1. Preventing Type 2 Diabetes Presented by: Cindy Sass, RD, CDE Registered Dietitian, Certified Diabetes Educator Nov. 12, 2013

2. The Blood Sugar Blues In 2009 2.4 million Canadians had type 2 diabetes. Numbers are predicted to climb to 3.7 million by 2019. Porrly controlled Diabetes can lead to heart attack, stroke, kidney failure, blindness, nerve damage, and amputations. Over 40% of people with diabetes don’t know they have it.

3. The Gathering Storm What worries experts the most are the estimated 4 million people who have “pre-diabetes”. Pre-diabetes is the term that is used to describe people who’s blood sugar is higher than normal, but not high enough to be called diabetes. Most of them don’t know they have it.

4. The Gathering storm cont’d Between a third and a half of people with pre-diabetes will develop diabetes. Pre-diabetes in itself is a risk factor for heart disease (1 ½ times increased risk).

5. Do You Have Pre-diabetes? Fasting blood sugar (12 hour fast) of 6.1 – 6.9 mmol/L. Previously called Impaired glucose tolerance or Impaired fasting glucose. Diabetes 7.0 mmol/L or higher Pre-Diabetes 6.1 mmol/L or higher Normal Below 6.1 mmol/L

6. What’s Your Risk ? Your risk is higher if you: Are age 40 or over. Are overweight. Have a parent, brother or sister with diabetes. Are of Aboriginal, Hispanic, Asian, South Asian, or African descent. Have high blood pressure (above 140/90). Have low HDL cholesterol (< 1.0 mmol/L for men, < 1.30 mmol/L for women). Have had diabetes when pregnant or gave birth to a large baby (over 9 lbs). Are active fewer than 3 times a week.

7. Diabetes can be delayed or prevented! Research studies done over the past decade have demonstrated that you can prevent or delay diabetes even if you have pre- diabetes. How?

8. Food intake: lower calorie, low fat low saturated fat high fibre (25-50 grams) 150 minutes of moderate intensity physical activity per week Resulted in a 5% reduction in body weight Lifestyle changes

9. Diabetes Prevention Program Results Diet and exercise lowered the risk of diabetes by 58%. The results showed: Small changes work. A modest amount of weight loss (5%) and exercise (30 min/day) was enough.

10. Don’t Weight Weight loss is key. 4 out of 5 Canadians with type 2 diabetes are overweight. In type 2 diabetes the body’s cells become resistant to the hormone insulin. The consequences of insulin resistance are not healthy: It may cause high blood pressure High triglycerides Inflammation in the blood vessels.

11. Don’t Weight cont’d When insulin is not doing its job, blood glucose levels start to climb. The pancreas secretes more insulin to keep up, gradually the pancreas tires out. This is when blood sugar levels rise into the diabetic range. Losing weight and exercising helps insulin work better.

12. How to lose weight? Build your diet around vegetables, whole grains, lean meat, fish, legumes and low fat dairy. Eat regular meals. Be aware of portions. Move more.

13. Beyond Weight Loss Weight loss is a slam dunk in keeping diabetes at bay. Even without weight loss, overweight people can reduce their risk if they eat healthy, stay active and don’t smoke.

14. Beyond Weight Loss - smoking Smokers have a higher risk of developing diabetes

15. Beyond Weight Loss - Exercise Half an hour of brisk walking or similar aerobic activity lowers the risk.

16. Beyond Weight Loss – Good Fats Using polyunsaturated oils (vegetable oils, nuts, salad dressing) and less saturated fats (meat, cheese, butter) and less Trans fat (muffins, donuts) lowered the risk.

17. Beyond Weight Loss- Good Carbs Risk is lower in people who consume more whole grains - rich in fibre and magnesium. People with diabetes who have a high fibre diet have better outcomes. Aim for 25-50 grams of fibre a day. (CDA handout)

18. Beyond weight loss -Glycemic Index Replace food high on the glycemic index with foods low on the glycemic index. ( see CDA handout) Sweet potato instead of regular potato Pumpernickel bread instead of white bread Oatmeal instead of rice krispies

19. Beyond Weight Loss – Alcohol Women who had as little as ½ drink a day had a lower risk of diabetes than non-drinkers. Men who had one or two drinks a day have a lower risk than men who drink less often. Heavy drinking may increase diabetes risk.

20. Beyond Weight Loss - Coffee Women or Men who drank 4 – 5 cups of regular coffee a day had a 30% lower risk than those who almost never drank coffee. Don’t add cream or sugar, use milk and try cinnamon vs. sugar.

21. Beyond Weight Loss – Processed Meats Women or Men who ate bacon, hot dogs or sausage at least 5 times a week had a 90% higher risk (women), 40% higher risk (men) of developing diabetes.

22. Beyond Weight Loss – Dietary Advanced Glycation Endpoints Thermal food processing at very high temperatures, such as frying, broiling and grilling, results in formation of dietary advanced glycation endproducts. These endproducts can affect how your body uses insulin. Cook food at low temperatures, preferably in liquid to avoid dAGE’s.

23. Sugary drinks Drinking one sugary drink a day increased diabetes risk by 15%. Drinking 2 per day, increased risk by 26%.

24. Sugar Reduce your intake of added sugars Women should limit their intake to 5 tsp./day (25 grams of sugar) Look at labels Don’t worry about the sugar in whole fruits In nature, sugar almost always comes packaged with fibre which slows its absorption and gives you a sense of satiety before you have consumed too much. That’s why you are better off eating the fruit than drinking the juice.

25. Get Tested Most people with pre-diabetes don’t know they have it. The only way to figure out is to get your blood sugar tested. Everyone 40 years or older should have their blood sugar tested at least every three years.

26. Get Tested If your results come back in the Pre- Diabetic range: Cut food portions by 1/3 Move at least 30 minutes a day If you are overweight, lose 5 - 10 lbs Being aggressive makes a difference!