Whether you have prediabetes or you’ve been living with type 2 diabetes for some time, you’ve probably been told that you can improve your health by making some lifestyle changes. But this can be difficult, especially if you’re not experiencing any symptoms. Understanding the stages of diabetes may help you make the changes that can benefit your health—and your quality of life.


When blood sugar levels are abnormally elevated, but not yet high enough to be considered diabetes, it’s known as prediabetes. "During this time, the individual’s body keeps trying to make insulin to keep the blood sugar normal," says Anita Swamy, MD, of La Rabida Children’s Hospital in Chicago. (Insulin is the hormone needed for metabolizing carbohydrates and managing blood sugar levels.) Over time, insulin resistance, in which the pancreas pumps out more and more insulin to meet increased demand in a person who is no longer using it effectively, develops. This is part of prediabetes, which can last for years. "The pancreas is overcompensating in order to make enough insulin, but eventually it can’t meet the demand," says Swamy. "The pancreas can make more insulin for awhile, but only for so long."

Overweight and obese individuals who carry their weight in the belly are likely to have prediabetes, Swamy says, as are people with a family history of diabetes. If prediabetes patients don’t address the problem, eventually they’ll develop full-blown diabetes.

How it’s Diagnosed: Prediabetes may be diagnosed with an oral glucose tolerance test. If the test shows that your blood sugar is between 140 and 199 two hours after drinking a sweet solution, this is indicative of prediabetes. (Normal blood sugar levels two hours after drinking the solution would be under 140.) Another way to diagnose prediabetes is with a hemoglobin A1C test, which measures an individual’s average blood sugar for the previous few months. A hemoglobin A1C result between 5.7 and 6.4 is indicative of prediabetes. (Normal is less than 5.7.)

Treatment: You’ll probably be told to lose weight and exercise.

What You Can Do: People with prediabetes may be able to reduce their risk of developing full-blown diabetes with exercise and diet, says explains Betul Hatipoglu, MD, of the Cleveland Clinic. "This is the best time to catch it," Hatipoglu says. "If you lose 5 to 7% of your body weight, you can actually prevent diabetes about 60% of the time." To improve your chances of avoiding diabetes, get at least 150 minutes of exercise per week and eat a healthy, balanced diet.

Onset of Type 2 Diabetes

When your pancreas is no longer able to produce enough insulin to keep up with your body’s needs, your blood sugar increases. You may also have symptoms such as tiredness, thirstiness, and frequent urination.

How it’s Diagnosed: If you have a fasting blood sugar (blood sugar levels measured after fasting for 12 hours) of 126 or higher, this is considered diabetes, Swamy explains. Alternatively, if your blood sugar is 200 or more two hours after an oral glucose tolerance test, diabetes is indicated, as is a hemoglobin A1C test result of 6.5 or higher.

Treatment: Oral medications are used to bring the blood sugar into the normal range, and, if these become ineffective, insulin. In general, insulin is started when an individual’s hemoglobin A1C is over 8.5. Medicines to lower cholesterol and blood pressure may also be used.

What You Can Do: Be sure to follow your health care provider’s recommendation for medications—even if you feel fine. Currently, many doctors believe in treating even early diabetes with what is known as combination therapy, in which the patient takes medication not just to lower the blood sugar, but to treat high cholesterol and high blood pressure, says Joel Zonszein, MD director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. (High cholesterol and high blood pressure are risk factors for diabetes; many diabetes patients have either or both of these conditions.) "Good studies show that when patients are treated aggressively with combination therapy and [make] lifestyle changes early in the disease, they do very well and the diabetes is much easier to manage," he says. "It’s much more effective than chasing the blood sugar by trying one medication at a time."

Diabetes With Complications

With proper care, you’ll never experience this stage of diabetes. But over time, especially if your blood sugar is not in the normal range, you can develop problems with your nerves (neuropathy), your vision (retinopathy) and your kidneys. It’s also possible to develop complications in the large blood vessels, which can lead to strokes or heart attacks. Stroke and heart disease are "the number one causes of death and disability among people with type 2 diabetes," according to the American Heart Association. "In fact, at least 65 percent of people with diabetes die from some form of heart disease or stroke."

Treatment: "We intervene with more medications," says Spyros Mezitis, MD, MPH, of Lenox Hill Hospital in New York City. "Our aim is to alleviate the complications. But if you control the blood sugars well, you are less likely to get complications."

What You Can Do: Try to lose weight, and monitor your blood sugar closely. If you smoke, quit, since smoking raises your risk of cardiovascular (heart and blood vessel) disease.

Anita Swamy, MD, of La Rabida Children’s Hospital in Chicago, reviewed this article.


Betul Hatipoglu, MD

Spyros Mezitis, MD, MPH.

Anita Swamy, MD

Joel Zonszein, MD. "Cardiovascular Disease & Diabetes." American Heart Association. Page updated August 30, 2013. 

"Blood Sugar Tests." Cleveland Clinic. Page reviewed September, 2013.