Insulin resistance and prediabetes: what they are, and what lifestyle can do

Prediabetes sounds like a sentence. It is more of a warning light. It means your blood sugar is higher than normal, and it is not diabetes yet. Lifestyle change can slow it down a lot, and in some people blood sugar goes back to normal. Below: what insulin resistance is, why it rises with age and weight, and what helps.

Insulin resistance and prediabetes, simply

When you eat, your blood sugar rises. The pancreas sends insulin, a hormone that works like a key: it unlocks cells so they can take sugar in as fuel. When everything works, sugar falls, and things are quiet.

Insulin resistance means the key turns poorly. Cells respond lazily to insulin, so the pancreas has to send more and more of it to keep sugar down. For a while, it manages. When it no longer can, blood sugar starts to creep up. That is where you enter prediabetes.

Prediabetes is the step between normal and type 2 diabetes: sugar higher than it should be, but still under the line for a diagnosis. A 2025 overview article in the Journal of the Association of Physicians of India puts the chance that people with prediabetes progress to full diabetes at about 5 to 10% a year. That is exactly why it pays to deal with it before the line is crossed.

Why it rises with age and with weight

Two things work against you, and you can influence both.

Weight, especially fat around the belly. Excess fat, particularly visceral fat around the organs and fat stored in the liver, worsens insulin sensitivity and keeps the body in a quiet inflammation. The liver then releases more sugar into the blood than it should. That is one of the main engines of the whole problem.

Age, and less muscle. Muscle is the biggest customer for sugar from the blood. As we get older and move less, muscle declines, activity drops, and insulin sensitivity drops with it. Over the years, less movement and less muscle add up, and the body handles sugar worse.

The good news: you can influence both, the kilos and the muscle activity. That is what the data below shows.

Fat loss and a deficit: the strongest lever

If I have to pick the one thing with the biggest impact, it is losing excess fat. And it is not only about the number on the scale.

The large international PREVIEW study followed people with prediabetes and overweight for three years. Those whose prediabetes went into remission, and stayed there, had not only lost more weight and fat. They also showed lasting improvements in markers of liver insulin sensitivity, even after accounting for weight change (an analysis of PREVIEW data from 2026). This was a post-hoc analysis, so it shows a link, not cause and effect. At the same time, lasting remission was the exception in that study, not the rule. So it is not enough to drop a few kilos. You have to keep them off for the long run. PREVIEW started with an 8-week rapid weight loss phase inside a trial. Outside a study, a modest deficit you can keep is a safer starting point.

A 2025 overview article in the Journal of the Association of Physicians of India looks at it from the other side: it cites about 40 to 70% lower progression from prediabetes to diabetes with intensive lifestyle change. That is a large number for something that does not require a prescription.

In practice: you do not need a starvation diet, and you do not need zero carbs. You need a modest calorie deficit you can keep, enough protein so you do not lose muscle while you lose fat, and a plan you can live with for months, not for two weeks. What that way of eating looks like is in what to eat to lose fat.

Movement: lifting, plus a walk after you eat

Movement works from two different directions, and combining them is best.

Strength training builds muscle, the tissue that takes the most sugar out of the blood. The more functional muscle you have, and the more regularly you use it, the better the body handles sugar. Two to three lifting sessions a week, with gradually added load, is a solid base.

A walk after a meal helps with the sugar rise from that meal. In a lab study published in 2025, 16 young adults with obesity walked lightly, either 30 minutes in one go or 3 minutes every half hour. Both lowered blood sugar after a meal compared with sitting, and the 30-minute walk also lowered insulin. You do not have to destroy yourself. This is ordinary easy walking, and from my coaching practice, soon after a meal is an easy time to fit it in.

A practical recipe from my coaching practice: the gym or body-weight training 2 to 3 times a week, plus 10 to 15 minutes of easy walking after main meals as a start, and a decent daily step count. For a non-specialist, that is the best ratio of effort to result. A step target is covered in how many steps a day.

Food quality and sleep

Food does not have to be perfect to work. The base that works: enough protein, plenty of vegetables and fiber, mostly minimally processed food, and a sensible amount of carbohydrate around your movement. Improve the overall pattern so it helps you hold the deficit and keep blood sugar steadier. With sugar, the dose and the pattern matter most, which is the point of the sugar myth.

Sleep is the lever I see clients underestimate most. In a 2026 lab study, 48 healthy young adults who had 6 hours, or an irregular 4 to 8 hours, in bed on simulated weekdays handled sugar worse than at the start, even with 8-hour simulated weekends in between. The group with 8 hours in bed every night stayed most stable.

