Diabetes is a growing health concern, and lifestyle modifications can play a significant role in prevention.
By Paulette Lambert, RD, CDE
Diabetes is a chronic disease that has increased worldwide in the past decade, nearing epidemic proportions. Today nearly half the US population either has prediabetes or diabetes.1 The growing prevalence of this debilitating condition is generating major concern among healthcare providers, as the number of patients managing diabetes becomes a significant cost and well-being concern.
Defining Diabetes and Prediabetes
There are two types of diabetes: In type 1 diabetes (formerly referred to as juvenile diabetes), the body does not produce the hormone insulin, which is required to get glucose from the bloodstream to the body’s cells; type 2 diabetes is a condition in which blood glucose (sugar) is elevated due to the lack of insulin production or to the body’s development of insulin resistance as a result of overweight and obesity, poor diet, and sedentary lifestyle. Elevated blood glucose levels, even those that are only slightly elevated, damage blood vessels in the heart, eyes, and kidneys and are now associated with higher risk of dementia and Alzheimer’s disease.
Prediabetes is the state in which glucose levels are higher than normal but not yet high enough to be considered full-blown diabetes. Ninety percent of those with prediabetes do not know they have the condition, as they generally have no symptoms. The only way to detect prediabetes is to have a blood test. Twenty-five to 30 percent of people diagnosed with prediabetes will develop diabetes in three to five years, and a significantly larger percentage will develop the disease over a longer period of time. Those who develop prediabetes under the age of 65 are more likely to progress to diabetes.
The Role of Lifestyle Factors in Diabetes Prevention
While genetics and ethnicity do increase risk, the sharp increase in the number of people diagnosed with diabetes over the past 10 years is largely due to lifestyle factors: overweight and obesity, poor diet, and lack of physical activity. Weight gain causes a cascade of hormonal and metabolic changes that trigger insulin resistance, meaning the body’s ability to effectively use insulin is impaired.
For the majority of those with prediabetes, making some changes in lifestyle can reverse or at least delay the onset of diabetes for 10 to 15 years. The Diabetes Prevention Program research has shown that intensive lifestyle changes, including weight loss, exercise, and healthy diet, decreased the progression to diabetes 60 percent more effectively than solely using medication and that, if maintained, lifestyle changes continued to reduce the progression to diabetes even 15 years later.2
Kick Your Prediabetes into Remission
What steps can you take if you are diagnosed with prediabetes? The following are some of the most effective lifestyle modification strategies to help avoid developing diabetes. (Be sure to discuss any lifestyle modifications with your physician.)
- Track Your Numbers. While daily testing of blood sugar is not necessary for those with prediabetes, having an A1C test every six months is recommended. This test provides a view of your average blood glucose (blood sugar) control for the past three months; a stable A1C is a good sign and a lower one even better.
- Lose Weight If Needed. Even losing 7 percent of the extra weight can make a difference. Losing weight and keeping it off over the years is the main predictor of slowing diabetes progression.
- Change Your Behavior. Aim to make long-term changes to your lifestyle. Life will get in the way, but seek to overcome the obstacles you encounter to maintain good habits.
- Stop Dieting. Instead, eat like you already have diabetes: control the amount of carbohydrate foods (grains, fruit, milk, and yogurt) that you consume at any one time. The focus is on balance and portion control of carbohydrate foods, as well as on keeping unhealthy fats low to avoid heart disease.
Most everyone with prediabetes and diabetes can handle a controlled amount of carbohydrate foods at one time, but problems arise when meals are skipped and overeating follows. Aim for no more than two to three carbohydrate servings per meal (see sidebar “Prediabetes and Type 2 Diabetes Carbohydrate Servings Guide”) and one for a snack. Space out your meals to about every five hours, and make sure any snack is at least two hours before or after a meal so that your glycemic load stays low (which results in lower blood sugar).
- Increase Your Physical Activity. Regular aerobic exercise lowers your glucose levels and decreases insulin resistance. If you do not currently exercise, start with 15 to 30 minutes of walking each day and work your way up to an hour a day. Your weight depends on your caloric intake more than your exercise, but exercise does play a very supportive role.
- Seek Help. If you are having difficulty making the recommended lifestyle changes, seek help from a registered dietitian or certified diabetes educator. These professionals can help you gain the knowledge you need to be successful. Online resources are also available, such as the Centers for Disease Control and Prevention’s National Diabetes Prevention Program (cdc.gov/diabetes/ prevention).
- Do Not Despair. If you learn you have prediabetes, know that you are fortunate to have been warned. Take advantage of that warning and kick the diabetes into remission.
Paulette Lambert, RD, CDE, is director of nutrition for California Health & Longevity Institute, located within Four Seasons Hotel Westlake Village (chli.com). With more than 27 years of private practice after an extensive clinical education, Lambert has wide-ranging experience in clinical nutrition and the development of individualized dietary plans.
Prediabetes and Type 2 Diabetes Carbohydrate Servings Guide
|All portions equal to 1 carbohydrate serving|
|1 piece of bread (1 ounce)||1 medium orange, apple, peach, or pear||1 cup nonfat or low-fat milk|
|6 crackers||2 apricots or plums||1 cup soy milk|
|Half of a small bagel||Half of a mango or papaya||6 ounces lite yogurt or nonfat Greek yogurt|
|1 whole high-fiber English muffin||2 kiwi||1 carbohydrate serving =15 to 20 grams (g) of total carbohydrateGoal: Two to three carbohydrate servings per meal
One carbohydrate serving per snack
|2 thin corn tortillas||½ cup pineapple|
|One-quarter large flour tortilla (burrito size)||1 cup berries|
|½ cup rice, pasta, corn, peas, potato, or couscous||1 cup melon|
|4-ounces of potato or yam||15 grapes|
|1 ounce cereal (check box for serving size)||Half of a banana|
|Mini, lite popcorn bag||3 small pieces dried fruit|
|½ cup lite ice cream or frozen yogurt||2 tablespoons dried cranberries|
|1 cup soup, not creamed||¼ cup dried blueberries|
|12 baked chips|
Screening for Prediabetes
The American Diabetes Association recommends hemoglobin A1C and fasting blood sugar testing in people at high risk of developing diabetes:
- Everyone over age 45
- Younger people who are overweight and who also have one of these diabetes risk factors: Little or no physical activity
- Family history of diabetes
- High blood pressure or high cholesterol
- Previous diagnosis of heart disease or polycystic ovary syndrome
- Diabetes during pregnancy (gestational diabetes) or having delivered a baby weighing more than nine pounds
If you have prediabetes or diabetes, follow up with your healthcare provider to help you plan how you are going to kick the prediabetes into remission or treat the diabetes effectively.
- Menke A, Casagrande S, Geiss L, Cowie CC. Prevalence of and trends in diabetes among adults in the United States, 1988-2012. Journal of the American Medical Association. 2015;314(10):1021-29. doi: 10.1001/jama.2015.10029.
- Diabetes Prevention Program (DPP). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Pages/default.aspx. Accessed October 10, 2015.