Prediabetes: What to Do and How to Eat Right

Dr. Boris Wydoff

If your blood tests show elevated blood sugar, the first thing to check is three key indicators: fasting blood glucose, glycated hemoglobin (HbA1c), and, if necessary, the results of an oral glucose tolerance test. These tests help identify prediabetes and assess problems with carbohydrate metabolism.

At the same time, take a fresh look at your daily diet. Cut back on candy, sugary drinks, white bread, pastries, and foods with added sugar. Include vegetables, legumes, whole grains, and suitable sources of protein in your meals.

Start walking regularly and gradually increase your physical activity. The sooner you begin changing your everyday habits, the more opportunities you have to improve your future health.

What Is Prediabetes and Why Does It Develop?

Prediabetes is a condition in which blood glucose levels are elevated but not yet high enough for a diagnosis of diabetes. It is a warning sign: your body is already having difficulty regulating blood sugar. This condition is associated with an increased risk of developing type 2 diabetes in the future.

One of the main causes is a change in how insulin works. This hormone helps glucose move from the bloodstream into cells, where it is used as a source of energy. If insulin does not work effectively enough or the body does not produce sufficient amounts, blood sugar levels can rise.

Several factors can increase the risk of carbohydrate metabolism problems:

• family history;
• excess body weight;
• insufficient physical activity;
• high blood pressure;
• age over 40.

It is especially important to pay attention to your health if a parent, brother, or sister has already been diagnosed with type 2 diabetes. A family history increases the likelihood of problems with carbohydrate metabolism. That is why regular testing is an important part of looking after yourself.

Prediabetes does not mean that a person will inevitably develop diabetes. It is a condition in which changes to diet, physical activity, and other everyday habits become particularly important.

What Are the Symptoms of Prediabetes?

Prediabetes often develops without noticeable symptoms. You may feel perfectly fine, carry on with your usual life, and have no idea that your carbohydrate metabolism has changed. That is why it can be difficult to identify the problem based on how you feel alone.

Sometimes people experience increased fatigue, thirst, and more frequent urination. Some also notice blurred vision or that minor skin injuries take longer to heal. However, these symptoms are more typical of type 2 diabetes that has already developed.

Fatigue can accompany problems with glucose metabolism. But it can also result from insufficient sleep, stress, and other causes. Increased thirst and frequent urination also deserve attention, especially when they occur together.

There is one important point: prediabetes is often discovered by chance during routine laboratory testing. A person may have blood tests for an unrelated reason, only to find changes in their glucose levels in the results.

That is why people over 40, especially those with a family history, excess weight, or a sedentary lifestyle, should keep an eye on their carbohydrate metabolism.

What Blood Sugar Levels and Tests Should You Check?

The main question after discovering elevated blood sugar is whether carbohydrate metabolism is actually impaired and how significant the changes are. Several laboratory tests are used to investigate this.

1. Fasting blood glucose.

This test measures your blood sugar after a period without food. It helps identify problems with glucose regulation. The result is interpreted according to the conditions under which the blood was collected and the relevant laboratory criteria.

2. Glycated hemoglobin (HbA1c).

This indicator reflects your average blood glucose level over a preceding period. Unlike a standard blood sugar measurement, it provides information about your body's condition beyond the actual day of testing.

3. Oral glucose tolerance test.

This test shows how your body handles an intake of glucose. It is prescribed when a more detailed assessment of carbohydrate metabolism is needed.

What blood sugar level indicates prediabetes? There is no single value that can be applied equally to every laboratory test and situation. The interpretation depends on the testing method, the conditions under which the test is performed, and the medical criteria used.

If one indicator is elevated, a healthcare professional will compare it with your other results and may recommend repeating the test. This helps distinguish prediabetes from diabetes and determine what to do next.

Do not rely exclusively on a single reading from a home glucose meter. A full assessment is based on laboratory tests, which provide a more complete picture of your carbohydrate metabolism.

