Pre-diabetes means that your blood sugar levels are higher than normal but not high enough to be labeled as Type 2 Diabetes.  In a way, pre-diabetes is a warning; without lifestyle changes or other treatment, you will likely develop diabetes in 10 years or less.  However, with a healthy diet and other lifestyle changes, people with pre-diabetes can prevent or delay the development of diabetes. So it is important to recognize this warning as an opportunity to make healthy changes.

What is glucose?

Glucose is a type of sugar in the blood that the body uses for energy.  Blood glucose comes from:

• Diet: Carbohydrates are large chains of glucose linked together.  They are found in many of the foods we eat and are broken down into glucose as part of normal digestion
• Liver: The liver produces glucose to be used by the rest of the body
• Muscle: We store glucose in our muscles for use during physical activity

Everyone has glucose in their blood.  The normal range for glucose in the bloodstream is 70-99 mg/dl.  Glucose is the preferred source of energy for the brain and provides energy for daily activities as well as moderate or intense exercise.  As glucose travels through the blood, it is taken up by cells, allowing them to function normally.  In order for the glucose to enter our cells, insulin must be present and the cell must be able to use it.  For people with higher than normal blood glucose levels, insulin may be present in lower levels, or the body may be resistant to the action of insulin.  This leads to build-up of glucose in the blood and cells that aren’t getting the energy they need.  Depending on the amount of glucose in the blood, a person may be diagnosed with pre-diabetes or diabetes using three lab tests: fasting blood glucose, hemoglobin A1C, or oral glucose tolerance.

Interpreting Lab Values

Blood Sugar Levels are Key

People with pre-diabetes may have to work harder to keep blood glucose levels within a normal range, but healthy blood glucose levels are key to preventing problems that are associated with diabetes.  In fact, most diabetes complications are related to chronic high blood glucose levels.  Too much glucose in the bloodstream damages blood vessels and impacts whole body health.

• Kidney health- When glucose levels are too high, the kidneys have to work harder to filter the blood.  In the long term this can lead to kidney disease.
• Heart health- Glucose accumulates and makes blood thicker, causing the heart to exert more pressure to move blood throughout the body. Glucose in the blood also contributes to the build-up of plaque in arteries.
• Nerve function- Nerves need glucose to function optimally.  But too much glucose makes the blood too thick to find its way into tiny capillaries in the hands and feet.  This can lead to pain, tingling, and decreased feeling in fingers and feet.
• Eye health- Again, blood may not be able to reach the capillaries in the retina if glucose levels are too high, leading to vision problems and possibly even blindness.
• Ability to heal- Having high blood sugar levels can, over time, make you prone to infection.  If infections go unchecked, skin ulcers and amputations are possible. Infections may also occur in the mouth leading to swollen or bleeding gums, a sign of periodontal disease.

To Lower Blood Glucose Levels:

1.  Gradually lose some weight by eating fewer calories and exercising.  Losing weight can help your cells respond to insulin better.  This helps glucose leave your blood and enter the cells that need it.

2.  Eat smaller, more frequent meals throughout the day.   Downsize your portions by using a smaller plate or serving yourself a little less than usual.  Try to eat at least 3 meals throughout the day at regular consistent times.  If meals are more than 4-5 hours apart, include a healthy snack.  Doing so will help to control hunger and improve blood glucose levels.

3.  Limit your use of foods high in sugar.  All carbohydrates you eat will eventually become sugar in the body.  However, not all carbs are created equal, especially with regards to how they affect blood glucose levels.  Carbohydrates can be divided into two broad categories:

• Sugary Foods­- Sugar is absorbed quickly into the blood causing glucose levels to rise after eating.  Sugars are found in  candies and desserts but are also common in beverages.  Regular soda, sweetened drinks (Kool-Aid®, lemonade, coffee drinks, Hi-C®, sports drinks and some flavored waters), and fruit juice (even without added sugars) are often a major source of sugars.  Limit your use of these sugary beverages to less than 8 ounces per day.

• Starchy Foods- Starchy foods are foods that naturally contain carbohydrates.  Pasta, rice, cereal, bread and some vegetables such as potatoes, corn and squash are considered starchy foods.  After eating a starchy food, glucose levels usually rise moderately quickly.  But, if starchy foods contain a good amount of fiber, their impact on blood glucose is lessened.  Starchy foods that are high in fiber are considered smart carbohydrate choices, or “smart carbs.”  Examples of “smart carbs” are whole grain bread, whole wheat pasta, brown rice and beans.

4.  Limit the amount of starchy foods in your diet. Starchy foods, if eaten in large amounts, can cause blood glucose to rise. Women should aim for 1-3 servings  and men should aim for 2-4 servings per meal

Examples of a serving of starchy foods, each with about 15 grams carbohydrates:

     1 slice of bread or 1 small tortilla (6”)

     1/3 cup cooked pasta, noodles or rice

     ½ cup cooked cereal (oatmeal, grits )

     ½ small bagel  ½ bun or ½ pita bread

     ½ cup starchy vegetables (corn, potato, squash, yam, peas)

      ½ cup beans or lentils

     ¾ cup unsweetened, ready to eat cereal

     15 chips or 3 cups popcorn

Create a Healthy Plate

Instead of filling up on starchy foods, balance your plate with 3-4 ounces of protein and lots of vegetables, which tend to be low in carbohydrate and calories and high in fiber and other nutrients.

