Prediabetes is reversible. People who lose 5 to 7% of their body weight through diet and exercise cut their risk of developing type 2 diabetes by 58%, according to the CDC’s Diabetes Prevention Program. That’s 10 to 14 pounds for someone who weighs 200 pounds. The changes required aren’t extreme, but they do need to be consistent.
What Prediabetes Actually Means
Prediabetes means your blood sugar is higher than normal but not yet in the diabetic range. Three tests can identify it: an A1C between 5.7% and 6.4%, a fasting blood glucose of 100 to 125 mg/dL, or an oral glucose tolerance test result of 140 to 199 mg/dL. Any one of these results qualifies.
What’s happening inside your body is straightforward. Your cells are becoming less responsive to insulin, the hormone that moves sugar out of your blood and into your cells for energy. Your pancreas compensates by producing more insulin, but over time it can’t keep up. Without changes, roughly 15 to 30% of people with prediabetes develop type 2 diabetes within five years. The good news is that this process works in reverse: reduce the demand on your insulin system, and your blood sugar levels can return to normal.
Move for 150 Minutes a Week
The CDC recommends at least 150 minutes of moderate-intensity physical activity per week. That breaks down to about 30 minutes, five days a week. “Moderate intensity” means you can talk during the activity but not sing. Brisk walking counts. So does cycling, swimming, dancing, or yard work.
You don’t need to do all 30 minutes at once. Three 10-minute walks spread throughout the day produce similar benefits. What matters most is regularity. Exercise makes your muscle cells more sensitive to insulin for 24 to 48 hours afterward, so skipping several days in a row lets that effect fade. Adding strength-building exercises like bodyweight squats, resistance bands, or light weights helps further because muscle tissue uses more glucose at rest than fat tissue does.
Rethink Your Plate
You don’t need a specific “prediabetes diet.” The core principle is reducing the speed at which sugar enters your bloodstream after meals. That means prioritizing foods that digest slowly and pairing carbohydrates with protein, fat, or fiber.
Fiber is especially important. The Dietary Guidelines for Americans recommend 22 to 34 grams per day depending on age and sex, and most people get barely half that. Soluble fiber (found in oats, beans, lentils, apples, and flaxseed) dissolves in water and forms a gel in your stomach that slows digestion, helping control blood sugar spikes. Insoluble fiber (found in whole grains, vegetables, and nuts) increases insulin sensitivity. Both types matter, and the easiest way to get more of each is to eat more vegetables, legumes, and whole grains while cutting back on refined carbohydrates like white bread, sugary cereals, and packaged snacks.
A few practical shifts that make a real difference: swap white rice for brown rice or cauliflower rice, choose whole fruit over fruit juice, eat a handful of nuts with your afternoon snack instead of crackers, and start lunch or dinner with a salad or vegetable soup. These aren’t dramatic changes, but they add up to meaningfully lower blood sugar over weeks and months.
Aim for 5 to 7% Weight Loss
You don’t need to reach an ideal body weight. The Diabetes Prevention Program research found that modest weight loss of 5 to 7% was enough to cut diabetes risk by more than half. For someone at 180 pounds, that’s 9 to 13 pounds. For someone at 250 pounds, it’s 12 to 18 pounds.
The method of weight loss matters less than the result. Calorie tracking, portion control, meal planning, or structured programs like the CDC’s National Diabetes Prevention Program all work. The DPP lifestyle-change program is available in person, online, and through many insurance plans. It pairs a trained coach with a year-long curriculum focused on building sustainable habits rather than short-term dieting.
Sleep Changes Your Blood Sugar Directly
Sleep is one of the most overlooked factors in blood sugar management. A Columbia University study found that cutting sleep by just 90 minutes per night for six weeks increased fasting insulin levels by over 12% and raised insulin resistance by nearly 15%. Among postmenopausal women, insulin resistance jumped by more than 20%. These effects occurred independently of body fat changes, meaning poor sleep disrupts your metabolism even if your weight stays the same.
The recommended range for adults is seven to nine hours per night. If you’re consistently sleeping six hours or less, improving your sleep may lower your blood sugar as meaningfully as dietary changes. Practical steps include keeping a consistent bedtime, limiting screens for an hour before bed, avoiding caffeine after early afternoon, and keeping your bedroom cool and dark. Over a longer period, ongoing stress on insulin-producing cells from chronic sleep loss can cause them to fail, accelerating the path toward diabetes.
What to Know About Alcohol
Moderate alcohol consumption (one drink per day for women, up to two for men) may actually improve blood sugar management and insulin sensitivity. Some people find their A1C is slightly lower during periods of moderate drinking. But more than three drinks per day has the opposite effect, leading to higher blood glucose and a rising A1C.
There’s a less obvious risk worth understanding. Your liver prioritizes metabolizing alcohol over regulating blood sugar. If you’re taking any glucose-lowering medications, this can cause blood sugar to drop too low hours after your last drink, especially if you’ve been exercising. The symptoms of low blood sugar, including slurred speech, drowsiness, and confusion, look a lot like intoxication, making them easy to miss.
When Medication Enters the Picture
Lifestyle changes are the first-line treatment for prediabetes, but some people benefit from medication alongside those changes. The 2025 ADA guidelines recommend considering metformin for adults ages 25 to 59 with a BMI over 35, a fasting glucose above 110 mg/dL, or an A1C above 6%. Women who had gestational diabetes are also candidates. Metformin works by reducing the amount of sugar your liver releases into your blood and making your cells more responsive to insulin.
Medication isn’t a substitute for lifestyle changes. It works best in combination with the diet, exercise, and sleep improvements described above. If your doctor prescribes it, the goal is still the same: bring your blood sugar back into the normal range and keep it there.
Tracking Your Progress
An A1C test is the most useful way to monitor prediabetes over time because it reflects your average blood sugar over the past two to three months rather than a single moment. Most providers will recheck your A1C at least once a year, though your doctor may test more frequently if your numbers are near the upper end of the prediabetes range or if you’ve recently made significant changes.
A home glucose meter isn’t required for most people with prediabetes, but it can be useful if you want to see how specific meals affect your blood sugar. Testing before a meal and then two hours after gives you direct feedback on which foods cause the biggest spikes. Over time, you’ll build an intuitive sense of which meals keep your blood sugar stable and which ones don’t, making it easier to stick with the changes that matter most.