Prediabetes: The Warning Sign Most Hyderabadis Ignore

By Dr. Md. Mudassir Ali — Consultant Physician & Diabetologist, Faith Hospital, Hyderabad

What Prediabetes Is — and Why It's a Window of Opportunity

Prediabetes is the stage where your blood sugar is higher than normal, but not yet high enough to be called diabetes. An HbA1c between 5.7% and 6.4%, or fasting sugar between 100–125 mg/dL, puts you in this zone.

Here is what most people don't realise: prediabetes is the one stage where diabetes can genuinely be reversed. Once you cross into diabetes, we manage it for life. In prediabetes, studies show that committed lifestyle change can reduce the risk of progressing to diabetes by nearly 58% — more effective than any tablet.

Yet in my clinic, when I tell a patient "you are prediabetic," the most common reaction is relief: "Oh, so I don't have diabetes." That relief is exactly the problem. Prediabetes is not a clean bill of health — it is your body's final warning, and the damage to blood vessels has often already begun.

Who Should Get Screened

You should be tested for prediabetes if any of these apply to you:

• Family history — a parent or sibling with diabetes. In Indian families this is extremely common, and our genetic risk is higher than in Western populations.
• Belly fat — for South Asians, a waist circumference above 90 cm (men) or 80 cm (women) already signals risk, even if your BMI looks "normal." This is the "thin-fat Indian" phenotype — outwardly slim, metabolically at risk.
• Sedentary desk jobs — 8–10 hours sitting, minimal walking, no structured exercise. The IT corridor lifestyle.
• Other markers — high BP, abnormal cholesterol (especially low HDL, high triglycerides), PCOS, or a history of gestational diabetes.
• Age above 30 — screen at least once, even if you feel perfectly fine. Prediabetes has no symptoms.

A simple fasting sugar plus HbA1c, done in under ten minutes, answers the question.

The Indian Diet Trap: Rice, Refined Carbs, and Hidden Sugars

When I ask patients what they eat, the answer is usually "not much sweet, doctor." But sugar in tea is only the visible tip. Our everyday diet is a carbohydrate delivery system:

• Large portions of white rice at lunch and dinner — often two-thirds of the plate.
• Refined staples — white bread, maida-based tiffins (poori, paratha made with maida, upma with rava), instant noodles, and biscuits with evening chai.
• Hidden sugars — breakfast cereals, flavoured yoghurt and milk, packaged juices ("real" is not real fruit), tomato ketchup, and the irreplaceable Hyderabad menace: sugary chai taken 3–4 times a day.
• Liquid calories — one large glass of a "fresh" juice or a soft drink can carry 8–10 teaspoons of sugar with zero fibre.

None of this means you must give up rice or chai forever. It means the proportions and combinations need fixing — more protein and vegetables, smaller rice portions, and whole grains (millets, brown rice, whole wheat) where possible.

Reversing Prediabetes: The Three Pillars

1. Diet — change the plate, not just the menu

• Half the plate vegetables, one quarter protein (dal, eggs, chicken, fish, paneer), one quarter rice/roti — not the reverse.
• Eat in order: vegetables and protein first, rice last. This simple sequence measurably blunts the after-meal sugar spike.
• Swap, don't stop: millet rotis or brown rice instead of white; fruit instead of juice; roasted chana or nuts instead of biscuits.
• Fix the chai: one spoon less, or shift to unsweetened chai/coffee. Three cups a day adds up to thousands of teaspoons a year.

2. Exercise — 150 minutes a week

This is the evidence-based minimum: 150 minutes of moderate activity per week — a brisk 30-minute walk, five days a week. "Moderate" means you can talk but not sing while walking. Add two sessions of basic strength training if you can, since muscle is where glucose gets stored. For desk workers, stand and walk for 2–3 minutes every hour — even this helps.

3. Sleep — the forgotten pillar

Sleeping under 6 hours regularly raises insulin resistance and drives evening cravings. Aim for 7 hours, keep a consistent bedtime, and stop screens 30–60 minutes before bed. Late-night bingeing and poor sleep feed each other — and both feed your sugar.

A Realistic 3-Month Action Plan

You don't need to transform overnight. Here is what I actually prescribe:

Month 1 — Measure and fix the biggest leak

• Get HbA1c, fasting sugar, and a lipid profile done.
• Cut sugary drinks and reduce chai sugar. One change, done properly.
• Walk 20 minutes daily, at a fixed time. Consistency over intensity.

Month 2 — Rebuild the plate

• Restructure meals: half vegetables, protein in every meal, rice reduced by one-third.
• Walk 30 minutes, five days a week.
• Fix bedtime — 7 hours, consistent.

Month 3 — Lock it in and re-test

• Repeat HbA1c. A drop of even 0.3–0.5% tells us the plan is working.
• If your numbers improve, we continue lifestyle alone. If they haven't, we adjust early — which is far better than discovering diabetes a year later.

Closing

Prediabetes is a crossroads, not a diagnosis to fear. I have seen patients bring their HbA1c from 6.3% back to 5.5% in six months purely through these changes — no tablets, no crash diets, no gym memberships. But it starts with a test most people never take.

If any of the risk factors above describe you, come in for a simple screening at Faith Hospital. Ten minutes today can spare you a lifetime of medication tomorrow.

Disclaimer: This article is for general awareness and is not a substitute for a personal medical consultation.