Checking your blood glucose levels several times a day helps you understand how your body responds to medications, exercise, and the foods you eat. When first starting out, keeping your glucose within a tight margin can often feel like hitting a moving target. It can suddenly spike with no reason or plummet the next day despite total adherence to your treatment.


The health benefits of a low-fat vegetarian diet such as portions of vegetables, grains, fruits, and legumes (excluding animal products) in people with type-2 diabetes. The vegan diet is based on American Diabetes Association (ADA) guidelines; the results of this study were astounding: Forty-three percent of the vegan group reduced their diabetes medications. Among those participants who didn't change their lipid-lowering medications, the vegan group also had more substantial decreases in their total and LDL cholesterol levels.

Like refined grains, sugary beverages have a high glycemic load, and drinking more of this sugary stuff is associated with increased risk of diabetes. In the Nurses’ Health Study II, women who drank one or more sugar-sweetened beverages per day had an 83 percent higher risk of type 2 diabetes, compared to women who drank less than one sugar-sweetened beverage per month. (26)


A good way to make sure you get all the nutrients you need during meals is to use the plate method. This is a visual food guide that helps you choose the best types and right amounts of food to eat. It encourages larger portions of non-starchy vegetables (half the plate) and moderate portions of protein (one quarter of the plate) and starch (one quarter of the plate). You can find more information about the plate method at the American Diabetes Association website: www.diabetes.org/food-and-fitness/food/planning-meals/create-your-plate/.

The good news is your risk of developing type 2 diabetes may be lowered with lifestyle changes like diet, exercise, and weight loss. If you’ve tried and failed to make changes before, remember that persistence is key, and even small changes can have a powerful impact. According to a Diabetes Prevention Program study sponsored by the National Institutes of Health (NIH), people at a high risk for developing type 2 diabetes who lost just 5 to 7% of their weight with diet or exercise were able to prevent or delay onset of the condition.
More recent findings from the Nurses Health Studies I and II and the Health Professionals Follow-Up Study suggest that swapping whole grains for white rice could help lower diabetes risk: Researchers found that women and men who ate the most white rice—five or more servings a week—had a 17 percent higher risk of diabetes than those who ate white rice less than one time a month. People who ate the most brown rice—two or more servings a week—had an 11 percent lower risk of diabetes than those who rarely ate brown rice. Researchers estimate that swapping whole grains in place of even some white rice could lower diabetes risk by 36 percent. (25)
In contrast, white bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what’s called a high glycemic index and glycemic load. That means they cause sustained spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk. (22) In China, for example, where white rice is a staple, the Shanghai Women’s Health Study found that women whose diets had the highest glycemic index had a 21 percent higher risk of developing type 2 diabetes, compared to women whose diets had the lowest glycemic index. (23) Similar findings were reported in the Black Women’s Health Study. (24)
Second – I tell clients with type 2 diabetes to find simple swaps for items that they should be limiting and easy to incorporate new habits to make diabetes easier to manage. The easy swaps could be switching from sweetened coffee creamer to unsweetened vanilla almond (just 30 calories per cup and low glycemic index) and stevia, which is not an artificially sweetener, but made from the stevia plant. The fact the research is showing that stevia has a glucose lowering effect and can increase insulin production for type 2 diabetics, is a plus.
In contrast, white bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what’s called a high glycemic index and glycemic load. That means they cause sustained spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk. (22) In China, for example, where white rice is a staple, the Shanghai Women’s Health Study found that women whose diets had the highest glycemic index had a 21 percent higher risk of developing type 2 diabetes, compared to women whose diets had the lowest glycemic index. (23) Similar findings were reported in the Black Women’s Health Study. (24)
Type 2 diabetes is often treated with oral medication because many people with this type of diabetes make some insulin on their own. The pills people take to control type 2 diabetes do not contain insulin. Instead, medications such as metformin, sulfonylureas, alpha-glucosidase inhibitors and many others are used to make the insulin that the body still produces more effective.

