Type 2 Diabetes and Prediabetes


diabetes_awareness_wristbandToday, 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

diabetes-basics-blood-glucoseBecause 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


new-medicines-for-type-2-diabetesPreventing 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

meal-plansYou 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-female-pedal-weighscaleExercise 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

exercise happyThese 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

elderly womanOlder 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.



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Constance Brown-Riggs, MSEd, RD, CDE, CDN—an award-winning RD, certified diabetes educator, and past national spokesperson for the Academy of Nutrition and Dietetics, is the author of The African American Guide to Living Well With Diabetes, which received the Favorably Reviewed designation from the American Association of Diabetes Educators, and Eating Soulfully and Healthfully with Diabetes.

Dr. Lori Shemek, PhD, CNC, CLC, the best-selling author of “Fire-Up Your Fat Burn! and leading health and weight loss expert, is also known as “The Inflammation Terminator.” She has made it her mission to educate the public on the toxic effects of certain foods and lifestyle choices and how they create inflammation in the body. She is a leading authority on inflammation and its role in weight loss, preventing disease and optimizing health.

Rebecca Bitzer – MS, RD/LD, CEDRD is an award-winning Registered Dietitian, writer, speaker, blogger, and REBEL Dietitian business owner. Rebecca and her team of six Registered Dietitians have counseled thousands of clients struggling with diabetes for over twenty-five years. They work closely with each other along with internists, endocrinologists, therapists, and families.

Maureen Sullivan – RN, CDE has worked for many years as a Registered Nurse, most of them in emergency and trauma services. She is a Certified Emergency Nurse, Certified Diabetes Educator, and the former manager of a hospital stroke program. Maureen’s wealth of knowledge, passion for nursing and education, and ability to engage people makes her an excellent teacher and a captivating lecturer. Recently, Maureen has been concentrating on writing, speaking and teaching, as well as working on her award-winning weekly podcast, “The Health and Humor Show.”

Lauren Harris-Pincus, MS, RDN is a nutrition communications specialist, registered dietitian in private practice, social media consultant, speaker, spokesperson and corporate consultant. She is currently the owner of Nutrition Starring YOU, LLC and www.NutritionStarringYOU.com. Lauren strongly believes that we should “Think Healthy, not Skinny”, and “EveryBODY is unique, your diet should be too”. Lauren was co-host of the Family Food Experts Kitchen radio show, available for listening on iHeart Radio and iTunes. Also known as one of the “NutritionBabes”, Lauren co-founded NutritionBabes.com, a popular Health and Wellness website in 2009. NutritionBabes.com was voted one of Healthline’s Top 100 Health Blogs in 2011, 2012 and 2013.

Mark Heyman, PhD, CDE is a clinical health psychologist and the director of the Center for Diabetes and Mental Health (CDMH). In addition to treating patients with type 1 and type 2 diabetes, Dr. Heyman provides training for health care providers on how to identify and address the emotional and behavioral aspects of diabetes in their patients. He also works with pharmaceutical and medical device companies to help them understand these issues and incorporate this information into their sales, marketing, and patient education materials. He is particularly interested in empirically supported behavioral interventions that promote behavior change and improve physical and mental health in people with diabetes.

Katie Ferraro, MPH, RD, CDE is a nationally-recognized registered dietitian, certified diabetes educator and author with an expertise in nutrition communications and curriculum development. She is the co-author of “Diet Therapy in Advanced Practice Nursing” (McGraw Hill, 2014) and an Assistant Clinical Professor of Nutrition at the University of California San Francisco and University of San Diego’s graduate schools of nursing.

Dr. Beverly S. Adler, PhD, CDE (aka “Dr. Bev”) is a clinical psychologist and certified diabetes educator, author and speaker. She specializes treating the emotional issues of people with diabetes. In her private practice, she provides individual, family and/or group therapy utilizing a cognitive behavior therapy orientation, combined with a spiritual approach. Her goal is to empower her patients to manage their diabetes.

