Unpacking pre-diabetes

Is Diabetes your Destiny 🤔

Across the country, millions of adults hear the words “pre-diabetes” after routine bloodwork. Any medical term can feel overwhelming, especially coming from providers lacking compassion. Let's start with what you might be most curious about- the fact that receiving this diagnosis does NOT mean you are automatically on a fixed path to develop type 2 diabetes! It's normal to feel worried, but this is simply a piece of information that gives us a chance to understand how your body manages energy and how we can support ourselves. No guilt or shame allowed! So- let's break down what this label means and what it doesn't!

First Things First: What is Pre-diabetes?

The term “pre” diabetes is often used as a general indicator, not a definitive prediction of your future health. Pre-diabetes happens when blood sugar (aka glucose) levels are consistently elevated, but are not high enough to be classified as type 2 diabetes. To help us understand pre-diabetes, let's imagine how your body uses energy. 

Every time you eat, your body breaks down carbohydrate-rich foods into glucose. Glucose is your body’s primary fuel, and your cells are like little houses that need fuel to run on. Your pancreas makes a hormone called insulin. Insulin acts like a key that unlocks your cells' front door, letting glucose step inside and power the house. With pre-diabetes, the locks on those doors to the houses start getting a little rusty or jammed, making it harder to open. When the key (insulin) doesn’t work well enough to get the fuel (glucose) into the houses (cells), it backs up in your bloodstream, raising blood sugar levels and keeping them higher than ideal. This condition, called insulin resistance, contributes to pre-diabetes.

Fun fact: Your body can actually make glucose from fat or protein, but this is not ideal and really only done when you aren't eating enough carbohydrates.

A Change in the Name - Why the Words We Use Shifted

As we research more about the intricate ways our bodies work, our understanding of their functioning changes, and with that sometimes comes updated language. 

Years ago, medical care used clinical terms like Impaired Glucose Tolerance (IGT) or impaired fasting glucose (IFG). While accurate in a lab, those terms felt a bit limiting. They only capture single moments in time. They missed the full, dynamic picture of how your unique body moves through its day. Over time, scientists began to see that our bodies share their story in a few different ways. 

Bloodwork we see in pre-diabetes:

• A glycated hemoglobin (A1C) test will fall between 5.7% and 6.4% - This reflects your average blood sugar over the past 3 months. These numbers are data points, not judgments. Blood sugar levels signal how your body is currently managing glucose. This does not reflect your self-worth, effort, or self-discipline. 

• Fasting blood sugar results are typically between 100 and 125 mg/dL. This measures blood glucose after an overnight fast. Typically after 8-12 hours with no food. This number is simply a starting point that gives you and your care team useful information. Your body works hard every day to keep it going. These numbers are an opportunity to tune in and offer supportive care without any pressure or perfectionism.

• Oral glucose tolerance test results are between 14 and 199 mg/dL. This measures how your body processes sugar two hours after drinking a specific sweet glucose beverage during a lab visit. This test is to see how your body responds. It does not define your overall health or your daily reality. Learning how your body responds to a challenge is a powerful tool that gives you the knowledge to move forward at a pace that feels comfortable and safe for you. 

In 2010, the American Diabetes Association (ADA) grouped these three signals under one heading: “pre-diabetes.” An interesting fact about this diagnosis is that the World Health Organization holds different criteria for diagnosing pre-diabetes. Additionally, studies have shown that most older adults (65+ years) who meet the ADA’s criteria for this diagnosis will never develop Type 2 Diabetes. 

It helps to hold this label with compassion. Medical names are not set in stone. They don’t reflect your worth, nor do they always reflect your efforts. They are simply helpful reference points to offer an opportunity for a proactive approach to practicing more mindfulness with regards to how you care for your body. 

Contributing Factors: 

Blood sugar levels do not reflect your willpower. A whole network of factors in your body and daily life shapes them.  A few interconnected pieces play a role, including: 

• Genetics and family history

• Visceral fat (The protective fat surrounding our internal organs)

• Physical inactivity

• Nutrition

• Medication, such as steroids

• Hormonal shifts and imbalances

• Sleep habits

• Stress levels

While we absolutely want to tend to the small changes we can make in our personal lives, we have to acknowledge the role that privilege plays in access to health and capacity for making changes. We MUST continue fighting to dismantle systems of oppression that are integrated into much of our society here in the US (like capitalism and yt supremacy) in order to truly create a more equitable world with access to better health for everyone. Our health will never be 100% in our hands for some factors like that are totally out of our control like genetics, but we can advocate to change these systems that impact our health.

