Lifestyle changes for pre-diabetes

July 23, 2024 6:57 PM

I am now pre-diabetic (I was expecting this) and advised by my doctor to try and reverse it with ‘lifestyle changes.’ Looking for authoritative non-faddish advice on what that might be.

The longer version: strong family history and I had gestational diabetes when pregnant. I knew this day would come :-)

I get a lot of activity (my daily commute involves at least 40 minutes of walking) and plan to add some more formal weight training/gym stuff.

I know I could stand to lose some weight and my diet could use some cleaning up (I’m a single parent and we order in too much). But there is so much conflicting information on the best diet for this. There is the forks over knives approach, where you don’t limit carbs, but you are vegan. Related, the ‘vegan until dinner’ approach (Mark Bittman). Info is also out there, much of it dodgy-seeming, on hormone regulation, glucose spikes, reducing pesticides and toxins etc.

When I was pregnant, the ‘standard’ recommendation was that one carb ‘unit’ is 15 grams and you could have 1-2 units per snack and 3-4 units per meal. Is this still the best way? Or are some of the above-mentioned ideas actually new and useful? How can I cull out the TikTok noise and actually learn what is current best practice?

posted by ficbot to Food & Drink (31 answers total)

Hi! I've been a type 1 diabetic for 14 yrs. welcome to the club :)
Honestly, just eat less carbs. Find out how many carbs you eat in a day regularly, then reduce it by 20%. Try to replace with protein. This is the only way I have been able to lose weight and achieve better glycemic control as a diabetic and Hashimoto's haver.
posted by marvelousmellitus at 7:27 PM on July 23

I got myself out of the pre-diabetic range by cutting way down on carbs of most kinds. I still ate a lot of non-starchy vegetables, including carrots and corn. I mention those because many people think these "sweet" vegetables will raise blood sugar, but they have so much fiber that it's okay to have them. An added benefit for me was that I very gradually lost weight...25 pounds in a year. Also, my cholesterol numbers went way down, even though I wasn't particularly limiting how much fat I consumed. I never was one to eat a lot of fat, but I probably ate more when I increased the amount of meat.
posted by wryly at 8:13 PM on July 23

biggest thing that worked for me? you don't drink soda or fruit juice. no exceptions. treat it as poison. saw my blood sugar and overall health incredibly improve.
posted by evilmonk at 8:18 PM on July 23

I'm a type II diabetic for just over a year. Many years ago I was told I was pre-diabetic and to make "lifestyle changes" but like you, I found there was so much conflicting advice and I mostly continued on until I ended up diagnosed.

If you can afford it, get a continuous glucose monitor (CGM). An over-the-counter one was recently approved (in the US) but they may give you a prescription. I got this about two months after I was diagnosed diabetic and it made a huge difference because I could see how what (and when) I ate affects my blood sugar.

My mother is also a type II and has very different responses than I do. I suspect glycemic response is highly individual.

By using the CGM, I was able to find:

- Walking for ~5 minutes after eating dramatically improves my blood sugar response
- Sourdough does not spike my blood sugar
- Carrots do spike my blood sugar (but they don't spike my Mom's)
- Intermittent fasting (or rather, no eating after 8pm) drops my fasting blood glucose

Generally I am eating high protein, high fat, but with a lot of non-starchy vegetables and berries that keeps it from being "keto". From what I've read, either low carb or vegan seems to work, but low carb seemed more attainable for me. I have lost over 50lbs on this diet.

The Direct UK study is worth looking into -- they found you could reverse diabetes with diet.
posted by miscbuff at 8:18 PM on July 23

It depends how much energy you want to put into it.

If you’re willing to take your glucose three times a day (or simply get a continuous glucose monitor) then spend a week writing down absolutely everything you eat and comparing it to what it does to your glucose levels.

