You got your lab results back. Your doctor said the word “prediabetes,” told you to watch your sugar, and said you’d recheck in six months or a year.
That’s it. No plan. No explanation of what’s actually going on inside your body.
If that’s where you are, you’re not alone. The CDC estimates that 115.2 million adults in the US have prediabetes. That’s more than 2 in 5 adults, and 8 in 10 of them don’t know they have it.
By the end of this, you’ll know the test most doctors skip and the changes that actually fix the root cause.
I’m Jamie. I spent more than 15 years as an ER nurse, and today I’m a master certified health coach who works with people who have prediabetes and type 2 diabetes. Here’s what I want you to know about that diagnosis. It’s not life long and progressive and it is reversible with the right lifestyle changes.
What is prediabetes?
Prediabetes means your blood sugar is higher than normal, but not high enough to be called type 2 diabetes yet.
It’s usually found with one of these three blood tests. These are the ranges the American Diabetes Association uses:
| Test | Normal | Prediabetes | Type 2 diabetes |
| A1C | Below 5.7% | 5.7% to 6.4% | 6.5% or higher |
| Fasting blood sugar | Below 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher |
| 2-hour glucose tolerance test | Below 140 mg/dL | 140 to 199 mg/dL | 200 mg/dL or higher |
Prediabetes raises your risk of type 2 diabetes, heart disease and stroke. But here’s how I want you to see it: this is your window. This is the stage where changes work best.
What is an A1C?
Your A1C is the test most people hear about. Sugar in your blood sticks to hemoglobin, a protein inside your red blood cells. The A1C measures what percentage of your hemoglobin is coated with sugar.
That gives you your average blood sugar over about the past three months. It’s a big-picture number, not a snapshot of today.
That makes it useful. But it has a blind spot, and that brings me to the most important part of this post.
Your blood sugar is the symptom, not the root cause
Most people think high blood sugar is the problem. I want you to think of it as the smoke. The fire is underneath.
Here’s what’s happening. Insulin is the hormone that moves sugar out of your blood and into your cells for energy. With insulin resistance, the cells in your muscles, fat and liver stop responding well to insulin. Think of it like a door that keeps sticking.
So your pancreas makes more insulin to push that door open. For a while, it works. Your blood sugar stays in range, and your labs look fine.
But your insulin is running high the whole time. Over time, your pancreas can’t keep up. That’s when your blood sugar starts to climb, and your A1C finally shows it.
A large study in the UK followed 6,538 adults for about 10 years. In the people who went on to develop type 2 diabetes, insulin sensitivity started dropping about five years before their diagnosis. Fasting blood sugar didn’t rise sharply until about three years before.
In other words, the problem was there long before the blood sugar number showed it.
If we only chase the blood sugar number, we’re treating the smoke. To turn this around, we have to look at insulin.
The test most people never get: fasting insulin
A fasting insulin test is a simple blood draw, usually done with your other morning labs after an overnight fast. It shows how much insulin your body needs to keep your blood sugar where it is.
If your fasting blood sugar looks normal but your fasting insulin is high, your body is working overtime to hold that number in place. That’s something your standard labs can miss.
A few honest things to know before you ask for it:
- It isn’t part of routine screening. The NIH says testing for insulin resistance is mostly used in research, so your provider may not order it unless you ask.
- There’s no single agreed-upon normal number. Labs use different tests and reference ranges. These reference ranges are standard… not optimal. Optimal fasting insulin should be 2-6 mIU/L
- It works best paired with fasting glucose. Together they can be used to calculate HOMA-IR, an estimate of insulin resistance.
- Check your coverage. Insurance doesn’t always cover it, so ask before the draw.
Here’s a simple way to ask: “I’d like to know whether insulin resistance is part of my picture. Can we add a fasting insulin test to my next labs?”
Signs you might notice before a diagnosis of Pre Diabetes
Here’s the frustrating part. The NIH says most people with insulin resistance and prediabetes have no symptoms at all. That’s why so many people don’t know.
But there are clues worth paying attention to. None of these diagnose anything on their own. They’re reasons to ask for labs.
- More weight around your middle. A large waist is a known risk factor for insulin resistance and prediabetes.
- Dark, velvety patches of skin, often on the back of the neck, in the armpits or in the groin. It’s called acanthosis nigricans, and research has linked it to insulin resistance.
- Lots of skin tags, especially on the neck and in the armpits. These have also been linked to insulin resistance.
- PCOS or irregular periods. Many women with polycystic ovary syndrome (PCOS) have insulin resistance.
- Changes on your other labs, like high blood pressure, high triglycerides or low HDL cholesterol.
- Feeling tired, hungry soon after meals, or craving sweets. These are common complaints, but they have plenty of other causes, so they don’t prove anything by themselves.
If several of these sound like you, it’s worth a conversation with your provider, especially if type 2 diabetes runs in your family.
Why quick fixes don’t fix pre-diabetes permanently
When people hear “prediabetes,” they want something fast. A detox. A supplement. A crash diet. Cutting out every carb for two weeks.
The trouble is that most quick fixes go after the blood sugar number, not the insulin resistance underneath it. The number may drop for a while. Then life happens, old habits come back, and so does the number.
Medication has a real place, and whether you need it is a decision for you and your doctor. But a pill doesn’t change the habits that led to insulin resistance in the first place. That’s why lifestyle is the foundation either way.
Lifestyle change is what works long term
Here’s the good news, and it’s backed by solid research. According to the CDC, a structured lifestyle change program can lower your risk of type 2 diabetes by 58%, or by 71% if you’re over 60. The NIH says healthy living may help prevent or reverse insulin resistance and prediabetes.
The changes that matter most aren’t complicated:
- Food. For most people, this is the biggest lever. I start clients with a simple plate: half vegetables, half protein, and keep the natural fat. No counting at the start.
- Movement, especially building muscle. Your muscles use a lot of the sugar from your meals. A walk after you eat and regular strength training both help.
- Sleep. Short or poor sleep can make your body less sensitive to insulin.
- Stress. Stress hormones push your blood sugar up. Managing stress is part of the plan, not an extra.
None of these are quick. But they work on the root cause, and that’s what makes the results last.
The bottom line
Prediabetes isn’t a life sentence. It’s a warning light, and catching it now gives you the best chance to turn things around.
- Your A1C tells you where your blood sugar has been.
- Your fasting insulin can tell you how hard your body is working to keep it there.
- Changing how you eat, move, sleep and handle stress is how you fix the root cause.
Want help with this?
I help people with prediabetes and type 2 diabetes get to the root cause, one realistic step at a time.
- Start with my guides: herestoyourhealthbyjamie.com/ebookoption
- Or book a free consultation call: [Schedule Here]