What should I do if I'm diagnosed with prediabetes?
What is Prediabetes?
Prediabetes is a diagnosis given to people who have higher than normal glycemia, or blood sugar.
When we eat carbohydrates, glucose (also known as sugar) enters the bloodstream. Normally, the liver releases insulin and the insulin acts as a key to open up cells and let the glucose in. This is important. We do not want sugar hanging out in the bloodstream for very long.
When we eat foods high in carbs, especially those with a lot of added sugar, glucose spikes in the bloodstream and a lot of insulin is released to unlock cells for the sugar to go into. If we eat foods high in added sugar frequently or in high portions, insulin gets released more frequently. Blood sugars spike and then crash as insulin enters the scene.
Over time, the signal to release insulin is overworked and starts to wear out. The signal gets weaker and less insulin is released in response to sugar in the blood. This is called insulin resistance.
The beginning of insulin resistance shows up in blood tests as high blood sugar such as a Hemoglobin (Hgb) A1c number of 5.7%-6.4%, fasting glucose number over 100mg/dL, or a glucose reading of 140-199 mmol/L after a 2 hour oral glucose tolerance test. (See table below). This is diagnosed as prediabetes.
Table 1: Criteria defining prediabetes in nonpregnant individuals
HgbA1C 5.7–6.4% |
OR |
Fasting Blood Glucose 100 to 125 mg/dL |
OR |
2-hours after glucose intake during 75g Oral Glucose Tolerance Test 140 to 199 mg/dL |
Prediabetes is a warning sign that the insulin signal is getting weaker and less able to move sugar out of the bloodstream and into cells. A prediabetes diagnosis should be taken seriously.
What should I do if I'm diagnosed with prediabetes?
While prediabetes can be scary, it’s an opportunity to modify lifestyle behaviors to ensure insulin resistance does not get worse.
It may be reassuring to know prediabetes can be managed through new diet and exercise habits without the need for medication or insulin. In fact, it can remain stable and never progress to Type 2 Diabetes or even be reversed altogether with sustained good habits.
Here are 9 habits you should start now to manage your prediabetes:
Dietary Habits for Prediabetes:
Limit sweets to a smaller amount. For instance, if you love cookies like me, limit yourself to 2 cookies per day. Ice cream should be limited to a half cup scoop. Consider eating half a piece of cake and saving the rest for tomorrow.
Recognize where sugar is coming from in your diet. If it’s difficult to give up cookies, look at the rest of your diet and cut the sugar in those places. Sugar is hiding in breakfast cereal, most instant oatmeal, flavored yogurt, ketchup, salad dressing, granola bars, protein shakes and bars, bread, granola, maple syrup, jellies and jams, and sweetened peanut butter.
Cut out the sugar sweetened beverages. More than food, blood sugar and weight is influenced by beverages that contain sugar such as juice, soda, and lattes.
Limit non-nutritive sweeteners. While sugar substitutes like stevia, aspartame, and sucralose can be used as a transition to wean off of sugar-sweetened beverages, these non-nutritive sweeteners should not replace sugar long-term. Research is now suggesting these may have negative health effects, including potential for increasing sugar cravings and weight gain, GI distress, migraines, insulin sensitivity, gut microbiome changes, and chronic disease risk. (Read more here.)
Limit carbs to one-quarter of the meal or snack. Aside from added sugar, be mindful of your carb intake in a meal or snack. Aim for no more than 60g of total carbohydrates during meals (1/4 of your meal or a ½ cup of rice/potato/pasta or 2 slices of bread). Include lean protein and fruits or vegetables with the starch. Snacks should be kept to 30g of carbs. Consider your milk, juice, tortillas, cheese, beans, and condiments when counting up the carbs.
Pair your carbs with protein. Fiber in fruits and vegetables helps prevent blood sugar spikes, but starchy veggies like corn, potatoes, lima beans, and peas, as well as high glycemic fruits like bananas, oranges, watermelon, mango, and grapes can still raise blood sugar. Pairing these higher sugar fruits and veggies with a source of protein can prevent blood sugar spikes.
Weight Loss for Prediabetes:
Lose weight. If overweight, losing just 5% of body weight can often reverse prediabetes or reduce the HgbA1c, preventing progression to Type 2 Diabetes. Schedule an appointment with me or another dietitian to get support losing weight.
Physical Acitivity
Exercise! The recommendation is to get at least 150 minutes of moderate to vigorous cardio per week plus 2 days of strength training. This can mean walking at a brisk pace everyday for 20 minutes, doing upper body resistance training (push-ups, tricep extensions, bicep curls) one day, and working the lower body (squats, calf raises, and lunges) another day. Some people get all of their physical activity into 2 days. Movement, especially after a meal, can reduce blood sugars and improve insulin sensitivity.
Get Tested Every 3-6 Months
Retest. Get your HgbA1c checked at least every 6 months, or every 3 months if your insurance covers it.
For personalized support managing a prediabetes diagnosis, make an appointment with a dietitian today.
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