Symptoms to Keep in Mind: 

Most of the time, people with pre-diabetes carry no noticeable symptoms at all. Your blood sugar levels could shift without sending you obvious signals. Which is why routine checkups and blood tests can be a mindful way to honor your body. It’s giving self-advocacy, self-love, and self-care. Sometimes your body may offer subtle clues, like darkened skin around the armpits and along the sides and back of your neck (a condition known as Acanthosis Nigricans- a form of hyperpigmentation), or skin tags- however these aren't always a sign of insulin resistance. See them as a gentle reminder to care for yourself and explore further. 

Your Journey Is Full of Hope: Pre-Diabetes Management

Pre-diabetes does not guarantee you will get type 2 diabetes. You have complete power to support your body’s innate wisdom. Nourishing ways to care for your well-being and promote balanced blood sugars include:

• Prioritize nutrient-dense foods: Choose colorful, satisfying foods that help your body feel grounded, energized, and cared for. 

• Engage in intentional movement: Engage in physical activities that feel revitalizing while meeting your body where it’s at.

  • Incorporate strength training a few times a week; having more muscle helps to better regulate glucose levels.

  • Go on a 10-15 minute brisk walk after carbohydrate-rich meals.

• Get enough sleep: Prioritize restorative sleep as best you can. Your body deserves to heal and restore its natural balance. 

• Limit alcohol intake: Keep alcohol intake mindful and limited to keep your organs thriving. You may like to reflect on your why behind drinking. 

• Protect your lungs: Avoid smoking to support overall heart and vessel well-being. 

• Macronutrient Balance:  Rather than focusing on restriction focus on addition. Pairing a carbohydrate with fiber, protein, or healthy fats slows digestion, prevents blood sugar spikes, and provides steady, long-lasting energy. 

  • A slice of toast with almond butter. 

  • Veggies with hummus. 

  • ½ cup of brown rice or quinoa with roasted chicken and leafy greens. 

• Consider eating your veggies & protein first- before carbohydrates at meals & snacks, when it doesn’t feel overwhelming. 

Reach out for more support:

If you are feeling overwhelmed about your health or feel like you have to take a super-restrictive approach to nutrition to maintain health- reach out here! I’d love to support you in assessing your health habits and creating changes that suit you- sustainably, over time, while supporting your relationship with food & your body.

Written with help from interns Elizabeth Rachels & Stacey Avila

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I truly enjoy creating content to help folx like you live your most informed, peaceful life with food & your body.

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Although I am a registered dietitian, I am not YOUR dietitian. All content and information on this website is for informational and educational purposes only, does not constitute medical advice, and does not establish any kind of client-provider relationship by your use of this website. A client-provider relationship with you is only formed after we have expressly entered into a written agreement with you that you have signed including our fee structure and other terms to represent you in a specific matter. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the area for your particular needs and circumstances prior to making any professional, legal, medical, and financial or tax-related decisions. 

Helpful Resources: 

Rooney, M. R., Rawlings, A. M., Pankow, J. S., Echouffo Tcheugui, J. B., Coresh, J., Sharrett, A. R., & Selvin, E. (2021). Risk of Progression to Diabetes Among Older Adults With Prediabetes. JAMA internal medicine, 181(4), 511–519. https://doi.org/10.1001/jamainternmed.2020.8774

American Diabetes Association. (2025). 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2025. Diabetes Care, 48(Suppl. 1), S27–S46. https://doi.org/10.2337/dc25-S002

Bansal, N. (2015). Prediabetes diagnosis and treatment: A review. World Journal of Diabetes, 6(2), 296–303. https://doi.org/10.4239/wjd.v6.i2.296

Mayo Clinic. (2023, April 14). Prediabetes: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/prediabetes/symptoms-causes/syc-20355278

Mayo Clinic Health System. (2022, November 8). I've been diagnosed with prediabetes: What does that mean? https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ive-been-diagnosed-with-prediabetes-what-does-that-mean

Seaborg, E. (2021, August 11). Next to normal: How useful is the concept of prediabetes in older adults? Endocrine News. https://endocrinenews.endocrine.org/next-to-normal-how-useful-is-the-concept-of-prediabetes-in-older-adults/

The Fat Doctor. (2023, March 19). Prediabetes: A lesson in PR. https://www.fatdoctor.co.uk/2023/03/19/prediabetes-a-lesson-in-pr/

Yudkin, J. S., & Montori, V. M. (2014). Prediabetes: Are there problems with this label? Yes. Diabetes Care, 37(6), 1468–1471. https://doi.org/10.2337/dc13-2114