What Can You Eat With Prediabetes, and What Should You Avoid?

Your diet with prediabetes should be regular, varied, and well planned. Pay particular attention to the amount of added sugar, the quality of carbohydrates, and how heavily foods are processed. Your everyday menu can include several food groups:

• vegetables and greens: cabbage, cucumbers, tomatoes, zucchini, and leafy greens;
• legumes: beans, lentils, and other familiar varieties;
• whole fruits: apples and other fruits instead of sugary drinks;
• whole grains and whole-grain products;
• nuts and seeds;
• suitable sources of protein;
• water and unsweetened drinks.

How Should You Distribute Foods Throughout the Day?

For breakfast, you can prepare porridge made from whole grains and add a suitable source of protein. Instead of sweetened yogurt or pastries, choose foods without added sugar.

For lunch, include vegetables, a legume dish or another source of protein, and a grain-based side. This combination helps keep your menu varied without limiting your meals to vegetable dishes alone.

For dinner, vegetables with a protein-rich food are a good choice. You can add grains or legumes, taking your overall daily diet into account. Whole fruits or a small portion of nuts make suitable snacks.

It is important not to turn snacking into a constant habit of eating cookies, candy, and sugary drinks. The exact portions of each food should take into account your individual needs, body weight, usual diet, and any other health conditions. One standard portion size does not suit everyone with prediabetes.

Prediabetes: What Foods Should You Avoid?

First of all, cut back on:

• candy, chocolate bars, and cakes;
• sweet pastries and cookies;
• carbonated soft drinks;
• packaged juices and sugary drinks;
• sweetened yogurts;
• foods containing large amounts of added sugar;
• white bread and products made from refined flour.

Ready-made sauces and products that appear healthy because of their attractive packaging deserve special attention. It is useful to read food labels when shopping. Sugar can be listed under names such as glucose syrup, fructose, and dextrose.

Do not assume that special diet sweets are automatically a suitable replacement for regular desserts. They may also contain significant amounts of sugars and other ingredients that need to be taken into account. At the same time, prediabetes does not mean giving up carbohydrates completely. Grains, legumes, fruits, and vegetables provide different nutrients and can remain part of a varied diet.

How Can You Change Your Lifestyle to Reduce Your Risk of Diabetes?

Simply giving up sweets is not enough if the rest of your daily life remains sedentary. Physical activity helps your body use glucose. That is why movement is an important part of preventing type 2 diabetes.

Start With Walking.

Regular walks are an accessible way to gradually increase your physical activity. Choose a comfortable pace that allows you to talk without experiencing excessive shortness of breath.

Start with a duration you can manage without becoming excessively tired. Gradually increase the time you spend walking. Try to walk more often when running everyday errands, take a walk after sitting for long periods, and avoid spending the entire day without moving. Consistency is more important than occasional intense workouts.

Keep an Eye on Your Body Weight.

If your body weight is above the recommended range, pay attention to your usual portion sizes, how often you snack, and the composition of your meals. Start by reducing sweets, white flour, and processed foods. There is no need to fast or drastically restrict your diet.

Establish a Healthy Sleep Routine.

Constant lack of sleep, a stressful work schedule, and insufficient rest can make it harder to maintain a healthy routine. Try to make time for recovery and follow a more consistent daily schedule.

Combine Physical Activity With Dietary Changes.

Do not expect one walk to make up for drinking sugary beverages and eating pastries every day. Results come from several habits working together: your diet, physical activity, body weight management, and adequate rest.

My Advice: My Approach to Eating With Prediabetes

Over the years of my practice, I have come to the conclusion that it is better to start making dietary changes with specific steps rather than strict diets. With prediabetes, I recommend paying attention to three food groups first: sugar, white flour, and processed foods. I consider reducing these the starting point of my approach.

First — Eliminate Added Sugar and Foods That Hide It.

