Prediabetes After 50: What Your HbA1c and Blood Sugar Numbers Really Mean

By Helen Chow, ND, Dip Herb, UK-qualified Naturopath & Herbalist,
Nutrition & Food Design Coach, Designer Realities Mind Coach
Originally published March 31, 2014. Reviewed & Updated on October 6, 2026

You go for your usual blood tests.

Perhaps you weren’t particularly worried about your blood sugar. You feel reasonably well. You’re getting on with life.

Then the results arrive: HbA1c: 43 mmol/mol
What on earth does that mean?

Someone may mention the word prediabetes, which sounds rather more frightening than that innocent-looking number on the page.

• Does it mean you have diabetes?
• Are you going to need medication?
• Have you eaten too much sugar?
• And why does Google tell you one set of numbers while your doctor, GP or healthcare practitioner seems to be using another?

Before you start worrying — or banishing every carbohydrate from your kitchen, let me explain what those numbers are actually trying to tell you.

Because prediabetes is information, not a sentence. And finding out now may give you a wonderful opportunity to change where your metabolism is heading.

First, what is prediabetes?

Prediabetes simply means that your blood glucose has risen above what your healthcare system considers the normal or lower-risk range, but has not yet reached the diagnostic threshold for diabetes.

And here is something important: Many people with prediabetes feel perfectly normal. No dramatic symptoms. No flashing warning light. No great moment when you wake up one morning and suddenly feel “prediabetic”.

That is why it is so often discovered during an ordinary blood test.

Prediabetes commonly develops against a background of insulin resistance. I explained this in my previous Health Sifu article on insulin resistance and blood sugar after 50.

Your pancreas produces insulin to help move glucose out of your bloodstream and into cells where it can be used or stored.

Your body can compensate for quite a long time when those cells become less responsive to insulin. The pancreas simply works harder. But eventually blood glucose may begin creeping upwards.

And that is often when the laboratory numbers finally get our attention.

Your HbA1c is rather like a blood-sugar diary

One of the most useful numbers to understand is HbA1c. The name sounds terribly technical. The idea really isn’t.

Haemoglobin is the substance inside your red blood cells that carries oxygen. Some of the glucose circulating in your blood naturally attaches itself to that haemoglobin.

The more glucose your blood has been exposed to over time, the more glycated haemoglobin tends to accumulate.

So HbA1c gives us an indication of your average glucose exposure during roughly the previous two to three months.

The American Diabetes Association has a very readable explanation of how A1C works and describes it as a longer-term picture of your blood glucose rather than a single moment in time. 

I like to think of it this way: A finger-prick glucose measurement is a photograph. Your HbA1c is more like a little home movie of the last few months.

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Neither tells us absolutely everything, but together they can reveal a great deal.

So what does your HbA1c number mean?

This is where things become confusing if Health Sifu has readers in London, Los Angeles, Sydney, Singapore, Kuala Lumpur, Toronto and Auckland.

Different healthcare systems draw the prediabetes line in slightly different places.

In the United States
The American Diabetes Association uses:

• Below 5.7% — normal range
• 5.7–6.4% — prediabetes
• 6.5% or above — diabetes range

In the alternative HbA1c measurement, 5.7% is approximately 39 mmol/mol, while 6.5% is 48 mmol/mol. 

In The UK
You’re more likely to see:

• Below 42 mmol/mol — below the high-risk range
• 42–47 mmol/mol — prediabetes or non-diabetic hyperglycaemia
• 48 mmol/mol or above — diabetes range

That 42–47 mmol/mol range corresponds roughly to 6.0–6.4%.

In Australia

Diabetes Australia also describes HbA1c 6.0–6.4% as the prediabetes range and 6.5% or above as indicating likely diabetes. 

So imagine that your HbA1c comes back at 5.8% — around 40 mmol/mol.

An American guideline may describe that as prediabetes. A British or Australian guideline may not. Same woman. Same blood. Same pancreas. Different line drawn on the chart.

This does not mean one country understands glucose and another doesn’t. It means that clinical definitions and screening conventions differ.

Your metabolism doesn’t suddenly become healthy at 5.9% and unhealthy at 6.0%.

