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. 

While carbohydrate counting is effective, it can be hard to go from eating whatever you want to calculating and measuring and measuring food intake. Carbohydrate counting is effective in managing blood sugars and controlling diabetes, though eating a balanced, healthy diet can help clients reach their goals. One way to do this is by following the plate method put out by www.myplate.gov. In this image, the recommendation for nutrient intake is to make ½ of your plate vegetables, ¼ of your plate lean protein and ¼ of the plate starch. This allows someone to incorporate carbohydrates into the diet, but in a balanced way that manages blood sugars. Getting a balance of nutrients provides energy, increases satiety and allows for optimal vitamin and mineral intake. The plate method is approachable and easy to incorporate whether you are at a restaurant, at a party, or at home cooking for yourself.
At Stanford Medical Center in California, while working as a clinical dietitian, I teamed up with a clinical research dietitian who specialized in diabetes.Our goal was to help women reach a weight recommended for their actual height. What resulted was a book Help! My Underwear is Shrinking: One woman’s story of how to eat right, lose weight, and win the battle against diabetes.The book tells the story of one woman as she struggles with her daily routine and responsibilities while trying to follow the plan and lose weight. The character provides humorous insight and methods she used for achieving her goal.
Meanwhile, saturated fats and trans fats can harm your heart and overall health, according to the American Heart Association. To spot trans fats, look for the term “hydrogenated” on labels of processed foods, such as packaged snacks, baked goods, and crackers. “I always tell my clients to double-check the ingredient list to make sure they don’t see any partially hydrogenated oil in their food products,” Massey says.
Pay attention to the balance of macronutrients (fat, protein, and carbohydrates) in a meal to support stable blood sugar levels. Specifically, fat, protein, and fiber all slow down the absorption of carbohydrates and thus allow time for a slower, lower insulin release and a steady transport of glucose out of the blood and into the target tissues - this is a good thing.
The glycemic index identifies foods that increase blood sugar rapidly. This handy tool allows you to favor foods that have much less effect on blood sugar. High-glycemic-index foods include sugar itself, white potatoes, most wheat flour products, and most cold cereals, e.g., pumpernickel, rye, multigrain, or sourdough bread, old-fashioned oatmeal, bran cereals, grape-nuts, most fruits, sweet potatoes, pasta, rice, barley, couscous, beans, peas, lentils, most vegetables [Table 1].
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Sugars and starches that you get from your diet enter your bloodstream as a type of sugar called glucose. In prediabetes, your body has trouble managing the glucose in your blood due to resistance to a hormone called insulin. Normally, insulin is able to help your body keep blood glucose levels in check, but the effect is weaker if you have prediabetes, so blood glucose rises.

If you choose to drink alcohol, remember: To drink with your meal or snack (not on an empty stomach!), to drink slowly or dilute with water or diet soda, that liqueurs, sweet wines and dessert wines have a lot of sugar, to wear your Medic Alert (Alcohol can cause hypoglycemia/low blood glucose), reducing alcohol can promote weight loss and help you lower your blood pressure.
One serving in a category is called a "choice." A food choice has about the same amount of carbohydrates, protein, fat and calories — and the same effect on your blood glucose — as a serving of every other food in that same category. So, for example, you could choose to eat half of a large ear of corn or 1/3 cup of cooked pasta for one starch choice.

There is much you can do with lifestyle alone to prevent diabetes. In a landmark study, the NIH-sponsored Diabetes Prevention Program, scientists tracked 3,234 pre-diabetic men and women for three years. A third of them adopted lifestyle changes. Another third took a drug – metformin (Glucophage®). The remaining third, the control group, took a placebo. Those on the lifestyle-change plan reduced the progression to full-blown Type 2 diabetes by 58% compared to the control group. The reduction was even greater – 71% – among adults aged 60 and older. Treatment with the drug metformin reduced the progression of Type 2 diabetes by just 31%.


Another area that I focus on is portion sizes. With the increase in portion sizes in our society, it can be hard to manage food intake. I recommend listening to your body and identifying your needs by being aware of your hunger and fullness. If you are feeling hungry, it is an indicator to eat, and once you start to feel satisfied, it is an indicator to stop eating, knowing that you can eat again later. This small change where someone begins to leave food on their plate or stops eating when feeling satisfied and not overly full can make a big difference in overall health.
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.
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.
It’s best to get fiber from food. But if you can’t get enough, then taking fiber supplements can help. Examples include psyllium, methylcellulose, wheat dextrin, and calcium polycarbophil. If you take a fiber supplement, increase the amount you take slowly. This can help prevent gas and cramping. It’s also important to drink enough liquids when you increase your fiber intake.
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