You’ll pretty quickly figure out which foods make your glucose spike. Don’t eat those.
posted by Tell Me No Lies at 8:28 PM on July 23

Talk to a registered dietitian. This is exactly the kind of thing they specialize in and the benefit is that it’s all grounded in science. A lot of science.
posted by corey flood at 8:45 PM on July 23

I'm going through this. I don't have scientific knowledge but my glucose tests have been getting slightly better so I'll just tell you what I'm doing for what it's worth: I went pretty much teetotal on stuff with obvious added sugar (sweets, soft drinks, anything I can taste is sweetened but I'm not super carefully reading labels) and also very largely cut out bread, pasta, and rice. I'm not doing keto. I cheat maybe once a month. I eat some stuff like corn tortillas, and I eat some fruit though I try even to limit that because the hardest part has been detuning my palate from wanting sweet stuff. I am eating more vegetables than I used to. That's the extent of it pretty much. I don't feel like it's going to do me much good to try and figure out something optimal when I am not a scientist and I'd rather do something that's working ok and that's manageable.
posted by less-of-course at 8:53 PM on July 23

Dr. Robert Baron on Managing Type II Diabetes Baron is Chief of the Weight Loss Program at UC San Franciso, and specializes in Nutrition. His advice is down to earth and reliable. UCTV has a whole library of lifestyle related information on health that is based on clinical evidence and is non profit oriented.

Dr. Gil Carvalho: Nutrition Made Simple Carvalho has a huge library of short videos to choose from on nutrition. He often reviews various clinical trials, but he also has guest speakers and diet recommendations for people looking to change their current diet. He is very evidence based, non profit and reliable.

I hope you find some useful information for your situation.
posted by effluvia at 9:24 PM on July 23

I am about to wrap up a year long pre diabetes group program at a hospital. The takeaway I have is to spend a few days logging what you eat to get an idea of how many calories and stuff you are getting and then aim to lower it by eating smaller portions if it is high. Then after that feels ok, start paying attention to what you eat. I talked to a dietician. Look up fiber rich foods and eat those a lot. Add more protein to your diet. Drink more water. At least glance at the amount of sugar on the label and prepare to be astonished how high it is for things. For building new habits, my therapist said I should never restrict — so I just add in new better things so I naturally will eat less of the Doritos and diet cokes I was snacking on. Today I had a few handfuls of cherries and a rocket apple and a banana as snacks, which is three more pieces of fruit than I was eating before. I discovered I actually do like blueberries and raspberries. I eat carrots and broccoli regularly now. I like olipop fiber sodas and coconut la croix and premier protein drinks. I started going to the health food store in town instead of Kroger or whatever, mainly to limit my Little Debbie consumption but also to make overall better food choices. While you are changing your diet, also try to aim for 150minutes a week of exercise that gets your heart rate up (in at least ten minute intervals). Walking is good, I also dance around the house and do some kettle bell stuff. I also joined the weightloss clinic at my hospital, and they started me on low doses of metformin and Wellbutrin (this also helped me quit smoking). I’ve lost 40 lbs in the past year. I also take trazadone for falling and staying asleep, which has greatly increased my energy and willingness to make changes. My A1C is now under the pre-diabetic range. It did take a year to make and keep the changes consistently, so be patient with yourself and make little changes every week or two so you’re not overwhelming yourself with “I have to do everything now” feelings. I tried a lot of things for a few weeks and found out I didn’t like them (eating a lot of meat for protein grossed me out, I won’t drink plain water all day even if I put ice and lemon in it, I am apparently never going to join a gym). So find stuff that works for you.
posted by oomny at 9:43 PM on July 23

Re: a registered dietician -- if you go this route you want one that specializes in diabetes. Loads of them just have whatever they got in school and haven't kept up-to-date (My sister is one).
posted by miscbuff at 10:07 PM on July 23

If you decide to go down the diet route, and you like apps, I love Macrofactor, which is designed to be "non-judgemental" in that it doesn't gamify, nag, or otherwise respond to whether you hit your targets or not... if you go over (as I will this evening, when I plan to have fish and chips) it takes that into account in its calculations but otherwise does nothing. It is also very usable and has a nice supportive user community.

