What Is Your Prediabetes Type?

Dr Jedha, Host

Hello wonderful people, Dr. Jedha here, and today we’re exploring something most people aren’t told about when they’re diagnosed with prediabetes—phenotypes, or in simpler terms, the different “types” of prediabetes.

In most cases, prediabetes is seen as a one-size-fits-all condition. Yes it’s true, the diagnosis may be the same. But the fact is, your body might be struggling in a completely different way than someone else who also has prediabetes. Yes, the treatment of prediabetes with nutrition and lifestyle will be similar for everyone. But if you can pinpoint what kind of prediabetes you have, it can help you focus on specific strategies that can help you get results faster or to improve your results in situations where you might feel stuck or on a plateau.

This is an empowering concept. Understanding your phenotype gives you a clearer picture of what’s really going on with your blood sugar, a more personalized way to approach treatment, whether it’s through food, exercise, specific supplements, or daily routines, and, in many cases, it can help you prevent or even reverse the trend toward type 2 diabetes. And no, this isn’t just academic. This is real-world, actionable stuff that can help you feel more confident and in control.

Let’s start with the word phenotype. I know it sounds like something from a science lab. But a phenotype is just a fancy way of saying “your body’s specific traits”—how it behaves and responds based on your biology, environment, and lifestyle. In the case of prediabetes, it means the pattern in how your blood sugar is rising, and why it’s rising. 

As we already established, most people are told, “You have prediabetes.” End of story. But prediabetes can show up in very different ways in different people. For some, blood sugar is high first thing in the morning. For others, it spikes mainly after eating. And in some cases, blood sugar looks mostly okay, but their A1c is climbing. These differences aren’t random, they represent different phenotypes, or types of prediabetes. And just to point out again, your phenotype refers to your body’s specific traits and the pattern in how your blood sugar is rising, and why it’s rising. 

So why would any of this matter? Because each phenotype has a different root cause. One person might have insulin resistance in their liver. Another might have it in their muscles. Of course, addressing prediabetes through nutrition and using programs like our Prediabetes Reset Program, most people with prediabetes can get back to normal glucose in 4-6 months – this is common despite people’s type because we address multiple factors in our program and nutrition is your primary treatment strategy. But, there might also be a missing key that unlocks your personal progress, so the powerful part in understanding your type is that you can focus on specific solutions that target the core of the issue, and we are going to explore some of those strategies later. 

For now, let’s walk through the four most common types of prediabetes. You might even start to recognise yourself in one, or more, of these patterns. And remember, we’re talking about the pattern in how your blood sugar is rising, and why it’s rising. 

There are four main types of prediabetes, or phenotypes, that researchers and clinicians have identified. These are based on your lab results, specifically fasting glucose, post-meal glucose (that’s usually tested with an oral glucose tolerance test), and HbA1c.

The first type of prediabetes is Isolated Impaired Fasting Glucose (iIFG). This is when your fasting blood sugar is high but post-meal glucose could look okay.

This type usually points to a problem with how your liver is managing sugar. Here’s what happens: overnight, your liver starts releasing stored glucose into your bloodstream. In someone with good insulin sensitivity, insulin gently tells the liver, “We’re good, no need to dump extra sugar.” But in this case, the liver doesn’t listen because it’s insulin resistant. So your fasting glucose rises, even though you haven’t eaten. In this type, prediabetes is caused by this progressive reduction of insulin sensitivity in the liver.

This type can occur in anyone, but interestingly, it is more common in men and people who tend to carry fat around the belly even if they’re not overweight overall.

To recap: the pattern is high fasting blood sugar and why it happens is because of a reduction in insulin sensitivity in the liver.

The second type is Isolated Impaired Glucose Tolerance. Here, fasting glucose is normal but blood sugar spikes significantly after meals. This is usually picked up during a 2-hour oral glucose tolerance test, where you’re given a sugary drink and your blood sugar is measured two hours later. If that result is elevated it suggests your body is having trouble processing the glucose load after eating.

