Prediabetes Signs and A1C Range: Can You Reverse Prediabetes?

For general educational purposes only, not a substitute for specific medical advice. Consult with a licensed provider before implementing any adjustments to your treatment regimen.

Prediabetes means your blood sugar is higher than normal but not high enough to be type 2 diabetes. On an A1C test, the prediabetes range is 5.7% to 6.4%. Most people with prediabetes have no symptoms, so a blood test is usually the only way to find it.

The good news is that healthy changes may help bring blood sugar back toward normal and prevent or delay type 2 diabetes. November is National Diabetes Month, which makes it a good time to ask whether you should be tested.

What Prediabetes Means

Insulin is a hormone that helps sugar (glucose) move from your blood into your cells for energy. With prediabetes, your body often doesn’t respond to insulin as well as it should. This is called insulin resistance. Over time, extra sugar builds up in your blood.

Prediabetes is common. MedlinePlus estimates that about 1 in 3 adults has it. It raises your chances of type 2 diabetes, heart disease and stroke. Not everyone with prediabetes goes on to develop diabetes, though, and there are real steps you can take to lower your risk.

Signs of Prediabetes and Why Most People Miss Them

Most people don’t know they have prediabetes because it usually causes no symptoms. Some people notice darkened skin in the armpits or on the back and sides of the neck, sometimes with many small skin growths in the same areas.

If blood sugar keeps rising, symptoms of diabetes may start to appear, such as:

• Urinating more often
• Feeling very thirsty, or very hungry even after eating
• Blurred vision
• Fatigue
• Sores that don’t heal or frequent infections

Feeling fine doesn’t mean your blood sugar is normal. That’s why screening matters.

Who Should Get Screened

Ask about testing if you are 35 or older, or if you have overweight or obesity along with other risk factors, such as:

• A parent, brother or sister with diabetes
• African American, American Indian, Alaska Native, Asian American, Hispanic/Latino, Native Hawaiian or Pacific Islander background
• Not being physically active
• High blood pressure or high cholesterol
• Past gestational diabetes, or having had a baby who weighed 9 pounds or more
• Polycystic ovary syndrome (PCOS) or sleep apnea
• Smoking or vaping
• Long-term use of certain medicines, such as steroids or some antipsychotics

If you take one of these medicines, don’t stop or change it on your own. Talk with your clinician or pharmacist first.

Prediabetes A1C and Fasting Glucose Ranges

Two blood tests are used most often. The A1C test shows your average blood sugar over the past 3 months, and you can eat and drink before it. The fasting plasma glucose test measures your blood sugar at one moment, after at least 8 hours with nothing but sips of water.

For adults who are not pregnant, here is what the results mean:

• Normal: A1C below 5.7%, or fasting glucose of 99 mg/dL or below
• Prediabetes: A1C of 5.7% to 6.4%, or fasting glucose of 100 to 125 mg/dL
• Diabetes: A1C of 6.5% or higher, or fasting glucose of 126 mg/dL or higher

A diabetes diagnosis is usually confirmed with a second test. A1C may not be accurate later in pregnancy, with certain types of anemia or with some inherited hemoglobin differences. If your A1C and glucose results don’t match, your clinician may suggest another test, such as an oral glucose tolerance test.

Can Prediabetes Be Reversed?

It can be. Healthy living may help bring blood sugar back into the normal range and prevent or delay type 2 diabetes. The changes that matter most include:

• Modest weight loss. In a large NIH-funded study called the Diabetes Prevention Program, people at high risk who lost 5% to 7% of their starting weight lowered their chance of getting diabetes. For someone who weighs 200 pounds, that is 10 to 14 pounds.
• Moving more. Regular physical activity is one of the main ways to lower your risk. Start small, like a short daily walk, and build from there.
• Eating well. Choose healthy foods and drinks, with a reduced-calorie plan if you need to lose weight.
• Sleeping enough. Good sleep is part of the healthy lifestyle experts recommend for prediabetes.
• Quitting smoking. Smoking and secondhand smoke raise your risk.

Some people may also talk with a clinician about medicine. In the Diabetes Prevention Program, metformin, a generic medicine used to treat type 2 diabetes, also delayed diabetes, though lifestyle changes worked better. In some cases, weight-loss medicine may be part of a plan, and medical weight management can review whether it is appropriate. Check with your insurer first. Most plans cover weight-loss medication only when you have a related condition, such as diabetes, high blood pressure or sleep apnea, and they may still deny coverage. Our post on insurance coverage for weight-loss medication explains what to ask.

A visit doesn’t guarantee any specific prescription. If you already take medicine for blood sugar, weight or blood pressure, don’t stop or change it without talking to your clinician or pharmacist.

How Labs and Follow-Up Work After a Video Visit

Prediabetes care fits well with telehealth. During a video visit, a clinician reviews your history, risk factors, medicines and any past results. If testing makes sense, the order goes to a lab near you for a blood draw, and the results come back to your clinician.

At a follow-up visit, you’ll go over what the numbers mean and make a plan. Your clinician may also check cholesterol and triglycerides, since these can rise with prediabetes. Home blood pressure readings can help too.

How often you retest depends on your results. If you have prediabetes, testing for type 2 diabetes is generally advised every year. If your results are normal but you have risk factors, retesting at least every 3 years is typical. Some care still needs an in-person visit, such as a sore that won’t heal or a foot exam.

When to Get Care Right Away

Prediabetes itself is not an emergency. But very high blood sugar can lead to a dangerous condition called diabetic ketoacidosis (DKA), and prediabetes raises the risk of heart disease and stroke. Call 911 or go to the nearest emergency room for:

• Trouble breathing
• Fruity-smelling breath with nausea, vomiting or belly pain
• Fainting or signs of serious dehydration
• Chest pain or pressure
• Sudden weakness or numbness on one side, trouble speaking or new confusion

If you notice strong thirst, frequent urination, blurred vision or weight loss you can’t explain, contact a clinician soon rather than waiting for a routine checkup.

The Short Answer

Prediabetes means your blood sugar is above normal but below the diabetes range: an A1C of 5.7% to 6.4%, or a fasting glucose of 100 to 125 mg/dL. It rarely causes symptoms, so testing is the way to know. Modest weight loss, regular activity, healthy eating and good sleep may bring your numbers down. A clinician can help you decide whether medicine makes sense and when to retest.

Learn more on our preventive care and health screenings page.

Get Support

Wade’s Care First provides telehealth care in Arizona, Florida, Illinois, Indiana, Kentucky, Michigan, Nevada and New York, with same-day appointments when available. Visits are with Charles Wade, FNP-BC, a board-certified family nurse practitioner.

We accept many major insurance plans, including Original Medicare (Indiana only), Medicaid (Indiana, Illinois and Nevada only), UnitedHealthcare, Aetna, Humana and Cigna. Plan participation varies by state, and self-pay visits are available.

If you have risk factors and haven’t had your blood sugar checked lately, a video visit is an easy place to start.

Book at wadescarefirst.com.