My partner who is not into that shit but was recently diagnosed as pre-diabetic has been successfully and gradually losing weight by the simple strategy of giving up confectionery and sweet baked goods. You could also start with some very simple rules like that, without wholesale adopting a rigid new regime. No diet in the world recommends confectionery and brownies.

As far as science goes, the Mediterranean diet and the DASH diet both have research supporting their use in people with type 2 diabetes. I think this web site has a really nice approachable introduction to the Mediterranean diet.
posted by i_am_joe's_spleen at 10:33 PM on July 23

Zero sweetened beverages, walk after you eat, reduce carb portions.

You've got this!
posted by latkes at 10:37 PM on July 23

Regarding the see a dietician option , this is usually what we do with all our diabetic and pre diabetic patients , ( but we have government mandated protocols which are regularly updated and adjusted according to the latest studies ).This is in my country , so idk how it works in other countries ?It does make a big difference to them as they get guidelines and a person to assist them in their journey and to ask all their queries to , but also accurate and useful feedback .
However one thing which I would like to add is regarding fruit , all fruit is not the same , ie check on the actual amount of each fruit portion wise , and try to eat the fruit whole with the peel ( in fruits which have edible peels.Also it is better
Not liquidising them .Eat them as is.
Personally , I have seen pre diabetic pts who have lost quite a bit of weight , changed their diet and upped their exercise , achieving normal glycemic control .Sorry I don't know if this answer helped much ..
posted by SarahSarah at 12:20 AM on July 24

When I was pregnant, the ‘standard’ recommendation was that one carb ‘unit’ is 15 grams and you could have 1-2 units per snack and 3-4 units per meal. Is this still the best way?

I would recommend this talk by Jason Fung - he explains why it is more important to understand how what we eat (and when we eat it) affects hormones - than it is to focus on calorie counting/carb counting, etc. You should be aware that there is a degree of conflict between the calorie people and the hormone people - and that the latter - with their talk of Keto diets and intermittent fasting - are the newcomers who could be considered faddish. But a really good practical step you could try from the latter camp would be to extend the daily window when you don't eat - for example as far as a 16-8 window. You can use this approach in conjunction with the other suggestions about reducing soft drinks etc - and the point is that it should make it easier for you to do this. Speaking only from my anecdotal evidence of having done this for 6 months: I've been able to lose about 12% of my body weight to bring it into a healthier looking range, I've cut way down on eating snacks and sugar and I don't feel I'm fighting against my body's instincts - all from just cutting out breakfast.
posted by rongorongo at 12:37 AM on July 24

Here is an article/podcast by a physician, evidence-based, grounded in science, etc: Why knowing your blood sugar level is important and how you can manage it.

It covers diet, sugar, exercise and sleep.
posted by lulu68 at 3:53 AM on July 24

Echoing rongorongo - Jason Fung is a practicing nephrologist. I don't have diabetes but I have family members following his advice.
posted by superelastic at 4:00 AM on July 24

Best practice is whatever works best for your body. Strongly seconding the recommendations to wear a CGM for a while in order to find out what best practice for you is going to need to look like.

That said, some variation on subbing in proteins for some of your carbs works pretty well for most people.
posted by flabdablet at 4:19 AM on July 24

I was diagnosed with diabetes about two years ago. I know exactly the sort of contradictory advice out there, because I spent many weeks trying to figure it out.

I heartily recommend the advice to get a CGM and use it to figure out what works FOR YOU and which foods spike your glucose the most. It’s so incredibly personal, and not at all one size fits all. I can eat potatoes no problem, but carrots are terrible. I can eat ice cream as a treat but not cookies. Stuff like that. The only things I cut out completely has been pasta, white rice, white bread, and no sugary drinks. More veggies (riced cauliflower =yum!) and brown rice, limit sugar consumption, read labels. It’s totally doable and sustainable!

