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Most people who search for prediabetes symptoms want a checklist they can tick off. The trouble is that most people with prediabetes feel completely fine. The few clues there are get put down to age, a busy job or too much chai and samosa at the office.
Usually there are none, which is why so much prediabetes goes unnoticed. A few signs make it more likely, like a dark velvety patch on the neck, a waist that keeps growing, PCOS, or diabetes during a past pregnancy. Heavy thirst and losing weight without trying point to diabetes itself. A blood test is the only way to know.
Does prediabetes cause symptoms?
Mostly, no. People with prediabetes tend to feel exactly as they did last year. They catch the 8:40 local to work, go back for a second helping of biryani at a cousin's wedding, and nothing tells them their sugar has moved. Prediabetes means blood sugar above normal but still under the diabetes line, and at those levels the body doesn't complain. Doctors find it on a blood report, usually a fasting sugar or HbA1c. From there some people go on to diabetes and some go back to normal.
When the ICMR-INDIAB survey went state by state testing people, it found prediabetes everywhere it looked. A lot of the people it picked up had never had their sugar checked before. Indian physicians writing about it say it's very common here and that Asian Indians tend to get to diabetes faster, so feeling well doesn't tell you which side of the line you're on.
I feel sleepy after lunch and crave sweets. Is that prediabetes?
Maybe, but the feeling can't tell you. Lots of websites list sleepiness after lunch, sweet cravings, brain fog and constant hunger as prediabetes symptoms. They're real, and they can go along with changes in how your body handles insulin. People with completely normal sugar get them too, after a bad night's sleep, a big plate of biryani or an afternoon in a stuffy office with the AC broken.
So dozing off after rajma chawal proves nothing either way. If that's what got you reading, treat it as a nudge to get tested.
There's more you can find out at home in ten minutes. Put a tape measure round your waist at the navel and look at the back of your neck in the mirror. Then dig out your old lab reports, and ask your parents whether either of them has diabetes. Between those four you'll know whether to book a blood test this month or leave it for the annual check-up.
Which visible signs do point to prediabetes?
Start with the back of your neck. A dark, slightly thick patch there that feels like velvet is called acanthosis nigricans, and it can also turn up in the armpits. People often think it's dirt. Some spend months scrubbing it with a loofah and wondering why it won't come off. An expert group brought together by the PCOS Society of India calls it a proven skin marker of insulin resistance, seen in prediabetes, diabetes and PCOS, and wants it used for early screening.
You'll need two mirrors, or a mirror and your phone camera, and some daylight from a window. If the patch is soft rather than rough and soap doesn't touch it, mention it at your next doctor visit.
Then look at your waist. Fat stored around the organs is more closely linked to metabolic trouble than fat on the hips or arms, and a consensus statement on waist size wants it checked as routinely as BMI. The Indian consensus uses lower cut-offs than the international ones. For men it's 90 cm or more, and for women 80 cm or more. Measure at the navel, standing relaxed, at the end of a normal breath out.
Plenty of people never measure and just notice the trousers. If you've gone up a size while the scale hardly moved, or your belt has slipped under your belly, that counts.
Other things can cause the neck patch, including some hormonal conditions and, rarely, an internal cancer, so if one appears suddenly or spreads fast, see a doctor soon.
Who is more likely to have prediabetes?
If PCOS is part of your history, get tested whatever you weigh. A detailed review found that women with polycystic ovary syndrome have reduced insulin sensitivity that has nothing to do with body weight, so a slim woman with irregular periods should still be checked.
The same goes if you had diabetes during a pregnancy. A meta-analysis of more than a million women found those who'd had gestational diabetes were almost ten times as likely to get type 2 diabetes later on. Many Indian women hear "your sugar is fine now" after delivery and then nobody brings it up again. Your gynaecologist's discharge note is worth digging out.
Other things nudge the odds up as well. A parent or sibling with type 2 diabetes does, and so does a waist over the Indian cut-offs. So do high triglycerides or low HDL on a lipid profile, high blood pressure, and being over thirty-five. Any one of them is a reason to get a blood test, though none of them on its own means prediabetes.
Which symptoms mean it may already be diabetes?
Thirst is usually the first thing people mention. They're getting through two or three bottles of water at the office and still feel dry, and they're up at night to pee. Some lose weight without trying, which feels like good news for about a week. Blurred vision can come with it, and so can a cut on the foot that won't heal or a urine infection that keeps coming back. These are signs of high blood sugar, and by the time they show up it's more likely to be diabetes than prediabetes.
Most Indian labs follow the American Diabetes Association standards. Under those, a random plasma glucose of 200 mg/dL or more in someone with these symptoms is enough to diagnose diabetes. If this sounds like you, see a doctor this week and ask for a blood sugar test the same day.
Sources: [9]
How is prediabetes confirmed?
With blood tests, usually more than one. The simplest is a fasting sugar, taken in the morning before you've had so much as a cup of tea. A result from 100 up to 125 mg/dL counts as prediabetes under the American Diabetes Association standards that most Indian labs print on their reports. The World Health Organization starts that band at 110, which is why a fasting sugar of 104 gets a red flag at one lab and nothing at another.
HbA1c is the one that doesn't need fasting. It reflects your average sugar over the past few months, and 5.7% to 6.4% is the prediabetes range. The third option is the glucose tolerance test, where you drink a sweet glucose solution and give blood two hours later. A two-hour result between 140 and 199 mg/dL means prediabetes.
A good doctor won't stop at the sugar numbers. They'll want fasting insulin, triglycerides and HDL, and probably liver enzymes and thyroid as well. Haemoglobin matters too, since anaemia can make HbA1c misleading. Together these explain why the sugar has gone up, and that's what decides the plan.
Sources: [9]
My report says prediabetes. What can I do?
More than most people expect. The best evidence comes from the Diabetes Prevention Program in the US, where people in the lifestyle group cut their risk of diabetes mainly by losing weight. For every kilogram they lost, the risk fell by about 16%. You don't need to get back to your college weight to see a difference, and a few kilos is a reasonable first goal.
How you lose it counts, though. A large American survey found that people carrying more muscle for their size had better insulin sensitivity and less prediabetes. Muscle is where the body puts most of the sugar after a meal. A month of skipping dinner and living on soup and papaya will take some muscle off along with the fat, which works against you.
Start with the unexciting things and keep them going. Lose weight slowly enough that you're not starving, and give your legs and arms some real work, whether that's squats while the pressure cooker whistles or carrying the sabzi bags up four floors. Then get your sugar rechecked later, so you know where you stand.
We should say where we stand, since you are reading this on our site. Metaboliq plans weight loss around keeping muscle, and our aim is simple to state: Lose up to 20% of your body weight — and keep your muscle. Results vary; your doctor decides what is right for you. The first step is a ₹1,699 blood test collected at home, which a doctor reads with your history before any plan is made.