The same benefits are seen when looking specifically at people with impaired prediabetes (glucose tolerance/impaired fasting glucose). When diet and exercise are used as tools in this population over a six year study and compared to a control group, glucose tolerance improves by about 76% compared to deterioration in 67% of the control group. The exercise group also had a lesser rate of progression to type 2 diabetes.


Your care team may recommend that you use a continuous glucose monitor (CGM). A CGM is a wearable device that can measure blood sugar every few minutes around the clock. It's measured by a thread-like sensor inserted under the skin and secured in place. The more frequent CGM blood sugar readings can help you and the care team do an even better job of troubleshooting and adjusting your insulin doses and diabetes management plan to improve blood sugar control.
Yes. Type 2 diabetes is a genetic disease. The risk is highest when multiple family members have diabetes, and if the children also are overweight, sedentary and have the other risk factors for type 2 diabetes. Your child has a 10-15% chance of developing type 2 diabetes when you have type 2 diabetes. And if one identical twin has type 2 diabetes, there is a 75% likelihood of the other twin developing type 2 diabetes also.
Of course, carbohydrate types, amounts and frequencies still matter. Setting up a routine is best so the body can become more regulated, and medications can be more easily adjusted with medical guidance. For example, a “consistent carbohydrate diet” may include 4-5 carbohydrate servings (60-75 grams) per meal, with 3 meals spaced 4 or 5 hours apart. The inclusion of an evening snack may be recommended pending morning glucose trends. If morning sugars are running under 70 mg/dl, it may be a wise choice to have a 2-carbohydrate evening snack about 1 hour prior to retiring to bed.
The American Diabetes Association (ADA) recommends lean proteins low in saturated fat for people with diabetes. If you’re following a vegan or vegetarian diet, getting enough and the right balance of protein may be more challenging, but you can rely on foods like beans, nuts, and tofu to get your fix. Just be sure to keep portion size in mind when snacking on nuts, as they are also high in fat and calories.
The risk factors for developing diabetes actually vary depending on where a person lives. This is in part due to the environment the person lives in, and in part due to the genetic makeup of the family. In the United States, it is estimated that one in three males and two out of every five females born in the year 2000 will develop diabetes (the lifetime risk). It has also been calculated that for those diagnosed with diabetes before the age of 40, the average life expectancy is reduced by 12 years for men, and 19 years for women.
Acarbose (Precose), a drug designed to reduce small intestinal absorption of carbohydrates has been used with some success as well and is licensed for diabetes prevention in some countries. The STOP NIDDM trial showed that in about 1400 patients with impaired glucose tolerance, acarbose significantly reduced progression to diabetes compared to placebo. However, the occurrence of gastrointestinal side effects have limited the use of this drug for some people.
What to drink in place of the sugary stuff? Water is an excellent choice. Coffee and tea are also good calorie-free substitutes for sugared beverages (as long as you don’t load them up with sugar and cream). And there’s convincing evidence that coffee may help protect against diabetes; (33, 34) emerging research suggests that tea may hold diabetes-prevention benefits as well, but more research is needed.
Our advice to anyone trying to live healthier lifestyles is simple, including diabetics trying to manage their disease. Our mantra: Eat real food. What does that mean? Eat whole foods that grow from the ground, are picked from a bush or tree, or came from an animal. Whole vegetables, fruit (both preferably organic), and responsibly raised and fed animals are all a part of a healthy, nutrient-rich diet. If one can stick to this simple rule and minimize or avoid processed and packaged foods and food-like items, you’ll find you look, feel, and perform better than ever.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), you can calculate the amount of carbs you need by first figuring out what percentage of your diet should be made up of carbohydrates. (The NIDDK notes that experts generally recommend this number be somewhere between 45 and 65 percent of your total calories, but people with diabetes are almost always recommended to stay lower than this range.) Multiply that percentage by your calorie target. For example, if you’re aiming to get 50 percent of your calories from carbs and you eat 2,000 calories a day, you’re aiming for about 1,000 calories of carbs. Because the NIDDK says 1 gram (g) of carbohydrates provides 4 calories, you can divide the calories of carbs number by 4 to get your daily target for grams of carbs, which comes out to 250 g in this example. For a more personalized daily carbohydrate goal, it’s best to work with a certified diabetes educator or a registered dietitian to determine a goal that is best for you.
Including a variety of carbohydrate-containing foods is important; options can include whole grains (≥ 3 grams of fiber per serving), fruits, starchy vegetables and dairy. All meals should include a carbohydrate source, protein and a fruit or a vegetable to help stabilize blood glucose levels and meet an individual’s nutrient needs. An example may be grilled chicken, sweet potato and roasted asparagus.
If you have prediabetes, losing a small amount of weight if you’re overweight and getting regular physical activity can lower your risk for developing type 2 diabetes. A small amount of weight loss means around 5% to 7% of your body weight, just 10 to 14 pounds for a 200-pound person. Regular physical activity means getting at least 150 minutes a week of brisk walking or a similar activity. That’s just 30 minutes a day, five days a week.
Although most vegetable oils are in some ways healthier than animal fats, you will still want to keep them to a minimum. All fats and oils are highly concentrated in calories. A gram of any fat or oil contains 9 calories, compared with only 4 calories for a gram of carbohydrate. Avoid foods fried in oil, oily toppings, and olives, avocados, and peanut butter. Aim for no more than 2-3 grams of fat per serving of food, e.g., white or wheat bread, most cold cereals, watermelon, pineapple, baking potatoes, sugar.
If you fall into the second camp, there is plenty you can do to minimize the risk of the prediabetes progressing to diabetes. What's needed is a ''lifestyle reset," says Jill Wiesenberger, MD, RDN, CDE, FAND, a certified health and wellness coach and certified diabetes educator in Newport News, Virginia, and author of Prediabetes: A Complete Guide.2  The new book is published in collaboration with the American Diabetes Association. 

Food can be powerful in preventing and reversing diabetes. However, dietary approaches have changed as we have learned more about the disease. The traditional approach to diabetes focuses on limiting refined sugars and foods that release sugars during digestion-starches, breads, fruits, etc. With carbohydrates reduced, the diet may contain an unhealthful amount of fat and protein. Therefore, diabetes experts have taken care to limit fats- especially saturated fats that can raise cholesterol levels, and to limit protein for people with impaired kidney function. The new approach focuses more attention on fat. Fat is a problem for people with diabetes. The more fat there is in the diet, the harder time insulin has in getting glucose into the cells. Conversely, minimizing fat intake and reducing body fat help insulin do its job much better. Newer treatment programs drastically reduce meats, high-fat dairy products, and oils.[46,47,48,49,50] At the same time, they increase grains, legumes, fruits, and vegetables. The study found that patients on oral medications and patients on insulin were able to get off of their medications after some days on a near-vegetarian diet and exercise program. During 2 and 3-year follow-ups, most people with diabetes treated with this regimen have retained their gains. The dietary changes are simple, but profound, and they work.[51,52,53]


There’s more troubling news. The pre-cursors of Type 2 diabetes – pre-diabetes and the Metabolic Syndrome – increase our risk of heart disease almost as much as Type 2 diabetes does. These pre-cursors are so widespread in 21st century America that scientists now estimate that the majority of the current U.S. population over the age of 65 has them. And they put people at dangerously high risk of developing full-blown Type 2 diabetes and cardiovascular disease, and dying prematurely.
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.
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