But just as with grains, it’s important to roll out your carb-counting skills when noshing on nature’s candy. The ADA notes that a small piece of whole fruit or ½ cup of canned fruit in natural juices or frozen fruit typically contains 15 g of carbs, while fruit juice — a less ideal source of fruit for diabetes — can have that much in 1/3 to ½ cup.
Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into cells for use as energy. If you have prediabetes, the cells in your body don’t respond normally to insulin. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes—and type 2 diabetes down the road.
While diabetes is characterized by high blood sugar values, type 2 diabetes is also associated with a condition known as insulin resistance. Even though there is an element of impaired insulin secretion from the beta cells of the pancreas, especially when toxic levels of glucose occur (when blood sugars are constantly very high), the major defect in type 2 diabetes is the body's inability to respond properly to insulin.

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.

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.


Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into cells for use as energy. If you have prediabetes, the cells in your body don’t respond normally to insulin. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes—and type 2 diabetes down the road.
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 COACH Program® provided by Diabetes Tasmania, is a free telephone coaching service for people at risk of or diagnosed with type 2 diabetes. It provides people with the opportunity to work with a coach (health professional) to understand, manage and improve their health in particular around the risk factors associated with diabetes and its complications.
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.
The good news is that prevention plays an important role in warding off these complications. By maintaining tight control of your blood glucose—and getting it as close to normal as possible—you’ll help your body function in the way that it would if you did not have diabetes. Tight control helps you decrease the chances that your body will experience complications from elevated glucose levels.
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].

