10 Prediabetes Signs You Must Know Before It Is Too Late

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10 Prediabetes Signs You MUST Know Before It Is Too Late
10 Prediabetes Signs You Must Know Before It Is Too Late Graphic © healthpowerboost.com. Photos: Pixabay (PD)

Diabetes is a global epidemic. It is one of the leading causes of morbidity and mortality all over the world, with millions of people affected. According to the WHO, there were 422 million people diagnosed with diabetes by 2014. Over 1.5 million deaths were directly attributed to diabetes in 2019 alone, with 48 percent of mortalities occurring before a person turned 70 years old. [1] But living with it is one thing and catching it before you become diagnosed is another. With that said, one of the foremost global health plans of the World Health Organization is early screening and diagnosis of uncommunicable diseases – diabetes included. [2] Regular health tests are key!

Pre-diabetes or insulin resistance affects over 88 million Americans. The numbers are actually higher now than his stated figure, with newer data from the Centers for Disease Control and Prevention reporting over 96 million adults 18 years and older were affected by pre-diabetes in 2019. [3]

What Is Prediabetes?

Prediabetes is a condition of elevated blood sugar with the level not high enough to be diagnosed with diabetes. Insulin resistance is a hallmark symptom of this, wherein the body’s cells and tissues do not respond to insulin produced by the pancreas, causing glucose to remain in the blood for prolonged periods of time, causing hyperglycemia. [4]

Dr. Ekberg mentions that being prediabetic is not merely a condition where you either “have it or you don’t”. It’s a sliding scale. Similar to diabetes, hemoglobin A1c or HbA1c is the scale used to determine if you are prediabetic or not. HbA1c is a blood test that determines your blood sugar level over a course of three to four months. A result lower than 5.7 percent is normal, 5.7 percent to 6.4 percent is prediabetic, and 6.5 percent and above is diabetic. [5] Dr. Ekberg reports than about 75 percent of pre-diabetics will eventually develop type 2 diabetes – and this number is close to that of the American Diabetes Association (ADA) expert panel, who reported that up to 70 of prediabetics will eventually become diabetic. A Chinese Diabetes prevention trial had even higher results; up to 90 percent of prediabetics developed diabetes after 20 years. [6]

Here are the ten pre-diabetes signs to keep an eye out for:

1. Elevated Blood Sugar Readings

With that much being said about pre-diabetes, the first sign is a higher than normal blood sugar, but one that is not as high as that of diabetics. That’s a blood sugar measurement between 100 and 125mg/dl and HbA1c levels between 5.7 to 6.4 percent. [5]

2. Elevated Fasting Insulin Levels

While fasting insulin is not the standard when it comes to diagnosing either prediabetes or diabetes, it can be a good measure of insulin resistance. Similar to fasting blood glucose or sugar, an elevated insulin level after fasting typically means that your body is experiencing insulin resistance. According to a study by Johnson, et. al. in 2010, a fasting insulin higher than 9 could be indicative of prediabetes. [7]

3. Fatigue

Dr. Ekberg links fatigue with insulin resistance, as the body exerts more effort and uses more energy for absorbing glucose from your blood. Because the cells are resisting absorbing the glucose, your body is now using up energy stores to process this glucose, instead of absorbing it and converting it into energy. Various studies have linked fatigue and prediabetes, showing similar fatiguability seen in people diagnosed with type 2 diabetes. [8][9]

4. Slow Wound Healing

The fourth sign is also a warning sign of diabetes, where wounds like small cuts take long to heal. An altered immune response, which involves wound healing, is caused by the chronic inflammation brought about by persistent hyperglycemia. Because of chronic inflammation, injuries to our tissues take longer to repair themselves. [10]

5. Numbness And Tingling

This is a sign of diabetic neuropathy, a condition where the chronic inflammatory state caused by high blood sugar levels start to the damage the small nerves in the tips of the hands and feet. You can start to feel persistent “pins and needles”, especially in the lower extremities. [11] Dr. Ekberg also mentions that hyperglycemia can even contribute to swelling of the hands and feet, which can contribute to poor circulation and eventually peripheral neuropathies. Worst case scenario, diabetic ulcers can occur — which can lead to amputation.

6. Kidney Damage

Similar to how hyperglycemia damages the nerves and circulation in the limbs, high blood sugar in prediabetes can also damage the small vessels in the kidneys. This condition is called microvascular disease or as Dr. Ekberg calls it, microvessel disease. Uncontrolled blood sugar levels can cause persistent damage to the kidneys and can cause kidney disease and failure. [12][13] According to the CDC, the prevalence of chronic kidney disease among diabetics is 1 in 3 Americans. [14] Regular medical checkups and tests should be used to monitor kidney function.

