When his doctor and dietitian urged him to make changes to improve his diabetes control, Phelps, then 57, took the challenge seriously. He weighed everything he ate to gauge portion size. And he went slow, knowing that abrupt changes to his diet had never worked in the past. Instead of giving up desserts, he focused on smaller quantities and better-quality foods.
While some people attempt to manage their type 2 diabetes with diet and exercise alone, this may not work for everyone. In fact, though the Centers for Disease Control and Prevention estimates 16 percent of people with diabetes don't take medication, the majority of people with diabetes require insulin or oral meds at some point, often at diagnosis.
Regular physical activity helps the body cells take up glucose and thus lower blood glucose levels. Regular physical activity also helps with weight loss as well as controlling blood cholesterol and blood pressure. You need to let your doctor and dietitian know about the kinds of physical activities you do regularly. Your doctor and dietitian will help you balance your physical activity with your medication and diabetic meal plan. If you are not physically active now, your doctor may recommend that you increase physical activity. Important benefits of a regular aerobic exercise program in diabetes management include decreased need for insulin, decreased risk of obesity, and decreased risk for heart disease. Exercise decreases total cholesterol, improves the ratio of low-density lipoprotein (LDL) to high-density lipoprotein cholesterol (HDL), and reduces blood triglycerides. It may also decrease blood pressure and lower stress levels. Walking is one of the easiest and healthiest ways to exercise. This is one activity that anyone can do for a lifetime without special equipment and with little risk of injury. Talk to your doctor about exercise. Supervised activity is best because of the risk of an insulin imbalance. Use the buddy system when you exercise.[71,72,73,74,75,76,77]
In recent times in Saudi Arabia, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity. Unfortunately, many Saudis are becoming more obese because of the convenience of fast foods, and this adds to the scary diabetes statistics.45 On the other hand, Saudis drink too many high-sugar drinks. In addition, Backman46 reported dietary knowledge to be a significant factor that influences dietary behaviors. In another study conducted by Savoca and Miller47 stated that patients’ food selection and dietary behaviors may be influenced by the strong knowledge about diabetic diet recommendations. Significant positive relationship was observed between knowledge regarding diabetic diet and the amount of calorie needs (r = 0.27, p < 0.05).48 The study concluded that knowledge regarding diabetic diet is essential and is needed to achieve better dietary behaviors. Results of study conducted in Saudi Arabia25 reported that more than half of the diabetic patients denied modifying their dietary pattern, reduction in weight and perform exercise.
DM is the fourth among the leading causes of global deaths due to complications. Annually, more than three million people die because of diabetes or its complications. Worldwide, this disease weighs down on health systems and also on patients and their families who have to face too much financial, social and emotional strains. Diabetic patients have an increased risk of developing complications such as stroke, myocardial infarction, and coronary artery disease. However, complications such as retinopathy, nephropathy, and neuropathy can have a distressing impact on patient’s quality of life and a significant increase in financial burden. The prevalence reported from studies conducted worldwide on the complications of T2DM showed varying rates. The prevalence of cataracts was 26-62%, retinopathy 17-50%, blindness 3%, nephropathy 17-28%, cardiovascular complications 10-22.5%, stroke 6-12%, neuropathy 19-42%, and foot problems 5-23%. Mortality from all causes was reported between 14% and 40%.71 In a study, researchers found that 15.8% incidence of DR is in the developing countries. The prevalence of DR reported from Saudi Arabia, Sri Lanka, and Brazil was 30%, 31.3%, and 35.4%, respectively; while in Kashmir it was 27% and in South Africa it was 40%. The prevalence of DR 26.1% was observed among 3000 diabetic patients from Pakistan; it was significantly higher than that what was reported in India (18%) and in Malaysia (14.9%).72-76 Studies conducted on diabetes complications in Saudi Arabia are very few and restricted. A 1992 study from Saudi Arabia showed that in T2DM patients; occurrence rate of cataract was 42.7%, neuropathy in 35.9% patients, retinopathy in 31.5% patients, hypertension in 25% patients, nephropathy in 17.8% patients, ischemic heart disease in 41.3% patients, stroke in 9.4% patients, and foot infections in 10.4% of the patients. However, this study reported complications for both types of diabetes.77
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].