In this case, it’s usually a problem with how your muscles are responding to insulin. Your muscles are one of the main places glucose is stored after a meal. But when they become insulin resistant, they don’t take up the sugar efficiently. As a result, glucose stays circulating in your bloodstream longer.

This type of insulin resistance often starts in the muscles, but it can be worsened by liver insulin resistance, higher body fat, and an overproduction of insulin—a condition called hyperinsulinemia. This is the body’s way of trying to compensate for the resistance by pumping out more insulin, but it can create a vicious cycle that makes the resistance worse over time.

This type can occur in anyone, but interestingly, it is often seen in women, and can be more common in people who are not very physically active or if there’s a family history of type 2 diabetes.

To recap: The pattern is normal fasting blood sugar but high blood sugar 2 hours after meals, and the reason why is because of muscle insulin resistance, which may be worsened by other insulin-related imbalances in the body.

The third type is combined impaired fasting glucose and Impaired Glucose Tolerance. 

This is where both your fasting glucose and your post-meal glucose are high. In this type, your liver is insulin resistant, which causes high fasting glucose, and your muscles are also insulin resistant, which leads to high blood sugar after meals. That means your body has multiple systems struggling to manage glucose properly. To compensate, your pancreas is often working overtime, producing more and more insulin in an effort to bring blood sugar down, that’s the hyperinsulinemia. This creates a vicious cycle: High blood sugar worsens insulin resistance; Insulin resistance keeps blood sugar high; Add in weight gain or excess abdominal fat, and the whole system becomes even more unbalanced.

This combination, resistance in both the liver and the muscles, plus increased insulin demand, is considered the highest-risk phenotype for progressing to type 2 diabetes. But that doesn’t mean it’s too late. It just means the body needs more support and more targeted action to start reversing the trend.

To recap: The pattern is elevated fasting and post-meal blood sugar, and why it happens is because both your liver and muscles are insulin resistant, placing a heavier demand on your pancreas and increasing the risk for progression.

The fourth type is a little different and sometimes the most confusing. It’s when your HbA1c is elevated but your fasting glucose and post-meal glucose tests still look okay.

This is what we call the “Elevated A1c Only” phenotype. It is less common than the other types of prediabetes.

A1c reflects your average blood sugar levels over the past 2 to 3 months, so when it’s high but other results look normal, it can raise a lot of questions. 

According to research there are a few possible explanations.

First, it might mean you’re having mild blood sugar elevations throughout the day, not high enough to be flagged by a fasting or post-meal test, but still enough to raise your average A1c result.

Or, it could be that you’re spiking at different times, maybe 30 minutes to an hour after meals, or during periods you’re not testing. Blood sugar is dynamic, and if you’re only testing at one or two fixed points, you might miss the bigger picture.

And then there’s another factor: red blood cell turnover. A1c is measured based on how much sugar is attached to your red blood cells. So anything that affects how long those cells live, like iron deficiency or certain health conditions, can influence your result.

So while this phenotype isn’t always as straightforward, it is important. It can be an early sign that something’s shifting metabolically. And because it’s based on a 2–3 month average, it’s still a strong signal that your glucose control may need attention, even if spot checks look fine.

To recap: The pattern is a raised A1c despite normal glucose tests, and the reason could be subtle but consistent elevations in blood sugar, or other factors influencing the average. It’s a signal to look a little deeper and start making supportive changes early.

Okay, so you might be wondering: “This is all really interesting… but how does it actually help me?”

The answer is: it helps by making your choices more targeted, more effective, and a whole lot less confusing.

Let’s say your fasting glucose is always high, but your post-meal numbers aren’t too bad. If you understand that your phenotype is isolated impaired fasting glucose, you can focus on strategies that lower overnight liver glucose production, like adjusting your dinner timing or modifying your evening meal by reducing carbs and including more protein, exploring different eating windows, or specific science-backed supplements. If you’re one of our members, find the Lower Fasting Blood Sugar Healthmap with your guides and this will guide you step by step on what to do to lower morning levels. 

