Prediabetes lifestyle in older adults

Overview

Prediabetes is a condition where your blood sugar level is higher than normal, but not high enough to be called type 2 diabetes. It's a warning sign that your body is starting to have trouble handling sugar, but you still have a chance to reverse it. For older adults, this is a key time to make healthy changes that can prevent diabetes.

Yes, prediabetes is very common, especially in older adults. In fact, about 1 in 3 people over the age of 65 has prediabetes. Many don't know it because they have no symptoms.

Prediabetes affects people of all ages, but it is most common in adults over 45. You are more at risk if you are overweight, have a family history of diabetes, or are not very active. It also affects people from certain ethnic backgrounds more, such as South Asian, African-Caribbean, and Black African.

Symptoms

Common symptoms

• Most people with prediabetes have no symptoms at all.
• When symptoms do occur, they can include feeling very thirsty, needing to urinate more often, or feeling more tired than usual.
• Some people notice blurred vision or slow-healing cuts.

Symptoms in children

• Prediabetes is less common in children, but when it occurs, symptoms are usually absent. If present, they may include increased thirst, frequent urination, and fatigue.

Symptoms in older adults

• In older adults, prediabetes often has no symptoms. Because many symptoms like fatigue or blurred vision can also be signs of aging, they may be easy to miss.
• Some older adults may notice increased thirst, a dry mouth, or needing to get up to urinate several times a night.

Causes

Main causes

• Your body becomes resistant to insulin, the hormone that helps sugar enter your cells.
• Your pancreas may not make enough insulin to keep blood sugar in a healthy range.
• Over time, too much sugar builds up in your blood.

Risk factors

• Being overweight or obese, especially having a large waist.
• Being physically inactive — not getting regular exercise.
• Having a family history of type 2 diabetes.
• Being over 45 years old — risk increases with age.
• Having high blood pressure or high cholesterol.
• Having had diabetes during pregnancy (gestational diabetes).
• Belonging to certain ethnic groups (South Asian, African-Caribbean, Black African).

When to see a doctor

See a doctor urgently if:

• If you have extreme thirst, urinating very often, rapid weight loss, or confusion — see a doctor or call emergency services immediately.

Book a routine appointment if:

• All adults over 40 should have a blood sugar test as part of a routine health check.
• If you have risk factors like being overweight or having a family history of diabetes, ask your GP about being tested for prediabetes.
• If you have prediabetes, see your doctor every 6 to 12 months to monitor your blood sugar.

Diagnosis

Prediabetes is diagnosed with a blood test that measures your blood sugar level. Your doctor will check if your blood sugar is higher than normal but not high enough for diabetes.

Tests that may be done

• HbA1c test — this shows your average blood sugar over the past 2 to 3 months. A result between 42 and 47 mmol/mol (6.0% to 6.4%) suggests prediabetes.
• Fasting blood glucose test — after not eating for at least 8 hours. A result between 6.1 and 6.9 mmol/L suggests prediabetes.
• Oral glucose tolerance test (OGTT) — you drink a sugary drink and your blood sugar is tested after 2 hours. A result between 7.8 and 11.0 mmol/L suggests prediabetes.

What to expect at your appointment

The tests are simple blood tests done at your GP surgery or a clinic. Results usually come back in a few days. Your doctor will explain what your numbers mean and what steps to take next. No preparation is needed for the HbA1c test, but for the fasting test you need to avoid food and drink (except water) for the hours before.

Treatment

The main treatment for prediabetes is lifestyle change. With the right steps, many people can bring their blood sugar back to normal and avoid diabetes. Medications are not usually the first step, but your doctor may consider them if lifestyle changes aren't enough or if you are at very high risk.

Self-care at home

• Aim to lose 5% to 7% of your body weight if you are overweight — that's about 5 to 7 kilograms for a 100-kilogram person.
• Get at least 150 minutes of moderate-intensity physical activity each week — like brisk walking, cycling, or swimming.
• Eat a balanced diet with plenty of vegetables, whole grains, lean protein, and healthy fats. Limit sugary drinks and processed foods.
• Manage stress and get enough sleep — both help your body use insulin better.

Medical treatments

If lifestyle changes are not enough or if you have a very high risk of diabetes, your doctor may prescribe a medication called metformin. This drug helps lower blood sugar. It is important to take it exactly as your doctor advises and never change the dose yourself. Your doctor will discuss the benefits and side effects with you.

When is surgery considered?

Surgery is not a treatment for prediabetes itself. Sometimes, weight loss surgery is considered for severe obesity that also causes prediabetes, but this is only for select cases after other treatments have been tried. Discuss with your doctor if you think this might apply to you.

Living with this condition

Living with prediabetes means making daily choices that keep your blood sugar in check. It doesn't have to be hard — small steps like taking a walk after meals and choosing water instead of sugary drinks add up. You will need to check your blood sugar only if your doctor recommends it; many people with prediabetes don't need daily monitoring.

Lifestyle tips

• Walk for 30 minutes most days.
• Include more vegetables and whole grains in your meals.
• Limit sweets, sugary drinks, and white bread or rice.
• Try to stay at a healthy weight.
• If you smoke, ask your doctor about help to quit.
• Limit alcohol to no more than one drink a day for women and two for men.

Diet and exercise

A healthy diet for prediabetes is the same diet that is good for everyone: plenty of fruits and vegetables, whole grains like oats and brown rice, lean proteins like chicken and fish, and healthy fats from nuts and olive oil. Aim for at least 30 minutes of activity that makes you breathe faster, like brisk walking, on most days. Even a little weight loss — 5 to 10% of your body weight — can make a big difference.

Mental health and emotional wellbeing

Learning you have prediabetes can be worrying. You may feel anxious or overwhelmed about changing your habits. That's normal. It's important to remember that prediabetes is a chance to take control of your health, not a diagnosis of disease. If you feel down or very stressed, talk to your doctor or a counsellor. You can also call a mental health helpline for support.

Prevention

Yes, in many cases prediabetes can be prevented or reversed. The best ways are to stay at a healthy weight, be physically active, eat a balanced diet, and avoid smoking. Even if you have a family history, these steps greatly reduce your risk.

Vaccines

Vaccines are not used for prediabetes, but staying up to date with recommended vaccines — like the flu vaccine — is important because diabetes can make infections worse.

Screening programmes

Screening for prediabetes is recommended for all adults over 40, and earlier if you have risk factors. This is usually a blood test done during a routine check-up. If you have had gestational diabetes, you should be tested regularly. Ask your doctor about screening.

Complications

If left untreated

• Without changes, prediabetes can progress to type 2 diabetes within 5 to 10 years.
• Type 2 diabetes increases your risk of heart disease, stroke, kidney problems, nerve damage, and eye problems.
• Even prediabetes itself may slightly increase your risk of heart disease.

Long-term outlook

The good news is that prediabetes is very often reversible. With modest lifestyle changes, many people bring their blood sugar back to a healthy range. Even if you do develop type 2 diabetes, managing it well can prevent or delay complications. You have the power to make a difference. Talk to your healthcare team about a plan that works for you.

Find support

Local organisations

• NHS Diabetes Prevention Programme · United Kingdom
• Diabetes UK · United Kingdom

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