Prediabetes & insulin resistance
Also known as:
Impaired fasting glucose, impaired glucose tolerance
Blood sugar above normal but below diabetes. The best window to prevent type 2 diabetes.
Written and reviewed by Farhan Tahir, MD · Last reviewed
VIDEO LESSON
What it is
In insulin resistance, muscle, liver and fat respond poorly to insulin, so the pancreas makes more to keep glucose normal. When it can no longer keep up, glucose rises into the prediabetes range.
How it's diagnosed
• A1c 5.7% to 6.4%
• Fasting glucose 100 to 125 mg/dL
• 2-hour glucose 140 to 199 mg/dL on an oral glucose tolerance test
Why it matters
Prediabetes raises the risk of type 2 diabetes and cardiovascular disease. In the Diabetes Prevention Program, an intensive lifestyle program reduced progression to diabetes by 58% and metformin by 31% compared with placebo.
Treatment
Modest weight loss (about 5% to 7%), at least 150 minutes a week of activity and better sleep are first-line. Metformin can be considered, especially under 60 with a BMI of 35 or higher or a history of gestational diabetes. GLP-1 medicines also prevent progression in people with obesity.
Clinical pearls
• Recheck at least yearly.
• Screen for fatty liver, high blood pressure and abnormal lipids at the same time.
Key studies and references
Educational content only, written and reviewed by Farhan Tahir, MD. It does not replace individual medical advice. For sudden chest pain, trouble breathing or stroke symptoms, call 911.
AT A GLANCE
Category
Blood sugar & liver
Also known as
Impaired fasting glucose, impaired glucose tolerance
Reviewed by
Farhan Tahir, MD
Questions about your own care?
Dr. Tahir’s team offers consults through Youthful Medicine.
Keep exploring
Weight & obesity
Obesity
A chronic disease of excess body fat. The 2025 Lancet Commission separates obesity that is already harming the body from obesity that raises future risk.
Read the guide →
Blood sugar & liver
Prediabetes & insulin resistance
Blood sugar above normal but below diabetes. The best window to prevent type 2 diabetes.
Read the guide →
Blood sugar & liver
Type 2 diabetes
Chronically high blood sugar from insulin resistance and failing insulin secretion. Modern medicines protect heart, kidneys and weight.
Read the guide →