Prediabetes Doesn’t Feel Like Anything. That’s the Problem.

More than 8 in 10 American adults with prediabetes don't know they have it. That's a remarkable number, especially considering that 115.2 million adults in the U.S. have prediabetes, according to the CDC.

The tricky part? Most people feel perfectly fine.

With World Diabetes Day approaching on November 14, this year's theme, Early Action on Diabetes, is a timely reminder that you don't have to wait for symptoms to start paying attention to your blood sugar.

What Is Prediabetes?

Prediabetes means your blood sugar is higher than normal but not yet in the range for type 2 diabetes. It usually develops gradually as your body becomes less responsive to insulin, the hormone that moves sugar from your blood into your cells. With early action, many people bring their numbers back into a normal range.

The American Diabetes Association uses these ranges for prediabetes:
A1c: 5.7% to 6.4%
Fasting glucose: 100 to 125 mg/dL
Two-hour oral glucose tolerance test: 140 to 199 mg/dL

Risk doesn't start at one magic number, though. It climbs gradually and begins even below these cutoffs, so a result at the high end of normal is worth a conversation.

Why Don't Most People Know They Have Prediabetes?

Prediabetes rarely causes symptoms. Underneath, insulin resistance can build for years while your pancreas makes extra insulin to compensate, which keeps glucose looking normal on routine labs for a long time.

Some physical clues can show up along the way. None of them diagnose anything on their own, but they're worth mentioning to your practitioner:

• Skin tags
• A growing waistline
• High triglycerides with low HDL cholesterol
• Darker, velvety skin in body folds like the neck or underarms
• Rising blood pressure

Plenty of people also notice afternoon energy crashes or stronger cravings, though those can have many causes.

Who Should Get Tested?

The American Diabetes Association recommends testing all adults starting at age 35, and sooner if you have overweight or obesity plus another risk factor.

Common risk factors include a family history of diabetes, high blood pressure, PCOS/PMOS, a history of gestational diabetes, and low physical activity. If your results are normal, retesting at least every three years is reasonable. If you land in the prediabetes range, the ADA recommends checking at least once a year.

What to Ask at Your Next Visit

If you're a patient at West Holistic Medicine, our doctors typically screen for prediabetes as part of your care, so you're in good hands. It still helps to know your numbers and ask questions, and these are worth bringing up at any checkup:

• A1c and fasting glucose together. A1c reflects your average over about three months, while fasting glucose is a single snapshot.

• Fasting insulin. High fasting insulin can signal insulin resistance before glucose rises. Labs don't share a standardized reference range, so it's best read in context, often alongside a calculation called HOMA-IR.

• Your triglyceride to HDL ratio. It comes from a standard lipid panel, and many clinicians use a high ratio as a practical clue for insulin resistance.

• Whether A1c fits you. Iron deficiency, anemia, recent blood loss or transfusion, hemoglobin variants, kidney disease, and pregnancy can all make A1c less reliable.

• Your trend over time. A fasting glucose that drifts from 85 to 98 over a few years tells a different story than one number alone.

For some people, a few weeks with a continuous glucose monitor shows how meals, sleep, and stress affect them day to day. Not everyone needs every test, and sorting out which ones fit your history is exactly what an integrative visit is for.

How Stress Raises Your Blood Sugar

Your nervous system plays a bigger role than most people expect. Cortisol and adrenaline push extra glucose into your bloodstream for quick energy, which is useful in an emergency and less useful during a packed holiday week.

Sleep matters too. In a classic 1999 study, healthy young men who spent four hours in bed for six nights handled glucose noticeably worse than when they were well rested.

That's why we look at stress, sleep, and the routines and relationships behind them alongside your labs. Tools like EFT tapping and slow breathing can help calm the stress response, and they fit easily into a busy week.

Can Prediabetes Go Back to Normal?

For many people, YES! Prediabetes is an early warning, and catching it early gives you the most room to turn things around.

The strongest evidence comes from the landmark Diabetes Prevention Program. Adults with prediabetes who made lifestyle changes lowered their risk of developing type 2 diabetes by 58% over about three years, compared with 31% for metformin. Their goals were modest: 150 minutes of activity a week and about 7% weight loss.

What tends to help most are steady, everyday habits. Walking after meals, strength training (muscle is where much of your blood sugar goes after you eat), getting enough protein, especially after 40, sleeping well, and managing stress all work together. Our post on metabolism hacks that actually work has more ideas.

Progress usually shows up gradually, and it looks different for everyone. Rechecking your labs at least once a year lets you and your practitioner see whether your numbers are moving back toward a normal range, and adjust your plan if they're not.

Heading Into Thanksgiving

If the post-turkey couch crash sounds familiar, our tips for keeping your blood sugar steady on Thanksgiving still apply (yes, pie is allowed). Already planning the menu? Start with last year's 15 doctor-approved Thanksgiving recipes, and watch for new ones next week.

Start With Your Numbers