7. Blurred Vision

Diabetic retinopathy is one of the worst effects of high blood sugar and blurred vision is one of the earliest signs that you may have it. The retina is found in the back of the eye and is made up of delicate tissue and small blood vessels. It is responsible for receiving and processing the light captured and focused by the lens, sending it to the brain to create images. The same microvessel disease that causes kidney damage can also damage the retina, causing it to develop lesions and even detach, causing blindness. Lechner, et. al. in 2017 reports that progressive retinal dysfunction can occur in the early stages of diabetes – or when you are prediabetic. [15]

8. Joint Pain And Arthritis

Dr. Ekberg mentions that when people see him because of joint pain and discomfort, his patients often think its because of weight gain. While this isn’t entirely false, in terms of prediabetes, the joint pain could actually be caused by the systemic inflammation caused by high blood sugar. In 2019, Rehling, et. al. published a study that linked musculoskeletal pain, osteoarthritis, osteoporosis, and even rheumatoid arthritis to diabetes. [16] They mentioned other contributing factors aside from obesity, such as vitamin D deficiency, neuropathy, and advanced glycation end products (which are the end products as the body processes sugar) – all three of which are linked to hyperglycemia.

9. Weight Gain

Weight gain is one of the classic hallmarks of high blood sugar, because the excess sugar that circulates in the blood and is not used by the cells ends up being stored as fat, typically in the abdomen. This becomes a part of the metabolic syndrome called central obesity. As the prevalence of obesity increases, so does the prevalence for type 2 diabetes. [17] According to Pulgaron in 2014, about one third of American children are either overweight or obese, increasing their likelihood of developing diabetes when they are older. [18]

10. Excess Sensation Of Hunger

The last item on Dr. Ekberg’s list is a symptom that is also found amongst diabetics. Because of insulin resistance, the cells are starving for glucose even when your blood sugar is high. [4] The glucose from the food you eat isn’t entering your cells and is instead being turned into fat. This is why people who are prediabetic or are already diabetic are always hungry despite gaining weight and staying in a prolonged hyperglycemic state.

Dr. Ekberg’s ten signs are very important if you have a family history of diabetes or weight gain, or if you have had trouble with high blood sugar in the past. Getting your A1C levels within a normal range is a great end goal but it is a constant work-in-progress, one that you will likely need to pay attention and effort to for the rest of your life. You have to make lifestyle adjustments, particularly when it comes to your diet, in order to prevent your prediabetes from turning into full-blown type 2 diabetes mellitus.


[1] World Health Organization. Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes

[2] World Health Organization. Global Action Plan. https://www.who.int/publications-detail-redirect/9789241506236

[3] Centers for Disease Control and Prevention. Prevalence of Prediabetes Among Adults. https://www.cdc.gov/diabetes/data/statistics-report/prevalence-of-prediabetes.html

[4] National Institute of Diabetes and Digestive and Kidney Disease. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance

[5] Centers for Disease Control and Prevention. All About Your A1C. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/a1c.html

[6] Tabak, A., et. al. (2014). Prediabetes: A high-risk state for developing diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3891203/

[7] Johnson, J., et. al. (2010). Identifying Prediabetes Using Fasting Insulin Levels. https://www.endocrinepractice.org/article/S1530-891X(20)40344-1/fulltext

[8] Senefeld, J., et. al. (2020). Greater Lower Limb Fatigability in People with Prediabetes than Controls. https://pubmed.ncbi.nlm.nih.gov/31815831/

[9] Zhu, et. al. (2020). Fatigue and Sleep Quality Predict Eating Behavior Among People With Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/32496398/

[10] Das, A., et. al. (2017). Correction of MFG-E8 resolves inflammation and promotes cutaneous wound healing in diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5090174/

[11] Mayo Clinic. Diabetic Neuropathy. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/

[12] Querfeld, U., et. al. (2020). Microvascular disease in chronic kidney disease: the base of the iceberg in cardiovascular comorbidity. https://pubmed.ncbi.nlm.nih.gov/32542397/

[13] Cade, W. (2008). Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579903/

[14] Centers for Disease Control and Prevention. Diabetes and Chronic Kidney Disease. https://www.cdc.gov/diabetes/managing/diabetes-kidney-disease.html

[15] Lechner, J., et. al. (2017). The pathology associated with diabetic retinopathy. https://pubmed.ncbi.nlm.nih.gov/28412095/

[16] Rehling, T., et. al. (2019). Diabetes Is Associated with Musculoskeletal Pain, Osteoarthritis, Osteoporosis, and Rheumatoid Arthritis. https://pubmed.ncbi.nlm.nih.gov/31886282/

[17] Maggio, C. & Pi-Sunyer, F. (2003). Obesity and type 2 diabetes. https://pubmed.ncbi.nlm.nih.gov/14711063/

[18] Pulgaron, E. & Delamater, A. (2014). Obesity and type 2 diabetes in children: epidemiology and treatment. https://pubmed.ncbi.nlm.nih.gov/24919749/

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