Nearly a third of American adults have a potentially chronic disease, and nine out of ten of them don't even know it yet. Eighty-six million American adults have prediabetes, a condition that increases your risk of heart disease, stroke, and type 2 diabetes.

What is prediabetes?

Insulin is a hormone made by the pancreas that plays a major role in metabolism. During digestion carbohydrates—sugars and starches—are broken down into glucose and then enter the bloodstream. With the help of insulin, glucose is absorbed in cells throughout the body and used for energy or stored for future energy in the form of glycogen. Insulin resistance occurs when the body still produces the hormone but doesn't use it effectively resulting in a build up of glucose in the blood. Prediabetes is when your blood sugar is elevated but not high enough to be diagnosed with diabetes.

Risk factors for prediabetes?

If you are over 40 years old, overweight, have high blood pressure or high cholesterol, you may be at risk of having—or developing—prediabetes. Other risk factors include having:

• an immediate family member with diabetes
• history of gestational diabetes
• delivering a baby over 9 pounds
• triglyceride level above 250 mg/dl
• history of heart disease
• polycystic ovary syndrome (PCOS)

Having a combination of any of these red flags may be an even stronger indication of your risk. If you're not sure,  take this quiz now. If you believe you are at risk, you should schedule an appointment for a simple blood test right away.

Know your numbers.

There are three tests to help determine if you have prediabetes: the glycated hemoglobin (A1C) test, the fasting blood sugar test, or the oral glucose tolerance test.

The A1C test measures the percentage of glucose that is attached to the protein, hemoglobin, in your red blood cells. This test shows your average blood sugar levels for the past three months, a good indicator since your body makes new red blood cells every three months.[1]  The fasting blood sugar test is taken after you have fasted for at least eight hours to reveal your blood sugar levels at that moment.  The oral glucose tolerance test is primarily used during pregnancy and measures your blood sugar two hours after consuming a sugary drink

See the chart below for the different blood sugar ranges.

Prediabetes can be reversed.

Getting diagnosed with prediabetes isn't a death sentence. Think of it as a second chance, an opportunity to make some lifestyle changes that can help reverse, prevent, or delay the progression to type 2 diabetes, which can put you at risk for really serious health complications. Without making any changes, 15-30 percent of people with prediabetes  will  develop type 2 diabetes and face the possibility of blindness, amputation or kidney failure, which could result in dialysis for the rest of your life.

If you've been diagnosed with prediabetes, consider this your second-opportunity checklist:

1. Move more.  If you think of exercise as the "e-word," don't. Just get up and move. This is one of the most important prevention actions you can take to prevent the onset of diabetes. Just going for extended, regular walks can lower blood glucose levels while reducing body fat. A single workout can boost insulin sensitivity for 16 hours or more. Any type of physical activity will help, but research shows a combination of aerobic and strength training has the biggest impact. Aerobic activities such as running, cycling, swimming, tennis, dancing, and cross country skiing, burn more calories (and glucose) per session, but resistance training builds more muscle which burns glucose, which, especially in the prediabetic patient's case, is the goal.[2]
2. Lose weight.  Losing 5 to 7 percent of your body weight can reduce your chances of getting diabetes by 58 percent. If you weigh 200 pounds, this means your goal is to aim to lose 10 to 14 pounds,[3]  which can easily—really!—be done by following three primary rules of eating:  fill up on fiber  (fiber helps fill you up and keeps you fuller, longer), practice portion control (don't give up your favorite foods, just eat less of them!), and eat consistently throughout the day (to avoid binging and spiking blood sugar later).[4]
   
   Remember, too, that people often mistake thirst for hunger, which leads us to prediabetes prevention tip #3
   
   
3. Drink water.  Not just liquids, butthe O.G. H20. Skip the bottled, sweetened, water-based drinks like sweet tea, lemonade, soda, juice, flavored lattes, and the misleadingly named "vitamin water." They provide empty calories, won't keep you full, and can raise your blood sugar.  Water not only keeps you hydrated but can help stabilize your blood sugar, too.  
4. Consider supplements.  There is emerging evidence that vitamin D can help with weight loss, glucose tolerance, and insulin sensitivity.[5]While there are no specific recommendations for people with prediabetes or diabetes, the current dietary reference intake is 600 international units (IU) of vitamin D daily for people aged 1 to 70 years, and 800 IU for 71 and over.[6]
5. Go to bed.  Consistently not getting enough sleep makes is harder to lose weight and increases insulin resistance, increasing the risk of obesity and type 2 diabetes. Untreated sleep disorders, such as sleep apnea, can contribute to poor sleep. Night shift workers may also be at increased risk for these problems.[7]
    

Get support.

If you find it daunting to try to change your lifestyle, build a support team. Having a team can help keep you inspired, while providing guidance and accountability. If you prefer one-to-one support, seek out a registered dietitian who can help provide personalized dietary guidance as well as behavior change goals. If you feel more comfortable in a group setting, find a  local diabetes prevention program.  Lastly, see your doctor more often. Visiting your doctor every three to six months can help you track your progress.

A prediabetes diagnosis is serious, and it can be scary, but with the right tools, knowledge, and tenacity, it can also be your wake-up call, and the beginning of a new, healthier, and happier life.