Many people are told they have “pre-diabetes”, are “borderline”, or are “at risk of type 2 diabetes”. Often this happens after a blood test at the GP surgery. The word “pre-diabetes” can feel frightening, especially when you see headlines about a “silent epidemic” or dramatic social media claims.

This guide explains what those terms usually mean, why they are a chance to act rather than a label to fear, and which gentle lifestyle changes have the biggest impact – without falling into harsh diets or unrealistic exercise plans.

What Do “Pre-Diabetes” and “Borderline” Actually Mean?

Health professionals use different phrases to describe blood sugar levels that are higher than normal but not yet in the diabetes range. You might see:

• Pre-diabetes
• Non-diabetic hyperglycaemia
• Impaired fasting glucose / impaired glucose tolerance
• “At risk of type 2 diabetes”

These are usually based on blood tests such as:

• HbA1c – an average blood sugar over 2–3 months.
• Fasting glucose – a blood sugar reading after not eating for several hours.
• Glucose tolerance tests – readings before and after a sugary drink.

Your practice or local NHS area will have specific number ranges they use. Your GP or nurse should tell you:

• Which test result put you in the “at risk” group.
• What your exact number was.
• What changes they recommend and when they will re-test you.

“Pre-diabetes” does not mean you will definitely get type 2 diabetes. It means your body is showing warning signs, and you have a chance – often over years – to shift the direction gently.

If you want to understand the tests themselves more clearly, it can help to read this article alongside our guide:

HbA1c, Finger-Prick Tests and Daily Life

Why You Might Have Been Put in the “At Risk” Group

Blood sugar tends to creep up for a mixture of reasons, often over many years. Common factors include:

• A family history of type 2 diabetes.
• Carrying extra weight, especially around the middle.
• Being less active than in earlier life.
• High blood pressure or raised cholesterol.
• Certain medicines or long-term health conditions.
• Ethnic background – some communities have higher risk at lower weights.

None of these are a personal failing. They are part of how your body, your life story and the wider environment interact. The “pre-diabetes” label is simply your body’s early warning system.

Headlines, Social Media and Scare Stories

Search for “pre-diabetes” online and you will quickly find:

• Headlines threatening “inevitable” type 2 diabetes.
• Extreme diets that promise to “reverse” diabetes in days.
• Videos blaming people for “bad choices”.

For older adults, this can be overwhelming and unhelpful. You may already be juggling arthritis, heart problems, breathlessness, pain, grief or caring responsibilities. A harsh plan designed for a 25-year-old with no other health issues is not realistic – and can even be unsafe.

You do not need a miracle cure, a celebrity diet or a punishing exercise regime. You need small, steady changes that fit your real life and can be kept up for years, not weeks.

Whenever you see a new trend online, ask:

• Is this based on proper evidence, or just a story?
• Is it suitable for someone my age, with my health conditions?
• Have I checked this with my GP, practice nurse or pharmacist?

Which Lifestyle Changes Help Most?

Everyone’s situation is different, but research and lived experience suggest that for many people the biggest gains come from five areas:

1. Food choices you can live with

You don’t have to give up every favourite food. Helpful shifts include:

• Cutting down sugary drinks and adding more water or sugar-free options.
• Choosing wholegrain versions of bread, rice or pasta where possible.
• Adding vegetables, beans or lentils to main meals for extra fibre.
• Eating regular meals rather than long fasting followed by large portions.

Our Food & Nourishment pathway includes a gentle guide here:

Balanced Plate After 60 – Eating for Energy, Not Just “Being Good”

2. Gentle movement most days

Moving your muscles helps them use sugar from the blood. This does not need to be intense:

• A 10-minute walk, once or twice a day.
• Chair-based exercises at home or during PHAT Zoom sessions.
• Light housework, gardening or walking indoors if the weather is poor.

If you have heart, lung or mobility problems, always ask your GP or rehab team what types of movement are safe for you.

3. Sleep and rest

Poor sleep can increase appetite and push blood sugars higher. Simple changes such as a regular bedtime, a wind-down routine and limiting screens late at night can support your body’s natural rhythm.

4. Stress and worry

When you are under constant stress, your body releases hormones that raise blood sugar – even if your food has not changed. Calm breathing, relaxation techniques, time in nature and talking to someone you trust all help.

You may find it helpful to link this article with our piece:

Stress, Worry and the Heart – Calming the System

5. Weight changes, if appropriate

For some people, losing a small amount of weight – even 5–10% of their body weight – can significantly reduce the risk of developing type 2 diabetes. For others, maintaining weight but eating more nourishing foods is more important.

Never start a strict diet, meal replacement plan or drastic weight loss programme without speaking to your GP or practice nurse, especially in later life or if you live with other conditions.

How Often Will I Be Checked?

If you are in the “at risk” group, your practice will usually:

• Explain your current numbers.
• Recommend lifestyle changes that suit your situation.
• Arrange to repeat tests after a set time (for example, 6–12 months).

Depending on your age, other health issues and results, they might:

• Invite you to a diabetes prevention programme or education session.
• Check your blood pressure, weight and cholesterol.
• Discuss medicines if your risk is particularly high.

These reviews are not there to “catch you out”. They are chances to see what is working, what has been difficult, and what support you might need next.

Our article on the first year after a type 2 diagnosis may also be helpful, even if you are not there yet. It gives a picture of what happens if diabetes does develop:

First Year After a Type 2 Diabetes Diagnosis – What to Expect

Ten Practical, Realistic Steps for “At Risk” Blood Sugar

You do not need to do everything at once. Choose one or two that feel possible this month.

1. Write down your results. Keep a simple note of your recent blood test numbers and what your GP or nurse called them (pre-diabetes, at risk, etc.).
2. Make a questions list. Each time you worry or wonder about something, jot it down for your next appointment.
3. Add one movement “snack”. For example, a 5–10 minute walk, or a few minutes of gentle chair exercises while the kettle boils.
4. Swap one drink. Replace one sugary or high-calorie drink each day with water or a sugar-free option.
5. Add colour to your plate. Aim for at least one extra portion of vegetables, salad or fruit (within your diabetes team’s guidance).
6. Plan a calm bedtime routine. Choose one small thing that helps you wind down – a warm drink, light stretching, or five minutes of quiet breathing.
7. Stay away from extreme online plans. If a diet or exercise trend sounds dramatic or promises miracles, hold off until you have checked it with a professional.
8. Use PHAT sessions as a gentle anchor. Joining our Zoom exercise or education sessions – even with your camera off – can give your week a healthy rhythm.
9. Share how you feel. Talk to someone you trust about your worries, guilt or anger. Keeping everything inside often makes stress and blood sugar worse.
10. Book and keep follow-up checks. Mark dates on your calendar and ask for help with transport or reminders if needed.