The No. 1 sign of prediabetes that often goes overlooked

Prediabetes is extremely common. According to the Centers for Disease Control and Prevention, approximately 98 million adults (or 1 in 3 people) in the United States have it. And it puts people at risk for developing more severe conditions such as Type 2 diabetes, stroke and heart disease.

But what is prediabetes, exactly, and how is it different from full-fledged Type 2 diabetes? What are the top signs, and what should you do when you know you have it? Here’s everything you need to know.

A precursor to diabetes

According to Dr. Florence Comite, an endocrinologist and a pioneer in precision medicine, prediabetes is simply the precursor to diabetes, commonly referred to as Type 2.

“Think of it as a warning shot to wake up and take control of your glucose before there is serious damage to your tissues and organs,” she explains. “When you have prediabetes, your sugar (glucose) level is higher or lower than optimal, whether fasting or in response to particular foods, but is not high enough to be diagnosed as diabetes.”

Typically, prediabetes is associated with insulin resistance, which may be present for a decade or more without evidence of elevated sugar, Comite adds.

“Insulin resistance means your cells aren’t responding effectively to the hormone insulin, which ushers glucose into your cells for use as energy,” she says.

“As sugar accumulates in your body, along with insulin resistance, damage begins to emerge in various organs — from the skin to nerves, heart, brain and elsewhere.”

Additionally, infectious diseases will be more severe with prediabetes and diabetes, she says.

“As prediabetes evolves into diabetes, more symptoms emerge. Both prediabetes and Type 2 diabetes are reversible, and ideally, it’s best to counter prediabetes before it advances to diabetes.”

Signs of prediabetes

It’s important to note that often, there are no warning signs of prediabetes, Comite says. That’s why many Americans go undiagnosed for years. However, with that in mind, there is one sign to know about: fatigue.

Because we’re tired for a million different reasons, it can be hard to connect the dots when it comes to fatigue as a prediabetes symptom.

There are other signs that may go unnoticed.

“Many of the common symptoms may be mild, like thirst and frequent urination, which often go unnoticed or are attributed to lack of sleep or dehydration,” Comite says.

“Additionally, one symptom to look out for is irregular meals or a pure carbohydrate breakfast (bran muffin and banana) leading to jitteriness and irritability after a couple of hours.”

Insomnia is another common issue with prediabetes, and it may be present due to glucose variability, reaction to wine or a rich carbohydrate dinner, Comite says.

“Tingling of the feet and/or hands is another possible symptom,” she adds. “One less frequent sign of prediabetes is darkened skin on the neck, groin and armpits due to a genetic underpinning of metabolic syndrome.”

If you’re diagnosed

While certain symptoms can tip you off to a glucose issue, Comite emphasizes the absolute best way to get a prediabetes diagnosis is to see your doctor at least once a year for fasting glucose, hemoglobin A1c (HbA1c) and fasting insulin tests.

If your doctor does flag an abnormal result, taking action as soon as possible is important. Here are Comite’s tips for managing and reversing prediabetes:

Lose weight: Reducing one’s body weight is one of the most effective ways to reduce the risk of diabetes. “The American Diabetes Association says just losing 7 to 10 percent of body weight is enough to prevent progression from prediabetes to diabetes,” Comite says.

“And, a recent study in the United Kingdom found that nine out of 10 people diagnosed with diabetes were able to achieve remission by reducing their body weight by just 10 percent within five years of being diagnosed,” she says.

Boost activity: Living a sedentary lifestyle raises your risk for diabetes, so Comite suggests getting more exercise. “Walking, biking, swimming, gardening and housework are all great exercises,” she says.

“Add high-intensity interval training two to three times a week, or simply increase the intensity of your walk, run or bike workout for 20 to 60 seconds alternating rest periods of a minute or two. Resistance exercises like bodyweight calisthenics, weightlifting, functional training or using resistance bands build muscle, which improves glucose control.”

Practice optimal sleep habits: Restorative deep sleep is extremely important for metabolic health, Comite explains. “Aim to get six to eight hours of restful sleep per night. Not getting enough quality sleep causes you to release more cortisol, the stress hormone, which elevates blood sugar levels,” she says.

“Poor sleep also triggers cravings for high-carbohydrate snacks the next day, like chips, pizza, (and) baked goods, due to selective release of hormones, which raises sugar and contribute to prediabetes.”

If you’re having trouble with sleep, she suggests potentially investing in a wearable (such as an Oura Ring, Whoop, Garmin Watch or Apple Watch), which can provide helpful insights as to what might be going on.