Type 2 Diabetes and Prediabetes

 

Today, 29.1 million people (almost 10% of the US population) have diabetes, including 8.1 million who are undiagnosed. Another 86 million Americans have prediabetes, which means they have a high risk of getting type 2 diabetes. Having diabetes raises your risk for blindness, kidney failure, amputation, heart disease, cancer, and dementia. These risks can double individual healthcare costs.

A balanced meal plan and regular physical activity are extremely important in treating and preventing type 2 diabetes. Ensuring that blood glucose, blood pressure, and cholesterol are within healthy ranges also makes a big difference. Because diabetes care and prevention is now better than ever, rates of complications–notably heart disease–have gone down. But diabetes management is not as effective as it could be, especially among poor and/or minority populations.

Testing for diabetes and prediabetes

Because the risk for type 2 diabetes goes up with age, all people over 45 should be tested regularly. You should also be tested every year if you are overweight and have one or more of the following risk factors:

• High blood glucose and/or A1C

• High triglycerides

• PCOS (polycystic ovarian syndrome)

• Dark, velvety patches of skin around the neck, elbows, groin and/or armpits

• High blood pressure

• A family member who has diabetes

Medicine for preventing type 2 diabetes

If you have prediabetes, your healthcare provider may suggest medicine to lower your risk of getting the full disease. Metformin is a medicine regularly prescribed to control blood glucose levels. It has been found to be effective in preventing diabetes among people who:

• Can’t get enough exercise

• Have not been able to lose 7% of their body weight

• Are young and obese

• Have had gestational (pregnancy) diabetes

Self-management

Preventing and managing diabetes is a team effort between you and your healthcare providers. A big part of that effort is self-management, an active, ongoing process that changes as your needs, priorities, and situations change. Whether you have type 2 diabetes or prediabetes, you should work closely with your healthcare team until you understand:

• the disease and your treatment options.

• how much physical activity you should get each week.

• how to take medicines safely and effectively.

• how to test and keep track of your blood glucose levels.

• how to recognize, prevent and treat high and low blood glucose reactions.

• where to seek help for mental and emotional issues.

Resources for people with diabetes

There are many resources for people with diabetes, such as:

• Peer support programs

• Community-based health programs

• Support groups (both in-person and online)

• Health tracking apps for your phone or computer

To learn more about these resources, make an appointment to speak with your healthcare provider or take a look at the American Diabetes Association’s website.

Meal plans for preventing diabetes

You can get information about changing your eating habits from a variety of healthcare providers, including:

• Primary care providers

• Certified diabetes educators

• Registered nurses

• Dietitians

They can help you create a balanced meal plan that provides you with all of the nutrients you need, without making you feel deprived. Remember that healthy eating is for life, so you have to follow a plan that works for you both physically and mentally. Here are a few general guidelines for healthy eating:

Have less:

• Trans fat, which is found in most processed foods

• Alcohol (less than 2 drinks/day for men; less than 1 drink/day for women)

• Added sugars like high fructose corn syrup

• Sugary drinks

• Salty, processed snacks

Have more:

• Monounsaturated fats from olive oil, nuts, seeds, avocados and fish

• Fiber from fruits, vegetables, and whole grains

• Lean protein from meat, eggs, fish and beans

• Water

Weight management

If you are overweight or obese, losing weight should be your top priority for preventing or managing diabetes. Although reaching and maintaining a healthy body weight (BMI under 25) is best, even a 5 to 10% weight loss can improve your health.

Taking in fewer calories and getting more exercise can lower your blood pressure, blood glucose and cholesterol levels. These changes can even allow you to take less diabetes medicine. A few behaviors have been shown in research to be helpful for weight loss and maintenance. These include:

• Keeping a food and exercise journal

• Choosing smaller portions or low-calorie options at restaurants

• Cooking most meals at home

• Drinking water instead of soda, energy drinks or juice

• Limiting screen time (watching TV and using the Internet less)

• Weighing yourself regularly

• Eating a well-balanced breakfast every day

Physical activity for preventing and controlling diabetes

Exercise has many benefits for people with or at risk for diabetes. These benefits include:

• Better insulin function

• Lower blood glucose levels

• Healthy cholesterol, triglyceride and blood pressure levels

• Higher energy

• Healthier body weight

• Lower heart disease risk

• Better moods and sense of well-being

• Helping you hold onto muscle mass as you lose weight

If you are an adult who has diabetes, or who is at risk for the condition, you should aim to get more physical activity. Check with your healthcare provider before you start any new exercise program, especially if you have any disabilities or health conditions that limit your movement. It’s best to set goals before you start, and work slowly towards them as you get stronger. Most adults will do best with:

• at least 150 minutes of moderate intensity exercise each week.