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.
A ketogenic diet for prediabetes might include about 20 to 50 grams per day of non-fiber carbohydrates, or about 5 to 10% of total calories from carbohydrates. The rest of your calories come from fat and protein. The food choices on this diet are similar to those on other low-carb diets, but you may need to further restrict some of the moderate-carbohydrate options that might be easier to fit in on a more moderate low-carb diet. Examples include fruit (an apple has 24 grams of non-fiber carbohydrates) and starchy vegetables (a half-cup of corn has 15 grams of non-fiber carbs).
Along with healthy eating, you can help keep your blood sugar in target range by maintaining a healthy weight. People with type 2 diabetes are often overweight or obese. Losing even 10 pounds (4.5 kilograms) can help you manage your diabetes better. Eating healthy foods and staying active (for example, 60 total minutes of walking or other activity per day) can help you meet and maintain your weight loss goal.
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.
Although kids and teens might be able to prevent or delay the onset of type 2 diabetes by managing their weight and increasing physical activity, other risk factors for type 2 diabetes can't be changed. Kids with one or more family members with type 2 diabetes have an increased risk for the disease, and some ethnic and racial groups are more likely to developing it.
Diabetic’s dietary practices are mainly influenced by cultural backgrounds. Concerning each of the dimensions of dietary practices, there were significant positive relationships between knowledge regarding diabetic diet and dietary practices. Knowledge was a salient factor related to dietary behaviors control.46 Moreover, patients’ knowledge on a recommended diet indicates their understanding of dietary guidelines which influenced their food selection and eating patterns.47 The association between dietary knowledge and dietary practices among T2DM patients in the previous studies were inconsistent. Another study revealed that there was no relationship between dietary knowledge and compliance of dietary practices.58 On the other hand, the same study found that a high dietary knowledge score was associated with following dietary recommendations and knowledgeable patients performed self-management activities in a better way. Dietary knowledge significantly influences dietary practices. In Indonesia, a study was conducted to measure dietary practices among diabetic patients, which elaborated that the Indonesian people, preferred to consume high-fat foods which lead to an increased risk of CVD.59 The trend of skipping breakfast has dramatically increased over the past 10 years in children, adolescents, and adults.60,61 There is increasing evidence that skipping breakfast is related with overweight and other health issues.62 In addition, frequent eating or snacking may also increase the body weight and risk of metabolic diseases.63,64 Rimm65 demarcated western and prudent dietary patterns. The prudent dietary pattern was characterized by increased consumption of fish, poultry, various vegetables and fruits whereas; the western dietary pattern was characterized by an increased consumption of processed and red meat, chips, dairy products, refined grains, and sweets and desserts. These patterns were previously associated with T2DM risk. The glycemic index is an indicator of the postprandial blood glucose response to food per gram of carbohydrate compared with a reference food such as white bread or glucose. Hence, the glycemic load represents both the quality and quantity of the carbohydrates consumed.66-69 Another study conducted in Lebanon demonstrated direct correlation of the refined grains and desserts and fast food patterns with T2DM, however, in the same study an inverse correlation was observed between the traditional food pattern and T2DM among Lebanese adults.70
Heart-healthy fish. Eat heart-healthy fish at least twice a week. Fish can be a good alternative to high-fat meats. For example, cod, tuna and halibut have less total fat, saturated fat and cholesterol than do meat and poultry. Fish such as salmon, mackerel, tuna, sardines and bluefish are rich in omega-3 fatty acids, which promote heart health by lowering blood fats called triglycerides.
John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
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.
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.
Combining the Nurses’ Health Study results with those from seven other studies found a similar link between sugary beverage consumption and type 2 diabetes: For every additional 12-ounce serving of sugary beverage that people drank each day, their risk of type 2 diabetes rose 25 percent. (27) Studies also suggest that fruit drinks— Kool Aid, fortified fruit drinks, or juices—are not the healthy choice that food advertisements often portray them to be: Women in the Black Women’s Health study who drank two or more servings of fruit drinks a day had a 31 percent higher risk of type 2 diabetes, compared to women who drank less than one serving a month. (28)
Hemoglobin A1c or HbA1c is a protein on the surface of red blood cells. The HbA1c test is used to monitor blood sugar levels in people with type 1 and type 2 diabetes over time. Normal HbA1c levels are 6% or less. HbA1c levels can be affected by insulin use, fasting, glucose intake (oral or IV), or a combination of these and other factors. High hemoglobin A1c levels in the blood increases the risk of microvascular complications, for example, diabetic neuropathy, eye, and kidney disease.
Dr. Erica Oberg, ND, MPH, received a BA in anthropology from the University of Colorado, her doctorate of naturopathic medicine (ND) from Bastyr University, and a masters of public health (MPH) in health services research from the University of Washington. She completed her residency at the Bastyr Center for Natural Health in ambulatory primary care and fellowship training at the Health Promotion Research Center at the University of Washington.
#8. COFFEE—Several studies have found coffee, whether regular or decaf, reduces risk of type 2 diabetes. Some research has found that those drinking 6 or 7 cups a day have about a 35% lower risk of getting diabetes than those drinking less than 2 cups.10 Drink wisely, Weisenberger says. Unfiltered coffee has compounds that raise your bad (LDL) cholesterol, so use a paper filter with methods such as French press. And don't undo the benefits by adding too much sugar, cream or syrup.
A relatively small weight loss of 7 percent of body weight has been shown to help prevent diabetes. Strive to stay at your own lowest sustainable weight, even if that is above what the charts say you should be. It is better to aim for a smaller weight loss and be able to keep that weight off than aim for an unrealistically low number, which could cause a "rebound" effect.
The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes. (39) Trans fats do just the opposite. (8, 40) These bad fats are found in many margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. Eating polyunsaturated fats from fish—also known as “long chain omega 3” or “marine omega 3” fats—does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease. (41) If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease. (42)
The best way to control Type 2 Diabetes through diet is eating in a metabolic pattern (eating every 2 1/2-3 hours) and eating low glycemic index/load diet (foods that break down slowly into glucose) to maintain blood sugar levels. The goal is to eat a balanced diet rich in lean animal proteins (chicken, turkey, fish), good fats (olive oil, coconut oil, avocado, seeds and nuts), fiber, fresh fruit, vegetables, and whole grains to balance the metabolism, hormones, and of course blood sugars. Fiber is key to maintain blood sugar. Most people get between 8-11 g of fiber a day and need between 35-45 g. Fresh vegetables (especially leafy greens) and fruit as well as whole grains like quinoa, whole brown rice, spelt, amaranth, buckwheat and whole oats) are filled with good fiber. It is best to avoid sugar, processed foods (packaged foods, breads), simple carbohydrates (white flours and grains), artificial sweeteners (Stevia in the Raw is ok), too much coffee, and sodas. Limit dairy which can affect blood sugars as well. Eating a variety of the above foods instead of the the same foods over and over again will also help maintain blood sugars.