5.  Include at least one ounce of protein in all meals and snacks.  Protein slows the absorption of sugars, which lessens their effect on blood glucose.  Proteins make meals and snacks more satisfying and provide longer lasting energy than carbohydrates alone. 

Examples of proteins:

Confused about portions?

2-3 ounces of meat = deck of cards

1 ounce of nuts = ¼ cup

1 egg = 1 ounce of protein

2 tablespoons peanut butter = 1 ounce protein

6. What about fruit?

Fruits naturally contain sugars but because of their higher fiber content they are considered “smart carbs.” Include at least 2 but no more than 4 fruits/day. 

Examples of fruits, each with about 15 g of carbohydrates:

     1 small piece of fresh fruit

(apple, orange, pear, etc)

     ½ banana

     15 grapes

     1 cup melon such as cantaloupe

     ¼ cup dried fruit

     ½ cup canned fruit, unsweetened

     1 ¼ cup strawberries

7.  Exercise!  Exercise improves your cells’ ability to take up glucose and allows the body to burn off some of the excess glucose in the blood, lowering blood glucose.  A regular exercise pattern can be very helpful in normalizing blood glucose levels.  Unless your physician has told you not to exercise, start right away.  See p. 5-6 for tips  to get started.

There are two main types of exercise that can benefit overall health and may lead to weight loss. 

• Aerobic or Cardio-activities that increase your heart rate and breathing.  Brisk walking, jogging, swimming, and bicycling are all examples of aerobic type exercise.
• Resistance Training- activities that increase strength and flexibility.  Resistance training aids the cells in using insulin and has been shown to decrease insulin resistance.  These activities are also good for bone health, increasing lean muscle, and are beneficial in weight loss.  Therabands, handheld weights, exercise balls, yoga, Tai Chi and pilates are all examples of resistance training. 

New Habits for Health

There is no quick cure for pre-diabetes- it’s all about lifestyle changes.  Regular activity and good nutrition are key- they can lead to weight loss and improved blood sugar levels.  Exercising and eating healthy can stabilize blood sugars, help weight loss, and improve overall health.

Create Healthy Meals and Snacks

• Eat a variety of foods in moderate amounts.  No single food will supply all the nutrients your body needs, so eat a variety of foods from each food group every day.  

• Meals should include foods from at least 3 food groups. 

• Snacks should include foods from at least 2 food groups and include a protein source (for example 1 cup milk, 1 stick cheese, 1 slice cold cut, 3/4 cup yogurt, 10 almonds).

• Although no foods are off-limits for someone with pre-diabetes or diabetes, it can be helpful to consider how the foods that you eat impact your blood sugar.  Over time, regular consumption of ice cream, cookies or candy will negatively affect your health.  Limit consumption of sweets such as these to 1 small serving per day or less.

• Consistency can be a helpful tool for controlling blood sugar levels.  Eat regular meals and snacks at similar times from day to day.

• Make a grocery shopping list and stick to it.  Plan out your  meals in advance and purchase healthy foods to snack on.   Keep tempting foods out of the house. 

Sticking with your Exercise Program

• One exercise plan does not fit all, but a typical recommendation is to get 150 minutes of moderate physical activity every week.  To establish a habit of regular physical activity, make simple, small changes.  If you are a beginner, you may start with 5-10 minutes per day and gradually increase to 30 minutes or more. 

• It can be easy to be sedentary during the day.  Here are a few suggestions for increasing your daily activity level:

                        -Take the stairs instead of the elevator

                        -Park your car further away

                        -Walk your dog an extra block each day

                        -Meet a friend for a walk instead of a coffee

                        -Go for a walk or climb the stairs during your lunch break

• Set a schedule and stick to it.  Make the commitment to exercise just as you would any other appointment.
• Get a training partner.  Find someone who enjoys the same type of activities as you and who will help keep you motivated.
• Keep it interesting.  Include a variety of activities every week.  For example, you might ride a bike one day, walk the next and swim another.  Or, try a new sport like tennis or racquetball. 
• Set goals.  Set specific, realistic and achievable goals to help you stay on track.  Have short term goals (I will walk a total of 150 minutes this week) and long term goals (I will be able to walk 3 miles by the end of the month without stopping to rest).
• Reward yourself.  Keep your motivation high by rewarding yourself when you accomplish a goal.  Avoid food rewards (no need to make progress in one area and backtrack in another). Instead, go to a movie you’ve wanted to see, take cooking lessons, or treat yourself to a massage.

Lifestyle changes take time.  Creating new habits does not happen over night.  We are available to help you with individualized programs for your lifestyle, tips for beginners and experts alike, and to offer support and motivation.  Meet with a dietitian at any of our locations: