Your doctor tells you your blood sugar is a little high and you’re in the prediabetes range. This may come as a surprise, especially if you eat well, exercise regularly, and are not overweight.
Many people assume blood sugar issues only happen with weight gain or high sugar intake, but that’s not always the case. Prediabetes is often more about how your body is functioning, particularly when it comes to insulin sensitivity, muscle mass, and daily habits, than the number on the scale.
The good news is that once you understand what may be driving your blood sugar, there are many ways to improve it that don’t involving losing weight.
What Is Prediabetes?
Prediabetes means your blood sugar levels are higher than normal, but not high enough to be diagnosed as type 2 diabetes. It’s often picked up on routine blood work and usually there are no symptoms.
Prediabetes is very common. About one in three adults in the United States has it, and most do not know it. It is typically defined as an A1c between 5.7 and 6.4 percent or a fasting glucose between 100 and 125 mg per deciliter. These numbers give a snapshot of your blood sugar, but they do not explain why your levels are elevated.
In many cases, prediabetes is driven by insulin resistance, meaning your body is not responding to insulin as efficiently as it should. Over time, the body may need to produce more insulin to keep blood sugar stable. Eventually, this system becomes less effective and blood sugar begins to rise.
In other cases, insulin resistance may not be the main issue. Instead, the beta cells in the pancreas may not produce or release enough insulin to keep blood sugar in a healthy range.
Blood sugar issues are not just about weight or sugar intake. They reflect how your body is functioning overall, including insulin sensitivity, insulin production, muscle mass, sleep, stress, and genetics.
Metabolic Health Matters More Than Weight
You can be at a normal weight and still have changes in how your body processes blood sugar. This comes down to metabolic health, which refers to how efficiently your body regulates blood sugar and uses insulin.
For some people, the main issue is insulin resistance, meaning the body is not responding to insulin as effectively as it should. In others, the pancreas may not produce or release enough insulin to keep blood sugar in a healthy range. Many people have a combination of both.
These changes are more common in people with higher body fat, but they are not limited to that group.
Many people are metabolically healthy, but weight alone does not tell the full story.
Why Prediabetes Can Happen at a Normal Weight
There are several reasons blood sugar levels can rise, even in someone who is lean and appears otherwise healthy. In most cases, it is a combination of factors:
Fat distribution
Even at a normal weight, carrying more fat around the abdominal organs is more closely linked to insulin resistance than overall body weight.
Muscle mass
Muscle helps your body use glucose efficiently. With aging, inactivity, or not eating enough protein, muscle mass can decline, making blood sugar harder to regulate.
Genetics
If you have a family history of prediabetes or type 2 diabetes, your body may be more prone to insulin resistance regardless of your weight. This can be a major reason for some people.
Aging and hormonal changes
As we get older, the body naturally becomes more insulin resistant. The pancreas may not release insulin as efficiently, and cells may become less responsive. Hormonal shifts, especially during perimenopause and menopause, can further impact blood sugar. Subtle increases in abdominal fat can also occur, even if overall weight stays the same.
Inadequate sleep
Poor sleep increases insulin resistance. Even a few nights of inadequate sleep can affect blood sugar levels, so chronic poor sleep can have a much larger effect.
Chronic stress
Stress affects blood sugar as well. When you are under stress, your body releases hormones such as cortisol, which signal the liver to release glucose into the bloodstream. This can raise blood sugar even if your diet is balanced.
Lifestyle patterns
Long gaps between meals and prolonged periods of sitting can also affect how your body manages blood sugar. Not all prediabetes is driven by the same issue. For some people, insulin resistance is the main driver. For others, the body may not be producing or releasing insulin as effectively. Many people have a combination of both.
Certain medications or medical conditions
Some medications and medical conditions can also affect blood sugar regulation. Examples include steroids, certain psychiatric medications, sleep apnea, and hormonal conditions such as PCOS.
Not all prediabetes is driven by the same issue. For some people, insulin resistance is the main driver. For others, the body may not be producing or releasing insulin as effectively. Many people have a combination of both.
And sometimes, there is no clear explanation. In those situations, it is more helpful to focus on what you can do to improve blood sugar rather than stressing over why it happened, especially since stress itself can raise blood sugar levels.
Subtle Signs Your Blood Sugar May Be Off
While many people do not have obvious symptoms of elevated blood sugar, there are often subtle clues that something is off. These changes can develop gradually and are easy to dismiss, especially when you otherwise feel healthy.
