Sandra Byer-Lubin, RD, CDE University Medical Center at Princeton PREDIABETES Sandra Byer-Lubin, RD, CDE University 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 4. Pancreas releases insulin 5. Insulin unlocks receptors The main fuel source for your body is GLUCOSE or BLOOD SUGAR. Your body produces glucose when the food (mainly carbohydrates) you eat is broken down and digested. We’ll talk a lot more about carbohydrates in a minute. Here we see that the body responds to the glucose in the blood by releasing insulin, which allows glucose to move into your body’s cells where it can be used for energy. With diabetes, you don’t have enough insulin, or your body can’t use it properly to move glucose into your cells. As a result, your cells can’t get the nutrients they need and your blood glucose levels rise. That’s why you feel tired and sluggish when your blood glucose is too high. 6. Glucose enters cell 3. Glucose enters bloodstream 2. Food is converted into glucose

Pre-Diabetes 1. Food enters stomach 4. Pancreas releases insulin BUT 5. Insulin does not fully unlock receptors 7. Liver dumps more glucose in the blood because the cells are “hungry”. The main fuel source for your body is GLUCOSE or BLOOD SUGAR. Your body produces glucose when the food (mainly carbohydrates) you eat is broken down and digested. We’ll talk a lot more about carbohydrates in a minute. Here we see that the body responds to the glucose in the blood by releasing insulin, which allows glucose to move into your body’s cells where it can be used for energy. With diabetes, you don’t have enough insulin, or your body can’t use it properly to move glucose into your cells. As a result, your cells can’t get the nutrients they need and your blood glucose levels rise. That’s why you feel tired and sluggish when your blood glucose is too high. 6. Glucose cannot enter cell and glucose builds up in the blood 3. Glucose enters bloodstream 2. Food is converted into glucose

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.

(5 g or less carbohydrate and 20 calories or less) 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. 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 ! Starch Fruit Milk

3-5 carbohydrate choices each meal Try to eat: WOMEN 2-4 carbohydrate choices each meal or 30-60 gm carbohydrate each meal 6 fists of carbs a day MEN 3-5 carbohydrate choices each meal or 45-75 gm carbohydrate each meal 9 fists of carbs a day

Shredded Wheat 1 fist of shredded wheat is equivalent to 1 portion of carbs.

Bread

Potatoes

Beans

Peas and Corn Here we have 2 portions of carbs. 1 fist of peas and 1 fist of corn.

Light Yogurt Plain yogurt or artificially sweetened 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 meat Poultry Fish Cheese Eggs Nuts Tofu

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 1 tip of thumb = 1 tsp

Regular Salad Dressing 1 whole thumb = 1 tablespoon

Almonds Small handful

What is a healthy meal? (amounts vary individually) 3-4 ounces of lean protein medium baked potato or 1-1/2 cups of pasta or rice(preferable whole grain) 1 cup vegetables salad with lite dressing/oil fresh 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 lifestyle changes in the prevention of DM2