Prediabetes is primarily associated with elevated blood sugar levels, but some people may also experience symptoms that resemble low blood sugar due to fluctuations in how their body regulates glucose. According to diabetologist Dr Vijay Negalur, insulin resistance can sometimes cause the pancreas to release excess insulin after carbohydrate-rich meals, leading to a rapid drop in blood sugar a few hours later—a condition known as reactive hypoglycaemia. This may trigger symptoms such as shakines