A prediabetes diagnosis often comes with a handout, advice to eat less sugar, and not much else. That leaves most people unsure what is happening in their body or which changes will help.
Our approach is health-centered and non-diet. We focus on the eating patterns and habits that support blood sugar, not on cutting out foods.
What Prediabetes Is
Prediabetes means blood sugar is higher than normal but not high enough for a type 2 diabetes diagnosis. It is identified by any one of these:
Fasting glucose of 100 to 125 mg/dL
HbA1c of 5.7 to 6.4 percent
Two-hour glucose of 140 to 199 mg/dL on an oral glucose tolerance test
About 115 million adults in the United States have prediabetes, and 8 in 10 of them don’t know it, according to the CDC. The good news is that it responds to change.
The Diabetes Prevention Program, a large randomized controlled trial in people with prediabetes, found that lifestyle changes lowered the risk of developing type 2 diabetes by 58 percent over an average of 2.8 years. Metformin lowered it by 31 percent. The lifestyle program focused on gradual changes to eating and activity, not a rigid meal plan.
Can Prediabetes Be Reversed?
For some people, yes: blood sugar returns to a normal range. For others, it holds steady or progresses despite real effort. That range of outcomes is normal, and it reflects genetics, age, and other health conditions, not only food choices.
Nutrition, movement, and medication when appropriate can all support blood sugar. A registered dietitian can help you find the mix that fits your life.
Why Cutting Carbs Isn’t the Answer
You don’t need a special prediabetes diet. Carbohydrates often get blamed first after a diagnosis, but treating all carbohydrates as a problem isn’t supported by the evidence.
The type of carbohydrate and your overall eating pattern matter more than the amount alone. Whole grains, beans and lentils, fruit, and vegetables all contain carbohydrates, and they are linked with better metabolic health, not worse.
Strict diets are also hard to keep up. An eating pattern you can live with for years is more likely to help your blood sugar than a strict plan that lasts a few months.
How to Build Meals That Support Blood Sugar
Some of this research comes from studies in type 2 diabetes and general populations, where the way meals affect blood sugar is well established and reasonably applies to prediabetes.
Fiber. Soluble fiber slows how quickly glucose is absorbed and improves insulin sensitivity. Oats, beans, lentils, apples, and barley are good sources. Higher fiber intake is consistently linked with better blood sugar.
Protein at meals. Eating protein alongside carbohydrates slows digestion and lowers the rise in blood sugar after a meal. It also helps you feel satisfied. Along with resistance activity, protein supports muscle, and muscle is the body’s main place for clearing glucose from the blood.
Pairing, not removing. Instead of taking carbohydrates away, add something to them. Pairing a carbohydrate with protein, fiber, or fat tends to make the blood sugar rise smaller and slower.
Prediabetes Breakfast Ideas
Oatmeal made with milk, topped with nuts and berries
Eggs with whole-grain toast and fruit
Greek yogurt with fruit and a sprinkle of seeds or granola
A breakfast taco with eggs, black beans, and salsa
Prediabetes Snack Ideas
An apple with peanut butter
Hummus with whole-grain crackers or vegetables
Cheese with crackers or fruit
A handful of nuts with a piece of fruit
Cottage cheese with fruit
These are starting points, not rules. The best options are the ones you like and will reach for.
The Role of Movement
Physical activity improves insulin sensitivity on its own, separate from food. Brisk walking and resistance activity both help, and they work differently than food does. In the Diabetes Prevention Program, 150 minutes of moderate activity per week was a key part of the program that lowered diabetes risk.
Movement doesn’t have to be formal exercise. A short walk after meals, for example, has good research support for lowering the blood sugar rise after eating.
Metformin for Prediabetes: Does Food Still Matter?
Some people worry that needing metformin means they failed at the nutrition piece. Others worry that being offered it at diagnosis means their efforts won’t matter. Neither is true.
Metformin and nutrition are different tools that often work together. In the Diabetes Prevention Program, both lowered the risk of type 2 diabetes. Whether metformin is right for you depends on your labs, your risk factors, and your full health picture, and that is a conversation with your prescribing provider.
If you take metformin, food still matters. Eating patterns that support steady blood sugar, satisfaction, and overall health help whether or not medication is part of your plan.
How a Dietitian Approaches Prediabetes
A registered dietitian starts with your life, not a template: your current eating patterns, the foods you like, and your schedule. We build from there.
At Wilfong Nutrition, prediabetes care is individualized. We don’t eliminate food groups or assign calorie targets. We help you understand what your body needs and how to meet those needs in a way you can keep up.
This approach draws on intuitive eating, a non-diet framework with a growing research base for improving people’s relationship with food. When tailored by a qualified dietitian, it can be part of care for blood sugar concerns.
If you’re in Texas and want nutrition support for prediabetes, we offer telehealth across the state and in-person sessions in Austin. We are in-network with Blue Cross Blue Shield, Aetna, Cigna, United, and Curative. Learn more about our Type 2 diabetes care.
Get in touch with our team to ask about availability and insurance coverage.
