So you have prediabetes. Now what?
Do you just wait for diabetes to happen before you act? Do you leap into intensive drug and other medical therapy?
The safest and healthiest approach usually lies somewhere in between.
- Do not just “wait” for diabetes to come. You can lower your risk for diabetes if you have prediabetes.
- Do not start with intensive therapy (unless your doctor suggests it). You can usually treat prediabetes with moderate lifestyle changes that you can make yourself.
You should stay in touch with your doctor and healthcare team, but also be aware that for most prediabetes patients, weight loss, increasing physical activity, and eating healthier are effective at lowering blood sugar. Your prediabetes treatment could also include
Be sure to ask your doctor what prediabetes treatments you should consider, and get approval before you start any new diet or exercise plan.
Having extra pounds is among the biggest predictors of having prediabetes or developing diabetes. Likewise, losing extra weight is one of the best ways to lower blood sugar or delay or prevent type 2 diabetes. 
A Little Weight Loss Goes a Long Way
In the famous clinical trial investigating the effects of lifestyle changes in prediabetic patients, weight loss was found to be the biggest factor in lowering risk for diabetes. You do not need to lose much weight to get benefits. In that study, each kilogram (2.2 pounds) that participants lost was linked to an impressive 16% lower risk for developing diabetes.
Keeping in mind that a little bit of weight loss can go a long way can help you stay positive and celebrate the small victories on your weight loss journey. It can motivate you to keep trying to lose weight, since you can gain bigger benefits from losing 5 to 7% of your original body weight (that is 10 to 14 lb. if you started at 200 lb.), and even more from getting into the “normal weight” category if you were obese or overweight to start.
Small Changes for Lasting Weight Loss
Starting a weight loss diet can make you anxious. You might worry that you will need to give up your favorite foods, or not be able to eat out with your friends, or feel like you are starving all the time.
Luckily, none of these are true. For lasting, healthy weight loss (and that is the goal here), you include foods you love, celebrate with friends, and eat filling meals and snacks. When you make small changes that fit into your life instead of turning to a fad diet, you have a better chance of losing weight and keeping it off for the long term.
Weight Loss Tips for Prediabetes
These are some ways to cut calories, carbs, and/or sugars to help the pounds come off as part of your prediabetes treatment.
- Have smaller portions. Serve yourself less at home. When you are at a restaurant, get into the habit of packing up half your order to take home before you even start eating.
- Skip the bread sometimes. Eat the burger on a bed of lettuce, order your sub sandwich as a salad, or use a fork to savor the filling in a burrito.
- Eat more vegetables. Fill at least half of your plate or bowl with vegetables at most meals and snacks. That can mean eating more salads, adding vegetables to soups, and crunching on raw veggies between meals.
- Swap your sides. Cut carbs and calories by swapping pasta, rice, or potatoes for steamed vegetables or side salads.
- Cut extra calories by grilling, steaming, or roasting instead of frying.
The best 2018 prediabetes diet has more weight loss tips, plus recipes to help.
Physical Activity and Exercise
Getting active is another of the most effective ways to lower blood sugar and prevent or delay type 2 diabetes. Physical activity burns calories and helps with weight control. Even if you do not lose weight, exercise increases insulin sensitivity and the effects of insulin in your body – leading to lower blood sugar.
How Much, and What Counts?
The goal for the average adult and people with prediabetes is to get 150 minutes per week of aerobic activity, plus 2 sessions per week of strength training. 
- Examples of aerobic activities include walking, biking, dancing, playing tennis, and anything else that gets your heart rate up and gets you moving continuously.
- Adding high-intensity bursts, such as jogging in the middle of a walk, can improve your results.
- Strength training can include exercises with body weight, such as pushups, squats, planks, and pull-ups.
- Using heavier weights and weight machines can lead to more benefits.
Even a little bit of exercise helps. According to the American Diabetes Association (ADA), you can get results by burning 400 calories per week if you have not been a regular exerciser recently. If you weigh 160 lb., you can do that by walking for 90 minutes, swimming for an hour, or doing aerobics for a little over an hour over the course of a week.
Tips to Start and Continue Exercising
Are you new to exercise? Have you had trouble being consistent in the past? You can try these tips to make exercise part of your long-term prediabetes treatment plan.
- Schedule it into your day so that you do not run out of time.
- To reduce barriers to getting started, put out your exercise clothes and shoes, and get your playlist ready if you like listening to music when you work out.
