More than 96 million American adults—more than one in three of us—have prediabetes: blood sugar levels that are lower than type 2 diabetes but higher than normal. Prediabetes is not a pre-problem: It puts you at increased risk for the same chronic conditions that are linked to diabetes, and for diabetes itself.

The good news: Decades of scientific research shows that reversing prediabetes by restoring your blood sugar to normal levels is possible if you make a few lifestyle changes. The Diabetes Prevention Program (DPP), a three-year-long study with more than 3,000 participants, showed that lifestyle changes like improving diet and increasing activity levels (exercising moderately for 30 minutes, five days a week) can cut the risk of developing type 2 diabetes by 58 percent—and 71 percent for people ages 60 and older. People who participated in the DPP also had lower cholesterol and triglyceride levels, healthier blood pressure, and less chronic inflammation.

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Prediabetes has no symptoms, but there are clues. It’s more likely you have prediabetes if you have excess weight, smoke, are inactive, sleep poorly, or have high blood pressure, high triglycerides, low HDL (good) cholesterol, or heart disease. However, the only foolproof way to diagnose prediabetes is through testing. If you have one or more of the risk factors for diabetes, you should be tested sooner rather than later. Prediabetes is progressive, and every day, the window of opportunity to stabilize or reverse blood sugar levels closes ever so slightly.

If you discover that you have prediabetes, research shows you should improve your diet, increase your activity, and lose a little weight (if you have excess weight to lose). Here are some proven ways to do just that.

Improve your diet

There is no “best” diet to stabilize and lower high blood sugar. Not keto. Not vegan. Not low carb. Not low fat. All those diets require willpower and deprivation, which work until you inevitably run out of willpower or rebel against deprivation. Rather, you should emphasize nutrient-dense foods that you enjoy—foods that keep you energized and satisfied, and that you can stick with. Nutrient-dense foods deliver high levels of nutrients and a relatively small amount of calories—like fruits, vegetables, whole grains, beans, nuts, seeds, lean meats, fish, and low-fat and nonfat dairy products. By eating more nutrient-dense foods, you’ll inevitably eat fewer foods that are less nutritious.

There is one category of food you should avoid: sugar-sweetened beverages, including soft drinks, fruit drinks, energy drinks, sports drinks, sweetened ice teas, and coffee beverages with added sugar or flavored syrups. Research links these beverages to insulin resistance, prediabetes, diabetes, and obesity (a leading risk factor for prediabetes and diabetes).

Plate method

To help you emphasize whole, nutrient-dense foods, use the plate method—one of the easiest, most flexible tools to help you build a wholesome meal:

  • Start with a 9-inch plate and draw an imaginary line down the middle. Fill one-half of the plate with non-starchy vegetables like broccoli, cabbage, tomatoes, carrots, or string beans.
  • Draw another imaginary line across the other half of your plate, so you have two sections equal to one-quarter plate. Put a protein-rich food like lean beef, salmon, black beans, or low-fat cottage cheese in one section.
  • Put a starchy food like corn, peas, quinoa, potato, or brown rice in the last section.

This method delivers variety and balance—the keystones of healthy eating. Eat three meals a day, and eat wholesome snacks—like an apple with peanut butter or hummus and whole-grain crackers—whenever you’re hungry.

Increase activity

Developing the habit of being active is more important than the immediate physical benefits of exercise because a habit will help you realize those benefits next month, next year, and all the years to come. If you enjoy walking, set aside at least five minutes every day rather than longer periods just two or three times weekly. A daily behavior is more likely to become a habit. Gradually increase the daily time you spend walking, until you’re walking about 20 to 30 minutes every day.

Ideally, you want three components of an exercise plan: aerobic (daily), muscle-strengthening (twice weekly), and flexibility (twice weekly). You could also add balance exercises twice weekly.

Use FITT principles to guide your routines: frequency (how often you will do a particular kind of exercise), intensity (how vigorously you will exercise), time (how many minutes you will perform the exercise), and type (what type of exercise you will do). For aerobic fitness, your FITT goals might look like this:

     F:       at least five times per week

     I:       at a moderate intensity (at this pace, you can hold a conversation)

     T:       for at least 10 minutes

     T:       walking.

As your fitness level improves, you can increase the frequency, intensity, and/or time.

Sleep deeply

Getting at least seven hours sleep a night is a must for good health—including healthy blood sugar levels. Sleep deprivation is a risk factor for obesity, which increases the risk of prediabetes and diabetes. Too little sleep and poor sleep also affect glucose metabolism, increasing insulin resistance. Some good ideas for getting sufficient and restful sleep:

Create a routine. Go to bed and wake up at approximately the same time each day, even on weekends.

Mind the light at night. Avoid light from TV, tablets, and computers shortly before bed. Keep your room dark for sleeping, too.

Cool off. Dial down the temperature to a cool 60 to 67º F.

Don’t fret. Instead of watching the clock, relax with deep breathing exercises or meditation.

Cut off the caffeine. Consuming caffeine six hours or less before bedtime can hinder good sleep.

Lose a little weight

Usually (but not always), prediabetes is accompanied by extra body fat. If you carry excess weight, losing even a few pounds can help. In one study, people at high risk for developing type 2 diabetes who lost just 5 percent of their body weight improved the function of their pancreas beta-cells and decreased insulin resistance.

Controlling portions (which automatically controls calories) is an excellent strategy for weight loss:

Use small dishes. Serve lunch and dinner on 9-inch plates. Ladle soups into cups that hold about 1 cup. Look for half-cup dishes for desserts.

Eat from a dish. No reaching into a bag or box.

Treat yourself to foods in single-serving portions. Skip the half-gallon containers of ice cream in favor of a small cone or cup.

Try a low-calorie, portion-controlled meal. Meal replacements and portion-controlled meals can help you relearn appropriate portions.

The Cause of Prediabetes

Prediabetes is a problem with insulin, the hormone that normally ushers blood sugar out of the bloodstream and into cells. In prediabetes, you might have insulin resistance—your cells don’t react normally to insulin, and blood sugar levels rise. Or you might have fewer insulin-producing beta cells of the pancreas, leading to impaired production of insulin and poor blood sugar control. (Research shows that people with prediabetes have lost about 30 percent of their beta cells.) Or you might have both. The result is slowly rising blood sugar levels—until prediabetes becomes diabetes.

Testing for Prediabetes

If you have one or more risk factors for prediabetes—like obesity or high blood pressure—you should ask your doctor to test your blood sugar levels. There are three tests for prediabetes and diabetes. If a test confirms higher-than-normal levels, your doctor will either repeat that same test or use a second type of test.

  • Fasting plasma glucose. Your blood glucose is measured first thing in the morning after having consumed nothing but water for eight to 12 hours. A result of 100 to 125 milligrams per deciliter (mg/dL) is prediabetes; 126 or higher is diabetes.
  • 2-hour oral glucose tolerance test. You consume nothing but water for eight to 12 hours, then drink a glucose-containing beverage, and your blood glucose is measured two hours later. A result of 140 to 199 mg/dL is prediabetes; 200 or higher is diabetes.
  • A1C. This test measures the percentage of blood glucose that is adhering to your hemoglobin molecules (a component of red blood cells). It is indicative of long-term blood glucose levels. A result of 5.7 to 6.4 percent is prediabetes; 6.5 percent or higher is diabetes.

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