1. What Is Pre-diabetes?

Every time we eat, our bodies convert food, especially carbohydrates into glucose, a form of sugar that fuels our cells. The hormone insulin, produced by the pancreas, helps move glucose from the bloodstream into the cells, where it is used for energy.

In pre-diabetes, the body either does not produce enough insulin or the cells stop responding properly to insulin (a condition known as insulin resistance). As a result, glucose builds up in the bloodstream.

Your blood sugar is not high enough to be diagnosed as diabetes, but it is above the healthy range, a warning sign that your metabolism is under strain.

2. Why Pre-diabetes Matters

Pre-diabetes is not harmless. It is a clear indicator that your body’s ability to handle sugar is weakening. Without intervention, many people with pre-diabetes will develop Type 2 diabetes within five to ten years.

However, studies show that making small, consistent lifestyle changes can reduce this risk by up to 70 percent. This is why early detection is so important. It offers a chance to act before serious damage occurs.

Even before full diabetes develops, pre-diabetes can begin to affect health by:

• Increasing the risk of heart disease and stroke.
• Contributing to weight gain, especially around the abdomen.
• Affecting energy levels and overall well-being.

Recognising and responding to pre-diabetes can protect not just blood sugar levels but overall long-term health.

3. Who Is at Risk?

Pre-diabetes can affect anyone, but certain factors make it more likely.

Common Risk Factors Include:

• Being overweight or obese, especially around the waist.
• Physical inactivity (less than 150 minutes of moderate exercise per week).
• A family history of Type 2 diabetes.
• Being over the age of 45.
• Having high blood pressure or high cholesterol.
• A history of gestational diabetes (diabetes during pregnancy).
• Certain ethnic backgrounds, including South African Indian, Coloured, and African populations, which have a higher genetic risk.

In South Africa, rising rates of overweight and obesity have made pre-diabetes increasingly common, often developing quietly over years without symptoms.

4. Symptoms: Often Silent but Serious

Most people with pre-diabetes do not have obvious symptoms, which is why it often goes undetected. Some may notice subtle signs such as:

• Increased thirst or frequent urination.
• Fatigue after meals.
• Blurred vision.
• Slow healing of small cuts or infections.
• Unexplained weight gain around the stomach area.

Because symptoms can be mild or absent, the best way to detect pre-diabetes is through routine blood sugar testing. This can be done at your doctor’s office or local clinic. Early detection gives you the best opportunity to act before permanent damage occurs.

5. How Is Pre-diabetes Diagnosed?

Doctors use simple blood tests to measure glucose levels. Common tests include:

• Fasting Blood Glucose Test: Measures blood sugar after not eating for 8 hours.
• Normal: Below 5.6 mmol/L
• Pre-diabetes: 5.6–6.9 mmol/L
• Diabetes: 7.0 mmol/L or higher
• HbA1c Test: Measures average blood sugar over the past 2–3 months.
• Normal: Below 5.7%
• Pre-diabetes: 5.7%–6.4%
• Diabetes: 6.5% or higher

Your doctor will interpret these results in context and guide you on next steps. Testing once a year, especially if you have risk factors this action is a smart preventive measure.

6. The Good News: Pre-diabetes Can Be Reversed

Unlike full Type 2 diabetes, pre-diabetes is reversible for many people. Through lifestyle adjustments, you can restore your body’s ability to regulate blood sugar effectively.

Key Strategies Include:

a. Healthy Eating

The goal is to stabilise blood sugar and improve insulin sensitivity.

• Focus on whole foods: vegetables, fruits, whole grains, legumes, and lean proteins.
• Choose high-fibre carbohydrates, which release energy slowly (such as oats, brown rice, beans, and sweet potatoes).
• Limit refined sugars and processed foods like sweets, pastries, and sugary drinks.
• Include healthy fats like avocado, olive oil, nuts, and seeds.
• Watch portion sizes, smaller, balanced meals help avoid blood sugar spikes.

In South Africa, traditional foods like beans, lentils, pumpkin, and spinach are naturally nutrient-dense and affordable options that fit well into a pre-diabetes-friendly diet.

b. Regular Physical Activity

Exercise helps muscles use glucose for energy and improves insulin sensitivity.

• Aim for at least 150 minutes of moderate activity per week (such as brisk walking, cycling, or swimming).
• Include strength training twice a week to preserve muscle mass.
• Even small actions such as taking the stairs, gardening, or walking after meals, make a difference.

If you have not exercised in a while, start slowly and speak to your doctor before beginning a new fitness plan.

c. Maintain a Healthy Weight

Losing even 5–10 percent of body weight can significantly reduce the risk of developing diabetes. For example, if you weigh 80 kilograms, losing 4–8 kilograms can have measurable benefits.

d. Prioritise Sleep and Stress Management

Chronic stress and poor sleep raise blood sugar by increasing stress hormones such as cortisol.

• Aim for 7–8 hours of quality sleep.
• Practise stress-reducing habits like deep breathing, prayer, or gentle stretching.
• Take time to relax and connect with loved ones.

e. Avoid Smoking and Limit Alcohol

Smoking increases insulin resistance and cardiovascular risk, while excessive alcohol can disrupt blood sugar control. Limiting both supports overall metabolic health.

7. Why Prevention Matters

Managing pre-diabetes is not just about avoiding diabetes, it is about protecting your heart, kidneys, eyes, and brain.

Type 2 diabetes can lead to long-term complications such as heart disease, kidney failure, nerve damage, and vision loss. By taking action early, you can prevent or delay these outcomes entirely.

Think of prevention as an investment in your future energy, independence, and quality of life.

8. The South African Context

In South Africa, diabetes is one of the fastest-growing chronic conditions. Many people only find out they have diabetes once symptoms become severe. Yet, public health data shows that up to one in three adults may already have pre-diabetes. Often without realising it.

Cultural and economic factors, including limited access to fresh food and long working hours, make lifestyle changes challenging. However, small, affordable adjustments, such as choosing water over sugary drinks, walking more, and cooking at home can have a powerful impact.

Community clinics, dietitians, and wellness programmes are increasingly focusing on early detection and education to help individuals take action before diabetes develops.

9. When to Seek Professional Advice

If you have risk factors or suspect you may have pre-diabetes, speak to your doctor, nurse, or dietitian. They can:

• Check your blood sugar and other risk indicators.
• Help design a personalised meal and exercise plan.
• Monitor your progress and adjust your goals over time.

Professional support can turn uncertainty into empowerment. The earlier you act, the better your chances of preventing progression.

10. Final Thoughts

Pre-diabetes is your body’s early warning system, “a red flag” that change is needed, but hope is very much alive. It is a chance to take charge before complications arise.

By choosing healthier foods, moving your body regularly, managing stress, and keeping up with medical check-ups, you can reset your health and prevent diabetes altogether.

Every positive choice counts. The best time to take control of your health is now, before the light turns from warning to alarm.

Disclaimer: The content presented on this article is provided for general informational and educational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a registered health practitioner with any questions you may have regarding a medical condition or treatment plan. Reliance on any information provided on this site is solely at your own risk and does not establish a practitioner–patient relationship.

The views and opinions expressed herein are those of the author and do not necessarily reflect the official policy or position of Equilibrium Health (PTY) or the Health Professions Council of South Africa. This article complies with the HPCSA’s Ethical and Professional Rules prohibiting untruthful, deceptive or misleading advertising and canvassing of services, and with its requirement that practitioners include clear disclaimers on public-facing platforms.