Understanding Pre-Diabetes


Before people develop type 2 diabetes, they almost always have "pre-diabetes" - when blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes. Many of these people will develop diabetes within 10 years.

Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes. But research has also shown that if you take action to control your blood glucose when you have pre-diabetes, you can delay or prevent type 2 diabetes from ever developing.

Could I have pre-diabetes and not know it?

People with pre-diabetes don't often have symptoms. In fact, millions of people have diabetes and don't know it because symptoms develop so gradually, people often don't recognize them. Some people have no symptoms at all. Symptoms of diabetes include unusual thirst, a frequent desire to urinate, blurred vision, or a feeling of being tired most of the time for no apparent reason.

How can you tell if you have pre-diabetes?

There are three different tests your doctor can use to determine whether you have pre-diabetes:

  • fasting plasma glucose test (FPG)
  • random serum glucose test
  • oral glucose tolerance test (OGTT).

Both the FPG and OGTT require a person to fast overnight. In the FPG test, a person's blood glucose is measured first thing in the morning before eating. A random or non-fasting glucose level is done anytime. A result of >200 along with classic symptoms means you have diabetes. In the OGTT, a person's blood glucose is tested fasting and every half hour for two to five hours after drinking a glucose-rich drink.

The blood glucose levels measured after these tests determine whether you have a normal metabolism, or whether you have pre-diabetes or diabetes. If your blood glucose level is abnormal following the FPG, you have impaired fasting glucose (IFG); if your blood glucose level is abnormal following the OGTT, you have impaired glucose tolerance (IGT).

We are giving IGT/IFG a new name for several reasons. Pre-diabetes is a clearer way of explaining what it means to have higher-than-normal blood glucose levels. It means you are likely to develop diabetes and may already be experiencing the negative health effects of this serious condition. People with pre-diabetes are at higher risk of heart disease. The good news is that we now know that people with pre-diabetes can delay or prevent the onset of type 2 diabetes through lifestyle changes.

Who should get tested for pre-diabetes?

If you are overweight and age 45 or older, you should be tested for pre-diabetes during your next routine medical office visit. If your weight is normal and you're over age 45, you should ask your doctor during a routine office visit if testing is appropriate. For adults younger than 45 and overweight, your doctor may recommend testing if you have any other risk factors for diabetes or pre-diabetes. These include high blood pressure, low HDL cholesterol and high triglycerides, a family history of diabetes, a history of gestational diabetes or giving birth to a baby weighing more than nine pounds, or belonging to an ethnic group at high risk for diabetes.

How often should I be tested?

If your blood glucose levels are in the normal range, it is reasonable to be retested every three years. If you have pre-diabetes, you should be tested for type 2 diabetes every one to two years after your diagnosis.


There is a lot you can do! Know your risks for pre-diabetes, and take action to prevent diabetes if you have, or are at risk for pre-diabetes. People with pre-diabetes can expect to benefit from much of the same advice for good nutrition and physical activity as those with diabetes.

What is the treatment for pre-diabetes?

Pre-diabetes is a serious medical condition that can and should be treated. Some medications may delay the development of diabetes, but recent research has shown that diet and exercise are more effective. Just 30-60 minutes a day of moderate physical activity, coupled with a 5-10 percent reduction in total body weight, can produce a 58 percent reduction in diabetes. For some people with pre-diabetes, intervening early can actually turn back the clock and return elevated blood glucose levels to the normal range.

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