• two to three days of muscle-building exercise each week (with one or two day breaks in between).

• no more than two days without exercise each week.

People who do both aerobic and muscle-strengthening exercise will benefit the most. According to research, adults with diabetes who exercise more than 150 minutes every week have even bigger reductions in A1C than those who exercise less than 150 minutes per week.

Moderate intensity exercise

You may be wondering what “moderate intensity exercise” means. As a rule of thumb, you are doing moderate intensity exercise if you can talk, but not sing, during the activity. Examples of this type of physical activity include:

• Walking briskly (around 3 miles per hour)

• Water aerobics

• Bicycling slower than 10 miles per hour

• Ballroom dancing

• Gardening

Muscle-building exercise

These activities are helpful if they work your major muscle groups: legs, hips, back, chest, core, shoulders, and arms. Examples of muscle-building exercise include:

• Weight lifting

• Working with resistance bands

• Body weight exercises (pull-ups, push-ups, sit-ups, etc.)

• Heavy gardening

• Carrying heavy loads

• Pilates

• Power yoga

Usually, one set of 8 to 12 repetitions of each exercise is effective, although two or three sets may be more so. Developing muscle strength and endurance takes practice, so you should build up to heavier weights over time.

Blood glucose management

As soon as you are diagnosed with diabetes or prediabetes, you should learn to manage your blood glucose levels. Work closely with your healthcare provider to set blood glucose and A1C goals. You will probably need to make a few lifestyle changes to stay healthy and lower your risk for serious complications, like kidney failure, blindness and heart disease. These lifestyle changes may include:

• A new meal plan

• An exercise program

• Medicines

• Insulin

• A stress-reduction plan

• A schedule for checking your blood glucose

Weight loss surgery

If you are obese and have a hard time controlling your blood glucose levels, your healthcare provider may suggest weight loss surgery. More research is needed to know the long-term effects of these surgeries for people with type 2 diabetes. However, short-term studies have shown that they can help control blood glucose levels and other heart disease risk factors. They may also be able to delay the onset of type 2 diabetes in obese people who have a high risk of the condition.

Diabetes in children

Diabetes is one of the most common chronic conditions in American school-aged children. Type 1 is the most common form in US youth, but type 2 is more common in new cases among minority groups, especially American Indians.

Like adults, kids with diabetes need to have a personal health management plan. With the help of a healthcare team, this plan will help the child or teen follow a healthy meal plan, get regular physical activity (60 minutes each day), check blood glucose levels, and take insulin and other medicines as prescribed. Family support for following the meal plan and setting up regular meal times is a key to success, especially if the child or teen is taking insulin.

Diabetes is stressful for both children and their families. Parents should look out for signs of depression, eating disorders, and insulin misuse, and should seek appropriate treatment. Depression is a common among youth with both type 1 and type 2 diabetes. A mental health specialist may be a necessary part of your child’s healthcare team.

Diabetes in older adults

Older adults are at an especially high risk for both type 2 diabetes and prediabetes. Research has shown that almost half of all older adults have prediabetes. Older people with diabetes have higher rates of death, disability, high blood pressure, coronary heart disease, and stroke than those without diabetes. They also have a higher risk for common geriatric (old age) conditions, such as:

• Polypharmacy (having to take many medicines at once)

• Depression

• Memory loss

• Urinary incontinence

• Falls

• Constant pain

The treatment goals for every older adult with diabetes should be personalized. For example, those who are mostly healthy could have an A1C goal of less than 7.5 percent, and a blood pressure goal of less than 140/90 mmHg. Those in poor health could have an A1C goal of less than 8.5 percent, and a blood pressure goal of less than 150/90 mmHg.
High-risk racial and ethnic groups

Certain racial and ethnic minorities have a higher risk of diabetes compared with Caucasians, and some minority groups also have higher rates of complications. Members of some Asian populations, for example, have a higher risk for type 2 diabetes at lower body mass indexes than the general population. However, all racial and ethnic groups can benefit from a balanced meal plan, regular physical activity, and high quality healthcare.