But contrary to a tossed-about diabetes myth, a lack of motivation isn't always a factor behind a person's need for medication. Type 2 diabetes is a progressive disease, and it's not always possible for people to control their blood glucose levels with diet and exercise alone over time. People with prediabetes or type 2, however, are encouraged to embark on lifestyle changes such as losing at least 5 to 7 percent of their body weight, exercising more, and choosing healthier foods with fewer calories.
Often, people with type 2 diabetes start using insulin with one long-acting shot at night, such as insulin glargine (Lantus) or insulin detemir (Levemir). Discuss the pros and cons of different drugs with your doctor. Together you can decide which medication is best for you after considering many factors, including costs and other aspects of your health.
If you are like me, going to the gym is not your favorite pass time. Physical activity with diabetes is so beneficial. Being active, however, does not mean having to work out. There are tons of ways to sneak in exercise in your everyday activities. For example, when grocery shopping, park at the end of the lot so you have to walk a longer distance to and from the store. If you enjoy watching tv, stand up and walk in place during the commercials. Take the stairs instead of the elevator as often as you can. If you enjoy dancing, instead of at- home work out videos, put on your favorite tunes and dance away! There are so many different ways to be active without “working out”!
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Over a period of years, you went from pre-diabetes, to diabetes, to taking one medication, then two then three and then finally large doses of insulin. Here’s the thing. If you are taking more and more medications to keep your blood sugars at the same level, your diabetes is getting worse! Even if your blood sugars get better, your diabetes is getting worse. This is unfortunately what happens to virtually every patient. The body is already overflowing with sugar.
It had been about a year since Akua Jitahadi felt like herself. But she was 51 and expected menopause to kick in soon. Plus, she and her daughter had just moved to oppressively hot Arizona. So she brushed off the tired, sluggish feeling as a side effect of being a middle-aged woman adjusting to sweltering temps. And then, overnight, her vision dimmed. Something was most definitely wrong.
At each meal and snack pair carbohydrates with a protein and heart healthy fat. For meals make half your plate vegetables (raw, steamed or sautéed in a heart healthy oil like olive oil),a quarter lean protein (think less legs are better – choose fish, chicken, pork and have beef (aka red meat) on occasion), the remaining quarter of your plate should be from grains, preferably whole (i.e. quinoa, couscous, rice or even a baked potato- just go easy on the butter and sour cream). Some snack ideas include pairing fruit or vegetable with a protein, such as a banana or apple with peanut butter, raw vegetables (carrots, bell or sweet pepper strips, snap peas, celery) with hummus or even whole grain crackers with a low-fat cheese or plain yogurt with added fruit.
High blood pressure may also be present with your diabetes. Limiting how much salt you eat can help keep your blood pressure low. Decrease the amount of salt you add during cooking and reduce salt in recipes, before adding salt at the table, taste first, try seasoning your food with (salt-free) herbs, spices, and garlic. Lemon juice brings out the natural saltiness of foods. Avoid processed foods that are high in salt (sodium chloride) such as canned or packaged foods and condiments such as mustard, watch for “Na” (sodium) on food labels. Chips, pretzels, and other such snacks are very high in salt, and check with your physician before using salt substitutes.
Your doctor will be able to check your heart health, which is particularly important if you already have blocked arteries or high blood pressure. You also need to take into consideration any other diabetes-related complications—retinopathy or neuropathy, for example. As you begin an exercise program, your doctor can refer you to an exercise physiologist or diabetes educator to help you figure out the best exercise program that allows you to get in shape for your fitness level.

Eat 5 – 9 servings of fruits and vegetables per day. Focus on non-starchy vegetables especially those that don’t impact the blood sugar as much as starchy vegetables. Non-starchy vegetables include foods like asparagus, green beans, beets, broccoli, brussel sprouts, cabbage, cauliflower, cucumbers, greens, and spinach. Non-starchy vegetables include foods like corn, potatoes, peas, lima beans, and black-eyed peas

Most people with diabetes find that it is quite helpful to sit down with a dietitian or nutritionist for a consult about what is the best diet for them and how many daily calories they need. It is quite important for diabetics to understand the principles of carbohydrate counting and how to help control blood sugar levels through proper diet. Below are some general principles about the diabetic diet.


