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April 23, 2008 4:31 PM   Subscribe

So I've been diagnosed as prediabetic. What now?

I've been expecting it. My family has a strong history of diabetes (as in "pretty much every male has had it except my brother and me"). I know and have accepted that I will very likely go "full blown" sooner or later. I am not freaked out about this, I just want to know what steps I can take to delay the inevitable.

My blood sugar is "a little high", but not critical at this point (less than 110). All my doctor said is that I need to eat well and exercise to keep it under control. I have to go in and get restested a few times in the future.

I've looked but can't find anything specific that is very helpful. Almost all of my searches have come up with either advice for existing diabetics, or dealing with hypoglycemia, when what I have is hyperglycemia.

The recurring themes that I could find are eating well and weight loss (a common theme is losing 5-10% of your body weight).

While not stellar, my eating habits are far from fast food three times a day with lots of sugary snacks. I do have some intense sugar cravings at times (licorice and jelly beans are particular weaknesses).

I'm a 36-year-old guy. As to weight, I'm 6'1 and a little under 180. I could definitely stand to lose a few, especially as it's all in my gut, but I am by no means "obsese". How important or relevant is the weight loss?

Should I cut out sugar altogether? Moderate sugar intake? What should I be eating more of? Less of?
posted by geckoinpdx to Health & Fitness (21 answers total) 12 users marked this as a favorite
This website seems to have some pretty good information.
posted by infinitywaltz at 4:48 PM on April 23, 2008

Hey, I'm a Type II and been diagnosed for several years now. Below are things that help me manage my blood sugar levels.

just want to know what steps I can take to delay the inevitable.

Eat well and exercise. Seriously, just doing those things in small quantities well help a lot. You don't have jog 5 miles every day, but try to do a bit of walking every day. Can you park 4 blocks from the office and walk the rest of the way? Try doing that 3 times a week or other small steps to get your body burning calories.

Lifting weights helps you body use sugar, so getting a person trainer would be good. Again, it doesn't have to hour long sessions as you bulk up, but 20-30 minutes a few times a week will work wonders.

Should I cut out sugar altogether? Moderate sugar intake? What should I be eating more of? Less of?

I think you should chose the Exchange Diet and get a nutritionist to help you implement the diet and understand the science of eating.

The basic idea of the Exchange Diet is moderation via calorie counting. You strive to eat a certain amount of carbs, protein and fat with each meal and it's less important what those things come from as opposed to how much you're eating. So for lunch, if I've having a sugar craving (which is mostly carbs), I'll have some protein (a piece of chicken with veggies) and not have a piece of bread to go with it, and instead eat some peanut m&ms, which contain carbs and fat and satisfy the sugar craving.

If you want, i can go into further detail about the diet, but that's the gist. You eat what you want, just do it moderation.

But eating right and exercise will go a long, long way to keeping the disease at bay and then managing it once you get.
posted by Brandon Blatcher at 5:01 PM on April 23, 2008

Read about the Paleo diet. Yes, it's a pretty drastic shift from the standard American diet. And don't let the word "diet" confuse the issue; this has to be a permanent lifestyle change. The improvement in your blood test results will leave the doctors speechless.
posted by Durin's Bane at 5:03 PM on April 23, 2008

Been diabetic (type 1, though) for going on 6 years, so I feel your pain.

Don't try to cut sugar out of your diet entirely, at least not at first - if you've been going your whole life with certain eating habits and you suddleny try to change them "cold turkey," you'll more than likely end up frustrated because you "cheat" (and you'll still have a high blood sugar to boot).

Adjusting your diet to be more natural is good for your overall health, but seems to especially help control blood sugars without resorting to insulin. By eating natural, I mean try to avoid overprocessed foods as much as you can, especially when it comes to sweeteners - go for brown sugar/cane sugar before you eat something sweetened with High Fructose Corn Syrup.

Eat brown rice instead of white, wheat bread instead of white. If you can, buy ingredients and make your food instead of buying prepackaged stuff. Try not to eat a large amount of the stuff that's high on the Glycemic Index.

Check out this book, it gives a lot more info about how your food choices affect your blood sugar (I know you're not "full-blown" diabetic now, but it should still be useful).

If you're going to indulge in sweets like candy and such, just remember to moderate. I'm sure you can figure out when you're enjoying a good licorice a little too often.
posted by juicedigital at 5:06 PM on April 23, 2008

The magic search term that you want is "insulin resistance." A previous comment of mine with experimental research (controlled clinical trial) on diet and exercise which demonstrably lowered the risk of progressing to diabetes. Scroll down a bit to see where I un-HTML-goblin'd the quote. From plenty of published research, I can also say that getting a full night of sleep is very important to preventing progression to insulin-dependence.
posted by a robot made out of meat at 5:10 PM on April 23, 2008

Change your diet, immediately, and permanently! Consumption of too much animal protein, animal fat, and cholesterol is very strongly correlated with the development of diabetes and other degenerative diseases (and the amounts consumed by most Westerners are way, way above the "too much" threshold). Type II diabetes can be made asymptomatic (i.e. medication can be stopped) and type I diabetes greatly mitigated (40%+ reduction in injected insulin) by following a low-fat, whole-foods, plant-based diet. See The China Study, chapter 7.
posted by brain at 5:15 PM on April 23, 2008

