Conditions
Prediabetes: what your results mean and how we help by video
Prediabetes means your blood sugar is higher than normal but not yet at the diabetes level: an A1C of 5.7% to 6.4%. It rarely causes symptoms, and it can be reversed. By video, the doctor explains your results, gives you a lab order to repeat your A1C and builds a realistic plan with you to prevent or delay type 2 diabetes.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Great thirst, peeing a lot and unexplained weight loss, with vomiting or fast breathing
- Confusion or extreme drowsiness
- Chest pain, shortness of breath or weakness on one side of the body
Help lines
At a glance
Prediabetes
Common symptoms
- Usually no symptoms
- Other names
- Borderline diabetes · Impaired fasting glucose
- Usual test
- A1C, fasting blood sugar or glucose tolerance test
- Treatment
- Changes in weight, eating and physical activity; medication only if the medical evaluation indicates it
- Possible complication
- Type 2 diabetes
On this page(10)
What prediabetes is
Prediabetes is the step before type 2 diabetes: your blood sugar is already high, but not yet at the diabetes level. It is very common. The CDC estimates that about 115 million US adults (more than 2 in 5) have prediabetes, and 8 in 10 of them do not know it.
It matters even more in Puerto Rico: in 2021, 14.4% of adults had diagnosed diabetes, the highest of any US state or territory, according to the CDC. Catching prediabetes early is your chance to stay clear of type 2 diabetes.
Prediabetes care by video
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you. You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico (check her license) with several years of emergency-department experience, in English or Spanish. You can have her as your online primary care doctor.
In your visit, the doctor explains your results, gives you a lab order to repeat your A1C, works out a realistic eating and activity plan with you, and checks other risks such as high blood pressure, high cholesterol and fatty liver. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. It is part of our chronic care, with clear prices, no membership, and run by a nonprofit.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
How to book your visit in 3 steps
Booking a prediabetes visit is simple:
Request your visit.
Request a visit online 24/7 — we confirm your time by email or text. Choose Doctor visit, or Follow-up visit if you only need a refill of a medicine you already take, and pay by card at secure checkout. Book your visit.
Get your link.
We send you a secure video link. It works on your phone, tablet or computer. You need to be in Puerto Rico during the visit (visitors are welcome). Patients under 21 need a parent or legal guardian on camera with photo ID.
See the doctor.
The doctor evaluates, diagnoses and treats you. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you need a test, we give you a lab order for a lab near you.
Price: a US$79 doctor visit, no membership
A doctor visit costs US$79, the same price for every age, with no membership and no insurance needed. You are charged when you request the visit, and you get a full refund if the visit can't happen. A doctor's note after your visit is included at no extra charge. See all prices.
If we have already seen you and you only need to go over your lab results, choose the US$49 follow-up visit. A refill of a medicine you already take is also a US$49 follow-up visit, and anyone can book it. If a US$49 visit turns out to need a full visit, the doctor explains why and, with your consent, you pay the difference.
Video visit
Doctor visit
US$79
For a new problem, urgent care (non-emergencies), primary care, children, birth control, STIs, skin and acne, and visitors. Includes a doctor's note if you need one.
- You’re charged when you request the visit.
- Full refund if the visit can’t take place
Does prediabetes cause symptoms?
It usually causes no symptoms. Testing is how you find out, especially if you are overweight, have a family history of diabetes or had diabetes during a pregnancy. If prediabetes moves on to diabetes, you may notice great thirst, peeing often, fatigue and blurry vision. Dark, thick patches on the neck or armpits (acanthosis nigricans) can be a sign of insulin resistance.
Treatment and when a lab test is ordered
Prediabetes is found with blood tests, and the doctor gives you a lab order whenever one needs to be done or repeated. These are the ranges:
- A1C: normal, below 5.7%; prediabetes, 5.7% to 6.4%; diabetes, 6.5% or above.
- Fasting blood sugar: normal, 99 mg/dL or below; prediabetes, 100 to 125 mg/dL; diabetes, 126 mg/dL or above.
- Glucose tolerance test (at 2 hours): normal, 139 mg/dL or below; prediabetes, 140 to 199 mg/dL; diabetes, 200 mg/dL or above.
Lifestyle change is almost always the first step. Some people at higher risk may benefit from a medicine; the doctor assesses whether that applies to you.
Changes that reverse prediabetes
The CDC says losing around 5% to 7% of your body weight and getting at least 150 minutes a week of brisk walking or similar activity help prevent type 2 diabetes. For a 200-pound person, that is 10 to 14 pounds.
In the National Diabetes Prevention Program, a CDC-recognized lifestyle change program, people with prediabetes lowered their risk of type 2 diabetes by 58% (71% for people over 60).
- Move more: for example, a 30-minute brisk walk, 5 days a week.
- Eat more vegetables, whole fruit and whole grains, and fewer sugary drinks.
- Sleep well and do not smoke.
Prediabetes in children and teens
We see adults and children of all ages. If your child has been told they have high blood sugar or prediabetes, the doctor evaluates them, gives you any lab order they need and builds a plan with the whole family: eating together, moving together and drinking fewer sodas helps everyone.
When to go to the ER
For your safety, call 911 or go to the emergency room if you have any of these signs. See also when to go to the ER.
- Great thirst, peeing a lot and unexplained weight loss, with vomiting or fast breathing
- Confusion or extreme drowsiness
- Chest pain, shortness of breath or weakness on one side of the body
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Can prediabetes be reversed?
What A1C level is prediabetes?
How often should I repeat the test?
Do I need medication for prediabetes?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (7)
- CDC: Preventing type 2 diabetes (opens in a new tab) (accessed 2026-09-30)
- CDC: Prediabetes, preventing type 2 diabetes (opens in a new tab) (accessed 2026-09-30)
- NIDDK (NIH): Diabetes tests and diagnosis (opens in a new tab) (accessed 2026-09-30)
- CDC, Preventing Chronic Disease 24_0221: prevalence of diagnosed diabetes by state and territory, 2021 (opens in a new tab) (accessed 2026-09-30)
- CDC: Diabetes symptoms (opens in a new tab) (accessed 2026-09-30)
- Acanthosis nigricans (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- NAFLD & NASH: Symptoms & Causes (NIDDK, NIH) (opens in a new tab) (accessed 2026-10-02)