Some common signs include:
- A1c or fasting glucose gradually increasing to the higher end of “normal”
- Energy dips, especially in the afternoon
- More fat around the midsection
- Loss of strength or muscle over time
- Feeling like you are doing everything right, but your numbers are not improving
These signs are easy to overlook, especially when weight is stable, but they can be early indicators that your body is becoming less efficient at managing blood sugar.
What to Do to Improve Blood Sugar Control
In people with excess body weight, losing about 5 to 10 percent can significantly improve blood sugar. But if you are already at a normal weight, the goal is not to lose weight. The focus is on supporting how your body processes and uses glucose. This means improving insulin sensitivity and keeping blood sugar more stable throughout the day.
Focus on:
- Building and maintaining muscle. Strength training a few times per week can significantly improve how your body handles blood sugar.
- Include enough protein at meals to help stabilize blood sugar and support muscle.
- Choose fiber rich foods such as vegetables, beans, lentils, and whole grains to slow the rise in blood sugar.
- Structure your meals so you are not going long periods without eating, and aim for balanced meals that include carbohydrates along with protein or fat.
- Do not overlook sleep and stress. Both can have a meaningful impact on blood sugar regulation.
- In some cases, even when you are doing many of the right things, blood sugar may still run higher than expected. Medications such as metformin or GLP 1 receptor agonists can help improve blood sugar control and may allow for a less restrictive approach to eating. Certain supplements may also be helpful depending on your individual needs.
- If you feel you’re doing everything right, consider using a continuous glucose monitor for a few weeks. This can help identify what foods, dietary patterns or lifestyle habits that can be contributing to elevated blood sugar. For more information on CGMs, ready my previous post on Using A CGM Without Diabetes: Pros, Cons, And An Evidence-Based Perspective
Common Mistakes I See
When people are diagnosed with prediabetes, especially at a normal weight, they often try to “fix” it quickly. Some of these strategies can actually make things worse.
Blaming yourself
It’s common to feel like you did something wrong. In reality, prediabetes is rarely caused by one habit or one type of food. It’s more helpful to step back and look at the bigger picture.
Over-restricting carbohydrates
Cutting out rice, bread, fruit, and other carbohydrates can lead to fear around food and often results in unwanted weight loss. It can also make eating feel unnecessarily complicated and difficult to sustain.
Thinking more exercise is always better
Exercise is important, but very long or intense workouts, especially when paired with poor sleep or not eating enough, can add stress to the body. In some cases, this may contribute to higher blood sugar levels.
Undereating
Eating too little can lead to muscle loss and higher stress hormones, both of which can worsen blood sugar control.
Focusing only on sugar
Avoiding sweets but overlooking overall carbohydrate intake can still leave blood sugar elevated. Foods like fruit juice, bread, rice, cereal, crackers, and even large portions of healthy carbohydrates can affect blood sugar levels. Meal balance, portion sizes, and overall eating patterns matter too.
Overlooking sleep and stress
Sleep and stress are often overlooked, but they play a major role in blood sugar regulation. Poor sleep can make the body more insulin resistant, while chronic stress increases cortisol, which signals the liver to release glucose into the bloodstream. This can raise blood sugar even when your eating habits are healthy
Trying to be perfect
A new diagnosis can lead to rigid rules or all or nothing thinking. This often creates frustration and is not necessary for improving blood sugar.
I see this often in people who become overly restrictive after being diagnosed with prediabetes. For example, I worked with a 60 year old client who was very lean, exercised about 2 hours a day, and ate a healthy diet. After learning his A1c was 6.0 percent, he cut out nearly all carbohydrates and increased his workouts. He unintentionally lost 8 pounds, and his A1c increased to 6.1 percent.
When we looked more closely using a CGM, we saw that his intense exercise routine and poor sleep were contributing to higher blood sugar levels. His very low carbohydrate intake also was not working well for his body.
We made a few targeted changes, including adjusting his exercise routine, improving sleep, and bringing more balance back into his meals. Three months later, his A1c dropped to 5.9 percent.
The Bottom Line
You do not have to have excess weight to develop prediabetes. What matters most is how your body is functioning, especially when it comes to insulin sensitivity, muscle mass, and daily habits.
If your numbers seem confusing, there is usually a reason. Tools like a continuous glucose monitor can help uncover patterns related to sleep, stress, meal timing, and food combinations. Once you understand what is driving your blood sugar, you can take a more targeted and effective approach.
If you have been told you have prediabetes and it does not seem to make sense, I can help you figure out what is really going on and create a plan that fits your life. Contact me here
If you’ve been diagnosed with prediabetes and aren’t sure what to do next, I’d love to work with you. We can could come up with a realistic plan to lower your blood sugar without restricting your favorite foods. Contact me here to learn more.