You will want to eat more complex carbohydrates that take longer to digest than simple ones (brown grains over white grains) as that will keep a steadier stream of sugar entering your body. Time it takes for the sugars to break down and get into your body is measure by the glycemic index. You will want to keep your GI as low as possible to avoid problems with blood glucose and cholesterol control.(ref) You also want to keep total carbs low.(ref) Satisfy your sugar cravings at a medium pace: one jelly bean every 30 minutes won't hurt you, as it won't contribute to hyperglycaemia.
There's decent evidence out there that the consumption of high fructose corn syrup aids in the obesity and diabetes epidemic going on, especially in the US. I would say avoid all foods (especially soft drinks) that use HFCS instead of real sugar. This is harder to do in the US but possible (ie, buy Mexican CocaCola if you need that sugary buzz). Health/organic stores will sell sugary snacks that actually have sugar.
In addition, diabetes patients have a very high risk of developing atherosclerosis, hypertension, and lots of other cardiovascular disease. One of the biggest links is with dyslipidemia (bad cholesterol function). Presumably your doctor took your cholesterol readings? What you would want to do is avoid saturated fats and get as much HDL consumption (avocados, nuts). Some more good foods to eat are mentioned here. A high fiber diet has shown to help with cholesterol maintenance, especially in diabetes. (ref).
In your consultation were you provided with a reference to a dietitian? They would be able to meet with you and help you to tailor a diet that will suit you. Good luck.

IANAD (IAAmedicalstudent)
posted by shokod at 5:15 PM on April 23, 2008

I'm prediabetic. My endocrinologist's recommendation is the Bernstein diet - it's incredibly restrictive and yes, sugar and grains are cut out entirely. The plus side? Improved cholesterol, triglycerides, stabilized blood sugar, and weight loss/maintenance. No guarantee that I won't become fully T-2 down the line, but it will definitely slow things down.

Also recommended is weight training. I have yet to follow this recommendation :)

Another indispensable resource is Blood Sugar 101.
posted by chez shoes at 5:19 PM on April 23, 2008 [1 favorite]

My blood sugar is "a little high", but not critical at this point (less than 110). All my doctor said is that I need to eat well and exercise to keep it under control. I have to go in and get restested a few times in the future.

So you know what you need to do: reduce your sugar intake, and exercise more.

The easiest path to do it is this: start by walking to and from the grocery store every day or two, only bringing home the groceries you can carry yourself. The more food you eat, the heavier the bags, so the more trips you'll have to make to be able to carry it. It's kind of self-regulating.

So there's the exercise, and as for the sugar, since you're only buying a few things each trip, you can and should take the time to read labels. Eliminating sugar from grocery store food is damn near impossible unless you live near a "healthy" store, but you can certainly make it a point to buy the one with 3g of sugar instead of 18g.

Just those two steps alone -- after a few weeks -- should start making you feel better, and without a drastic lifestyle change.

Here are a few more things to minimize or eliminate in your diet:

- Enriched Flour
- Partially Hydrogenated Oils
- Corn Syrup

Reduce intake of sugar and those three items above (best to eliminate partially hydrogenated oils altogether, esp. because foods with it tend to have the other ingredients as well, but not necessarily vice-versa) and walk to the store and back several time a week, and you'll be fine -- my wife was diabetic while pregnant (twins, it's common) and she did the above *without* the walking and kept in under control. With the walking, you'll do even better.
posted by davejay at 5:19 PM on April 23, 2008

Oops, borked link. Blood Sugar 101.
posted by chez shoes at 5:20 PM on April 23, 2008

How important or relevant is the weight loss?

Very important. It's important not to have a lot of fat around your abdominal area. You can search "diabetes and abdominal fat" or "diabetes and obesity" and end up with tons of evidence that maintaining a normal weight is extremely important in preventing type II diabetes and managing type II diabetes.

While not stellar, my eating habits are far from fast food three times a day with lots of sugary snacks. I do have some intense sugar cravings at times (licorice and jelly beans are particular weaknesses).

Well, the majority of people don't eat fast-food three times a day. We can hope not anyway. The thing is this: You have pre-diabetes. You were told this by your doctor. It is time to tighten up. Under 110 is not the end of the world, but I will still urge you to take this finding very seriously.

180 at 6'1" is not bad at all. Try to get a little weight off if there is some on your gut and take control of your diet. What you can do is follow the trendy mantra of the moment: Eat food. Not too much. Mostly Plants. You can still have some jelly beans now and then. The exchange diets are helpful but kind of old school. It's all about calorie (and refined carb) control. Managing Type II diabetes is mostly common sense: Lose the junkfood. Exercise more. Try to get in as much aerobic exercise and general physical activity you can. Regular physical activity is important. Walk during your lunch break, bike or walk to work if you can. Join a gym if that's your thing and get your heart rate up. Aerobic exercise (and strength-training) improves your insulin sensitivity.

