Reversing Prediabetes Through Proactive Nutrition & Health

Dr Jedha, Host

Hello there, Dr Jedha here and welcome to episode 32. 

All across the podcast episodes we always include prediabetes, because the information shared is relevant to both type 2 diabetes and prediabetes. But,  in this episode we’re going to dive deeper into PREdiabetes specifically. We’ll chat about the development and causes of prediabetes, risk factors and diagnosis; along with sharing the ways in which you can turn your prediabetes around in the opposite direction – and I’ll be sharing one of our members stories – Cheryl – to demonstrate just what’s possible, so I’m sure you will find that very inspiring. We’ll also be covering a few questions sent in by Tammy, Sue, Margret and Marsha, all focused on prediabetes as well. 

Dr Jedha, Host, 1:53

So here’s the thing, diabetes happens on a spectrum over time and prediabetes marks an early stage of losing blood glucose control. It’s when your blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. 

Think of prediabetes as a red flag or a warning light, signaling that it’s time to take action before things get worse. And that’s the good news, you don’t have a diagnosis of diabetes, so it’s a great opportunity to get proactive because we know in many cases you can reset your blood sugar balance and metabolism back to normal. You can reverse your prediabetes. 

Unfortunately, there are usually no symptoms associated with prediabetes, which is why it can go undiagnosed for a long time, sometimes a decade. But there are certain risk factors that increase your odds of developing prediabetes. Many of these are similar to type 2 diabetes, because as we just covered, diabetes happens on a spectrum over time. 

Age is a big one—all of our chances of prediabetes increase once we hit 45 or older. Weight also plays a crucial role; being overweight significantly raises the risk. Having high blood pressure or cholesterol could indicate something is off with your metabolic system. Other factors include a family history of diabetes, leading a sedentary lifestyle, ethnicity – people of Asian, African, Hispanic, Indian, or Pacific Island descent are at greater risk than Caucasian, a prior history of gestational diabetes, polycystic ovarian syndrome and even sleep problems put you at higher risk. 

Over 45, we really need to have regular check ups, and that includes blood tests, because this gives us the best indicators of our overall metabolic health and importantly, our blood glucose control, which is how you know you’re in this prediabetes stage – and for many people we know the diagnosis often comes as a shock. It’s often when people are having tests for something else, that they find out they have prediabetes or type 2 diabetes. Or if the doctor thinks you have certain risk factors they may order the blood tests required.

Dr Jedha, Host, 4:41

There are two main tests that doctors use to diagnose prediabetes. First, there’s the fasting blood glucose test, which measures your blood sugar after an overnight fast. If your results are between 100 to 125 mg/dL or 5.6 to 6.9 mmol/L, that’s a sign of prediabetes.

The second test is the HbA1c test, which gives us a snapshot of your average blood sugar levels over the past three months. An A1c between 5.7% and 6.4% falls into the prediabetes range; or if you’re in Canada, the UK or Australia, prediabetes A1c levels between 6.0 and 6.4 will likely indicate prediabetes. Yes, it is confusing that there are two different A1c levels depending where you’re located, but unfortunately that’s the way it is!

Dr Jedha, Host, 5:46

Now, you might be wondering, why do we lose blood sugar balance in the first place. It all comes down to the hormone insulin, which is produced by an organ called the pancreas. I covered the Insulin diabetes Connection in episode 26, but just briefly let’s go over this again here. Insulin acts as a ‘key’ to unlock cells in the body, so that glucose (sugar) can move out of the bloodstream and into the cells. What happens in prediabetes, is the key starts to falter, it’s no longer able to open the lock every time. This is called insulin resistance. 

During prediabetes, the pancreas is often overworking, producing higher amounts of insulin to try to get blood glucose levels lower. And unfortunately, the combination of higher glucose and insulin in the bloodstream causes the body’s cells to become more resistant to the insulin – meaning, though the pancreas is pumping more insulin, your cells are still not responding effectively, they are insulin resistant. If glucose can’t get out of the bloodstream effectively, then obviously your blood glucose levels rise, hence the development of prediabetes or type 2 diabetes. Lots of things can contribute to the development of insulin resistance – including those risk factors we just covered genetic factors, lifestyle factors, hormonal factors, age, and environmental factors. The key is to be proactive in the areas we can, prediabetes is an opportunity to really take care of yourself.

