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Prediabetes | Why Early Action Matters | Windback NZ

Prediabetes | Why Early Action Matters | Windback NZ

Disclaimer: The information in this article is for educational and general wellness purposes only. It is not a substitute for professional medical advice and is not intended to diagnose, treat, or cure any health condition. Always seek the guidance of a qualified healthcare professional before making changes to your diet, lifestyle, exercise routine, or supplement use, particularly if you have any existing medical conditions or concerns. 

Prediabetes | Why Early Action Matters | Windback NZ

What is prediabetes?

Prediabetes means your blood sugar levels are above normal but not yet in the diabetes range. In New Zealand, this is defined as either:

  • Fasting glucose: 6.1 – 6.9 mmol/L*

  • HbA1c (average 3-month glucose): 41 – 49 mmol/mol* (6.82 mmol/L - 7.98 mmol/L)

  • 2 hour glucose on 75 g glucose tolerance test: 7.8 – 11 mmol/L*

*New Zealand Society for the Study of Diabetes (NZSSD) - Ministry of Health

Fasting glucose and HbA1c are simple blood tests, yet they are not always included in annual check-ups unless you ask. The challenge is that by the time Type 2 diabetes symptoms appear, changes may already be harder to reverse. Early detection makes a real difference.

For further information, we encourage you to review the New Zealand Society for the Study of Diabetes (NZSSD) - Ministry of Health website guidelines on prediabetes.

Renowned health experts such as Dr Mark Hyman, a pioneer in functional medicine, and Dr Casey Means, a leading physician in metabolic health, argue that conventional definitions of “normal” glucose may sometimes be too broad and can miss early signs of metabolic changes. Their focus is on optimising glucose control, particularly reducing post-meal rises and keeping levels stable.

Dr Mark Hyman vs Dr Casey Means: Optimal ranges

Fasting Glucose

  • Dr Mark Hyman: 3.9 – 4.7 mmol/L; suggests risks may rise above 4.7 mmol/L.

  • Dr Casey Means: 3.9 – 4.7 mmol/L; aligns with Hyman’s tighter target.

HbA1c

  • Dr Mark Hyman: 5.6 mmol/L (33 mmol/mol) or lower is optimal for overall health.

  • Dr Casey Means: Agrees — 5.6 mmol/L (33 mmol/mol) or lower is optimal for overall health.

Dr Means highlights that HbA1c may not fully reflect the variability in blood glucose levels, including glucose spikes and crashes, which can have long-term consequences on insulin resistance and overall metabolic health. She recommends using a Continuous Glucose Monitor (CGM) to identify these spikes, as it gives a real-time view of glucose fluctuations that HbA1c doesn’t capture.

Post-Meal (Postprandial) Glucose

  • Dr Mark Hyman: Recommends limiting rise to ≤ +1.7 mmol/L from baseline.

  • Dr Casey Means: Suggests an even stricter rise of ≤ +0.8 mmol/L from baseline.

Normal vs optimal

“Normal” ranges are used mainly for diagnosis. These cut-offs are based on population studies that identify when health complications become more likely. In fact, the NZSSD guidelines state that "the term ‘prediabetes’ is a misnomer because patients with prediabetes are still at an increased risk of macrovascular complications and early death".

Dr Hyman and Dr Means, however, suggest “optimal” ranges designed for prevention, long-term health and wellness. Research using CGMs in healthy individuals shows that metabolically fit people often stay between 3.9 and 6.7 mmol/L during the day, with fasting glucose typically below 5.6 mmol/L.

Their approach focuses on:

  • Reducing large spikes

  • Maintaining stability

  • Supporting long-term health and wellbeing

Rather than waiting until blood sugar is considered “too high” in a clinical setting, CGM offers the opportunity to:

  • Observe your unique patterns

  • Learn how your body responds

  • Make small, daily adjustments to support long-term metabolic health

Why it matters

Based on the NZSSD and MoH data, an estimated 20% of New Zealand adults have prediabetes. Most may be unaware of it, as it often has no obvious symptoms. Without lifestyle changes and intervention, many progress to Type 2 diabetes.

In the United States, the numbers are even more striking: 38% of adults (around 98 million people) have prediabetes. This global trend underlines the urgent need for earlier testing, prevention, and education.

We service our cars regularly to prevent breakdowns, yet many of us only see a doctor when something is already wrong. Prediabetes is like the warning light on your dashboard: it signals that it’s time to act.

What you can do

  • Ask your GP for a fasting glucose and HbA1c blood test referral at your next visit.

  • Focus on food first: whole, unprocessed foods are the best. Vegetables, legumes, high-quality proteins, and healthy fats help stabilise blood sugar naturally. Limit refined sugar and processed carbohydrates, which can cause glucose spikes.

  • Stay active with walking, strength training, or any movement you enjoy, and lose weight if your BMI is > 30 kg/m2.

  • Prioritise sleep and stress management, both of which play a role in blood sugar balance.

  • Stop smoking.

  • Remember: nutrition is important and supplements are not cures. They can only support your efforts alongside a nutrient-rich diet and healthy lifestyle. They are not intended to treat, cure, or prevent any disease.

Consult your doctor if you have any symptoms or concerns. Prediabetes increases the risk of heart complications and other serious health issues. Talking with your doctor about early diagnosis and management can make a real difference, helping reduce the chance of progression to Type 2 diabetes and supporting better long-term health and wellbeing.

References

Ministry of Health NZ. Living Well with Prediabetes and Diabetes. (2023) https://t2dm.nzssd.org.nz/Section-98-Prediabetes
American Diabetes Association. Diagnosis and Classification of Diabetes. Diabetes Care 46(Suppl. 1): S19–S40 (2023)
Means, C. (2023). Good Energy: The Surprising Connection Between Metabolism and Healthspan

Hyman, M. (2012). The Blood Sugar Solution. Little, Brown and Company.
Levels Health. (2022). What do healthy glucose levels look like? Levels Blog.
Means, C. (2021). Personalized nutrition: Deep dive with Dr. Casey Means of Levels. Medium.
The Living Well. (2023). Dr. Casey Means: Tips to lower blood glucose.

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