Inclusion criteria: Subjects will include both males and females, ages 45-75, that have suspected or diagnosed prediabetes with or without neuropathy (to be confirmed at pre-intervention evaluation).  Exclusion criteria: (1) skin conditions, circulatory insufficiency, or open wounds in the leg that would interfere with healing from a biopsy; (2) stroke or other significant nervous system pathology; (3) lidocaine allergy; (4) anticipated difficulty with blood clotting due to disorder or use of a blood thinner such as Coumadin, Xarelto, or Eliquis; (5) use of any medication used to treat abnormal blood glucose such as Metformin; (6) body weight > 350 lbs.; (7) history of anemia or vitamin b12 deficiency; (8) clinical anemia (hematocrit <32 for women, <36 for men); (9) abnormal SPEP result; (10) history of cancer or chemotherapy treatment; (11) current or recent use (within the last 6 months) of artificial fingernails / nail enhancements that would interfere with quantitative sensory testing; (12) no special classes of subjects such as fetuses, neonates, pregnant women, prisoners, institutionalized individuals, non-English speaking individuals, or other who may be considered vulnerable populations will be included in this study.  Withdrawal/Termination criteria: Prediabetes will be determined using the American Diabetes Association (ADA) Diabetes Management Guidelines. The subject will meet the criteria for a diagnosis of pre-diabetes if the subject has one or more positive test(s) for either A1c (5.7-6.4%), fasting glucose (100-125 mg/dl), or 2-hr oral glucose tolerance test (140-199 mg/dl). If at pre-intervention evaluation, the subject does not meet the criteria for prediabetes (lower than the above-mentioned range), meets the ADA criteria for diabetes (higher than the above-mentioned range), the subject will be considered a screen fail and will not progress to skin biopsy or intervention.