Prediabetes: A Silent Warning Sign You Should Take Seriously

When Ms. K. went to her family doctor for a routine checkup, she expected a quick appointment and to hear, “Everything’s fine.” Instead, a short time later, she found herself sitting there with a lab report in her hand that listed a term she’d never heard before: prediabetes. Not diabetes, but no longer healthy either. A condition in between—a warning sign her body was sending her long before it had to develop into a serious illness.

This is more or less the situation for a great many people in Germany. Prediabetes affects about 20 percent of adults in Germany, and most of them are unaware of it. That’s exactly why it’s worth taking a closer look: What exactly is prediabetes, what are its symptoms, what risk factors are involved, and, most importantly, what can those affected do to prevent the progression to type 2 diabetes?

What exactly is prediabetes?

Prediabetes or the early stage of diabetes is a type of precursor to type 2 diabetes mellitus. Blood sugar levels are already elevated and are no longer within the normal range, but they do not yet meet the criteria for a classic diabetes diagnosis. You could say that the body is sending a warning signal before the actual disease sets in.

This is primarily caused by developing insulin resistance. Insulin is the hormone that ensures sugar is transported from the blood into the body’s cells, where it can be used as energy. If insulin no longer works properly, more sugar remains in the blood than there should be. The pancreas tries to compensate by producing even more insulin until it eventually reaches its limits. It is precisely at this point that the disease begins for many people affected.

How can you tell if you have prediabetes? The diagnosis

The tricky thing about prediabetes is that in most cases, it progresses without any noticeable symptoms. People with prediabetes often feel perfectly healthy, which is precisely why the condition is often discovered by chance during routine checkups, as was the case with Ms. K.

Nevertheless, there are possible symptoms to watch for: increased fatigue, a strong sensation of thirst, or difficulty concentrating. However, these signs are nonspecific. In most cases, a blood test is required to diagnose prediabetes with certainty.

When making a diagnosis, doctors generally rely on three values:

• Fasting blood sugar: A level above 100 mg/dl (equivalent to about 5.6 mmol/l) indicates prediabetes. A level of 126 mg/dl or higher—or about 7.0 mmol/l—is considered a diagnosis of diabetes.
• Impaired glucose tolerance: This is indicated by blood glucose levels above 140 mg/dl two hours after an oral glucose tolerance test. Levels of 199 mg/dl or higher (7.8 mmol/l according to international reference values) are already considered a warning sign of a significantly increased risk.
• Long-term blood sugar (HbA1c level): A level above 5.7 percent indicates prediabetes; a level of 6.5 percent or higher generally indicates a diagnosis of diabetes.

Who Is at Particular Risk? – An Overview of Risk Factors

Not everyone is at the same risk for type 2 diabetes. Researchers are actively investigating which factors contribute to the development of prediabetes. The most important risk factors include:

• Excess weight, especially abdominal fat: It promotes insulin resistance and is considered one of the strongest risk factors of all.
• Lack of exercise: People who don't get enough exercise risk a deterioration in their glucose metabolism.
• Unhealthy diet: Sugary drinks, in particular, cause blood sugar levels to rise rapidly and contribute to the development of prediabetes.
• Genetic predisposition: People with a family history of diabetes mellitus are at higher risk.
• Advancing age: The risk of prediabetes increases with age.
• Chronic stress: Long-term stress can disrupt blood sugar balance and contribute to prediabetes.

Another interesting finding from recent research is that scientists now speak of different subtypes of prediabetes, which differ in their progression and risk of complications. This analysis shows that prediabetes is not a uniform condition: men and women, young and older people, and those who are slim and those who are overweight can have very different starting points.

Prediabetes and Cardiovascular Diseases

When people are told they have “prediabetes,” their first thought is often simply that they have an increased risk of type 2 diabetes. But the condition has other, often underestimated consequences. Prediabetes significantly increases the risk of cardiovascular disease; over time, elevated blood sugar levels take a toll on the cardiovascular system, the blood vessels, and the entire metabolism.

Studies also show that prediabetes can increase the risk of chronic kidney disease. There is also a link to an increased risk of dementia and certain types of cancer is also being discussed in current research. This makes it clear: Prediabetes is not an isolated blood sugar problem, but a condition that affects the entire body and should be taken seriously, even if it seems harmless at first.

The good news: Prediabetes can often be prevented

As serious as these facts may sound, there is also some very encouraging news: In many cases, prediabetes can be prevented or even reversed through behavioral and lifestyle changes. The key lies in consistent changes that can be incorporated into daily life.

Weight loss as the most important lever

Even a weight loss of five to ten percent of body weight can noticeably improve glucose metabolism. For most people, this does not require a radical diet, but rather a realistic, long-term lifestyle change. Internists repeatedly emphasize that it is not rapid weight loss that counts, but sustainable weight loss.

Make Targeted Changes to Your Diet

A balanced, wholesome, varied diet has been shown to lower blood sugar levels in people with prediabetes. Foods rich in fiber, such as whole grains, legumes, and vegetables, cause blood sugar to rise slowly and are therefore much more beneficial than sugary drinks, which cause blood sugar to spike rapidly. Healthy fats, such as those found in fish and vegetable oils, also play an important role. Experts often recommend a Mediterranean diet for the prevention of type 2 diabetes: one that is rich in vegetables, fish, and olive oil, and low in processed foods.

Exercise as Daily Medicine

Regular physical activity lowers blood sugar levels in the short term and has a positive long-term effect on insulin sensitivity. At least 150 minutes of moderate physical activity per week is recommended; some professional organizations even suggest 150 to 300 minutes. Even a walk after a meal can noticeably reduce blood sugar spikes—a simple but effective strategy for everyday life.

Don't Underestimate Stress and Sleep

Stress reduction and adequate sleep help control blood sugar levels, yet these factors are often overlooked during counseling sessions. People who are constantly under stress or don’t get enough sleep make it even harder for their bodies to regulate blood sugar.

What specific steps can people with prediabetes take right now?

If you or someone close to you has been diagnosed with prediabetes, there’s no need to panic—but it’s a good time to take action. Some helpful first steps include:

1. Regular medical checkups to monitor blood sugar levels and keep track of changes.
2. Rethink your diet: more fiber, fewer sugary drinks, more healthy fats.
3. Incorporate physical activity into your daily routine, even in small ways, such as taking daily walks.
4. Keep an eye on your weight without putting pressure on yourself—even small changes can make a difference.
5. Reduce stress and make sure you get enough sleep.

The current state of research is encouraging: Prediabetes is not a foregone conclusion, but rather a stage in which there are still many options available. People who consistently make lifestyle changes can significantly reduce their risk of developing type 2 diabetes—and, as a result, their risk of complications such as cardiovascular disease.

You don't have to go down this path alone

A diagnosis like prediabetes often raises many questions: How do I change my diet? How can I manage to get more exercise when my daily schedule is already so full? And what does this actually mean for my life in the long run?

It is precisely during times of upheaval like these that support in everyday life can make all the difference. Whether it’s about finding more time for exercise and preparing healthy meals, or simply not having to handle everything on your own during a stressful period: We’re here for people who are starting to feel that their daily lives are becoming too much to handle.

That's exactly why we're here. Let's work together to find out what support you're entitled to.

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