The problems behind the numbers are even more alarming. Diabetes is the leading cause of blindness and kidney failure among adults. It causes mild to severe nerve damage that, coupled with diabetes-related circulation problems, often leads to the loss of a leg or foot. Diabetes significantly increases the risk of heart disease. And it’s the seventh leading cause of death in the U.S., directly causing almost 70,000 deaths each year and contributing to thousands more. (4)


The role of inflammation is an area of extreme interest in regard to disease development. For example, we have begun to understand the importance of inflammation and heart disease. We now know that inflammation may play an important role in the development of diabetes as well. An inflammation marker known as C-reactive protein (CRP) has been shown to be increased in women at risk for developing the metabolic syndrome, and in both men and women at risk for developing type 2 diabetes. Recent studies have shown shifts in the blood levels of a number of markers for inflammation during the progression from no disease, to prediabetes, and then to full-blown diabetes. This research highlights the importance of inflammation as part of the mechanism of diabetes development.
It’s no secret that diet is essential to managing type 2 diabetes. Although there isn’t a one-size-fits-all diet for diabetes management, certain dietary choices should act as the foundation for your individual diet plan. Your diet plan should work with your body — not against it — so it’s important that the food you eat won’t spike your blood sugar levels to high.
In conclusion, effective lifestyle modifications including counseling on weight loss, adoption of a healthy dietary pattern like the Mediterranean diet, together with physical activity are the cornerstone in the prevention of type-2 diabetes. Therefore, emphasis must be given to promoting a healthier lifestyle and finding solutions in order to increase adherence and compliance to the lifestyle modifications, especially for high-risk individuals. Results from epidemiological studies and clinical trials evaluating the role of the Mediterranean dietary pattern regarding the development and treatment of type-2 diabetes indicate the protective role of this pattern. As a result, promoting adherence to the Mediterranean diet is of considerable public health importance as this dietary pattern, apart from its various health benefits, is tasty and easy to follow in the long-term. Diet is an important aspect in the management of a diabetic patient. The diabetic healthcare provider and the patient should understand the basic dietary needs of the patient. In this form, there may be plenty of insulin in the bloodstream, but the cells are resistant to it. Glucose cannot easily get into the cells, and it backs up in the bloodstream. Over the short run, people with uncontrolled diabetes may experience fatigue, thirst, frequent urination, and blurred vision. In the long run, they are at risk for heart disease, kidney problems, disorders of vision, nerve damage, and other difficulties.
Designed to support positive behaviour change, the program helps eligible participants plan and action small lifestyle changes that have long term health benefits. The program involves six sessions overs six months and is delivered by qualified health professionals. Participants have the choice of group sessions or phone coaching options. Group sessions in local areas work well for people who enjoy social interaction and learning from others’ experiences while phone coaching appeals to those whose work or life situation make it difficult for them to commit to set days and times.
Interventional studies showed that high carbohydrate and high monounsaturated fat diets improve insulin sensitivity, whereas glucose disposal dietary measures comprise the first line intervention for control of dyslipidemia in diabetic patients.78 Several dietary interventional studies recommended nutrition therapy and lifestyle changes as the initial treatment for dyslipidemia.79,80 Metabolic control can be considered as the cornerstone in diabetes management and its complications. Acquiring HbA1c target minimizes the risk for developing microvascular complications and may also protect CVD, particularly in newly diagnosed patients.81 Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the principal macronutrient of worry in glycemic management.82 In addition, an individual’s food choices and energy balance have an effect on body weight, blood pressure, and lipid levels directly. Through the mutual efforts, health-care professionals can help their patients in achieving health goals by individualizing their nutrition interventions and continuing the support for changes.83-85 A study suggested that intake of virgin olive oil diet in the Mediterranean area has a beneficial effect on the reduction of progression of T2DM retinopathy.86 Dietary habits are essential elements of individual cardiovascular and metabolic risk.87 Numerous health benefits have been observed to the Mediterranean diet over the last decades, which contains abundant intake of fruit and vegetables. The beneficial effects of using fish and olive oil have been reported to be associated with improved glucose metabolism and decreased risk of T2DM, obesity and CVD.88
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.
Regular exercise is an equally important part. Not only can it help you maintain your ​ideal body weight, it can have a direct impact on your blood glucose control. This is because insulin resistance is closely linked to increased fat and decreased muscle mass. Muscle cells use insulin far more efficiently than fat, so​ by building muscle and burning fat, you can help lower and better control your blood glucose levels.
The more intense the exercise, the better. According to the British diabetes association diabetes.co.uk, high-intensity interval training (HIIT) may be better for weight loss and glucose control than continuous aerobic activity like jogging. HIIT involves alternating between short bursts of increased intensity exercise and rest — for instance, running and then walking on and off throughout the workout.
Each person needs individualized treatment. Type-1 diabetes always requires insulin, diet, and exercise. Type-2 diabetics require insulin or oral hypoglycemic agents (medication that helps lower blood sugar), if diet and exercise alone fail to lower blood glucose. If you have diabetes, you need to have a medical team (doctor, nutritionist, and health educator or nurse) working with you. Whichever type of diabetes you have, the key to proper control is balancing the glucose and the insulin in the blood. This means adjusting your diet, activity, and sometimes taking medication.[29,30]

Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Approximately 84 million American adults—more than 1 out of 3—have prediabetes. Of those with prediabetes, 90% don’t know they have it. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.
Losing weight can lower your blood sugar levels. Losing just 5 to 10 percent of your body weight can make a difference, although a sustained weight loss of 7 percent or more of your initial weight seems to be ideal. That means someone who weighs 180 pounds (82 kilograms) would need to lose a little less than 13 pounds (5.9 kilograms) to make an impact on blood sugar levels.
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.

Ethnic background: For example, the actual prevalence of diabetes in the Caucasian population of the US is about 7.1% while in the African American population; it increases to about 12.6%. Approximately 8.4% of Asian Americans and 11.6% of Hispanic Americans are affected. In a well-studied group of Native Americans, the Pima Indians, the prevalence increases to almost 35%.
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.
Following a healthy eating plan. It is important to reduce the amount of calories you eat and drink each day, so you can lose weight and keep it off. To do that, your diet should include smaller portions and less fat and sugar. You should also eat a variety of foods from each food group, including plenty of whole grains, fruits, and vegetables. It's also a good idea to limit red meat, and avoid processed meats.
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.

The prediabetes diet plans below are designed to help you lose weight, improve your blood sugar control and overall health, and be easy to follow. Each plan has about 1,200 to 1,400 calories per day. If you need more, you can add in one or more of the healthy snack options listed below the menus. There is are one-week menus for a low-carb ketogenic diet and for a balanced, DPP-based prediabetes diet, and snacks listed for both types of diets.
How do sugary drinks lead to this increased risk? Weight gain may explain the link: In both the Nurses’ Health Study II and the Black Women’s Health Study, women who increased their consumption of sugary drinks gained more weight than women who cut back on sugary drinks. (26, 28) Several studies show that children and adults who drink soda or other sugar-sweetened beverages are more likely to gain weight than those who don’t, (28, 30) and that switching from these to water or unsweetened beverages can reduce weight. (31) Even so, however, weight gain caused by sugary drinks may not completely explain the increased diabetes risk.  There is mounting evidence that sugary drinks contribute to chronic inflammation, high triglycerides, decreased “good” (HDL) cholesterol, and increased insulin resistance, all of which are risk factors for diabetes. (32)
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