FWIW it took me less than 6 months to go from an A1C of 12+ to now a consistent 4.7-4.9 even without any medications. You can do it, you totally got this!
posted by gemmy at 5:03 AM on July 24

I was pre-diabetic, started doing high intensity workouts twice a week, dropped out of the risk zone wth no particular diet changes. Stopped working out, have diabetes now. Doh.
posted by Iteki at 5:27 AM on July 24

My MIL has transformed her type II diabetes. She is an actual patient of Jason Fung’s. We thought she’d be on dialysis in a year; that was 8 years ago. She started with his approach and lost over 80 lbs. Shes gone from a lot of insulin to a very small amount. then some of her other numbers were showing stuff, so she went to the Forks over Knives approach, using the blood glucose monitor. Here’s what I can share:

It is individual and the advice is contradictory and hard. Find what works for you scientifically- by the numbers. Be prepared to adjust.

Stress completely changes my MIL’s numbers.

Exercise seems to address the stress, and also really helps with dealing with the annoying and contradictory information.
posted by warriorqueen at 5:47 AM on July 24

Registered dietitian here, but not YOUR dietitian so just some general things and to build on some other people's answers too:

- When you look for a dietitian, you may be interested in someone who is a Certified Diabetes Care and Education Specialist (CDCES) because they live and breathe all things diabetes related. They'll be able to sit with you to help you come up with a plan that fits not only your specific medical needs but also how to fit these changes into your busy life as a single parent.

- Try to couple your high carb foods with protein and/or higher fiber fruits and vegetables as often as possible. This is more easily done at meal times, but a snack that follows this principle could be a few whole wheat crackers with cheese and a few slices of apple. And when meal planning, focus on what you want your protein and your non-starchy produce first. Then, fit some carbs around that.

- Try to hit your 7-9 hours of sleep at night! Getting adequate sleep is so so so important!
posted by astapasta24 at 5:52 AM on July 24

Also recommending some of Jason Fung's work - he is adjacent to some of the more faddish "broscience" influencers so be aware, but I personally have never found anything objectionable in his work.

The takeaway I have is to spend a few days logging what you eat to get an idea of how many calories and stuff you are getting and then aim to lower it by eating smaller portions if it is high. Then after that feels ok, start paying attention to what you eat. I talked to a dietician. Look up fiber rich foods and eat those a lot. Add more protein to your diet. Drink more water. At least glance at the amount of sugar on the label and prepare to be astonished how high it is for things.

I really endorse this method. Over the last couple of years, my spouse has edged towards the danger zone for prediabetes based on family history, and I have gotten big into long distance running, so we have had to really zero in on our diets. The biggest challenge with diet is striking a balance between eating "properly" and becoming obsessive or disordered about it. Calorie counting, if you're not prone to disordered eating, can be very helpful in short bursts to understand what exactly you are putting into your body. I would only recommend it periodically though because you can become more focused on metrics instead of finding a healthy balance for your body.

We find "diets" to be difficult to follow and the more we have to focus on what, exactly, we are preparing and eating, the more chance we get frustrated and relapse. After a lot of trial and error, we found our overrriding principle is eating whole foods as much as possible and avoiding snacking.

This means we try in many of our meals to have the simplest possible grouping of foods: A steak, white rice and chopped carrots for dinner. Scrambled eggs for breakfast. A plate of sliced cheese, cold chicken and dates for lunch. If we "snack" we try to eat fruit or low calorie popcorn (probably our biggest weakness). Limited seasoning or condiments. I eat a lot of oatmeal and whole wheat pasta when I carb load for races. The more ingredients a dish has, the less likely we are to eat it.

We do exercise a little bit of portion control, using small bowls and plates and restricting multiple grocery visits during the week, the more you're in the supermarket the more tempted you are to buy some snacks.

