Prediabetes – What do You Need to Know?

23 Feb 2023

Prediabetes causes Type 2 Diabetes Mellitus (T2DM). Blood glucose levels are slightly elevated from normal but not enough to trigger the clinical condition of T2DM. Many people may be living with it without even suspecting it. In this article, the endocrinologist Assoc. Dr. Radka Savova from the SBAL for Children’s Diseases “Prof. Dr. Ivan Mitev” will pay special attention to the pre-diabetic condition, its symptoms, and urgent measures against the further development of the disease.


Having prediabetes means that blood sugar levels are above normal but not high enough to diagnose the chronic disease: type 2 diabetes. The condition is also known by other names. They are as follows:

- Impaired Fasting Glucose (IFG) with higher than normal blood sugar readings in the morning before meals.

- Impaired Glucose Tolerance (IGT), with higher than normal blood sugar readings after a meal.

- Altered glycated hemoglobin A1C levels.

People with prediabetes have been found to be at an increased risk (between 10 and 20 times) of developing type 2 diabetes. The good news is that more than half (58%) can prevent it through a healthy lifestyle, diet, and exercise.

Signs, Symptoms, and Risk Factors

The predispositions to prediabetes development are several and well-known. If 2 or more risk factors are recognized this means an increased probability of having pre-diabetes and the corresponding development of type 2 diabetes. According to Prof. Savova, the most tangible are the following:

1. Overweight (increased body mass index)

2. Reduced/minimized physical activity

3. High levels of “bad” cholesterol

4. High blood pressure

5. Age over 45 years

6. People who have relatives in your family who have type 2 diabetes and/or heart problems

7. Women who have had gestational diabetes and/or have given birth to a large baby weighing more than 4.5kg

8. Women with polycystic ovary syndrome

The signs and symptoms of prediabetes are similar to those of diabetes mellitus. They include the following:

1. Increased thirst

2. Frequent urination, especially in the evening

3. Increased hunger

4. Frequent fatigue even with small physical efforts

5. Blurred vision

6. Numbness or tingling in the feet or hands

7. Frequent infections

8. Slow-healing wounds

9. Unwanted/unplanned weight loss (both fat and muscle tissue)

Tests and examinations

Prof. Dr. Savova is convinced that only through medical tests and follow-ups with the patient, the prediabetes condition can be really diagnosed. She recommends the following tests and examinations:

1. Fasting blood sugar test (levels between 100 and 125 mg/dL suggest prediabetes may be developing)

2. Glycaran Hemoglobin A1C test (prediabetes is within A1C values between 5.7% and 6.4%)

3. Insulin Resistance Index test (IRI)

4. Oral Glucose Tolerance Test (OGTT) – prediabetes is present when blood glucose levels are between 140 and 199 mg/dL after the 2nd test

5. Homeostasis model for assessment of insulin resistance (HOMA-IR) - where the risk zone falls in the range 2.5-5.0

6. Leptin (readings above 10 ng/ml are characteristerized by prediabetes)

7. Uric acid (average value in men over 18 years old is 200.00 - 420.00 µmol/l, and in women over 18 y.o. the average is 142.00 - 340.00 µmol/l, above these levels there is a risk of prediabetes)

8. A complete lipid profile that includes:

a. Total cholesterol (above the following readings 3.5 – 5.2 mmol/l)

b. Triglycerides (with levels above 0.3 – 1.7 mmol/l)

c. LDL cholesterol (above 3.37-4.12 mmol/l are outside the norm)

d.HDL cholesterol (above 1.15 - 1.68 mmol/l in women and above 0.90 - 1.45 mmol/l in men are at risk)

9. Homocysteine

10. Thyroid hormones

11. Echo of the liver and gallbladder

12. Consultation with a pulmonologist and examination for sleep apnea

Possible Health Complications

Prof. Savova shared the accompanying complications in the body of a person who is in a pre-diabetic state, specifying that they are very similar to that of a person with already manifested diabetes mellitus. The chronic condition called diabetes for short affects several important organs in the body, namely: the heart (heart disease), kidneys (kidney problems), eyes (reduced vision), skin (skin diseases), etc. Nerve cells that are highly dependent on blood sugar levels can also be affected if the appropriate average blood sugar levels are not controlled.

Timely measures and health management

1. Management of hyperinsulinemia, insulin resistance, and/or Leptin resistance (if present)

2. Normalization of the function of the Thyroid Gland

3. Normalization of high levels of homocysteine

4. Coping with hepatic steatosis, by limiting fast carbohydrates and fructose in the diet, avoiding alcohol and the abuse of toxic medications, cleaning from heavy metals, etc. ways to detox

5. Treatment of sleep apnea

6. Supplements inclusion - vitamins and trace elements, in the presence of important deficiencies such as /vit. D3, vit. B12, other B vitamins, Iron deficiency/

7. Treatment with probiotics for chronic intestinal damage

8. Maintaining weight within the normal limits of the body mass index

9. Maintaining an active body movement

The role of Digital Technologies

Identifying and tracking prediabetes takes time and effort. For many, this process can bring unwanted stress and confusion. This is where Diabetes:M comes to the rescue! In the application, you can track all your glucose readings by entering relevant indicators, store your medical records, and even calculate the caloric intake of home-cooked meals. Dr. Savova, as a member of the Medical Board, recommends the use of the Diabetes:M digital app for health tracking. You can download it for iOS or Android from here.


Prediabetes (Borderline Diabetes)

Prediabetes – Your Chance to Prevent Type 2 Diabetes

Prediabetes by Mayo Clinic

The Surprising Truth About Prediabetes

Diabetes by NHS