The important thing is to look at your trend, your other metabolic markers, your health history and the whole picture, rather than becoming frightened by one decimal point.

And what about fasting blood sugar?

HbA1c is not the only way to look at glucose.

A fasting blood glucose test tells us how much glucose is circulating after you have gone without food for about eight hours, usually overnight.

Again, international guidelines vary slightly.

In the United States:

• under 100 mg/dL — under about 5.6 mmol/L — is considered normal
• 100–125 mg/dL — about 5.6–6.9 mmol/L — is the prediabetes range
• 126 mg/dL / 7.0 mmol/L or above reaches the diabetes threshold

Australia and Singapore commonly place impaired fasting glucose at 6.1–6.9 mmol/L, equivalent to approximately 110–125 mg/dL. Singapore also uses a two-hour oral glucose tolerance result of 7.8–11.0 mmol/L (140–199 mg/dL) in its definition of prediabetes.

Again, don’t let the different cut-offs drive you mad. What I want you to understand is much simpler: Blood glucose exists on a continuum.

If your fasting glucose has been steadily moving from 4.9 to 5.4 to 5.9 to 6.2 mmol/L over several years, that trend deserves your attention regardless of which country happens to have drawn its official line at 5.6 or 6.1

“But Helen, I feel fine!”

Exactly. And that is one of the interesting things about prediabetes. You can feel absolutely fine while your glucose control is gradually changing.

By the time blood glucose becomes substantially higher, some people develop thirst, frequent urination, tiredness, blurred vision, unexplained weight loss or recurrent infections.

But prediabetes itself is often silent. That makes a routine blood test rather useful. It is a little tap on the shoulder from your metabolism saying: “Perhaps we should pay attention to this now.”

Not ten years from now. But NOW!!!

Why can this start happening after 50?

Your 50-year-old body is not simply your 30-year-old body with another twenty candles on the cake. Things change. Hormones change. Body composition changes.

Many women become less active without even realising it. Muscle can gradually disappear. Fat may begin accumulating more readily around the abdomen. Sleep can deteriorate. Stress may be relentless.

You may be looking after ageing parents while worrying about adult children and attempting to hold your own life together somewhere in the middle.

And all of these things can influence metabolic health. This is why I keep talking about muscle after 50.

Muscle isn’t merely something you build to look nice in a sleeveless dress. It is extraordinarily metabolically useful tissue. Working muscle uses glucose.

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And when we preserve and build muscle, we give the body a larger, healthier place to put that glucose.

That is why I want women to include some form of resistance work rather than relying entirely on dieting. My Health Sifu article on weight-training benefits explains why strength matters far beyond appearance.

Now, let me tell you “the water story”

When I originally wrote this Health Sifu article years ago, I told you about a fascinating French study. I still want to tell you about it.

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The researchers began with 3,615 middle-aged men and women whose fasting blood glucose was normal. Then they followed them for nine years.

Every three years, the researchers looked at what these people were drinking — water, wine, beer, cider and sweet drinks — and checked what was happening to their blood sugar.

By the end of the study, 565 people had developed hyperglycaemia and 202 had developed diabetes.

And something interesting appeared: Overall, people reporting greater water intake had a lower likelihood of developing hyperglycaemia than those drinking very little water.

The study was observational, so it cannot prove that drinking water itself prevented high blood sugar. People who drink more water may differ from people who drink very little in other ways too.

But I still think it is a lovely story. Because it reminds us that metabolic health is built out of the ordinary things we do repeatedly.

Not one miracle food. Not one supplement. Not one heroic week of dieting. Ordinary things. Done over and over again.

You can read the original nine-year research here. The French D.E.S.I.R. water and hyperglycaemia study

And yes — drinking enough water remains a sensible part of looking after yourself. But please don’t turn water into medicine and start forcing litres down your throat because you have an HbA1c of 43. Hydration is, again, only one piece of a much larger picture.

I have written much more about water and everyday health here, and Health Sifu also has an article specifically about water and blood-sugar control.

What can you actually do about prediabetes?

This is the part I care about most. You have received the information. Now what?