We do try to eat a lot of protein since we found we were really leaning on carbs / fat too much when we tracked our meals. Since we're not vegetarians, that means meat, but I know there are plenty of non-meat options. I try to eat a little bit of fermented food (sauerkraut, kefir, kimchi) every day as it seems to have cleared up some digestive issues I had. If we want treats, we love a little bit of Greek yogurt or skyr with some honey or chopped fruit mixed in.

For liquids, we try to stick to tons of water, both still and carbonated, whole milk, tea, and kefir. I do drink a big cup of coffee every morning but skip the sugar and cream. When I run in the summer I do drink zero sugar Gatorade but I treat that as a "sports" accessory and don't drink it outside of that context.

Anecdotally, we found the worst offenders for sugar were highly processed cereals, snack foods, juice, beer (both of us have stopped drinking except on very rare occasions), pasta sauce, and white bread. Try to get your sugars from natural sources like fruit. I have known of some people going on zero sugar diets, which is very intense and I wouldn't recommend.

I hope some of this helps. Trying to establish healthy eating habits is very hard, and there is so much misinformation and noise out there.
posted by fortitude25 at 7:40 AM on July 24

I reached my highest-ever (non-pregnant) weight earlier this year and started working with an online trainer (shoutout to Kim Schlag on IG). While I haven't historically been a chronic dieter, I've tried enough things over the years to know that none have previously worked for me. The advice I've been following since this spring has been the most sustainable I've ever tried. I have finally made peace with tracking calories, but I've started thinking of it as data more than anything. (I love Cronometer, which feels more more science-y than most.) Seems obvious, but I discovered that I was simply eating too much to maintain a healthy weight.

Most days, I aim for calories around 10x my goal weight (ex: 1500 cal). Two days per week, I bump that by a fair amount (ex: 2000 cal) to allow for more flexibility, especially for weekend events with friends and family. I'm also really focusing on protein (trying for at least 100g/day). This simple method allows me to eat anything, but forces me to prioritize the food that keeps me satisfied... lots of veggies, more meat than I'm used to, fewer carbs. I've also been exercising, but really just things that I find fun anyway. I'm slowly working toward consistent weight training too, but still have a ways to go. This relatively simple method has helped me lose 15 pounds since April, and I'm feeling better than I have in years.
posted by hessie at 7:41 AM on July 24

A very low-hanging fruit approach that steers many people out of pre-diabetes, if you haven't already done these:

- Drop sugar drinks and ideally do not replace with artificial sweetener wherever you can manage it. Unsweetened teas, water, coffee (creamer OK, no sugar). Use a completely unsweetened electrolyte additive (I use LyteShow).
- Cut your alcohol use.
- Take a clear-eyed look at your snacks and snacking habits. This is actually the hardest one in my opinion, because "snacks" are often shelf-stable items, which means they are highly-processed, which means they have very little protein content. When I'm on my game I have two prepped bins in the fridge - one's a veg tray, one's cheese-salami-pepperoni - for our grazing needs.
- If you are living a largely pastatarian life, or tatertarian, you have to course-correct to other foods. When I serve pasta now, the pasta is at most 25% of the total plate, with the rest protein and real vegetables that are probably green, plus tomato products. And I use protein pasta. But mostly I use no pasta at all, and sub in cauliflower. I don't think I've eaten a whole potato except as a treat* in over 20 years.
- Learn what portion sizes look like, particularly with regard to carbs, starchy veg, and fruit. Get a food scale if you need to. Just like the pasta note above, many of us have just lost sight of what a "reasonable" amount of starch is.
- When you do choose carbs, try to swap in the best possible options. We use modest amounts of parboiled brown rice, protein pasta, and ancient grains.
- I personally have to be a little bit careful with what I track and count because I have an eating disorder in my past and stuff like counting calories too closely is extremely triggering, but I do read nutrition labels on packaged food before I buy it, and I have a general idea of the macros on whole foods. You will be surprised, becoming a label-reader, how much starch-filler and sugar is in stuff that shouldn't need it.
- I do recommend an exercise for a few weeks of tracking dietary fiber intake, soluble and non, and start augmentation if necessary. We don't have a whole picture of why so many people are getting colon cancer so young now, but this is certainly one thing you can do to help prevent it, plus fiber is a game-changer to the way your body processes and metabolizes food.
- One simple overall change: cram as many recognizable vegetables into your meals as you can. With the exception of breakfast, everything I cook is 1/3 to 1/2 broccoli, cauliflower, green beans, kale, cabbage, brussels sprouts. I consider squashes to be a high-sugar vegetable so they are for special occasions. We go through pounds of frozen veg a week, plus another couple pounds fresh. (On that note: get an air fryer if you don't have one. It's a game-changer for roasted vegetables.)
- It's not protein making you diabetic. You can go vegan if you want, but be aware that does not mean pastatarian. You have to put in some hours to eat healthy vegan.
- Drink water
- Walk
- Fix your sleep if it needs fixing

