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Diabetes is a condition that occurs when the body isn’t able to turn sugar (glucose) into energy, a natural process involving the hormone insulin. It affects more than 29 million Americans.

For people with diabetes, their bodies either don’t make enough insulin or don’t use insulin properly. Glucose is not moved into the cells normally, and this causes an increase in blood glucose levels.

Over time, if untreated, this can cause more serious problems. Because diabetes can become a serious health-related sickness, it’s important to stay educated on the various symptoms and stages of disease. Pre-diabetes may be a wake-up call to alert you that you’re on the path to diabetes. It’s certainly not too late to turn things around.

It’s reported that one in three adults in the U.S. has pre-diabetes. According to the Center for Disease Control and Prevention (CDC), it increases your risk for a heart attack, stroke, or developing type 2 diabetes. Without treatment, nearly 30% of people with pre-diabetes will develop type 2 diabetes within five years.

Three Common Types of Diabetes

Type 1 diabetes is most common in children and young adults. With this type, the pancreas doesn’t make insulin.

Type 2 diabetes is the most common type. It develops when the body doesn’t produce enough insulin or the cells ignore the insulin.

The third type of diabetes is gestational and can develop in women as a result of hormonal changes during pregnancy. Gestational diabetes typically disappears after pregnancy; however, these women are at risk for developing type 2 diabetes.

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Pre-diabetes is the stage right before a person develops type 2 diabetes when blood glucose levels are higher than normal, but not yet high enough to diagnose the person with diabetes.

Although there are no clear symptoms of pre-diabetes, there are some risk factors to be aware of. While a pre-diabetic’s blood sugar is not as high as someone with type 2 diabetes, they do share the same risk factors, such as:

  • Weight. This is a primary risk factor. The more fatty tissue you have, the more resistant your cells become to insulin.
  • Family history and genetics. Your risk of pre-diabetes increases if you have a parent or sibling with type 2 diabetes.
  • Waist size. A larger waist size can indicate insulin resistance. The risk goes up for men with waists larger than 40 inches and for women with waists larger than 35 inches.
  • Diet and nutrition. Eating red, processed meat and drinking sugar-sweetened beverages increase the risk. A diet high in fruits, vegetables, nuts, whole grains, and olive oil lowers your risk.
  • Inactivity. Physical activity helps you control your weight, uses glucose as energy, and makes your cells more sensitive to insulin. Simply walking more combats this risk factor.
  • Age. Although diabetes can develop at any age, the risk of pre-diabetes increases after age 45. This may be because people as they age tend to exercise less, lose muscle mass, and gain weight.
  • Race. Certain races have a higher risk of developing the disease. They include Black Americans, Hispanics, Native Americans, Asian-Americans, and Pacific Islanders.
  • High blood pressure
  • Gestational diabetes. If your baby weighed more than 9 pounds at birth or you had gestational diabetes while pregnant, you’re at increased risk.
  • Polycystic ovary syndrome. This common condition increases women’s risk of pre-diabetes.
  • Sleep. Certain sleep disorders (such as sleep apnea) increases the risk of insulin resistance. Those who have jobs with changing shifts or night shifts may also have an increased risk of pre-diabetes or type 2 diabetes.

Diabetes Diagnosis

If your doctor determines that you are at risk for diabetes, there are a number of tests that they may order to confirm the diagnosis. The American Diabetes Association (ADA) recommends that screenings for adults begin at age 45. If a person is overweight and has additional risk factors, they should start earlier.


This test measures your average blood glucose level over the previous two or three months. The test measures the percentage of blood sugar attached to proteins in red blood cells (hemoglobin). The higher your blood sugar levels, the more hemoglobin you’ll have with sugar attached.

The results are given in percentages:

  • Normal is less than 5.7%.
  • Pre-diabetes is 5.7 to 6.4%.
  • Diabetes is anything higher than 6.5%.

Unlike other tests, the A1C does not involve fasting from food or drinks.

Fasting Plasma Glucose (FPG)

The fasting plasma glucose screen checks your blood glucose levels after not eating or drinking anything other than water for the previous eight hours.

These scores are presented in terms of milligrams per deciliter:

  • Normal results are less than 100mg/dl.
  • Pre-diabetes is 100 mg/dl to 125 mg/dl.
  • Diabetes is diagnosed over 126 mg/dl.

Oral Glucose Tolerance Test (OGTT)

The third common test option is the oral glucose tolerance test. This two-hour test checks your blood glucose levels before and two hours after you consume the provided drink. The results of this test will indicate how your body processes glucose.

The results of this test are also given in milligrams per deciliter:

  • Normal is considered less than 140 mg/dl.
  • Pre-diabetes ranges from 140 to 199 mg/dl.
  • The diabetes range is anything higher than 200 mg/dl.

Preventing Type 2 Diabetes

It’s important to note that being told you have pre-diabetes does not necessarily indicate that you will be diagnosed with diabetes. There are a number of lifestyle changes that your doctor may recommend to help delay or reverse the course of diabetes, such as:

  • Eating more fiber and less sugary, refined carbohydrates and fats.
  • Quitting smoking.
  • Increasing physical activity to one hour or more each day.
  • Losing 10 to 15 pounds if overweight.

The first step to becoming healthier is introducing a smart diet paired with a variety of physical activities. By transforming the way you eat and exercise, you have the ability to bring your blood sugar level back to normal.

Discuss any supplements or alternative therapies with your physician prior to use. Some could be harmful and interfere with other prescribed medications.

The American Diabetes Association offers an interactive questionnaire that can help determine if you are at risk, or in the pre-diabetic stage. The questions ask about age, gender, family history, height, and activity level. It’s important to remember not to panic, as there is good news that comes with the diagnosis of pre-diabetes. This can be an opportunity for you to improve your overall health, as the progression from pre-diabetes to type 2 diabetes is avoidable if handled correctly.

To discuss your risk for developing diabetes, contact your primary care physician.

The UPMC Centers for Diabetes Education and Support offer educational sessions and events for people with diabetes. Find events near you.

About Endocrinology

The UPMC Department of Endocrinology stands as a national leader in research of diabetes and endocrine conditions. We partner with the University of Pittsburgh Division of Endocrinology and Metabolism for research and clinical trials. We treat diabetes, obesity, osteoporosis, hormonal disorders, and thyroid disorders at several locations across our communities. We also have specialized Diabetes Centers to help you manage your disease. Find an expert near you.