1. Stop Drinking Your Sugar

This is often one of the easiest places to begin.

Soft drinks, sweet teas, sweetened coffees, energy drinks and many fruit juices can deliver a surprisingly large glucose load without making you particularly full.

Water, mineral water, unsweetened tea and coffee are very different companions to your metabolism.

You don’t have to become obsessive. Just make the drinks you consume every day work for you instead of quietly working against you.

2. What Carbohydrates Do You Eat Most Often?

I’m much less interested in whether somebody ate one carrot than I am in what she does every single day.

• Biscuits at 11 am
• White bread at lunch
• Cake because the office had a birthday celebration
• Sweet coffee at 3pm
• Crisps while cooking dinner
• Dessert because dinner somehow doesn’t feel finished without it

None of these makes somebody a bad person. But repeated day after day, highly refined carbohydrate foods can create a very different metabolic load from meals built around nourishing protein and minimally processed foods.

Harvard Health has a particularly readable discussion of food and prediabetes. It makes the useful point that there isn’t one magical “prediabetes diet”; the overall pattern matters much more. Harvard Health: Prediabetes diet and preventing progression

3. Make Protein A Proper Part of Your Meal

Especially after 50. Protein helps you preserve the muscle we have just been talking about, helps make meals more satisfying. Protein as the prime component makes it far easier for you to build meals around real food instead of endless snacks.

You don’t have to live on chicken breasts and lettuce. Meat, fish, eggs, dairy where tolerated, and appropriate plant proteins can all contribute.

The precise amount you need depends on your body, health and activity level. The principle is the important part: Don’t let protein become the garnish!

4. Use your muscles

• .Walk
• Carry things
• Garden
• Climb stairs
• Get up and down from a chair
• Lift appropriately chosen weights
• Use resistance bands
• And particularly after meals, even a walk can be a useful habit

Singapore HealthHub recommends regular physical activity, including both moderate exercise and strength training, for people with prediabetes. HealthHub’s practical prediabetes advice

You do not need to become an athlete. You need a body that remembers it was designed to move.

5. If you carry excess abdominal fat, work on reducing it with exercise — don’t sacrifice your muscle

This is so important! The goal after 50 should not simply be “Get the number on the scales as low as possible.”

I would much rather see a woman lose excess abdominal fat while protecting her muscle, strength, energy and healthy adult shape. That is quite different from starving yourself until both fat and muscle disappear.

If fat loss is one of your goals, Health Sifu has an article on weight-loss guidance can help you look at the bigger picture.

6. Pay attention to your sleep

A woman can eat beautifully all day and then undo an enormous amount of good work simply because she has spent years being exhausted.

Poor sleep influences appetite, cravings, activity and glucose regulation. And after 50, sleep problems can collide with menopause, stress, ageing parents, work and family responsibilities.

Sometimes improving metabolic health means dealing with things that don’t look remotely like “diet”.

7. Deal with ‘internal’ stress

I don’t separate the mind from the body. If you live every day as though an invisible tiger were chasing you, your physiology receives that message too.

Stress can influence sleep, appetite, movement, food choices and glucose regulation.

And perhaps, most importantly, it can make you feel that looking after yourself is yet another impossible job on an already impossible list.

That is why I believe creating a less stressful life belongs in a metabolic-health conversation too. Health is not merely what is on your plate. It is also the life in which that plate sits.

Can prediabetes reverse itself?

Sometimes, yes. And I want you to understand this because the word ‘prediabetes’ can sound horribly final when it isn’t. Blood glucose and HbA1c can improve.

Diabetes UK describes the reversal of prediabetes as bringing HbA1c back below its high-risk range, while the American Diabetes Association likewise notes that lifestyle intervention can help regulate glucose levels and substantially reduce the progression to type 2 diabetes. Diabetes UK: Reversing prediabetes

That, however, does not mean that everybody will achieve the same result. Nor does it mean that once one good blood test arrives, you can forget about your metabolic health forever.

It means something much more encouraging: Your numbers CAN move and change.

Don’t become obsessed with one number

This may be the most important thing I tell you.

