Diabetes

You Could Have Prediabetes Right Now and Not Know It

The Pin Health Staff Writer

January 21, 2026 11 min read

1 in 3 adults has prediabetes — and 80% don't know it. Here's why you can't feel it, what tests catch it early, and how to reverse it.

1 in 3 adults has prediabetes. 8 out of 10 don’t know it. That’s not a typo — the vast majority of people with prediabetes are walking around completely unaware that their blood sugar is elevated and that they’re on the path to type 2 diabetes.

Here’s what makes this statistic so frustrating: prediabetes is almost entirely reversible. Caught early, lifestyle changes can bring blood sugar back to normal and dramatically reduce the risk of ever developing diabetes. But you can’t reverse what you don’t know you have.

This is the paradox of prediabetes. It’s silent. It causes no symptoms. You feel completely fine — until you don’t. And by the time symptoms appear, you may have crossed the line into type 2 diabetes, a chronic condition that’s much harder to reverse and comes with serious complications.

The good news? A simple blood test can tell you exactly where you stand — years before any symptoms would appear.

Why Prediabetes Has No Symptoms

If your blood sugar is elevated, shouldn’t you feel something? It seems logical, but the body is remarkably adaptable. Moderately elevated blood sugar — the hallmark of prediabetes — doesn’t trigger the warning signals that very high blood sugar does.

With prediabetes, your cells are becoming resistant to insulin, the hormone that helps glucose enter cells for energy. Your pancreas responds by producing more insulin, working overtime to keep blood sugar in a relatively normal range. This compensation can continue for years.

During this time:

• You feel normal
• You have energy
• Nothing seems wrong

But under the surface, your pancreas is straining. Your insulin levels are elevated (which has its own health consequences). And your blood sugar, while not yet in the diabetic range, is creeping upward.

By the time classic diabetes symptoms appear — excessive thirst, frequent urination, fatigue, blurred vision — your blood sugar has typically been elevated for years, and significant metabolic damage may have already occurred.

The 10-Year Window You Don’t Want to Miss

Research suggests that prediabetes typically precedes type 2 diabetes by 7-10 years. That’s a decade during which intervention can change the trajectory entirely.

The landmark Diabetes Prevention Program study showed that people with prediabetes who made modest lifestyle changes reduced their risk of developing type 2 diabetes by 58%. For people over 60, the risk reduction was even higher — 71%.

People with prediabetes who made modest lifestyle changes reduced their risk of developing type 2 diabetes by 58%. For people over 60, the risk reduction was even higher — 71%.

Diabetes Prevention Program study

What were these dramatic interventions? Nothing extreme:

• Losing 5-7% of body weight (for a 200-pound person, that’s 10-14 pounds)
• 150 minutes of moderate physical activity per week (a 30-minute walk, 5 days a week)

That’s it. No medications. No surgery. Just sustainable lifestyle changes that most people can achieve.

But here’s the catch: you need to know you have prediabetes to take action. And the only way to know is through blood testing.

What Blood Tests Reveal — And What They Miss

The standard test for blood sugar is fasting glucose — a measurement of your blood sugar after not eating for 8-12 hours. It’s included in most basic metabolic panels and annual checkups.

Fasting glucose can identify prediabetes, but it has limitations:

The prediabetes range: Fasting glucose has established thresholds for normal, prediabetes, and diabetes. Your lab report will show where you fall — but a single “normal” result doesn’t tell the whole story.

The problem? Fasting glucose is a snapshot — it tells you what your blood sugar is at one moment in time. It can be affected by stress, sleep, recent meals, and normal day-to-day variation. More importantly, fasting glucose is often the last marker to become abnormal. By the time fasting glucose is elevated, metabolic dysfunction has often been present for years.

HbA1c: The Bigger Picture

Hemoglobin A1c (HbA1c) gives you a broader view. It measures the percentage of hemoglobin in your blood that has glucose attached to it, reflecting your average blood sugar over the past 2-3 months.

HbA1c isn’t affected by what you ate yesterday or whether you’re stressed about the blood draw. It’s a more stable, reliable indicator of overall glucose control.

Like fasting glucose, HbA1c has established ranges for normal, prediabetes, and diabetes. The advantage of HbA1c is that it reflects your average over months, not just one morning.

For comprehensive assessment, both fasting glucose and HbA1c together provide the clearest picture. Sometimes one is elevated while the other is normal — checking both ensures nothing is missed.

Fasting Insulin: The Early Warning

Here’s where standard testing often falls short. Most annual checkups don’t include fasting insulin — yet it’s often the earliest marker of metabolic trouble.

Remember how the pancreas compensates for insulin resistance by producing more insulin? This means insulin levels often rise before glucose does. You can have completely normal fasting glucose and HbA1c while your insulin is elevated — an early signal that your body is working harder than it should to maintain blood sugar control.

Elevated fasting insulin suggests:

• Insulin resistance is developing
• Your pancreas is compensating (for now)
• Without intervention, glucose will likely rise over time

Catching elevated insulin before glucose rises gives you even more time to intervene — potentially years before you would meet the technical definition of prediabetes.

Who’s at Risk?

