Symptoms of Prediabetes
Symptoms of prediabetes can be related to high blood sugar and insulin levels. If you have any signs of prediabetes, or even think you do, contact your healthcare provider. You can discuss your symptoms and ask for tests. Also keep in mind that most people do now have prediabetes symptoms, so checking for symptoms is only one part of finding out if you are at risk of prediabetes.
Prediabetes Symptoms and Your Skin
Prediabetes may be defined by high amounts of sugar in your blood, but many of the possible early symptoms are related to your skin. They are typically the result of damage to your blood vessels from chronically high blood glucose, or too much insulin. The American Academy of Dermatology (AAD) describes a number of possible warning signs of prediabetes. 
Acanthosis Nigricans and Skin Tags
Acanthosis nigricans is a classic condition linked to prediabetes and diabetes. The National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK) describes it as a skin condition that may appear on the back and sides of your neck or in your armpits or groin.  Your skin appears dark and may feel velvety.
The NIDDK explains that skin tags may be present in the same areas as the places where you have acanthosis nigricans. The AAD says that these skin growths are not themselves harmful, but you should follow up if you have them, since they tend to result from high insulin levels that could be a sign of prediabetes or diabetes.
If you have granuloma annulare, you may have large regions of skin covered with bumps that are red, purple, or even skin-colored. The bumps may come and go. Research published in “Danish Medical Journal” shows that there is often a link between granuloma annulare and diabetes. Granuloma annulare can be the result of other conditions besides diabetes, but it is worth checking out to see whether it is a sign that you have prediabetes.
Necrobiosis lipodica is another skin condition that is not harmful, but it is worth a trip to a doctor or dermatologist. You may first notice small bumps on your skin, and eventually see them develop into raised brownish, reddish, or yellowish patches with shiny skin surrounding them. The area may be painful or itchy, and the condition can go through cycles where it becomes more and less severe.
Additional Skin Symptom in Prediabetes
· Blisters that appear suddenly on your hands, arms, feet, or legs.
· Diabetic dermopathy, which look like brown age spots, and are also called shin spots.
· Eruptive xanthomatosis, or yellowish bumps that otherwise look like pimples.
Symptoms of Prediabetes That Has Progressed
You are more likely to get symptoms if your blood sugar stays high for longer periods of time. This can happen if you have prediabetes or diabetes and do not manage to get your blood sugar to target levels.
Symptoms of diabetes, or uncontrolled high blood sugar, include the following:
· Increased thirst and more frequent need to urinate. The thirst results from too much sugar in your blood, similar to excessive thirst when you eat salty foods, and the extra urination comes from the need to excrete that extra water and sugar.
· Fatigue, which results from your cells literally being low on energy because they are unable to get the glucose, or sugar, that they need due to insulin resistance.
· Weight loss and hunger, again as the result of insulin resistance. Instead of extra sugar from carbs in your food being converted to and stored as fat, it gets excreted from your body. Reminder: weight loss may be desirable, but this is not a healthy way to do it!
· Blurred vision, slow wound healing, and dry skin.
Risk Factors for Prediabetes
You are unlikely to have clear signs of prediabetes, but you can still take action to stay healthy. The CDC suggests checking with your doctor about testing for prediabetes if you have any of the common risk factors.
· Being overweight or obese.
· Being 45 years or older.
· Having a parent or sibling with type 2 daibetes.
· Are African American, Hispanic American, Asian American, Native American, or Pacific Islander.
Additional risk factors for women are if you had gestational diabetes, gave birth to a baby over 9 lb., or have polycystic ovary syndrome (PCOS).
Don’t Wait for Symptoms of Prediabetes
Only 1 in 10 people with prediabetes know they have it. Reasons may be because they do not have symptoms or do not get diagnosed with it. Since being diagnosed with prediabetes can motivate you to make healthy changes to prevent diabetes, you should learn your risk factors and act if you have one or more.
Blood Sugar in Prediabetes
· Fasting blood glucose. This is a blood draw after an 8-hour or overnight fast. A value of 100 to 120 mg/dl indicates prediabetes.
· Glycated hemoglobin, or A1c. This shows your blood glucose control over the past 3 months. A value of 5.7 to 6.5% indicates prediabetes.
· Oral glucose tolerance test. You drink a solution containing 75 grams of glucose (about the amount in two cans of soda) and get your blood sugar measured 2 hours later. A value from 140 to 199 mg/dl is prediabetic.
For each of these tests, a lower value is considered normal, while a higher value is characteristic of diabetes.
Significance of Prediabetes
Type 2 diabetes certainly deserves its time in the limelight, but prediabetes is also worth more than a passing thought. As type 2 diabetes becomes more common, so does its precursor: prediabetes. While 1 out of 13 American adults have diabetes, an overwhelming 1 in 3 have prediabetes, and nearly half of adults over 65 years old had the condition in 2015.
