Prediabetes means your blood sugar is higher than it should be, but not high enough yet for a diabetes diagnosis. Most people feel completely fine, which is why it's so easy to miss. Maybe you got a call saying your labs "looked fine," felt relieved, and never asked for the actual number. That's very common, and it isn't carelessness. The good news is that prediabetes isn't a verdict, and a real plan with your doctor can lower your chance of moving into type 2 diabetes.
I'm Cheri Sacks, a registered nurse and Certified Diabetes Care and Education Specialist, and this is the conversation I wish more people got while they still have time to act.
Why is prediabetes so easy to miss?
Prediabetes usually has no symptoms. NIDDK, the National Institute of Diabetes and Digestive and Kidney Diseases, says so on its page about insulin resistance and prediabetes. Nothing hurts when your fasting glucose creeps from 96 to 108, so life just carries on.
You may also have heard gentle words like "a touch of sugar" or "borderline." They sound reassuring, but they don't tell you much. It's worth asking for the name of the test and the actual number so you and your physician can talk about what it means.
How is prediabetes diagnosed?
A clinician makes the diagnosis, not an article or a smartwatch. NIDDK's tests and diagnosis page lists three blood tests that can show prediabetes:
- A1C (your average blood sugar over the past few months) of 5.7 to 6.4 percent
- Fasting plasma glucose of 100 to 125 mg/dL
- Two-hour oral glucose tolerance test (the sugar-drink test) of 140 to 199 mg/dL
The 2026 ADA Standards use the same ranges. They also say there isn't enough evidence to use a continuous glucose monitor, the small sensor worn on the skin, to screen for or diagnose prediabetes (ADA 2026 on diagnosis).
These three tests don't always catch the same people. NIDDK explains on its page about recommended tests for identifying prediabetes that you can have a normal fasting glucose and an A1C in the prediabetes range, or the other way around. If you feel off and your A1C looks normal, ask your physician about one of the other tests.
How common is it?
The CDC's National Diabetes Statistics Report, updated January 2026, estimates that 115.2 million U.S. adults have prediabetes. The CDC's prediabetes page for the public puts that at more than 2 in 5 adults, and says about 8 in 10 of them don't know they have it.
I share that so you know why a "fine" phone call is such a common story, and why asking for your number is a way of taking care of yourself. If a parent or sibling has type 2, or your weight, blood pressure or cholesterol has been flagged, ask whether you should be screened. You're allowed to have your numbers in writing.
What does the research say about lowering your risk?
The study that gives me real hope is the Diabetes Prevention Program (DPP). NIDDK's DPP overview says that after about three years, the lifestyle program lowered new cases of type 2 diabetes by 58 percent compared with placebo. In people 60 and older in that same program, it was 71 percent.
The program wasn't a miracle diet. NIDDK describes the Diabetes Prevention Program as aiming for about 7 percent weight loss and at least 150 minutes of activity a week, with coaching. About 5 percent of the lifestyle group developed diabetes each year, compared with about 11 percent on placebo, so roughly half as many, though not zero. In the same trial, metformin lowered risk by 31 percent compared with placebo. Metformin is a prescription, so if your physician brings it up, that's a conversation about your labs and your life. I've written more about metformin and lifestyle and about insulin resistance.
The honest word here is delay. Lowering your risk isn't a cure, but years of steadier blood sugar are still years of your life. If someone told you it's too late because of your age, that 71 percent figure was specifically for people 60 and older. I've had women in their seventies apologize for "not doing this sooner," and there's nothing to apologize for.
It's also not proof that you did anything wrong. Genetics, age, sleep, medicines and where we carry weight all play a part, and NIDDK says researchers still don't fully understand every cause of insulin resistance.
What does "lifestyle" look like day to day?
In my work with clients, it usually looks like a balanced plate you can picture, a short walk after meals, and sleep that's treated as important. You don't have to do all of it this week. One habit you can keep is worth more than a perfect week you can't repeat.
If you take medicines that can lower your blood sugar, please check with your doctor before you add a lot of walking or cut back a lot on carbohydrates. Please don't start, stop or change a medicine, a diet or a big activity plan based on this article. I don't diagnose or prescribe, and I work alongside your doctor, not instead of them.
What can you do this month?
- Get your numbers. Ask your physician, "Do I meet the criteria for prediabetes, and what's our plan?"
- Bring your results to the visit. Circle the A1C and ask what it means in plain words. If you hear "let's watch it," ask what you're watching and when you'll recheck.
- Pick one daily habit you can live with.
- Ask about a program. Find out whether a CDC-recognized National DPP program is available near you or online.
- Ask for diabetes education if you'd like a specialist in your corner. That's what a CDCES does.
You still have time
Prediabetes is one of the few places in chronic illness where the door is clearly still open. You don't need an overhaul. You need your numbers, a plan that fits your life, your physician on your team, and someone who won't shame you when the plan wobbles.
I offer diabetes education and coaching, one-to-one or in a group when that's a better fit, always alongside your doctor. The first conversation is a free call so we can see if it feels right, and you can book that here. If you'd like to know what that first hour looks like, here's what to expect in your first coaching session.
With Care, Cheri Sacks, R.N., C.D.C.E.S. Your Neighbor, The Nurse
Education, not a diagnosis. Please talk with your physician before you change a medicine, a meal plan, or an activity plan.
Related reading
- What is a CDCES
- Living well with type 2 diabetes
- The balanced plate
- Walking after meals
- Metformin and lifestyle
- Working with a nurse health coach
Frequently asked questions
NIDDK lists 5.7 to 6.4 percent for prediabetes, and 6.5 and higher for diabetes, on the same [tests and diagnosis](https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis) table. Your physician reads it in context. A1C is not the only test.
For some people, with a plan and follow-up tests, yes. The research shows less risk and delay, not a guarantee. Recheck. Do not assume.
No. It is a comparison from that study: the lifestyle group developed type 2 less often than placebo over about three years. Your own risk is your labs, your age, your family, and what you can sustain, with your doctor in the room.
No. Talk with your physician. Metformin is a prescription. It may be right for some people. It is never a do-it-yourself project.
Feeling fine is how this hides. The test is the news, not the mood. Ask your doctor for the number.