Unfortunately though, even when people know they have prediabetes, we’ve seen that many people don’t take it seriously until they start experiencing pain or discomfort of some kind – like tingling in the hands and feet, for example. That’s an indication of complications developing and you don’t want that to happen and that’s the thing: prediabetes isn’t just a risk factor for developing type 2 diabetes; it’s also linked to other serious health issues. If not addressed, it can lead to heart disease, stroke, and even kidney damage over time – it is the time when your risk of developing complications also happens. So this stage in your health is a critical moment where the choices you make can literally change the course of your life.

Dr Jedha, Host, 8:46

Prediabetes is a great opportunity to get proactive. The sooner you take action, the greater your chances of resetting your blood sugar balance and metabolism back to normal. 

Take Cheryl, one of our members as an example. Getting the diagnosis of prediabetes actually changed her life for the better, because that’s how she found us at DMP. After joining us, Cheryl first got her A1c down from 6.1 to 5.6, then over a year or so, she managed to keep her A1c down under 5.7% so her doctor took her off all medications, in this case metformin, which is the most commonly prescribed drug for prediabetes. Cheryl also lost 21 pounds of stubborn weight she thought she could never lose – that’s 9.5 kg for our metric listeners. And all her other numbers normalized – cholesterol and blood pressure. Cheryl reset her blood sugar balance and metabolism back to normal. Essentially Cheryl reversed her prediabetes. 

We’ve seen this happen many times among our members. So let’s talk about some daily habits that can make all the difference with your prediabetes, starting with your diet. 

Dr Jedha, Host, 9:48

Your primary treatment strategy in resetting your prediabetes health is diet and nutrition. That’s how Cheryl managed to reverse her prediabetes, it was all by using our nutrition programs, meal plans, and food guides and receiving our ongoing support. Like diabetes, a key nutrient of focus for prediabetes is carbohydrates. Certainly one key daily habit to focus on is reducing your sugar intake. Check food labels and choose items with minimal added sugar and steer clear of those high in added sugar, and that includes sugary drinks as well. But it isn’t just about cutting back on sugar but about understanding and managing all types of carbohydrates that affect your blood sugar. You really need to understand all the different types, and that’s the kind of stuff we delve right into with our members. As I’ve spoken about in episode 20 on macronutrients, ideally you want to aim below 20% of your daily calories from carbs, so a range of 50-100 grams a day. But again, that doesn’t mean eating 100 grams of sugar or high carb starchy pasta – that’s not going to help reset your prediabetes. You have to focus on quality nutrient dense carbohydrates, like vegetables, fruit, beans, legumes and dairy products – so choosing more of those types of foods on a daily basis is a good habit to get into. 

Fiber is your friend. Aim for foods higher in fiber as these have a lesser impact on blood sugar spikes, not to mention the benefits fiber has for nurturing our gut health and keeping us regular too, which is important. 

Protein is paramount. We need it for so many important physical functions, and as we age, our protein requirements increase – we need it for preserving muscle mass, among other things. A good daily habit for meal planning is to plan meals around protein sources – make sure there is good quality protein in every meal. For example, a breakfast might include eggs with spinach and mushrooms, and feta or goats cheese, lunch could be a salad with grilled marinated chicken and a tasty salad topped with avocado, and dinner could be salmon or beef with a delicious veggie side dish. Snacks can include nuts, seeds, or protein-rich yogurt.

As a daily habit, it’s about making smarter food choices that not only help reset your blood sugar balance and metabolism but also contribute to an overall healthier lifestyle. You will feel much better by choosing healthy foods – healthy foods literally make us shine from the inside out. 

Dr Jedha, Host, 13:10

Alongside dietary changes, there are other daily lifestyle habits that can significantly impact your prediabetes health. 

