Underlying today's epidemic of type 2 diabetes is a larger epidemic—prediabetes, meaning blood sugar levels that are higher than normal but not high enough to be called diabetes. A diagnosis of prediabetes doesn't mean that you're destined for diabetes. Prediabetes can be reversed—and diabetes prevented—simply by making some basic lifestyle changes.
Almost everyone who develops type 2 diabetes has passed through the earlier phase of prediabetes. The number of Americans with prediabetes is now about 41 million. If left untreated, prediabetes almost always turns into diabetes within 10 years. Even if it's not high enough to be labeled diabetes, high blood sugar can still significantly harm your body. It can cause high blood pressure and damage to small blood vessels, including those in your kidneys and eyes.
Who’s At Risk
If your fasting blood sugar level (after not eating or drinking anything but water for at least eight hours) is between 100 and 125 milligrams per deciliter (mg/dL), you already have prediabetes. Your doctor can do a simple blood test to find this figure. You're at greater risk of prediabetes now and diabetes later if you...
- Are age 45 or older. Prediabetes risk increases with age.
- Have a family history of diabetes.
- Had gestational diabetes (high blood sugar during pregnancy) or gave birth to a baby weighing over nine pounds.
- Are overweight, with a body mass index (BMI) of 25 or more. (To find your BMI, divide your weight in kilograms by your height squared in meters-or check the calculator at www.nhlbisupport.com/bmi.) The heavier you are, the greater your risk. If overweight, you're at greater risk if your excess weight is around your waist (in other words, you're shaped like an apple) than if it's carried in your hips and thighs (you're shaped like a pear).
- Have low HDL ("good") cholesterol and high triglycerides (tiny fat particles in the blood).
- Have high blood pressure (129/90 or higher).
- Have a sedentary lifestyle.
African-Americans, Asian-Americans and Native Americans are at the highest risk, but anyone with one or more risk factors can develop prediabetes and diabetes. The more risk factors you have, the greater the likelihood that you'll become diabetic.
Steps To Take
You can prevent or reverse prediabetes and keep diabetes from developing. How? With three small but consistent lifestyle changes…
1. Lose weight. If you are overweight losing just 5% of your body weight can make a big difference, but even just holding your weight steady and stopping weight gain will help. If you weigh 180 pounds, for example, you would need to lose only nine pounds to see improvement. Cutting just 100 calories a day (the equivalent of a couple cookies) and adding 30 minutes of walking a day, which burns about 100 calories, will lead to slow, safe, steady weight loss.
2. Eat better. Cut back on high-calorie, low-nutrition food, such as cookies and chips.
3. Get moving. Do moderate exercise (walking, for instance) for 30 minutes every day.
Can this plan really prevent diabetes? Yes. A major study called the Diabetes Prevention Program proved it in 2002. Overall, the study participants who followed all three steps cut their risk of diabetes by nearly 60%. Among those over age 60, the improvement was even greater --they cut their risk by more than 70%.
Better Food Choices
- Eat good carbohydrates (food made from whole grains without added sugars). Take an inventory of the carbohydrates you regularly eat. If you're eating bread, make it whole grain. If you're eating sugary breakfast cereal, make it unsweetened whole grain. Instead of ordinary pasta, try whole-wheat pasta—today there are many excellent whole-wheat and other wholegrain pastas. Instead of white rice, switch to brown. Substitute other whole grains, such as barley, for white potatoes. Instead of cookies and snack foods, go for fresh fruit or a handful of dry-roasted nuts.
- Get rid of bad fats. Choose lean meats and low-fat dairy products. Avoid dangerous trans fats (partially hydrogenated vegetable oil) that are found in processed foods and margarine. Use healthy oils, such as canola and olive oils, when cooking or in salad dressing,
- Enjoy dessert, but in moderation. The first few bites of a dessert taste the best, so go ahead and have them—just don't have any beyond that. If you keep your portion small to begin with, you won't be tempted to eat more.
At home, put portions on small plates. When eating out, ask for a half portion or split an order with someone else. When making desserts yourself, cut back on the sugar and use wholegrain flours. Make an apple crumble with oatmeal, nuts and a small amount of brown sugar instead of using the standard recipe.
You can even continue to enjoy between meal snacks. We've come to think that a snack has to come from a package and be highly processed, but snacks should be real food as often as possible—think of a snack as a mini-meal. Try fresh fruit, low-fat yogurt, vegetables with hummus, low-fat popcorn, baked corn chips with bean dip, string cheese, some salad, half a sandwich or a small bowl of soup
The Active Ingredient
Exercise is a very powerful tool for preventing diabetes. Just a half hour a day of moderate exercise acts on your body very much like an insulin-sensitizing drug. Think of exercise as your daily dose of anti-diabetes medication—a medication that's free and has no side effects. Exercise makes your cells more responsive to insulin, and that helps lower your blood sugar. In addition, regular exercise helps with weight loss.