What Is Prediabetes? Understanding What It Means—and What It Doesn't
What Is Prediabetes? Understanding What It Means—and What It Doesn't
Written by Kerri Rachelle, PhD c., RDN, CSSD, FMP-AC
Founder & CEO, REV0lution | Doctor of Integrative & Natural Medicine Candidate
Quick Answer
Prediabetes is a condition in which blood sugar levels are higher than optimal but not yet high enough to meet the criteria for type 2 diabetes. While hearing the diagnosis can feel overwhelming, prediabetes is not a guarantee that you will develop diabetes. In many cases, personalized lifestyle changes can improve metabolic health and return blood sugar markers to healthier ranges.
At REV0lution, we don't see prediabetes as the beginning of the story. We often see it as the first time the healthcare system gives a name to a metabolic process that may have been developing quietly for years.
Key Takeaways
Prediabetes is an opportunity to improve metabolic health—not a life sentence.
In many cases, prediabetes can be improved through personalized nutrition, movement, sleep, stress management, and other lifestyle changes.
Blood sugar is only one part of the metabolic picture.
Small, consistent habits create far more lasting results than short periods of perfection.
Nutrition, muscle, sleep, stress, environment, relationships, hormones, and inflammation all influence blood sugar regulation.
Taking an active role in your health early creates the greatest opportunity to prevent future disease.
How Does Prediabetes Develop?
One of the biggest misconceptions about prediabetes is that it develops suddenly.
In reality, it rarely does.
For many people, metabolic changes have been occurring quietly for years before fasting glucose or hemoglobin A1c finally cross the threshold into the prediabetes range. The body is remarkably good at adapting. As cells become less responsive to insulin, the pancreas compensates by producing more of it, often keeping blood sugar within the normal range for years.
Eventually, however, that compensation becomes more difficult to maintain.
By the time someone is diagnosed with prediabetes, the underlying metabolic process has often been unfolding long before the diagnosis itself.
The encouraging news is that the body can adapt in healthier directions, too. Understanding what's happening earlier creates more opportunities to change the trajectory.
If you'd like to understand that earlier stage in more detail, read our article on Fasting Insulin: The Metabolic Marker Most People Never Have Checked.
What Does a Prediabetes Diagnosis Really Mean?
One of the first things we talk about after someone receives a prediabetes diagnosis is what it doesn't mean.
It does not mean you're destined to develop type 2 diabetes.
It does not mean you can never eat carbohydrates again.
It does not mean you've failed.
It does not mean your health can only improve if you lose weight.
And perhaps most importantly, it does not mean you have to be perfect.
Many people respond to a diagnosis by trying to change everything overnight. They eliminate entire food groups, exercise every day despite hating it, promise themselves they'll "be good," and sustain that approach for a few weeks until life inevitably gets busy again.
Then they feel like they've failed. The problem isn't usually a lack of motivation. It's that perfection isn't sustainable.
At REV0lution, we'd rather help someone build five habits they can maintain for years than fifty habits they'll abandon in a month. Lasting health is rarely built through short bursts of perfection. It's built through small decisions repeated consistently over time.
What Causes Prediabetes?
One of the most common questions we hear is, "How did this happen? I thought I was eating healthy."
Sometimes people truly have made meaningful changes. Other times, there are gaps they simply haven't recognized yet.
Many people overestimate how consistently they follow healthy habits. They may eat nutritious meals during the week but underestimate restaurant meals, alcohol, ultra-processed snacks, portion sizes, or the long hours spent sitting at a desk. Others exercise several days each week but don't realize how much the other 165 hours of the week influence their metabolism.
Nutrition is certainly important, but prediabetes is rarely caused by food alone.
Sleep quality, chronic stress, muscle mass, physical activity, hormones, inflammation, medications, environmental exposures, genetics, relationships, social support, and even opportunities for play and recovery all influence metabolic health.