Physical activity—exercise plays a vital role in controlling blood sugar levels. Regular physical activity helps your body use insulin more efficiently, and it doesn’t have to be high intensity to be effective. Studies have shown that even moderate exercise, such as brisk walking for 30 minutes a day, can help improve blood sugar control and prevent the progression from prediabetes to type 2 diabetes. For those who can, incorporating a mix of aerobic activities, resistance training, and flexibility exercises, like yoga – variety is the best way to get a wide range of benefits. And the message is this: do what you can and do a bit more activity every day. It can take a bit to get into a habit, but doing something daily is important. 

Consistent, quality sleep is another pillar of good health, particularly when it comes to managing blood sugar levels. Research indicates that poor sleep patterns can disrupt insulin secretion and glucose metabolism, increasing the risk of type 2 diabetes. Aim for 7 to 8 hours of sleep per night. To improve your sleep quality, maintain a regular sleep schedule, create a relaxing bedtime routine, and make your bedroom conducive to sleep—think cool, quiet, dark and comfortable.

Stress management is equally important. Chronic stress can trigger the release of hormones like cortisol, which can spike your blood sugar levels. To manage stress effectively, consider practices such as yoga, mindfulness, meditation, or deep-breathing exercises. These techniques not only help reduce stress but also improve your overall mental health, making it easier to stick to your health goals. 

All of these lifestyle habits do not replace the daily diet and nutrition habits we discussed but rather enhance them. By combining these approaches—diet, exercise, sleep, and stress management—you create a holistic plan that tackles prediabetes from all angles. And trust me, by taking small steps across these various things, you are going to feel amazing in no time at all. 

Dr Jedha, Host, 16:21

Now that we’ve covered all that, we’re going to do a Q&A, covering questions submitted by our members and subscribers. 

First up we’ve got something from Tammy Said: 

I was diagnosed with prediabetes two weeks ago and put on metformin and it has given me an awful cough. I have lost my sense of taste. Also, it gives me a low grade fever and heart palpitations.

Tammy, please book an appointment to see your doctor as the medication is clearly giving you concerning side effects. Anytime you are prescribed medication, or even if you’ve been taking it a while, please be aware that all medications can induce side effects, so for any concern, any concern, it’s really important to see your doctor as soon as possible. 

Next up, something from Sue, she said:

I am a 67 year old woman. I have been prediabetic for many years. My A1c ranges between 6.1 to 6.3. I recently started 500mg of metformin since my last test was 6.8. After 3 months I got it back down to 6.5. My post meal is still high at times and wondering if 6.5 is an acceptable range or should I increase the metformin. 

Hi Sue, if you have prediabetes with an A1c of 6.5 you are on the verge of a type 2 diabetes diagnosis. As we shared before, A1c levels up to 6.4% are prediabetes, and usually anything over that will be diagnosed as type 2 diabetes, so right now you’re really on the borderline of getting that type 2 diabetes diagnosis. You can certainly get this down though. The thing is, It’s best to avoid increasing medications and I think you are asking the wrong question. You said your post meal levels are still high – then that’s what you should be working on as this will lower your A1c. The goal is to aim for an A1c under 6%, or even better, under 5.7% and with some diet and nutrition changes you should easily be able to do that. And as I said, focusing on the post meal levels is important and can help you lower your A1c so you won’t have to increase your metformin dosage. Listen to episode 11 where we talked about Normal blood sugar ranges and goals for type 2 diabetes and prediabetes. It really gives a lot of info on where to focus your attention so you can get better A1c results.

Margret said: 

It is a challenge to eat foods that will not raise your blood sugar and exercise to help the balance between carbs/and other foods. I do the best I can. I also have to monitor high blood pressure and cholesterol. These conditions do not make the prediabetes easy to manage. If you can make any suggestions to maintain a healthy balance with all of these conditions in mind, that would be most helpful.

Okay, it’s interesting because people often think that managing these conditions requires a completely different eating approach. But an eating plan to achieve better blood sugar also applies to achieving better blood pressure and cholesterol. The thing is, all of these conditions are a result of the same thing, metabolic imbalance. And in fact, insulin resistance has a major impact on our metabolism, triggering a cascade effect throughout the body. Insulin resistance contributes to high cholesterol and altered cholesterol profiles, frequently increasing triglycerides, decreasing HDL cholesterol the “good” cholesterol, and increasing small dense LDL particles. Insulin resistance causes sodium retention in the kidneys, and can contribute to high blood pressure levels. Insulin resistance is also associated with increased sympathetic nervous system activity, which can further contribute to high blood pressure by increasing heart rate and constricting blood vessels. I talked about the insulin resistance diabetes connection in episode 26, and I really would encourage you to listen to it. 