Counting carbohydrates: Dietary fiber may be listed underneath the listing for total carbohydrates. Dietary fiber is not digested by the body and can be subtracted from the total amount of carbohydrates present in food. This gives the net carbohydrates and will give a more accurate count of how much of the carbohydrates that affect blood sugar are present.
[1] Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: the Diabetes Prevention Program Outcomes Study. The Lancet Diabetes & Endocrinology. 2015;3(11):866‒875. You can find more information about this study at the Diabetes Prevention Program Outcomes Study website.
Phelps also made significant changes to his exercise routine, which went from 1/3-mile walks around his neighborhood (it took him 40 minutes and three rest stops the first time) to walking a half marathon a little under a year later. As he lost weight and became fitter, Phelps got addicted to triathlons. At 64, he's now set his sights on Ironman races, which he hopes to compete in next year.
Food sources of carbohydrates including breads, cereals, crackers, pasta, starchy vegetables (peas, corn, potatoes), fruit and sweets/desserts need to be eaten consistently throughout the day by focusing on small and frequent meals every 3-4 hours. Patients with type 2 diabetes should work with a dietitian who can prescribe a goal number of carbohydrate servings (or grams) at each meal and snack and teach appropriate portion size for each carbohydrate food. Daily carbohydrate needs will vary based on the individual.
The Centers for Disease Control and Prevention (CDC) and the American Medical Association (AMA) are sounding an alarm about prediabetes because a national effort—by everyone from physicians to employers to patients to community organizations—is required to prevent type 2 diabetes in the United States. In addition to focusing on the person with prediabetes or diabetes, we also must engage the systems and communities where people live, work and play. We can all Act – Today.
Eat a Source of Protein with Breakfast: As the first meal of the day, breakfast can set the tone for your body’s blood sugar balance and overall mindset on eating well (which, of course is also affected by a steady blood sugar!). Many typical breakfast foods tend to be rich in carbohydrates (fruit, cereal, oatmeal, toast, etc.) which may lead to spikes in blood sugar if eaten in large quantities alone.Add in sources of protein, fiber and/or healthy fats to create a blood-sugar steadying breakfast: pair fruit with yogurt or cottage cheese, oatmeal with a spoonful of peanut or almond butter, or a slice or two of whole grain toast with a couple of eggs or hummus.
The difference between glycemic index and glycemic load is that glycemic index is a standardized measurement and glycemic load accounts for a real-life portion size. For example, the glycemic index of a bowl of peas is 68 (per 100 grams) but its glycemic load is just 16 (lower the better). If you just referred to the glycemic index, you'd think peas were a bad choice, but in reality, you wouldn't eat 100 grams of peas. With a normal portion size, peas have a healthy glycemic load as well as being an excellent source of protein.
I think the best response to a one sentence question that includes the words diet and control is Mindfulness. Get knowledgeable about this topic so that you realize that eating is a continuum. There are so many decisions that go into what and how much we eat, that if we do not elevate intention to the priority level it requires to attain control, we will flounder in reaching our goals. Food choices, eating, and time management are so complex in our lives that clarifying our specific goals related to food and our health is imperative to approach control in a positive way.
The difference between glycemic index and glycemic load is that glycemic index is a standardized measurement and glycemic load accounts for a real-life portion size. For example, the glycemic index of a bowl of peas is 68 (per 100 grams) but its glycemic load is just 16 (lower the better). If you just referred to the glycemic index, you'd think peas were a bad choice, but in reality, you wouldn't eat 100 grams of peas. With a normal portion size, peas have a healthy glycemic load as well as being an excellent source of protein.
The process of type 2 diabetes begins years or even decades before the diagnosis of diabetes, with insulin resistance. Insulin resistance is the beginning of the body not dealing well with sugar, which is the breakdown product of all carbohydrates. Insulin tells certain body cells to open up and store glucose as fat. When the cells stop responding your blood sugar rises, which triggers the release of more insulin in a vicious cycle. Insulin resistance is associated with abdominal obesity, high blood pressure, high triglycerides, and low HDL ("good cholesterol"). When these occur together, it is known as metabolic syndrome or pre-diabetes. It is a risk factor for heart disease and type 2 diabetes.
Low-carbohydrate diets have gotten a lot of attention recently as strategies for reversing prediabetes. The carbohydrates in your diet that provide calories include sugars and starches. Starches are in grains and flour, beans, and starchy vegetables. Added sugars include sugars in sweets, sweetened foods such as flavored oatmeal and ketchup, and sugar-sweetened beverages such as soda. There are also natural sugars, which are found in nutritious foods such as dairy products and fruit.
This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The theory behind a ketogenic diet for prediabetes is that when your body is in ketosis, you can be sure that you do not have excess carbohydrates in your diet. Since carbohydrates in your diet are broken down into glucose that goes into your bloodstream, being in ketosis assures that you are not inundating your bloodstream with excessive amounts of glucose due to the foods you eat.
In general, prediabetes is not associated with any specific symptoms. However, there may be indicators of problems in blood sugar metabolism that can be seen years before the development of overt diabetes. Health-care professionals in the field of endocrinology are now routinely looking at these indicators in patients who are high risk for developing diabetes.
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