Prediabetes: Signs Often Ignored and How to Act Early

One in four Quebecers could be living with prediabetes without knowing it. This figure, derived from data from the Quebec National Institute of Public Health, is striking precisely because it concerns people who feel fine. Not particularly tired, not constantly thirsty, not necessarily overweight. Just people whose blood sugar has started to drift without anyone noticing.

Prediabetes is not a disease in itself. It is a metabolic gray area, reversible in many cases, provided it is detected in time.

What a prediabetes diagnosis means

Prediabetes refers to a condition in which fasting blood glucose is higher than normal but has not yet reached the diagnostic threshold for type 2 diabetes. The reference value is between 6.1 and 6.9 mmol/L according to Canadian criteria, or between 5.6 and 6.9 mmol/L according to other classifications used in clinical practice. The doctor or nurse practitioner always interprets these results in their overall context, taking into account other health assessment parameters.

What happens in the body is increasing insulin resistance. The pancreas continues to produce insulin, but the cells respond to it less effectively. To compensate, it produces more. This compensatory mechanism can last for years, but it gradually wears out. Without a change in trajectory, approximately 15 to 30 % of people with prediabetes develop type 2 diabetes within five years (Diabetes Canada, 2023).

What distinguishes prediabetes from diabetes is precisely this window of opportunity. Type 2 diabetes, once established, cannot be cured; it can only be managed. Prediabetes, however, can still be reversed.

Why do the signs go unnoticed

This is where the central problem lies. Prediabetes doesn't hurt. It doesn't disrupt sleep, interfere with work, or trigger any obvious alarms. The few signs that can be associated with it are so common that they're blamed on something else.

Fatigue after meals, for example. Or sweet cravings in the middle of the afternoon. Gradual weight gain around the abdomen. Infections that take a little longer to heal. Slightly blurred vision at times. None of these spontaneously prompt a doctor's visit, especially when you don't have a family doctor who reviews your situation once a year.

This is precisely why more than 1.5 million Quebecers without a family doctor (MSSS, 2024) fall through the cracks. Without regular blood sugar monitoring, prediabetes progresses silently for years before a diagnosis is made, often at a stage where diabetes is already present.

A blood test remains the only reliable tool. Fasting blood sugar or the glycated hemoglobin test (HbA1c) detect the abnormality long before any symptoms appear.

Who is at risk

Certain factors significantly increase the likelihood of prediabetes. Age is one of them: the risk notably climbs after 40 years old, and even more so after 45. Abdominal overweight, meaning a waist circumference greater than 102 cm in men and 88 cm in women, is a strong indicator. A first-degree family history of type 2 diabetes also counts, as does a sedentary lifestyle, a history of gestational diabetes, polycystic ovary syndrome, or known high blood pressure.

Certain ethnic groups, including those of South Asian, Latin American, African, or Indigenous descent, are at higher risk at equivalent body weight, a reality that Canadian clinical guidelines explicitly acknowledge (Diabetes Canada, 2023).

Smoking, regular alcohol consumption, and chronic sleep disorders are also among the factors associated with increased insulin resistance. These elements are included in the overall assessment of metabolic risk during a medical consultation.

How is the diagnosis made

Two tests can detect prediabetes. Fasting blood glucose measures blood sugar levels after a fast of at least 8 hours. This is the first-line test, included in most annual health check-ups. The HbA1c test, on the other hand, reflects the average blood glucose level over the past two to three months. It has the advantage of not requiring fasting and provides a more representative picture of usual blood glucose status.

The two tests can be prescribed together to cross-reference results. In some cases, an oral glucose tolerance test may complete the assessment, particularly if the values are in a borderline range.

An abnormal result from a single test is usually not enough to make a diagnosis. The doctor or NP typically repeats the measurement before confirming prediabetes and proposing a follow-up plan.

What difference does it make to know it early

La détection précoce du prédiabète change concrètement le cours des choses. Des modifications du mode de vie suffisent dans beaucoup de cas à ramener la glycémie dans les valeurs normales. Une alimentation équilibrée pauvre en sucres ajoutés et en aliments ultra-transformés, une activité physique régulière d’intensité modérée, comme 150 minutes de marche rapide par semaine, et une perte de poids de 5 à 7 % du poids corporel permettent de réduire de façon significative le risque de progression vers le diabète de type 2 (Programme de prévention du diabète, États-Unis, 2022 ; données corroborées par des études canadiennes).

This isn't a matter of a draconian diet. It's a matter of direction. And this direction is much easier to correct at this stage than once diabetes is established, with its long-term cardiovascular, renal, and neurological complications.

Regular monitoring is an integral part of follow-up care. Individuals with prediabetes generally benefit from an annual blood glucose check to track progress and adjust the approach if necessary.

Frequently Asked Questions About Prediabetes

Can prediabetes disappear completely?
Yes, in many cases. Changes in lifestyle habits can bring blood sugar levels back to normal. It is one of the few metabolic conditions where early intervention can achieve a lasting reversal.

Should I take medication if I have prediabetes?
Not necessarily. The vast majority of prediabetes management relies on lifestyle changes. In some very high-risk profiles, a doctor may discuss medication options, but this decision is entirely up to the healthcare professional who knows the patient's full medical history.

Can you have prediabetes without being overweight?
Yes. Being overweight is a significant risk factor, but not a mandatory condition. People with a normal weight can exhibit insulin resistance, particularly due to genetics, a sedentary lifestyle, or ethnicity.

Does prediabetes increase the risk of cardiovascular disease?
Yes. Even before progressing to diabetes, prediabetes is associated with a higher cardiovascular risk. This is one of the reasons why early management goes beyond just sugar and addresses overall health.

What tests should I ask my doctor for?
Fasting blood glucose and the glycated hemoglobin (HbA1c) test are the two standard tests. Both are done by blood draw. The doctor or NP determines which is most appropriate based on the clinical situation.

When to consult a healthcare professional

If you are 40 years or older, have one or more of the risk factors mentioned in this article, or if your last blood sugar test was over two years ago, you should consult a doctor to assess your situation. The process is simple: a fasting blood test to measure your blood glucose or HbA1c is sufficient to determine your status.

A doctor or a nurse practitioner can interpret your results, assess your overall risk profile, and refer you to appropriate resources if needed. This assessment does not require you to have a primary care physician. A consultation at a medical clinic or teleconsultation at one of our Omicron Clinic in Quebec allows for quick access, without a waiting list.

 

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