediabetes and diabetes in older adults
Older adults, those aged 65 and above, are at the highest risk for developing elevated blood sugar and diabetes. According to the latest CDC data in the US about 29 percent of people aged 65 and older have diabetes, and an additional 48.8 percent have prediabetes. This data means that nearly four out of five older adults in the United States are affected by one of these conditions, and only about one in five have neither.
When prediabetes and diabetes are combined with other common health challenges in older age such as heart disease, reduced kidney function, and cognitive decline, the result can be significant illness, the need for multiple medications, and a higher risk of complications that require ongoing medical care. Managing blood sugar is therefore an important part of maintaining health and independence for many older adults.
Prediabetes in the elderly is reversible just as it is in children, adolescents, and adults. Reversing the condition may be more difficult because of the reduced ability to exercise and the tendency to eat a less healthful diet, but it’s never too late to prevent and reverse prediabetes.
Considering the Costs
The health and economic burden of elevated blood sugar is enormous and continues to grow. In 2022, the total annual cost of diabetes in the US reached $412.9 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect costs such as lost productivity. About one in every four healthcare dollars in the US is now spent on caring for people with diabetes. Beyond these financial figures, there are also significant personal costs: individuals and families often face ongoing physical challenges, emotional stress, and disruptions to daily life as they manage the complications and demands of living with diabetes and prediabetes.
Actual health costs
Most of the costs of diabetes and prediabetes are for treating the complications which include:
Eye disease possibly leading to blindness
Kidney disease possibly leading to kidney failure
Nerve disease possibly leading to severe pain or amputation
Heart disease and arterial disease possibly leading to heart attacks, strokes, or severe leg pain
The fact is that the top three complications will never occur if prediabetes is reversed or never allowed to occur in the first place. Stopping prediabetes in its tracks is preventive medicine. Unfortunately, health insurance companies are willing to spend the thousands needed for treating the end results of disease but won’t spend the much smaller sums needed to prevent the complications in the first place.
The Diabetes Prevention Program shows that preventive methods such as diet and exercise delay the development of Type 2 diabetes by an average of eleven years and reduces the number of new cases of diabetes by 20 percent.
According to recent estimates in the US, people with diabetes have medical expenditures 2.6 times higher than those without the condition. Among Medicare beneficiaries aged 65 or older with Type 2 diabetes, the median cost associated with diabetes complications is nearly $5,900 per person each year. Up to 64 percent of a person’s lifetime medical costs with diabetes are spent on managing these complications.
Other economic costs
The indirect costs of diabetes and prediabetes are also substantial. These include lost productivity, higher disability rates, and increased taxes to cover public health expenditures. For example, indirect costs — such as missed work and reduced ability to work — add more than $90 billion to the national burden in the US each year. The societal cost savings from effective prevention programs are estimated to be as high as $8,800 per person.
Industries across the economy, from manufacturing to services, are affected by these costs. The high price of diabetes-related care is a significant challenge for employers, health insurers, and public programs such as Medicare and Medicaid.
Social costs
People who suffer blindness or kidney failure can’t work at the level of people without these conditions, so much of their productivity is lost. Sometimes these complications — and the heart disease that is so much worse with diabetes — lead to an early death, so the losses from diabetes also affect entire families.
Because prediabetes and Type 2 diabetes are now being seen so often in children and adolescents, we can expect that people will develop complications at much younger ages. People who should be in the prime of their lives will instead be suffering illness and premature death.
The goal of this book is to show you that such a path isn’t inevitable and that these costs can be avoided. By reading this book you can begin finding out how to walk the road back to health.
Chapter 2
Suspecting Prediabetes in Yourself or a Loved One
IN THIS CHAPTER
Assessing your risk of prediabetes
Getting your risks under control
Concentrating on glucose
Visiting the doctor
You gained a few pounds over the years. You don’t have the energy you used to have. Your mother has diabetes, and you have been reading about this condition called prediabetes so you want to know whether you may have it. In this chapter you find everything you need to know to tell whether you or a loved one may have prediabetes or diabetes. If, after reading this chapter, your suspicion is confirmed, the next step is to see a doctor to get yourself tested.
Taking a Risk Quiz
You don’t need to wait for a lab test to start thinking about your risk for prediabetes. In fact, a number of simple online tools are now available to help you assess your personal risk in just a few minutes, using information you probably already know about yourself. One of the most trusted is the American Diabetes Association (ADA) Diabetes Risk Test, developed in collaboration with the US Centers for Disease Control and Prevention (CDC).
This short questionnaire doesn’t diagnose prediabetes or diabetes, but it gives you a reliable estimate of how likely it is that you already have prediabetes and should be tested by your healthcare provider.
The ADA tool looks at seven key risk factors:
Age
Sex assigned at birth
Family history of diabetes
History of high blood pressure
Physical activity levels
History of gestational diabetes (for women)
Body weight and height (used to calculate BMI)
Each answer is assigned a particular score, and when you total them up, you get a number between 0 and 11. A score of 5 or higher suggests you’re at increased risk of having prediabetes or Type 2 diabetes and should talk to a healthcare provider about getting tested. The good news is that finding out early gives you the best possible chance to take action and prevent or delay diabetes.
You can take the test online at www.diabetes.org/risk-test or fill it out on paper — it takes just a minute or two.
Different countries use different risk assessment tools which may differ slightly. For example, in the UK, the Q-Diabetes score is commonly used, while in parts of Europe, the FINDRISC (Finnish Diabetes Risk Score) is widely used to identify people at risk of Type 2 diabetes and prediabetes.
If you’re unsure of your weight in pounds or height in inches, many versions of the tool now support metric units (kilograms and centimeters), making it easy to use wherever you live.
Even if you score low on the ADA risk test, it doesn’t guarantee that you do not have prediabetes or may develop it later. The only way of knowing for sure is with a blood test. Being aware of how your lifestyle affects your long-term health is still important. Staying active, eating a good diet, and maintaining a healthy weight can reduce your risk of prediabetes and many other chronic conditions.
Identifying Key Risk Factors That You Can Control
There’s not much you can do about your age. But you can alter all the other risk factors that promote prediabetes and diabetes. In this section, we introduce these factors and point you to the chapters later in the book that give specific advice on how to affect them.
