Prediabetes and type 2 diabetes

What it is

Insulin's job is to move glucose out of the blood, and around three quarters of that goes into skeletal muscle. When muscle is small, untrained and rarely contracting, it takes up less for the same insulin signal - the pancreas compensates by producing more, and eventually cannot keep up.

This is why exercise is not a lifestyle footnote here. A single bout of exercise increases glucose uptake by a route that does not need insulin at all, and regular training increases the muscle's capacity to store glucose in the first place. Prediabetes in particular is highly reversible.

What it feels like

• Very often nothing at all, particularly at the prediabetes stage
• Thirst, needing to pass urine more often, especially at night
• Tiredness after meals, and energy that dips and spikes
• Slow-healing cuts, repeated skin or urinary infections
• Later, tingling or numbness in the feet, or blurred vision

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

Low muscle mass

The main destination for glucose is muscle. Less muscle is a smaller sink, so the same meal produces a higher and longer glucose rise regardless of anything else.

Inactivity, independently of weight

Muscle that is not contracting downregulates its glucose transporters. Even a few days of enforced inactivity measurably worsens insulin sensitivity in healthy people.

Excess fat around the abdomen and inside the liver

Visceral and liver fat drive insulin resistance far more strongly than fat under the skin. This is why waist measurement predicts better than weight does.

Long unbroken sitting

Sitting for hours without interruption raises post-meal glucose independently of total daily exercise. Breaking sitting up every half hour has measurable effects on its own.

Genetics and family history

Type 2 diabetes has strong heritability and a strong ethnic gradient - risk begins at lower body weights in South Asian, African and Caribbean populations. It sets the starting point, not the outcome.

Poor and short sleep

A few nights of restricted sleep produce measurable insulin resistance in healthy volunteers. Sleep apnoea compounds it further.

Diet quality, especially liquid sugar

Refined carbohydrate and sugary drinks produce the largest and fastest glucose loads with the least satiety, so they contribute both to the immediate spike and to the surplus.

Age

Insulin sensitivity falls with age, largely through muscle loss and reduced activity rather than through age itself - which is why the same interventions still work in older people.

Some medications and conditions

Steroids, some antipsychotics, and conditions like polycystic ovary syndrome all raise blood glucose. Gestational diabetes is a strong predictor of later type 2.

Stress hormones

Cortisol and adrenaline raise blood glucose by design - it is a mobilisation response. Sustained stress therefore keeps glucose elevated at a time when it is not being used.

Who tends to get it

• Anyone with a family history, and anyone of South Asian, African or Caribbean background at a lower body weight threshold
• People carrying weight around the middle
• Anyone with a sedentary job and low overall muscle mass
• Women who had gestational diabetes
• People with polycystic ovary syndrome, sleep apnoea or on long-term steroids

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineWeight, Cholesterol & Metabolic Health

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Hypoglycemia risk if on insulin or sulfonylureas; check feet for numbness before impact work

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Insulin sensitivity improves within days of starting to exercise and much of the benefit is lost within about three days of stopping, which makes consistency more important than intensity. Prediabetes is reversible in a large proportion of people, and established type 2 diabetes can be pushed into remission in some, particularly early on and with substantial weight loss. Medication decisions belong with the prescribing clinician - improving numbers is a reason to review a dose, never to change it alone.

Prevalence basis: CDC National Diabetes Statistics Report

Others the same routine covers

These share the Weight, Cholesterol & Metabolic Health routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.