Dr. Bev is the author of two self-help diabetes books. She has written numerous articles which are published in print and online – always focused on diabetes from the emotional perspective. She also speaks to audiences of people living with diabetes, as well as, to audiences of healthcare professionals and diabetes educators. Dr. Bev, herself, has been living successfully with type 1 diabetes for 40+ years.

In August 2016, Dr. Bev was honored to receive the “CDE Entrepreneur of the Year” Award from her Metropolitan NY Association of Diabetes Educators.

Jill Weisenberger, MS, RDN, CDE, FAND is an internationally recognized nutrition and diabetes expert with more than two decades experience. Through writing, speaking and one-on-one coaching, Jill empowers people to grab control of their health. She has worked as both a nutrition counselor and a diabetes educator in the hospital and research settings, and now in private practice in Newport News, VA. Jill is known for her practical approach and caring attitude. Her no-nonsense strategies to eating well include foods that both taste good and are good for you.

Marlene Koch (pronounced ‘cook’) is a nationally recognized nutritionist, popular TV personality and New York Times bestselling author. She graduated Magna Cum Laude from UCLA with a Bachelor’s degree in Nutritional Science. She is a registered dietitian and one of a select group of dietitians to hold an advanced certificate in Child and Adolescent Weight Management from the Academy of Nutrition & Dietetics.

Marlene has taught professional chefs from the American Culinary Federation the principles of healthy cooking and eating. She has been adjunct Nutrition professor and cooking instructor for Columbus State College and the Columbus State Culinary Academy, and she is a nationally recognized expert in weight loss, diabetes, child and adolescent nutrition, and sugar substitutes.

Marlene has sold over one million cookbooks, and is a regular guest on QVC.

Barbara Ruhs – MS, RDN is a Registered Dietitian Nutritionist and owner of Neighborhood Nutrition LLC, a consulting firm focused on providing solutions to help food companies and supermarkets improve consumer health & wellness. She’s a former supermarket dietitian and has run a successful business for 17 years. A leader in the field of nutrition, her mission is to help people by impacting the way food is produced, marketed and sold. She’s a strong advocate for supermarket dietitians and believes the retail food industry has the greatest potential to impact public health.

Cheryl Orlansky has over 25 years of experience in health promotion and chronic disease prevention and management. Her first career as a registered dental hygienist led her towards a path of wellness and nutrition! Her expertise is in diabetes, weight management and cardiovascular disease for individuals and groups. She works in a large private practice including endocrinology, internal medicine, rheumatology, neurology and sleep medicine. She is an award winning dietitian with current leadership positions in state and local dietetics organizations.

She has been interviewed and quoted in media outlets for WebMD, Atlanta Sports and Fitness, Georgia Public Broadcasting, and the Atlanta Journal and Constitution. She has partnered with V-103 Radio to lead supermarket tours as part of a community outreach during National Nutrition Month.

Cheryl helps her clients reach balance through lifestyle choices: cooking and eating, activity and purpose in life.

Jackie Newgent, RDN, CDN, is a registered dietitian nutritionist and classically-trained chef. With a passion for helping people (including her father) with diabetes, she’s author of The With or Without Meat Cookbook: The Flexible Approach to Flavorful Diabetes Cooking and the award-winning The All‐Natural Diabetes Cookbook, both published by the American Diabetes Association. Jackie is also author of 1,000 Low-Calorie Recipes and Big Green Cookbook. Her next book, The All-Natural Diabetes Cookbook—2nd Edition, was published in 2015.

Nutritionist Rania Batayneh, MPH is the author of the best-selling book, The One One One Diet. She holds a master’s degree in public health nutrition from the University of Michigan School of Public Health and is also a Wellcoaches Certified Health and Wellness Coach endorsed by the American College of Sports Medicine (ACSM).

OmnichannelHealth Media, publisher of DiabetesDigest.com, does not provide medical advice, diagnosis or treatment. See additional information.