PREDIABETES

1. PREDIABETES Sandra Byer-Lubin, RD, CDE University Medical Center at Princeton

2. Blood sugar or glucose levels are higher than normal, but not high enough to be classified as diabetes.

3. Prevalence • 41 million Americans have prediabetes • All will develop type 2 diabetes within the next 10 years unless they do something about it. • All have increased risk of heart disease and strokes.

4. Diagnosis(by fasting blood sugar) Less than 100 100-125 126 or higher (Normal) (Pre-Diabetes) (Diabetes)

5. Diagnosis(by oral glucose tolerance test) • Sometimes pre-diabetes is diagnosed by drinking a high sugar beverage. Blood sugar is then checked. • Pre-diabetes: A reading of 140-199 (2 hours after drinking the beverage). • Diabetes: A reading of 200 or higher ( 2 hours after drinking the beverage).

6. Risk Factors of Pre-Diabetes • 45 years of age or older and overweight. • Under 45 with other risk factors for diabetes.

7. Other risk factors: • Physically inactive. • Family history of diabetes. • Are African American, Native American, Asian American, Pacific Islander or Hispanic American.

8. Other risk factors, cont’d • Have had a large baby weighing 9 lbs. or more or have had gestational diabetes. • Have high blood pressure. • Have low HDL cholesterol (35 or lower) or high triglycerides (250 mg/dl or higher).

9. How Food is Digested 1. Food enters stomach 4. Pancreas releases insulin 5. Insulin unlocks receptors 6. Glucose enters cell 3. Glucose enters bloodstream 2. Food is converted into glucose

10. Pre-Diabetes 1. Food enters stomach 4. Pancreas releases insulin BUT 5. Insulin does not fully unlock receptors 7. Liver dumps more glucose in the blood because the cells are “hungry”. 6. Glucose cannot enter cell and glucose builds up in the blood 3. Glucose enters bloodstream 2. Food is converted into glucose

11. Insulin resistance is the main problem!

12. How to help insulin work better: • Increase physical activity. • Eat a healthy balanced diet. • Lose a little weight if needed. • Take prescribed medication.

13. Healthy Eating: The first step

14. When should you eat? • Eat regular meals about 4-5 hours apart. • Skipping meals can cause weight gain and then more insulin resistance. • Eating 3 smaller meals and a few snacks may also be helpful.

15. Increase fiber! • Fiber helps you feel full and can help with weight loss. • Fiber aids in regularity. • Fiber helps to lower cholesterol.

16. You can get more fiber by eating: • Beans • Whole grains (5 g fiber/serving for cereal, 2 g fiber/slice of bread) • Whole fruits instead of fruit juice. • Vegetables.

17. Know your vegetables…… • Starchy veggies are good for you, but limit the amount, if you are having other carbs with your meal ½ cup= 15 gm carb/1 carb choice or serving • Non-starchy veggies eat all you want (no need to measure). • ½ cup= 5 gm carb

18. Starchy Vegetables • These are nutritious and high in fiber, and are counted as Carbohydrates, not vegetables: • Corn - Peas • Potatoes - Sweet potatoes

19. Eat more low starch vegetables • !/2 of your plate should be these vegetables.

20. FOODS TO AVOID Sweet tea Regular sodas Lemonade Kool-Aid Gatorade FREE FOODS (5 g or less carbohydrate and 20 calories or less) Sugar Substitutes Equal Splenda Sweet N’ Low Diet Soda Unsweetened Tea Crystal Light Sugar Free Flavored Waters Sugar Free Jello Sugar Free Popsicles

21. Decrease amount of: • Fruit juice to 4-6 oz a day • Desserts and other sweets • High fat foods • Salty foods (if blood pressure is high) • Alcohol (especially if overweight and/or elevated triglyceride level)

22. DECREASE DOESN’T MEAN NEVER!

23. Starch Fruit Milk All carbohydrates turn to sugar (glucose). It’s a good idea to eat some healthy carbohydrates at each meal, even if you have pre-diabetes ! Carbohydratesgive you energy.

24. WOMEN 2-4 carbohydrate choices each meal or 30-60 gm carbohydrate each meal 6 fists of carbs a day MEN 3-5 carbohydrate choices each meal or 45-75 gm carbohydrate each meal 9 fists of carbs a day Try to eat:

25. Shredded Wheat

26. Bread

27. Potatoes

28. Beans

29. Peas and Corn

30. Light Yogurt

31. Milk

32. Apple

33. Treats • 2-3 times a week • Small portions • Check carbohydrate content: 15-20 gm = 1 carb choice or portion

34. Pudding

35. Moderation with Proteins • 32 oz steak dinners are out • Protein foods include Red meat Poultry Fish Cheese Eggs Nuts Tofu

36. How Much Protein Foods? • Use palm of hands to estimate portions • 2-3 palms or decks of card a day • 1 protein food portion is about 3 oz

38. Go Easy on Fat • Limit deep frying • Choose lean meats • Fat sources • Butter, margarine • Oil • Salad dressing • Sour cream • Bacon • Nuts

39. The Better Fats • Canola oil • Olive oil • Peanut oil • Tub Margarine • Nuts and their butters • Avocados

40. How Much Fat? • Use thumb to estimate portions • 3-4 portions a day • 40-60 grams of fat/day

41. Tub Margarine and Peanut Butter

42. Regular Salad Dressing

43. Almonds

44. What is a healthy meal?(amounts vary individually)3-4 ounces of lean proteinmedium baked potatoor1-1/2 cups of pasta or rice(preferable whole grain)1 cup vegetablessalad with lite dressing/oilfresh fruit

45. Healthier snack suggestions: • Lite yogurt • Nuts (small handful) • Graham crackers • Fruit • Low fat cottage cheese • Low fat cheese stick • Sugar-free pudding • Raw veggies

46. Exercise is also important in managing your insulin resistance & pre-diabetes. • Out of shape? Start slowly. • Maybe 10 to 15 to 20 minutes. • A little every day is good. • In better shape? • 30 to 45 to 60 minutes, 3 to 5 times a week.

47. Need motivation? • Try using a pedometer. • Wear for 7 days to determine your daily average. • Increase steps gradually.

48. Irregular schedule? • Take stairs instead of elevator. • Park farther away. • Take several 5 minute breaks during the day.

49. Time? • Set aside a time at lunch. • Walk or go to gym right after work (before you go home!).

50. Unable to walk? • Water exercise • Chair exercises