*Don't deprive or harshly restrict. I still get that potato sometimes, but it is one of those things I never make at home because I don't have the equipment to make it exquisite. If I'm going to eat something outside of my daily goals, I want it to be amazing.
posted by Lyn Never at 8:22 AM on July 24

I was diagnosed prediabetic in 2019 and the doc wanted to put me on meds. I opted for lifestyle change.

My dietician was good in that she told me to keep track of what I had in 2 weeks/ what I like to eat. She adjusted those. Which seems to be working as my A1C is now under control for over 4 years.

I am a ovo-lacto-vegetarian and I don't drink. That was the starting point.

1) Exercise, especially resistance based not just cardio-vascular, is important. Cardio is good for cardio vascular health of course. But you need some kind of weight based workout to exercise core muscles too.

2) Eat protein with every meal. Plus, lentils/beans and potatoes are now carbs for me. Which means I intentionally add one of eggs (with added eggwhites), Tofu, non-fat Greek Yoghurt or Seitan in every meal I eat. And I treat lentils/beans as carbs not sources of protein.

3) I am South Indian so Rice is a big part of my diet. Switched completely to parboiled rice, which has a glycemic index of around 40. This reduces the glycemic load when I eat, even though I am getting the same amount of carbs from eating rice.

4) I do 20-4 Intermittent fasting. This puts the body into ketosis everyday and reduces Insulin resistance.

5) I do a multivitamin+multimineral tablet everyday, supplemented by a big dose of Vitamin B12 and D once a week.

This combination has had the added effect of getting my cholesterol under control too!
posted by indianbadger1 at 9:41 AM on July 24

I know what you mean about the conflicting information, after living a lower carb lifestyle for many years and experimenting with keto, I'm in the middle of a book on diabetes that recommends a very non processed carb heavy vegan diet and my brain is about to explode it's so contradictory to everything I thought I knew.

I have never been diagnosed as prediabetic, but my A1C was approaching the lower bound last year and I was starting to have some other typical mid life medical issues, and mostly I just felt like crap and both unmotivated and overwelmed at how to address it all as it seemed that whatever path I choose was one I was probably going to have to live with. On the advice of a friend who works in a drs office and my own dr. I started intermittent fasting. I didn't change anything else intentionally about my diet, but I found that after a couple weeks it helps curb my snacking and I was craving healthier food and lots of vegetables, fiber etc. I lost weight I've been holding on to for nearly 20 years and my bloodwork and blood pressure was improved within 4 months. I still have some weight I'd like to lose, but I'm feeling totally different physically and mentally and I have a way forward. I follow Gin Stephen's approach (who is informed by Jason Fung mentioned above), I like her strategy b/c it's simple and sustainable and has a strong 'every body is different you have to figure out what works for yours' approach, but there are lots of different ways of approaching it.