Modern life asks a great deal of us. We sleep less. We move less. We spend more time indoors. We're constantly connected to screens. Many people juggle demanding careers while also managing households, caregiving responsibilities, meal planning, children's activities, finances, and countless daily decisions. That chronic mental and physical load affects our biology.
Health doesn't happen in isolation from the life you're living.
Should You Stop Eating Carbohydrates If You Have Prediabetes?
If you've been diagnosed with prediabetes, you've probably heard someone say, "Just stop eating carbs."
Unfortunately, that advice oversimplifies a much more complex topic.
Carbohydrates include vegetables, fruits, beans, lentils, whole grains, and other foods that provide fiber, vitamins, minerals, antioxidants, and thousands of beneficial plant compounds called polyphenols. They also provide the prebiotic fibers that feed the beneficial bacteria living in your gut.
For athletes, carbohydrates are an important fuel source. For many women during their reproductive years, adequate carbohydrate intake also supports healthy hormonal function.
The conversation shouldn't simply be about eating fewer carbohydrates.
It should be about choosing higher-quality carbohydrates, balancing them appropriately with protein and healthy fats, understanding portion sizes, and matching nutrition to your individual metabolism, activity level, medical conditions, and goals.
Nutrition should be personalized—not fear-based. Learn more about how our Functional Medicine Dietitians will personalize your recommendations.
Who Is Most Likely to Develop Prediabetes?
Prediabetes doesn't occur in isolation.
Certain medical conditions make insulin resistance and blood sugar changes more likely, which is why understanding the whole picture matters.
One example is Polyendocrine Metabolic Ovarian Syndrome (PMOS), formerly known as Polycystic Ovary Syndrome (PCOS). The updated name reflects what researchers have increasingly recognized for years: this condition is about much more than the ovaries. It affects hormones, metabolism, insulin sensitivity, inflammation, and overall health throughout the body.
Other conditions, including thyroid disorders, fatty liver disease, chronic inflammation, iron deficiency in certain situations, pregnancy, postpartum changes, menopause, and some medications, may also influence blood sugar regulation or how laboratory markers should be interpreted.
At REV0lution, we don't stop after identifying prediabetes.
We ask what may have contributed to it in the first place.
Because understanding the why is what allows us to build a personalized plan that addresses the underlying contributors—not just the diagnosis itself.
How Is Prediabetes Usually Treated?
Every healthcare provider approaches prediabetes a little differently, but many people leave their appointment with very little guidance. Some are told to lose weight, exercise more, cut back on sugar, or come back next year to recheck labs. Others are not told much at all, and that may be the most frustrating scenario because it misses a major opportunity for prevention.
Those recommendations are not always wrong, but they are often incomplete. Knowing that you should “eat better” or “move more” is very different from knowing how to do that in a way that fits your body, your schedule, your labs, your preferences, and your life. Most people do not need another vague instruction. They need a plan they can actually follow.
What Should You Do If You've Been Diagnosed With Prediabetes?
One of the greatest opportunities after a prediabetes diagnosis is becoming an active participant in your own health and care. Instead of waiting another six or twelve months to see what happens, you can start learning how your daily choices influence your metabolism now.
This does not mean becoming obsessive or trying to be perfect. It means becoming curious. How does your body respond to different meals? How does sleep affect your cravings? What happens when you walk after dinner? How do stress, alcohol, travel, or long workdays change how you feel?
Health improves when awareness becomes action. The goal is not to overhaul your entire life overnight. The goal is to identify the next few changes that matter most and build from there.
Can a Continuous Glucose Monitor (CGM) Help With Prediabetes?
A Continuous Glucose Monitor, or CGM, can be a powerful educational tool for people with prediabetes. A CGM shows how glucose changes throughout the day, which helps connect blood sugar patterns with food, movement, sleep, stress, and daily routines.
One of the most valuable lessons from CGM data is that people respond differently to the same foods. One person may tolerate oatmeal beautifully, while another may see a much larger glucose rise from the same meal. That does not mean oatmeal is “bad.” It means your body’s response matters.