Regular sleep of 7 to 9 hours is the first thing to fix, before any supplement.

What to do now, and where the line is

So this does not stay theoretical, here is the order by size of impact:

• Lose excess fat with a modest deficit you can keep. The biggest lever.
• Lift 2 to 3 times a week and add load. You are building the muscle that takes sugar up.
• Walk 10 to 15 minutes after meals, and keep an eye on daily steps.
• Straighten the food: protein, fiber, less industrially processed food.
• Sleep 7 to 9 hours regularly, not only on the weekend.

This is an educational piece about lifestyle, not medical advice. I am not diagnosing you, and I am not prescribing anything. Prediabetes and diabetes belong with a doctor. They measure your sugar and your HbA1c and tell you what is next. If you take any medication, do not change it and do not stop it on your own. If you take medication for blood sugar, tell your doctor before you start a deficit or a new training plan. Eating less and moving more can change how much medication you need, and some drugs can push sugar too low. Some drugs can also interact with training. One 2026 trial in adults at risk for metabolic syndrome found that metformin blunted some training adaptations, such as gains in fitness and in how blood vessels respond to insulin. Do not stop metformin because of this: it is a first-line drug with proven benefits. Keep your doctor in the loop when you change your training. Lifestyle and medical care work best together.

Frequently asked questions

What is insulin resistance?

Cells respond lazily to insulin, so the pancreas has to send more and more of it to keep blood sugar down. When it can no longer keep up, sugar starts to creep up, and you move into prediabetes.

What is the risk that prediabetes becomes diabetes?

Prediabetes is the in-between step: sugar is higher than it should be, but still under the line for a diabetes diagnosis. A 2025 overview article in the Journal of the Association of Physicians of India puts the chance that people with prediabetes progress to full diabetes at about 5 to 10% a year. Prediabetes belongs with a doctor, and if you take medication, do not change it or stop it on your own. If you take medication for blood sugar, tell your doctor before you start a deficit or a new training plan, because some drugs can push sugar too low.

Why does insulin resistance rise with age and with weight?

Excess fat, especially visceral fat around the organs and fat stored in the liver, worsens insulin sensitivity. Muscle is the biggest customer for sugar from the blood, and as it declines with age and less movement, insulin sensitivity declines too. You can influence both, the kilos and the muscle activity.

What kind of exercise helps insulin resistance?

A combination works best. Strength training 2 to 3 times a week, with a gradual increase in load, builds the muscle that takes the most sugar from the blood. From my coaching practice, 10 to 15 minutes of easy walking after main meals is a practical start. In a lab study published in 2025, light walking instead of sitting lowered blood sugar after a meal in young adults with obesity.

Does sleep affect blood sugar?

In a 2026 lab study, 48 healthy young adults who had 6 hours, or an irregular 4 to 8 hours, in bed on simulated weekdays handled sugar worse than at the start, even with 8-hour simulated weekends in between. The group with 8 hours in bed every night stayed most stable. Aim for a regular 7 to 9 hours, a common general recommendation for adults.

You might also like

• What to eat to lose fat
• How many steps a day
• Is sugar bad for weight loss?

If you want a calorie number to start from, use the calorie calculator.

Sources, so you can check:

1) Zhu R, et al. (2026). Enduring improvements in hepatic insulin sensitivity predict sustained remission of prediabetes during a 3-year lifestyle intervention: results from the PREVIEW multinational diabetes prevention trial. Metabolism. DOI: 10.1016/j.metabol.2026.156546

2) Wongpipit W, et al. (2025). Light Walking Patterns and Postprandial Cardiometabolic Responses in Young Obese Adults: A Randomized Crossover Study. Journal of Clinical Endocrinology and Metabolism. DOI: 10.1210/clinem/dgae789

3) Cheung Y.Y.Y., et al. (2026). Glucose homeostasis during recurrent periods of sleep restriction and recovery in healthy young adults. Sleep. DOI: 10.1093/sleep/zsaf339

4) Malin S.K., et al. (2026). Metformin Blunts Vascular Insulin Sensitivity After Exercise Training in Adults at Risk for Metabolic Syndrome. Journal of Clinical Endocrinology and Metabolism. DOI: 10.1210/clinem/dgaf551

Martin Barna

Online nutrition and fitness coach. Since 2013 I have coached 600+ clients through fat loss. Plans built on research and habits you can keep.

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This article is for information and education only. It is not medical advice and it is not a diagnosis. Talk to your doctor about prediabetes, diabetes, and any medication. Do not change or stop a medicine on your own.