If you are interested in wearing a CGM you might look at Zoe, they send you a CGM, you record what you ate while you are wearing it and based on that they recommend food pairings. It's not cheap, but to me a more interesting way of putting money towards the issue when you start to compare it to traditional 'diet company'. They have a free podcast and blog where you can read about them, the studies they've done, etc.c to get a sense of their company culture. Here's an article they wrote about a study they did on IF last year (37K people participated) Again there are other companies these days that do something similar helping you make sense of using a CGM.
posted by snowymorninblues at 10:34 AM on July 24

I really feel that your doctor is doing you a grave disservice by not offering specific guidance or directing you to another professional who can help — you are absolutely right about the rampant misinformation and disinformation online and elsewhere. Please call the office, say you need that guidance, and ask to be referred to a "registered dietitian nutritionist" (terms vary, but it's the credentialed professional, licensed or certified by the appropriate regulatory body in your area; some USA & Canada info). Depending on where you live, referral to an endocrinologist (ideally with a certified diabetes-education specialist on staff) may be the best option for sound advice; your community may have prediabetes education or diabetes prevention programs, too.

It's worth being aggressive about improving your health right now, and "lifestyle changes" alone do not work for every patient. You've entered a window of opportunity to prevent or delay a systemic disease *and* protect yourself from conditions with known ties to it.

Find A Lifestyle Change Program (in person, online, distance learning, or a combination of methods), at the CDC National Diabetes Prevention Program

What doctors wish patients knew about a prediabetes diagnosis at the American Medical Association
Diabetes prevention info, at the American Medical Association

Recently-Diagnosed Prediabetes Toolkit at diabetes.ca

Diet for Prediabetes — What foods should I eat? (Johns Hopkins)

Prediabetes? How to delay or prevent type 2 diabetes at McMaster University
posted by Iris Gambol at 11:59 AM on July 24

In particular, given your history of gestational diabetes [GDM]:
"For women with history of GDM, metformin and intensive lifestyle modification led to an equivalent 50% reduction in diabetes risk, and both interventions remained highly effective during a 10-year follow-up period. Metformin therapy for prevention of type 2 diabetes should be considered in those with prediabetes, especially for those with BMI [equal to or greater than] 35 kg/m2, those aged [less than] 60 years, women with prior gestational diabetes mellitus, and/or those with rising A1C despite lifestyle intervention." (per the Diabetes Prevention Program, at the American Diabetes Association) Patients prescribed metformin also warrant close monitoring of B12 levels (linked to deficiency) and complete iron (possibly linked to deficiencies).
posted by Iris Gambol at 12:40 PM on July 24

Been pre-diabetic twice, successfully reversed it both times with lifestyle changes, I also get ridiculously nauseous on metformin. The major thing that helped me was reducing my cortisol levels as much as possible, which means getting enough Vitamin D from sunshine, doing physical activities and managing my emotional regulation/migraines/acid reflux/ADHD/other conditions.

Second, I cut out soda/juices/boba/lattes/etc, halved my carb amount, doubled my protein and my vegetable intake and also doubled my water intake. I no longer eat desserts or fruit that much, I have an occasional cookie once a week or I get a pastry if I'm out with friends, but otherwise I just stick to water or a single shot espresso. That was not intentional dieting, I just lost my sweet tooth once I made other lifestyle changes.

Third, I also ate three meals a day, no matter what time, so I can have stable and smaller portion sizes for each meal to prevent binge eating and hunger pangs and shakes.
posted by yueliang at 12:17 AM on July 25

For people who are recommending a CGM - is there a particular brand you recommend?
posted by punchtothehead at 7:08 AM on July 25

By the way, it’s easy to get lost trying to optimize all of this. The most important advice I’ve ever received around lifestyle changes is this: the “best” diet is the one that you will follow. The “best” exercise routine is the one that you will do.

You can tweak the details as you go along, but the real challenge here is to change your habits in a way that you can sustain. That is a very hard thing to do.
posted by Tell Me No Lies at 7:24 AM on July 25