CGMs can be incredibly helpful for personalization. Rather than guessing, we can observe patterns and use that information to make better decisions.
Should You Take Medication for Prediabetes?
Medications can play an important role for some people with prediabetes, especially when risk factors are higher or lifestyle changes alone are not enough. Metformin and GLP-1 medications may be appropriate in certain situations, and those decisions should always be made with your healthcare provider.
At REV0lution, we view medications as tools, not magic wands. Even when medication is appropriate, nutrition, movement, sleep, stress management, and muscle preservation still matter. GLP-1 medications can be very effective for some people, but they do not replace the need to build healthy habits.
This is especially important because weight loss without attention to muscle is not the goal. If someone uses a GLP-1 medication, resistance training and adequate protein become even more important to help protect lean mass. Different GLP-1 medications work in different ways, and each comes with its own considerations. If you're taking a GLP-1, we'll help you build a personalized plan that supports your goals while prioritizing adequate nutrition, muscle preservation, resistance training, and long-term metabolic health.
What Is the Best Exercise for Prediabetes?
One of the most common questions people ask is, “What is the best exercise for prediabetes?” Our answer usually starts with the most practical truth: the best exercise is the one you will actually continue doing.
A perfect workout plan does not improve your health if you hate it and stop after two weeks. Walking, cycling, strength training, dancing, swimming, hiking, yoga, pickleball, or any other activity you enjoy can be valuable if it helps you move consistently. At REV0lution, we care about building a movement plan that fits your life, not forcing you into a plan that looks good on paper but does not last.
That said, resistance training is especially valuable because muscle plays an important role in insulin sensitivity and healthy aging. Walking after meals is also a simple and effective habit for supporting post-meal blood sugar regulation. Start with what you will do, schedule it into your calendar, lace up your shoes, and build from there.
What Tests Should Be Checked Besides Blood Sugar?
Prediabetes is not only about blood sugar. Blood sugar is one marker, but it does not explain the whole metabolic picture. When someone has prediabetes, we often want to understand what else is happening underneath the surface.
We may look at fasting insulin, triglycerides, HDL cholesterol, liver enzymes, inflammatory markers, thyroid function, iron status, body composition, sleep, stress, nutrition, alcohol intake, daily movement, medications, and personal history. Sometimes fasting insulin, lipids, and triglyceride-to-HDL patterns tell a clear metabolic story. Other times, those markers look fairly good and we need to ask what else may be driving the change.
This is where thoughtful care matters. Prediabetes is not a reason to assume everyone needs the same diet, supplement, exercise plan, or medication. It is a reason to ask better questions.
What Happens If Prediabetes Is Left Untreated?
Prediabetes does not automatically progress to type 2 diabetes, but it also should not be ignored. Without addressing the underlying contributors, blood sugar may continue to rise over time and metabolic dysfunction may progress.
Prediabetes can also be associated with increased risk for cardiovascular disease, fatty liver disease, kidney concerns, nerve changes, and other chronic health conditions. That does not mean people should panic. It means the diagnosis deserves attention.
The encouraging part is that early action matters. Your body has already shown that it can adapt in one direction. With the right support, it can often adapt in a healthier direction too.
Our Approach to Prediabetes at REV0lution
At REV0lution, we do not define people by diagnoses. Prediabetes is information. It is not your identity.
We see prediabetes as an opportunity to understand your metabolism, ask better questions, and become an active participant in your health. We believe in sustainable habits instead of temporary perfection. We believe lab testing should create clarity, not fear.
Most importantly, we believe every recommendation should be personalized. Preventing disease is one of the greatest gifts you can give your future self, but prevention does not come from shame, fear, or all-or-nothing thinking. It comes from understanding what your body needs and building habits you can keep.
Ready to Improve Your Metabolic Health?
Whether you have recently been diagnosed with prediabetes, have a family history of diabetes, or simply want to better understand your metabolic health, our Functional Medicine Registered Dietitian Nutritionists are here to help.