From Prediabetes to Diabetes
Having prediabetes puts you at risk for developing type 2 diabetes. As you might expect, prediabetes is a condition with higher blood sugar, or blood glucose, than normal, but lower levels than in diabetes. It happens as your body develops insulin resistance and is less able to regulate blood sugar levels properly. Every year, 5 to 10% of people with prediabetes develop diabetes. 
So what are prediabetes and diabetes? When you are healthy, your body breaks down carbohydrates from food and turns them into glucose (a type of sugar) that goes into your blood. As your blood sugar (blood glucose) levels increase, a type of cells in your pancreas secrete a hormone called insulin. Insulin helps your fat, muscle, and liver cells to take up glucose from your bloodstream.
· Your cells become less insulin sensitive, or more resistant to the effects of insulin.
· This means your body requires more insulin to remove the sugar from your blood.
· At some point, your insulin supply cannot keep up with demand, and your blood sugar levels rise.
The progression can take years or decades, but you can stop or slow the progression if you make healthy changes such as losing weight and exercising more.
Managing Prediabetes and Prediabetes Symptoms
Nobody wants prediabetes or symptoms of prediabetes, but you can turn your diagnosis into something positive rather than a prediction of future type 2 diabetes. Prediabetes is known to be largely modifiable – many people can reverse it or at least delay its progression with lifestyle changes and proper monitoring.
The most well-known research into the effects of healthy lifestyle changes on prediabetes may be on the CDC-recognized Diabetes Prevention Program (DPP). This large-scale clinical trial compared the effects of taking the blood sugar medication, metformin, to participating in the DPP, which involved weight loss, healthy eating, and physical activity goals among people with prediabetes.
Weight Loss, Nutrition, and Physical Activity
· Make small changes. There is no rush to lose the weight. It is more important to make small changes that you can keep up for years.
· Try smaller portions at home and in restaurants.
· Make lower-calorie swaps, such as a broth-based soup instead of a cream-based one.
· Set reasonable goals. Losing as little as 5% of your body weight if you are overweight can lower your risk for diabetes.
· Get help. Recruit friends or family members to support you, and consider a weight loss coaching app such as Lark.
Choosing certain foods instead of others can also lower blood sugar. These are some basic guidelines for a healthy prediabetes diet.
· Look for high-fiber foods, such as vegetables, whole grains, beans, and fruit.
· Swap butter for olive oil, avocado, and nuts.
· Limit fatty meat, sugary foods, and fried foods.
· Limit refined starches, such as white bread, pasta, rice, and crackers.
Physical activity is another important part of your prediabetes management plan. First, it can help you lose weight or prevent weight gain, since it burns calories. In one hours, a 160-lb person can burn about 300 calories with brisk walking or moderate bicycling, or about 400 calories swimming laps or hiking.
Exercise also directly affects prediabetes because it increases your body’s insulin sensitivity, which lowers blood sugar. Get your doctor’s approval before starting any exercise program, and then work towards increasing your levels to at least 30 minutes a day, 5 days a week. Walking, biking, swimming, dancing, and most other continuous activities that get your heart rate up are great choices.
These are some tips for turning exercise into a habit.
· Start slow, at a low intensity and short time, and only increase your intensity and time gradually.
· Try out several activities until you find one or more that you enjoy.
· If 30 minutes is too much to do at one time, try working in 5 to 10 minutes at a time, 3 or more times per day.
· Try scheduling workouts or walks with friends to make them more enjoyable and to commit to a time that you will get active.
Medical Management of Prediabetes
· Regular checkups.
· Annual blood sugar tests to monitor your prediabetes and assess how well your plan is working.
· Monitoring of weight loss.
· Discussion of medication, such as metformin, to improve insulin sensitivity and lower blood sugar if lifestyle changes are falling short.
Diabetes Prevention Program
The CDC-recognized DPP is focused on the lifestyle changes that can reduce or eliminate symptoms of prediabetes. It is designed to help people with prediabetes lose weight, eat better and increase physical activity. The DPP curricula includes 26 lessons, and is intended to take about a year to complete as you make gradual changes for a healthy life.
Many DPP programs involve in-person meetings weekly, biweekly, or monthly in a group setting. Lark DPP is an alternative to these meetings. Lark DPP provides the same curriculum, and has some advantages.
· Conveniently delivered lessons through your smartphone – no need to drive to a meeting at a set time.
· Extra coaching beyond what is in the DPP curriculum.
· 24/7 availability so you can chat with your Lark coach anytime.
· Personalized feedback on your progress.
Prediabetes symptoms are a sign that your body is asking for help. Even without symptoms of prediabetes, you may have risk factors for prediabetes or diabetes, and it could be time to act. Instead of ignoring the symptoms, use your prediabetes symptoms as motivation to get healthy, and know that help is available.
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What is Lark?
A new study reveals that artificial intelligence mobile app Lark could be a useful tool to help patients with Prediabetes prevent Type 2 diabetes. The study, published in the Journal of Medical Internet Research, showed that patients at risk of Type 2 diabetes who had Prediabetes and who used the Lark Weight Loss Health Coach, dropped their baseline weight and increase their percentage of healthy meals eaten by 31 percent.