Certain factors increase prediabetes risk:

• Weight: Being overweight, especially carrying weight around the abdomen
• Age: Risk increases after 35, and significantly after 45
• Family history: A parent or sibling with type 2 diabetes
• Ethnicity: Higher risk in African American, Hispanic, Native American, Asian American, and Pacific Islander populations
• Sedentary lifestyle: Physical inactivity increases risk
• History of gestational diabetes: Women who had diabetes during pregnancy
• Polycystic ovary syndrome (PCOS): Strongly associated with insulin resistance
• Sleep issues: Sleep apnea and chronic sleep deprivation affect glucose metabolism

But here’s an important point: you don’t need risk factors to have prediabetes. While risk factors increase likelihood, prediabetes can develop in anyone. The only way to know for certain is testing.

The Damage That Happens Before Diabetes

There’s a dangerous misconception that prediabetes is “not that serious” — that it’s just a warning, and the real concern starts when you cross into diabetes territory.

This isn’t accurate. Research shows that damage begins in the prediabetes phase:

• Cardiovascular risk: People with prediabetes have increased risk of heart disease and stroke — not just compared to people with normal blood sugar, but significantly so
• Nerve damage: Early signs of neuropathy can begin in prediabetes
• Kidney effects: Subtle kidney changes may start before diabetes diagnosis
• Eye changes: Retinal changes have been documented in prediabetes

This isn’t meant to frighten you — it’s meant to emphasize that prediabetes isn’t a “pre-problem.” It’s a problem now. But unlike many health conditions, it’s a problem you can often solve.

Reversing Prediabetes: What Actually Works

The evidence is clear: prediabetes is reversible for most people. Here’s what research supports:

Weight Loss

You don’t need to reach an “ideal” weight. Losing just 5-7% of your body weight significantly improves insulin sensitivity and can normalize blood sugar. For many people, this is 10-15 pounds. The weight loss doesn’t need to be dramatic to be effective.

Physical Activity

Exercise improves insulin sensitivity independent of weight loss. Even if the scale doesn’t move, regular physical activity helps your cells respond better to insulin. The target is 150 minutes per week of moderate activity — but any increase from your current level helps.

Dietary Changes

No single diet is proven best for prediabetes, but certain principles consistently help:

• Reducing refined carbohydrates and added sugars
• Increasing fiber intake
• Choosing whole foods over processed foods
• Watching portion sizes

Sleep

Poor sleep worsens insulin resistance. Prioritizing 7-8 hours of quality sleep supports metabolic health. If you have symptoms of sleep apnea, getting evaluated and treated can significantly improve glucose control.

Monitoring Progress

This is where ongoing testing becomes valuable. How do you know if your changes are working? You test. Watching your fasting glucose, HbA1c, and fasting insulin over time tells you objectively whether you’re moving in the right direction.

Some people see dramatic improvements in months. Others take longer. Having data removes the guesswork and keeps you motivated — or signals when you need to adjust your approach.

Why Standard Checkups Often Miss Prediabetes

If prediabetes is so common, why do 80% of people with it not know?

Several reasons:

Testing gaps: Not everyone gets annual blood work. And when they do, fasting glucose alone may miss early metabolic dysfunction. Fasting insulin — the earliest marker — isn’t typically included in standard panels.

“Normal” isn’t optimal: A fasting glucose of 99 is technically “normal” but is at the top of the range. Someone at 99 is metabolically very different from someone at 75, but both get labeled “normal.”

One-time snapshots: A single test can be affected by many factors. Tracking trends over time is more informative than any single measurement.

No symptoms to prompt testing: When you feel fine, there’s less motivation to dig deeper. But waiting for symptoms means waiting too long.

A Different Approach to Metabolic Health

Comprehensive metabolic assessment goes beyond basic screening. Instead of asking “do you have diabetes yet?” it asks “how is your metabolic health, and where is it heading?”

This means looking at:

• Fasting glucose — the standard measure
• HbA1c — your 2-3 month average
• Fasting insulin — the early warning signal
• Related markers like triglycerides and inflammatory markers that often track with insulin resistance

It also means tracking these markers over time. A single snapshot tells you where you are. Repeated measurements tell you where you’re heading — and whether your interventions are working.

The Bottom Line

Prediabetes is common, silent, and serious — but it’s also preventable and reversible when caught early.

The question isn’t whether testing is worthwhile. The question is whether you want to know where you stand while you still have time to change course.

For most people with prediabetes, the path back to normal blood sugar doesn’t require medication or dramatic measures. It requires awareness, modest lifestyle changes, and the willingness to track progress over time.

1 in 3 adults has prediabetes. You might be one of them. But unlike most of that group, you now know how to find out — and what to do about it.

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Key Takeaways

• 1 in 3 adults has prediabetes; 80% don’t know it because there are no symptoms
• Prediabetes typically precedes diabetes by 7-10 years — that’s your window to intervene
• Lifestyle changes can reduce diabetes risk by 58% — just 5-7% weight loss and 150 minutes of weekly activity
• Fasting glucose alone may miss early problems; HbA1c and fasting insulin provide a more complete picture
• Damage begins in prediabetes, not just after diabetes diagnosis
• The only way to know your status is through testing — you can’t feel prediabetes
• Prediabetes is reversible for most people with sustainable lifestyle changes