We review your laboratory results, health history, nutrition, lifestyle, and goals to create a personalized plan that fits your life.
Frequently Asked Questions
What is prediabetes?
Prediabetes is a condition in which blood sugar levels are higher than optimal but not yet high enough to meet the criteria for type 2 diabetes. It is an early warning sign that your metabolism is changing and an opportunity to make meaningful improvements before diabetes develops.
Learn more: What Is Insulin Resistance?
Can prediabetes be reversed?
In many cases, yes. Prediabetes often responds well to personalized nutrition, regular movement, improved sleep, stress management, weight management when appropriate, and other lifestyle changes. The earlier these changes begin, the greater the opportunity to improve metabolic health.
What causes prediabetes?
Prediabetes rarely has a single cause. Genetics, insulin resistance, sleep, chronic stress, nutrition, physical activity, muscle mass, hormones, medications, environmental exposures, inflammation, and aging can all contribute. Understanding why blood sugar is changing is often more valuable than focusing only on the diagnosis itself.
Learn more: What Is Root Cause Medicine?
Is prediabetes caused by eating too much sugar?
Not necessarily. While excessive added sugar and highly processed foods can contribute, prediabetes is much more complex than sugar alone. Sleep, stress, physical activity, muscle mass, hormones, medications, and overall dietary patterns all influence blood sugar regulation.
Should I stop eating carbohydrates if I have prediabetes?
No. Carbohydrates include vegetables, fruits, legumes, lentils, and whole grains that provide fiber, vitamins, minerals, polyphenols, and prebiotics that support gut health. The goal is usually to improve carbohydrate quality, portion size, timing, and overall balance rather than eliminating carbohydrates completely.
What foods should I eat if I have prediabetes?
There isn't one perfect diet for everyone. Most people benefit from meals built around quality protein, vegetables, healthy fats, fiber-rich carbohydrates, and minimally processed foods. The best nutrition plan depends on your medical history, goals, medications, activity level, and laboratory findings.
Learn more: What Is Nutrition Counseling with a Functional Medicine Dietitian?
What is the best exercise for prediabetes?
The best exercise is the one you'll continue doing consistently. Walking, cycling, swimming, strength training, dancing, hiking, and many other activities can all improve metabolic health. We especially encourage resistance training to preserve muscle and walking after meals to help support healthy blood sugar responses.
Should I have my fasting insulin checked?
Many people with prediabetes can benefit from having fasting insulin measured because it often changes years before fasting glucose or A1c become abnormal. It provides valuable insight into how hard your body is working to maintain blood sugar.
Learn more: Fasting Insulin: The Metabolic Marker Most People Never Have Checked.
Are continuous glucose monitors helpful for prediabetes?
For many people, yes. Continuous glucose monitors (CGMs) provide real-time feedback about how your body responds to meals, movement, sleep, and stress. They can be valuable educational tools that help personalize nutrition recommendations.
Is nutrition counseling covered by insurance?
In many cases, yes. Nutrition counseling provided by a Registered Dietitian Nutritionist is often covered by health insurance, especially for preventive care and many metabolic conditions. Coverage varies by insurance plan and diagnosis.
Learn more: Is Functional Medicine Covered by Insurance?
Continue Exploring Metabolic Health
If you're interested in learning more about metabolic health, these articles are a great next step:
Fasting Insulin: The Metabolic Marker Most People Have Never Checked
Functional Medicine Lab Testing: What It Is, What It Isn't, and When It's Helpful
References
American Diabetes Association. Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl. 1).
Centers for Disease Control and Prevention. Prediabetes.
National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance & Prediabetes.
Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. New England Journal of Medicine. 2002.
Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance. New England Journal of Medicine. 2001.
American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and Prescription.
Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care.
Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial. Cell Metabolism. 2019.
Means C, Means C. Good Energy: The Surprising Connection Between Metabolism and Limitless Health. Avery; 2024.