I am talking not only about candy, cakes, and sweet pastries, but also sweetened yogurts, ready-made sauces, soda, and packaged juices. In my books, I specifically warn that syrups and "diet" sweets do not become healthy alternatives to sugar simply because of their labels.

Read food labels. Fructose, dextrose, and glucose syrup are also sources of sugar. I believe this is the most sensible place to start when reviewing your diet.

Do not buy sweets automatically out of habit. First, check the ingredients and consider whether the product really needs to be part of your daily menu.

Second — Remove White Flour From Your Everyday Diet.

I consider white bread, rolls, pasta made from soft wheat varieties, and cookies to be foods that should not form the foundation of your diet. In my system, I associate excess white flour and sugar with what I call a "fermentation environment." In my view, this is where bloating and heaviness originate.

This is my naturopathic interpretation, not an established medical mechanism of prediabetes. Doctors explain the particular attention paid to flour-based products primarily in terms of their refined carbohydrate content and their effect on blood glucose levels.

I suggest gradually reviewing your usual food choices. Choose whole-grain alternatives more often instead of white bread, and whole fruits instead of sweet pastries. This makes your diet more varied while reducing the amount of familiar sugary and flour-based foods.

Third — Reduce Processed Foods.

I recommend removing sausages, hot dogs, smoked meats, fast food, and chips from your daily menu. In my books, I group these foods together with sugar and white flour as three categories that I suggest eliminating first.

In my experience, there is no need to try to change everything in one day. What matters much more is consistently establishing new habits. One useful practical step is simply not to buy these products for your home. When your usual processed-food snacks are not within easy reach, it becomes easier to choose vegetables, legumes, and other foods that support a balanced diet.

Fourth — Pay Attention to Food Combinations and Your Drinking Habits.

In my dietary system, I follow a food-combining approach: I pair protein-rich foods with vegetables and recommend eating fruit separately. I also advise drinking water before meals rather than replacing it with sugary beverages during meals.

I consider this routine part of the overall organization of your diet. These are features of my naturopathic system, not generally accepted medical requirements for people with prediabetes.

I do not recommend turning these changes into a short-term restrictive diet. Start by gradually reviewing your usual menu: less sugar, white flour, and processed foods, and more attention to the composition of your meals. Taking things step by step makes it easier to turn new habits into part of everyday life.

When to See a Doctor

If you suspect problems with carbohydrate metabolism, it is important to distinguish routine checkups from situations that require urgent medical attention.

When to Call Emergency Services

If you develop chest pain that spreads to your arm, call emergency services immediately. Do not mistake this for ordinary heartburn, wait for it to improve on its own, or try to manage it by changing your diet. Chest pain that spreads to the arm may be a sign of a dangerous heart condition that requires an emergency medical assessment.

Emergency assistance is also necessary if you lose consciousness, experience severe confusion, or have a sudden deterioration in your condition. Do not try to explain away such symptoms as prediabetes.

When to Schedule a Routine Doctor's Appointment

See a primary care doctor or endocrinologist if your blood tests show elevated glucose or you suspect that you have problems with carbohydrate metabolism. It is especially important to get checked if close relatives have type 2 diabetes or if you have excess weight, a sedentary lifestyle, or high blood pressure.

Do not delay a consultation if you experience persistent thirst, frequent urination, unexplained weight loss, or severe fatigue. These signs can occur with diabetes and need to be investigated.

Even if you have no symptoms, you should get tested if you have risk factors. Prediabetes is often discovered during routine screening, when a person has not yet noticed any changes.

If the diagnosis has already been confirmed, your doctor will determine which tests are needed, assess your individual risks, and prescribe treatment if necessary. Dietary changes and physical activity complement medical care; they do not replace prescribed medication.

Find out more about how I approach this subject on the "Diabetes" page.

Boris Wydoff — naturopath and author, Ph.D. in nutrition. For over fifty years I have helped people restore health through nutrition, cleansing and the power of the mind — in Europe, America and Asia. About the author →

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