Prediabetes is the strange in-between place where your blood sugar is too high to be normal, but not yet high enough to be diabetes.
The trouble is, it usually feels like nothing. No pain. No obvious symptom. No moment that pushes you to book a doctor's visit.
That's why most people in this grey zone don't know they're there. And it matters, because prediabetes isn't a waiting room for diabetes — it's a reversible state. Most people who reach it have years in which a modest shift in habits can close the door entirely. But you can only act on information you have.
The grey zone
The simple way to think about it: your body still produces insulin, but your cells have started to ignore it. The pancreas compensates by pumping out more, and for a while everything looks fine on the outside. Behind the scenes, your insulin-producing cells are quietly tiring out.
The blood test that catches it is called HbA1c — it measures your average blood sugar over the past three months. One number, no fasting needed, takes ten minutes at the doctor's. That's the single most useful piece of metabolic information you can have about yourself.
Three signs the body sometimes gives
Prediabetes is usually silent. But there are quiet signs your body sometimes shows — worth knowing how to spot.
Dark, velvety patches in skin folds. The back of the neck, armpits, groin, sometimes the knuckles. It looks a bit like sun damage or "the skin won't clean," but it's actually high insulin telling the skin cells to multiply. It's the most specific physical sign of insulin resistance there is.
Tired after meals. Disproportionate to what you ate, hard to push through, drags you toward the sofa. Lots of things cause fatigue, but a consistent post-meal slump is worth mentioning.
Thirst and frequent bathroom trips. Classic diabetes signs. At prediabetes levels they're usually not there yet — when they appear, you've crossed a line and need testing now.
Who should ask for the test
Risk isn't evenly spread. The strongest predictors:
- Family history of type 2 diabetes (parent, sibling)
- Age over 40 — earlier in South Asian, Black, and other minority ethnic groups
- Carrying weight around the middle
- History of diabetes during pregnancy
- Polycystic ovary syndrome (PCOS)
- Long-term steroid medication
If two or more of these apply to you, ask your doctor for an HbA1c test. Most will say yes on the spot. If you've never had a metabolic screen and you're over 40, booking one is the single most efficient action you can take for your future health.
If the result comes back high
A prediabetes result is not the beginning of the end. It's an early warning, caught before any damage starts. Most cases reverse with three small habits, in this order:
- A 10-minute walk after meals. Specifically after eating. The evidence here is unusually strong — it blunts the post-meal glucose spike more than most other interventions.
- Better carbs, not fewer carbs. Whole grains, beans, vegetables instead of white bread and ultra-processed snacks. No starvation diets needed.
- Sleep first. Less than six hours a night for weeks at a time worsens insulin sensitivity. Most people skip this one.
The window between prediabetes and type 2 diabetes is real, and it's wider than most people realise. But it only opens once you know it's there.
Curiosity first. — Dr. Brugal