prediabetes sandra byer-lubin, rd, cde university medical center at princeton

PREDIABETES

Sandra Byer-Lubin, RD, CDEUniversity Medical Center at

Princeton

Blood sugar or glucose levels are higher than normal, but not high

enough to be classified as diabetes.

Prevalence

• 41 million Americans have prediabetes

• All will develop type 2 diabetes within the next 10 years unless they do something about it.

• All have increased risk of heart disease and strokes.

Diagnosis(by fasting blood sugar)

Less than 100 100-125 126 or higher

(Normal) (Pre-Diabetes) (Diabetes)

Diagnosis(by oral glucose tolerance

test)

• Sometimes pre-diabetes is diagnosed by drinking a high sugar beverage. Blood sugar is then checked.

– Pre-diabetes: A reading of 140-199 (2 hours after drinking the beverage).

– Diabetes: A reading of 200 or higher ( 2 hours after drinking the beverage).

Risk Factors of Pre-Diabetes

• 45 years of age or older and overweight.

• Under 45 with other risk factors for diabetes.

Other risk factors:

• Physically inactive.

• Family history of diabetes.

• Are African American, Native American, Asian American, Pacific Islander or Hispanic American.

Other risk factors, cont’d

• Have had a large baby weighing 9 lbs. or more or have had gestational diabetes.

• Have high blood pressure.

• Have low HDL cholesterol (35 or lower) or high triglycerides (250 mg/dl or higher).

How Food is Digested

1. Food enters stomach

5. Insulin unlocks receptors

4. Pancreas releases insulin

2. Food is converted into glucose

3. Glucose enters bloodstream

6. Glucose enters cell

Pre-Diabetes

1. Food enters stomach

5. Insulin does not fully unlockreceptors

4. Pancreas releases insulin BUT

2. Food is converted into glucose

3. Glucose enters bloodstream

6. Glucose cannot enter cell and glucose builds up in the blood

7. Liver dumps more

glucose in the blood because the cells

are “hungry”.

Insulin resistance is the main problem!

How to help insulin work better:

• Increase physical activity.

• Eat a healthy balanced diet.

• Lose a little weight if needed.

• Take prescribed medication.

Healthy Eating:The first step

When should you eat?

• Eat regular meals about 4-5 hours apart.

• Skipping meals can cause weight gain and then more insulin resistance.

• Eating 3 smaller meals and a few snacks may also be helpful.

Increase fiber!

• Fiber helps you feel full and can help with weight loss.

• Fiber aids in regularity.

• Fiber helps to lower cholesterol.

• You can get more fiber by eating:– Beans– Whole grains (5 g fiber/serving for

cereal, 2 g fiber/slice of bread)– Whole fruits instead of fruit juice.– Vegetables.

Know your vegetables……• Starchy veggies are

good for you, but limit the amount, if you are having other carbs with your meal

½ cup= 15 gm carb/1

carb choice or serving

• Non-starchy veggies eat all you want (no need to measure).

• ½ cup= 5 gm carb

Starchy Vegetables

• These are nutritious and high in fiber, and are counted as Carbohydrates, not vegetables:

– Corn - Peas – Potatoes - Sweet potatoes

Eat more low starch vegetables

• !/2 of your plate should be these vegetables.

FOODS TO AVOID

– Sweet tea– Regular sodas– Lemonade– Kool-Aid– Gatorade

FREE FOODS (5 g or less carbohydrate

and 20 calories or less)

• Sugar Substitutes– Equal– Splenda– Sweet N’ Low

• Diet Soda• Unsweetened Tea• Crystal Light• Sugar Free Flavored

Waters• Sugar Free Jello• Sugar Free Popsicles

Decrease amount of:

• Fruit juice to 4-6 oz a day• Desserts and other sweets• High fat foods• Salty foods (if blood pressure is

high)• Alcohol (especially if overweight

and/or elevated triglyceride level)

DECREASE DOESN’T MEAN NEVER!

Carbohydrates give you energy.

•Starch•Fruit•Milk

• All carbohydrates turn to sugar (glucose).

• It’s a good idea to eat some healthy carbohydrates at each meal, even if you have pre-diabetes !

Try to eat:

WOMEN• 2-4 carbohydrate

choices each meal

or• 30-60 gm

carbohydrate each meal

• 6 fists of carbs a day

MEN3-5 carbohydrate

choices each mealor

• 45-75 gm carbohydrate each meal

• 9 fists of carbs a day

Shredded Wheat

Bread

Potatoes

Beans

Peas and Corn

Light Yogurt

Milk

Apple

Treats

• 2-3 times a week• Small portions• Check carbohydrate content: 15-20

gm = 1 carb choice or portion

Pudding

Moderation with Proteins

• 32 oz steak dinners are out• Protein foods include

Red meatPoultryFishCheeseEggsNutsTofu

How Much Protein Foods?

• Use palm of hands to estimate portions

• 2-3 palms or decks of card a day• 1 protein food portion is about 3 oz

Go Easy on Fat

• Limit deep frying• Choose lean meats• Fat sources

– Butter, margarine– Oil– Salad dressing– Sour cream– Bacon– Nuts

The Better Fats

• Canola oil• Olive oil• Peanut oil• Tub Margarine• Nuts and their

butters• Avocados

How Much Fat?

• Use thumb to estimate portions• 3-4 portions a day• 40-60 grams of fat/day

Tub Margarine and Peanut Butter

Regular Salad Dressing

Almonds

What is a healthy meal?(amounts vary individually)

3-4 ounces of lean proteinmedium baked potato

or1-1/2 cups of pasta or

rice(preferable whole grain)1 cup vegetables

salad with lite dressing/oilfresh fruit

Healthier snack suggestions:

• Lite yogurt• Nuts (small handful)• Graham crackers• Fruit• Low fat cottage

cheese• Low fat cheese stick• Sugar-free pudding• Raw veggies

Exercise is also important in managing your insulin

resistance & pre-diabetes.

• Out of shape? Start slowly.– Maybe 10 to 15 to 20 minutes.– A little every day is good.

• In better shape?– 30 to 45 to 60 minutes, 3 to 5 times a

week.

Need motivation?

• Try using a pedometer.

• Wear for 7 days to determine your daily average.

• Increase steps gradually.

Irregular schedule?

• Take stairs instead of elevator.

• Park farther away.

• Take several 5 minute breaks during the day.

Time?

–Set aside a time at lunch.

–Walk or go to gym right after work (before you go home!).

Unable to walk?

–Water exercise

–Chair exercises

Lack of energy?

–Start with just 5 minutes.

–Walk in place during commercial breaks when watching TV.

Goal Setting

• New habits take some practice.• You will have good days & bad

days.• Give yourself lots of credit for each

new accomplishment.• How realistic is it to try to change

many things at the same time?

Setting some simple goals:

• Let’s set 1 nutrition and 1 exercise goal right now.

• Don’t make it too hard.• Remember, be patient with

yourself as you make changes.

Prescription Medications

Metformin

Much less effective than lifestylechanges in the prevention of DM2