Suppose your HbA1c is 44 mmol/mol. That number is useful. However

• it doesn’t show how strong you are
• It doesn’t indicate whether you sleep
• It doesn’t tell whether your waist has expanded dramatically in three years
• It doesn’t show what you eat
• It doesn’t indicate how stressed you are
• It doesn’t show what medication you take
• It doesn’t tell whether your glucose has been steadily rising or whether this result is completely out of character

And there are also circumstances in which HbA1c can be less reliable, so unexpected or contradictory results should be interpreted by an appropriate healthcare professional rather than treated as a DIY diagnosis.

Mayo Clinic provides a useful overview of both HbA1c and fasting glucose testing and some of the circumstances that can affect interpretation. Mayo Clinic: Prediabetes diagnosis and testing

Remember: this number is just information — it’s not your identity

So if your next blood test says: HbA1c 43 mmol/mol.

Or: A1C 5.8%.

Or: Fasting glucose 108 mg/dL — 6.0 mmol/L.

Don’t immediately decide that your body has failed you. Become curious. Ask yourself:

• What has changed?
• How are you eating?
• How are you sleeping?
• Are you using your muscles?
• Has your waist changed?
• Are you moving after meals?
• Are you under extraordinary stress?
• Are you eating because you’re hungry—or because you’ve finally got five quiet minutes after taking care of everybody else?

Those questions can tell us much more than simply saying: “My sugar is high.”

When the numbers inform you that you need medical attention…

Prediabetes is an opportunity for action, but genuinely diabetic-range results need proper clinical assessment.

An HbA1c of 6.5% / 48 mmol/mol or above reaches the diabetes threshold used by many international authorities.

A fasting plasma glucose of 7.0 mmol/L / 126 mg/dL or above likewise reaches a commonly used diabetes diagnostic threshold.

Diagnosis normally requires appropriate laboratory testing and, depending on the circumstances and whether symptoms are present, confirmation rather than relying on a casual home reading.

And if you develop

• marked thirst
• frequent urination
• unexplained weight loss
• blurred vision
• other symptoms of substantially raised blood glucose

Please obtain proper medical assessment as soon as possible.

Your blood sugar story isn’t finished

I began the original version of this Health Sifu article by talking about something as ordinary as drinking water. Years later, I still like that idea.

Because we often imagine that health is determined by enormous dramatic decisions. Usually it isn’t:

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• It is breakfast.
• It is the drink beside your lunch.
• It is whether you walk afterwards.
• It is whether you use your muscles.
• It is what you reach for when you’re stressed.
• It is whether you sleep.
• It is what you do again tomorrow.
• And the day after that.

Your HbA1c gives us a glimpse of the metabolic story your body has been living during the last few months.

If you don’t particularly like the direction that story is taking, you can begin writing the next chapter differently.

That’s what your numbers are for: Not to frighten you. BUT to help you

Health Sifu NOTE:

This article is for education and general health information and is not a diagnosis or substitute for individual medical care. Blood glucose and HbA1c results should be interpreted in the context of your health, medicines, symptoms and local clinical guidelines.

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Scientific References & Further Reading

American Diabetes Association: Understanding A1C

See the ADA diabetes diagnostic numbers

Diabetes UK: What is prediabetes?

Diabetes Australia: Screening for type 2 diabetes

Cleveland Clinic has a simple fasting blood-sugar explanation

Singapore HealthHub: Understanding Prediabetes

Harvard Health has a particularly readable discussion of food and prediabetes. It makes the useful point that there isn’t one magical “prediabetes diet”; the overall pattern matters much more. Harvard Health: Prediabetes diet and preventing progression

Singapore HealthHub recommends regular physical activity, including both moderate exercise and strength training, for people with prediabetes. HealthHub’s practical prediabetes advice

Diabetes UK describes the reversal of prediabetes as bringing HbA1c back below its high-risk range, while the American Diabetes Association likewise notes that lifestyle intervention can help regulate glucose levels and substantially reduce the progression to type 2 diabetes. Diabetes UK: Reversing prediabetes

Mayo Clinic provides a useful overview of both HbA1c and fasting glucose testing and some of the circumstances that can affect interpretation. Mayo Clinic: Prediabetes diagnosis and testing

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