But let’s say your fasting is fine, and it’s your post-meal numbers that go through the roof. That points to impaired glucose tolerance, and now you know your muscles aren’t handling glucose well. So your focus shifts to walking after meals, modifying your macronutrient intake, focusing on specific micronutrients – vitamins and minerals that support your phenotype, and working on building muscle over time. If you’re one of our members with this type, use the monthly member check ins to troubleshoot the specific steps you can take to address your unique situation.

The point is, nutrition is your primary treatment strategy for prediabetes. Then there are specific targeted steps you can take depending on your type of diabetes.

So, how can you figure out your phenotype? You don’t need fancy tests or genetic screening to get started. In many cases, your routine blood work already gives you the clues.

Here’s what you can do:

Look at your fasting glucose.
Is it consistently above 100 mg/dL (5.6 mmol/L)?
That points to impaired fasting glucose, likely an issue with liver insulin resistance.

Check your A1c.
If it’s between 5.7 and 6.4%, and fasting glucose is normal, you might be in that “elevated A1c only” group. Or you may be spiking after meals without realizing it.

Consider post-meal testing.
If you have a glucometer, try checking your blood sugar 2 hours after a typical meal. If your glucose is going above 140 mg/dL (7.8 mmol/L) and taking a while to come down, you could be dealing with post-meal glucose intolerance related to muscle insulin resistance.

Now, you might be thinking, wait, I’ve got high fasting blood sugar and high A1c. It’s very common to see overlapping patterns, especially once you’ve received a diagnosis. You might see high A1c and post-meal spikes, or high A1c with a mix of impaired fasting glucose and impaired glucose tolerance. That’s why phenotyping should be used as a guide, not a box. Remember these are patterns that can help us determine why certain things are occurring in your body. 

Let’s look at a scenario: When someone has a high A1c, that tells us there’s a sustained glucose elevation happening over time. But A1c doesn’t tell you when the highs are happening. That’s where additional data like fasting and post-meal testing gives context.

So if someone has:

• A1c between 5.7–6.4%, and
  
• 2-hour post-meal glucose above 140 mg/dL or 7.8 mmol/L, this would point toward Impaired Glucose Tolerance (IGT) being a major contributor to the elevated A1c.

Now if their fasting glucose is also elevated, we’re probably looking at combined impaired fasting glucose and impaired glucose tolerance, which makes the A1c elevation easier to understand, it’s being pushed up from both ends (fasting and post-meal).

Perhaps a better way to think about this is by asking: What is driving my A1c up? Is it fasting glucose? Post-meal spikes? Or both? Map your type to the pattern. 

What matters is identifying what’s driving your blood sugar up, and then targeting your actions toward that. If your numbers are high in the morning, that’s a liver issue. If they spike after meals, that’s muscle resistance. If they’re high all the time, you might need to address both.

That’s exactly why we provide tools and support in our membership programs. Whether you’re just starting to track your numbers, or you’ve been trying to lower your A1c for years, there’s a way forward that actually makes sense for your body and we can help you figure out exactly what to do.

So let’s wrap this up.

Prediabetes isn’t a single condition. It’s a collection of patterns—different ways that your body might be struggling to manage blood sugar. And when you understand your pattern—your phenotype—it can help you plan a clearer path forward. You can start making decisions that are more focused, more effective, and experience a whole lot less frustration.

Whether your fasting glucose is high… your numbers spike after meals… your A1c has crept up… or you’re just trying to make sense of it all, there’s always a next step. While all this can sometimes seem complicated, the most important thing is you just need the right starting point for where you’re at now.

And that’s what I hope you take away from today’s episode: a better understanding of your own body, and a little more confidence to take the next step, whatever that looks like for you. And if you want more guidance and support tailored to your own results, please head to our website to explore our programs and services, we’d love to see you join us as a member. 

Until next time, take care of yourself—and keep taking those small steps forward.

Dr Jedha, over and out.