The point is, that focusing on achieving normal blood sugar levels is the first step in helping to normalize blood pressure and cholesterol, because we bring down the glucose and bring down the insulin levels through diet and nutrition, and we start to balance out our metabolism. So Margaret, to maintain a healthy balance with all of these conditions in mind focus on nutrient dense whole foods, lots of fresh vegetables, low sugar fruits, beans and legumes, nuts and seeds, herbs and spices, quality proteins and monounsaturated fat rich foods like avocados, nuts, seeds, and olive oil. These are all foods that form a balanced foundation for all three conditions – blood sugar levels, blood pressure and cholesterol. 

As I mentioned at the beginning of the podcast, one of our members with prediabetes, Cheryl, reset her blood sugar balance and metabolism back to normal. She lowered her A1c levels to normal, got off all medication, lost 21 pounds (9.5kg) and her blood pressure and cholesterol normalized too – it is all connected. All part of the picture of what’s happening in your body overall, the metabolic imbalance – that’s the thing to always keep in mind. episode 6 has some more great info on what to eat, so make sure to go back and listen to that as well. 

Marsha asked: 

Making sure I have this correct…..Is it true you can reverse PREdiabetes with diet and exercise, but not once one has diabetes? 

Thanks Marsha, that’s an excellent question and one that many people wonder about. Let’s unpack that.

At the stage of prediabetes you do have a huge opportunity to get proactive and reverse your condition back to normal. For many people, the opportunity exists to completely reset blood sugar balance, reset metabolism, rebalance weight and essentially, get back to normal. In prediabetes, this is entirely possible. We see it all the time, as I’ve shared in this podcast about Cheryl, she essentially reversed her prediabetes.

Diet and nutrition are your primary treatment strategy, they are the things that will help the most to reset metabolic function back to normal. Exercise is secondary and can help restore insulin sensitivity and overall physical function as well. So yes, it is true you can reverse PREdiabetes with diet and exercise. 

When prediabetes progresses to type 2 diabetes, the situation can be a bit different, it can vary a bit more and will depend on each individual person. Reversing type 2 diabetes is also possible for many people. In clinical terms we call this diabetes remission, which I spoke about in episode 24. Diabetes remission is when people achieve and maintain an A1c less than 6.5% taking no glucose-lowering medication. Some people term this reversing diabetes and, as I said, it is certainly possible for many people. For others, a complete reversal or complete remission may not be possible once one has a type 2 diabetes diagnosis. But instead, focusing on diet and exercise and being really well controlled with a healthy A1c level and as little medication as possible is certainly achievable for everyone with type 2 diabetes. 

Dr Jedha, Host, 25:14

The key point is, for both diabetes and prediabetes, diet and exercise play crucial roles in improving blood sugar levels, metabolic function and overall health. And especially, what we eat is absolutely essential. 

It’s clear from the stories and questions we’ve covered that managing prediabetes is not just about preventing diabetes. It’s about overhauling your lifestyle, resetting your metabolism, and reclaiming your health. Remember, every step you take—whether adjusting your diet, integrating exercise, ensuring quality sleep, or managing stress—builds towards a healthier you. And as we’ve seen with Cheryl and many others, these changes can lead to remarkable transformations.

If today’s episode inspired you, or if you have your own story to share, please reach out. We love your feedback and stories; they shape our community and help others feel less alone in their journey. And if you’re looking for more detailed guides or support, remember, we’re just a click away at Type2DiabetesTalk.com.

Next week, we’re taking a slightly different turn with an episode you won’t want to miss—‘Diabetes Bloopers.’ We’ve got a lineup of real-life mishaps, astonishing stories, insightful tips, and yes, even some laughs. It’s going to be enlightening, and I promise, it will be entertaining so please do tune in. 

Until then, keep taking those steps towards a healthier life.

Dr Jedha, over and out.