The types of fats in your diet can also affect the development of diabetes. Good fats, such as the polyunsaturated fats found in liquid vegetable oils, nuts, and seeds can help ward off type 2 diabetes. (39) Trans fats do just the opposite. (8, 40) These bad fats are found in many margarines, packaged baked goods, fried foods in most fast-food restaurants, and any product that lists “partially hydrogenated vegetable oil” on the label. Eating polyunsaturated fats from fish—also known as “long chain omega 3” or “marine omega 3” fats—does not protect against diabetes, even though there is much evidence that these marine omega 3 fats help prevent heart disease. (41) If you already have diabetes, eating fish can help protect you against a heart attack or dying from heart disease. (42)
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.
They would often say to me, “Doctor. You’ve always said that weight loss is the key to reversing diabetes. Yet you prescribed me a drug that made me gain 25 pounds. How is that good?” I never had a good answer, because none existed. It was not good. The key was weight loss, whereupon the diabetes often goes away or at least gets significantly better. So, logically, insulin does not help reverse the disease, but actually worsens it.
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)
Other medications such as metformin or the DPP4 drug class are weight neutral. While this won’t make things worse, they won’t make things better either. Since weight loss is the key to reversing type 2 diabetes, medications won’t make things better. Medications make blood sugars better, but not the diabetes. We can pretend the disease is better, but that doesn’t make it true.

Hyperglycemia or high blood sugar is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms of high blood sugar may include increased thirst, headaches, blurred vision, and frequent urination.Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
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.

The good news is that prevention plays an important role in warding off these complications. By maintaining tight control of your blood glucose—and getting it as close to normal as possible—you’ll help your body function in the way that it would if you did not have diabetes. Tight control helps you decrease the chances that your body will experience complications from elevated glucose levels.
Paleolithic diets include a moderate amount of protein, and have gained a lot of attention recently. The theory behind this dietary pattern is that our genetic background has not evolved to meet our modern lifestyle of calorically dense convenience foods and limited activity, and that returning to a hunter-gatherer way of eating will work better with human physiology. This has been studied in a few small trials, and it does seem beneficial for people with type 2 diabetes.
Some people with type 2 diabetes are treated with insulin. Insulin is either injected with a syringe several times per day, or delivered via an insulin pump. The goal of insulin therapy is to mimic the way the pancreas would produce and distribute its own insulin, if it were able to manufacture it. Taking insulin does not mean you have done a bad job of trying to control your blood glucose—instead it simply means that your body doesn’t produce or use enough of it on its own to cover the foods you eat.
Activity – so important to keep busy – mentally as well as physically. Find an activity that you really WANT to do. I like to garden and now that I am tracking my activity, I find it gives me an excuse to go out and putter. Since I enjoy it and accomplish something good, it satisfies me. I have discovered that with some practice I can read while walking on the treadmill. If the book engrosses my mind, I will walk much longer than if I am just watching the timer.
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.
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]

The best way to control Type 2 Diabetes through diet is eating in a metabolic pattern (eating every 2 1/2-3 hours) and eating low glycemic index/load diet (foods that break down slowly into glucose) to maintain blood sugar levels. The goal is to eat a balanced diet rich in lean animal proteins (chicken, turkey, fish), good fats (olive oil, coconut oil, avocado, seeds and nuts), fiber, fresh fruit, vegetables, and whole grains to balance the metabolism, hormones, and of course blood sugars. Fiber is key to maintain blood sugar. Most people get between 8-11 g of fiber a day and need between 35-45 g. Fresh vegetables (especially leafy greens) and fruit as well as whole grains like quinoa, whole brown rice, spelt, amaranth, buckwheat and whole oats) are filled with good fiber. It is best to avoid sugar, processed foods (packaged foods, breads), simple carbohydrates (white flours and grains), artificial sweeteners (Stevia in the Raw is ok), too much coffee, and sodas. Limit dairy which can affect blood sugars as well. Eating a variety of the above foods instead of the the same foods over and over again will also help maintain blood sugars.

Although kids and teens might be able to prevent or delay the onset of type 2 diabetes by managing their weight and increasing physical activity, other risk factors for type 2 diabetes can't be changed. Kids with one or more family members with type 2 diabetes have an increased risk for the disease, and some ethnic and racial groups are more likely to developing it.


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.
Exercise can also help people with type 2 diabetes avoid long-term complications, especially heart problems. People with diabetes are susceptible to developing blocked arteries (arteriosclerosis), which can lead to a heart attack. Exercise helps keep your heart healthy and strong. Plus, exercise helps you maintain good cholesterol—and that helps you avoid arteriosclerosis.

Foods might sometimes appear to be packaged into individual serving sizes even though they contain two or more servings per package. To determine that, look at "serving size" and "servings per container" at the top of any food label. For example, if a serving size is 1 and there are 2 servings per container, you will need to double all of the nutrient values on the label in order to get a clear picture of the value of the entire container.


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.
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