- Start with only a small amount of exercise, without worrying about hitting 150 minutes per week at the beginning.
- Keep trying new activities until you find one or more that you like. You might find that you dislike walking and tennis, but love kickboxing or rock climbing.
- Squeeze in 5 to 10 minutes at a time if you do not have time for a half-hour at once.
Along with helping you to lose extra pounds, a healthy prediabetes diet can improve blood sugar control. An overall healthy diet tends to be good for diabetes prevention, too. These are some basic guidelines from the ADA. 
- Emphasize non-starchy vegetables, lean proteins such as low-fat dairy, fish, and eggs, and healthy fats, such as nuts, olive oil, and avocados.
- Limit fried foods and solid fats, such as shortening and butter.
- Limit sugar-sweetened foods and beverages, such as soft drinks, energy and sports drinks, desserts, and sweetened condiments.
The plate approach is a quick and easy way to plan healthy meals. Fill half your plate with non-starchy vegetables or salad. Divide the rest of your plate in half. Put a lean protein into one of those sections. Into the final section, you can place a high-fiber carbohydrate, such as whole-grain pasta, fruit, or sweet potato.
Glycemic Index Diet
The ADA explains that a glycemic index diet can help with controlling blood sugar. The glycemic index is a measure of how fast and how much carbohydrates in the foods you eat spike your blood sugar levels after you eat them. When you can, choose lower-glycemic foods to reduce your blood sugar spikes.
These are some strategies for choosing a lower-glycemic diet.
- Emphasize higher-fiber carbohydrate sources, such as vegetables, beans, nuts, and whole grains.
- Each time you eat carbohydrates, include some lean protein and/or healthy fat.
- Limit refined starches, such as white bread and pasta, and sugar-sweetened foods, such as sodas and candy.
Keep in mind that the total number of carbohydrates in your meal or snack is more important than the glycemic index, so watch those portions, too!
Other Lifestyle Behaviors
You have opportunities all day to lower blood sugar and prevent diabetes! These are some choices you can make.
- Get enough sleep. Lack of sleep reduces insulin sensitivity. It also makes you more likely to crave sugary foods.
- Lower or manage stress. Stress changes your hormone balance. Strategies such as exercising, meditating, and taking a warm bath can help you manage it.
- Stop smoking. Smoking raises diabetes risk and risk for other conditions, too. Ask your healthcare provider about smoking cessation programs if you smoke and need help quitting.
Some prediabetes patients end up going on medications if their blood sugar levels do not hit recommended targets with weight loss and other lifestyle changes. A common medication is metformin, or Glucophage. It is designed to increase insulin sensitivity in your body so that cells can more easily take up sugar from your blood, which therefore lowers blood sugar.
Creating Your Prediabetes Treatment Plan
The sooner you act, the better chance you have of reversing prediabetes or delaying the onset of type 2 diabetes for longer. Take action as soon as you can after getting the news that you have prediabetes. This can mean contacting your healthcare provider and gathering any information that you can about prediabetes and any resources, such as a Diabetes Prevention Program, that are available to you.
Building Your Healthcare Team
The ADA recommends a patient-centered, collaborative care approach to manage diabetes. Your healthcare team for prediabetes can include a range of professionals who care about you, include you in decision-making processes, and have a wealth of knowledge and experience to share.
- Your primary care doctor.
- A nurse who is experienced in working with patients with prediabetes and diabetes.
- A registered dietitian or nutritionist with expertise in weight loss and blood sugar management.
- An exercise physiologist to help you plan an exercise program that is safe and effective for you, and maybe even enjoyable.
The Center of Your Care Team – You
Any prediabetes treatment plan that you have can only be successful if it works for the patient it is trying to help - you. The patient-centered approach puts you first. Your healthcare team should not only recommend the best strategies for lowering blood sugar, but consider your personal factors, such as the following.
- Your school, work, and/or family schedule.
- Your eating patterns and preferences.
- Your health priorities and any other health conditions.
Scheduling Follow-up and Monitoring Appointments
Your healthcare provider may schedule a blood sugar or A1c test again within 3 months to see if your prediabetes treatment plan is working. You may need to adjust your plan if you are not hitting your targets.
It may be easier to carry out your prediabetes treatment plan if you enroll in a digital Diabetes Prevention Program such as Lark. The program offers lessons that help you turn those lifestyle behaviors into healthy habits to lower prediabetes risk. Get started with your prediabetes treatment plan by signing up for Lark, and keeping in touch with your doctor throughout the process.