I like the website dlife.com for diabetes info and recipes. Good luck to you.
posted by LoriFLA at 5:26 PM on April 23, 2008 [1 favorite]

You can beat your genes! 50% of Pima Indians develop diabetes, but that's because they have adopted Western foods. Interventions involving pre-diabetic Pima and other native peoples predisposed to diabetes where they eat traditional foods have even reversed type II diabetes! I would suggest a Paleo diet, check out Cordain's books and Pollan's new book, as well as Gary Nabhan's book Why Some Like it Hot.

My Big Fat Diet, an intervention study of First Nations people.
posted by melissam at 6:01 PM on April 23, 2008

the most important risks of diabetes are to the heart, so do whatever you can to lower your risk of heart disease : stop smoking, get lots of cv exercise, lose some weight, eat a healthy diet, get enough rest.
there are studies of using meds to lower your risk pf diabetes and studies of exercise to do the same. speak to your doctor about them. personally i would get lots of exercise and lose some weight
posted by dougiedd at 6:06 PM on April 23, 2008

About that licorice, even small amounts can have adverse effects on some people
posted by hortense at 6:09 PM on April 23, 2008

If you're becoming insulin-resistant, you need to offset that tendency to the greatest extent possible. That means paying attention to two things: (1) keeping your insulin production as low as you can, and (2) keeping your insulin sensitivity as high as you can.

(1) is done by keeping the aggregate glycemic load of every meal as low as you can get it. "Eat better", while correct, doesn't give you much to go on; "Eat slower carbohydrates, more vegetable proteins, and more fibre" is the specific direction you need to go in.

If you have cravings for jelly beans and whatnot, try eating a whole apple before you pop your JB's. Jelly beans are what's given to diabetics to bring their blood glucose level up quickly if they're having a hypoglycaemic episode, because they work. You don't want your blood glucose level getting jerked around, because that will cause insulin spikes, and insulin spikes promote insulin resistance.

(2) is all about your musculature. You want as much muscle mass as you can reasonably get, and you want to sensitize that muscle to insulin as much as you can. Resistance training will build muscle mass, and aerobic exercise will greatly increase muscle insulin sensitivity.

All of which is why your doctor's advice is perfectly sound.

Insulin resistance is a progressive thing, and it's caused by repeated insulin overloads. These, in turn, are caused by repeated blood sugar spikes. If you stop spiking your sugar now, there's no reason I'm aware of why your insulin resistance should get any worse than it already is. Plus, you'll feel generally better. You'll also find your weight dropping into a healthier range.

I'm writing this advice for my own benefit, as much as for yours :-)

Best of luck.
posted by flabdablet at 6:20 PM on April 23, 2008 [2 favorites]

Look into low-carb. It works well for type-2 diabetics.

Low-carbohydrate diets in the management of obese patients with type 2 diabetes seem intuitively attractive due to their potent antihyperglycemic effect.

We previously reported that a 20 % carbohydrate diet was significantly superior to a 55–60 % carbohydrate diet with regard to bodyweight and glycemic control in 2 non-randomised groups of obese diabetes patients observed closely over 6 months. The effect beyond 6 months of reduced carbohydrate has not been previously reported. The objective of the present study, therefore, was to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. In addition, we report that, after the 6 month observation period, two thirds of the patients in the high-carbohydrate changed their diet. This group also showed improvement in bodyweight and glycemic control.

posted by callmejay at 6:35 PM on April 23, 2008

Can your doctor recommend a dietician? They often work with endocrinolgists. You are definitely taking the right steps while you are in the "pre-diabetic stage" - remember that your genes are only part of the equation, and you can control the other one, environment.

Just as an anecdote, my grandfather is an identical twin. He has always eaten well and been active (plays tennis, uses the treadmill, etc), while my great uncle's lifestyle isn't as healthy. Guess which one has full-blown diabetes.
posted by radioamy at 8:58 PM on April 23, 2008

More smaller meals can be key to managing weight and blood sugar. Also, losing visceral fat (internal fat around organs) is more important to your health than subcutaneous fat. Do your best to completely eliminate trans-fats from your diet.
posted by BrotherCaine at 1:29 AM on April 24, 2008

Response by poster: Thanks very much for all the responses, looks like I have a lot of planning to do.

Most of these changes won't be difficult. I'm a flexitarian (I'll eat meat on occasion but don't really like it that much) and normally prefer wheat to white, brown rice to white, etc. I don't eat a whole lot of sugar as is.

As far as exercise, I could do better. I don't know how to drive so I walk everywhere, so walking more isn't a problem but I could probably increase my activity level.
posted by geckoinpdx at 9:43 AM on April 24, 2008

Do the easiest things first, then work in more of the harder things once the easiest things have become totally routine.

Brown rice is good; long-grain brown rice is better.
posted by flabdablet at 4:29 PM on April 24, 2008

Exercise + eat well. The South Beach diet incorporates nicely the glycemic theory of foods and the fact that humans crave carbs in a lifestyle way. Cardiovascular exercise can actually reverse diabetes to a certain extent. Good luck.
posted by skepticallypleased at 1:04 PM on April 30, 2008

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