Relationships: Insulin and Blood Sugar

Who cares about insulin? Or blood sugar? And what are they, anyway?

Most of us have heard the words, but we’re not clear on the roles that insulin and blood sugar play in our bodies.

We need to learn, because they matter. Especially if we’re prediabetic and have too much blood sugar (glucose) floating around inside.

Here’s how the insulin/blood sugar relationship works:

Let’s say we’re having shrimp, some white rice, and an avocado for lunch. We’ll skip the green vegetable because we don’t need it for this example.

Once eaten, all three food items will break down and provide energy (food) to our body.

The shrimp provides proteins, which become amino acids.

The rice provides carbohydrates, which become sugars (also known as blood sugar, or glucose).

The avocado provides fats, which become fatty acids and glycerol.

Because we’re prediabetic, we’ll focus on the carbohydrates.

The cells in our body are clamoring for their lunch. And since we’re made up of cells, it’s important to feed the little guys. They want a boost to get them through a long afternoon. They want a sugar boost because that’s what most of the cells prefer for energy. Come on, carbs!

The sugar, which is what the rice became after it was digested, is floating around in the blood and the body notices that there’s extra sugar (food) ready to be transported to the hungry cells.

An alert is sent to the pancreas, a gland which is tucked down behind the tummy and next to the spine.[i] The alert goes to the islets of Langerhans – which sounds straight out of Lord of the Rings – and these little floating islands of cells in the pancreas start squirting out hormones called insulin.

The majority of the body’s cells aren’t going to let the sugar just walk in. Our cells are like hotel rooms requiring a key to open.

This is where the insulin shines. The insulin is the key. It attaches to the cell and unlocks it, letting the sugar in to feed the cell. You’d think the cell wouldn’t require coaxing to be fed, but that’s how it works.

Insulin also shepherds extra blood sugar into the liver where it’s stored until the body needs it. Maybe it’ll get called out if you haven’t eaten for several hours, or you’re exercising and need the extra food for your cells.

All of this happens when the body is working as it should, but what happens if your body isn’t cranking out enough insulin? Or what if your cells don’t want to open up when insulin comes knocking?

If your body can’t control the amount of sugar (glucose) floating around in your blood, that’s when trouble starts.

Too much blood sugar floating around and not doing its job of feeding cells, or simply sitting in storage until it’s needed, can cause damage to the body.

There’s a window of time where our body’s in trouble but not yet in full type 2 diabetes. That’s where we are – in prediabetes land.

If we don’t do something about the insulin problem, we’ll cross the border into type 2 diabetes land.

Once we’re living with type 2 diabetes, we’re at a much higher risk of stroke, heart disease, kidney failure, nerve damage and vision loss.[ii] For starters.

But, if we’re lucky enough to find out we’re prediabetic, and that’s a big if since 90% of those living with prediabetes don’t know it[iii], we have a good chance of successfully making the changes necessary to avoid type 2 diabetes, leave prediabetes behind, and get our bodies back to being efficient at the whole insulin/blood sugar relationship.


[i] Johns Hopkins Medicine/Pathology, The Pancreashttp://pathology.jhu.edu/pc/BasicOverview1.php?area=ba, (March 5, 2019).

[ii] Centers for Disease Control and Prevention, Diabetes Quick Factshttps://www.cdc.gov/diabetes/basics/quick-facts.html, (March 5, 2019).

[iii] Centers for Disease Control and Prevention, Prediabetes: Your Chance to Prevent Type 2 Diabeteshttps://www.cdc.gov/diabetes/basics/prediabetes.html, (March 5, 2019).

Prediabetes: Are You at Risk?

Wondering what your chances are of being prediabetic?

The Centers for Disease Control and Prevention reports that “approximately 84 million American adults—more than 1 out of 3 . . . “[i] are prediabetic. We don’t love those odds.

Most specialists agree that these are the primary risk factors:

Age 45 and older: Prediabetes can come on at any age, but the older you get the more at risk you are.

Affected family members: If your parents or siblings have type 2 diabetes, that increases your chance of becoming prediabetic.

Weight: Are you chubby, obese, fat? Do you carry that extra weight around the middle? This is one of the biggest risks for prediabetes.

Exercise: Actually, the lack of exercise. If you’re not active at least three times a week, this puts you at risk.

Ethnicity/Race: Although it’s not clear why, if you’re Latinx, African American, Native American, Asian American, or Pacific Islander, you may be at higher risk of developing prediabetes.

PCOS: Polycystic Ovary Syndrome. If you have it, it is a risk factor.

Gestational Diabetes: Developing this during pregnancy, or giving birth to a baby weighing more than nine pounds, increases your risk of developing prediabetes.

Sleep: If your sleep is interrupted or just not good, this is a risk factor.

Feels sort of random, but there it is.

If any risk factor listed above is ringing your bell, check with your provider about getting tested. Have the conversation.

You can’t solve the problem if you don’t know about it. And there is a solution – you don’t have to end up with type 2 diabetes.


[i] Centers for Disease Control and Prevention, Prediabetes: Your Chance to Prevent Type 3 Diabeteshttps://www.cdc.gov/diabetes/basics/prediabetes.html, (March 6, 2019).

Medications and Blood Sugar

As prediabetics, the number we look at on a daily basis is our fasting blood sugar level.

We can do that at home with a monitor. Knowing that number, as well as the numbers pre- and post-meal, helps us to track our prediabetes. These numbers give us the information we need to not eat this or eat more of that, with the end result (we hope) of reducing our blood sugar levels.

A sneaky enemy of blood sugar levels that most of us don’t think about is medicine.

Some of the prescription or over-the-counter medications we take raise our blood sugar. This can blow a big hole in our how-to-beat-prediabetes game plan.

It’s tricky if the medication that raises our blood sugar is one we absolutely must take!

Some blood pressure medications, like beta-blockers or thiazide diuretics[i], raise our blood sugar.

Steroids in oral (pill) form can bump our blood sugar level up, but if used in the form of a cream or inhaler, they’re generally not an issue[ii].

Other drugs can also affect blood sugar levels, such as niacin, which is a B vitamin, some antipsychotic drugs, and a sprinkling of others.

Because you’re prediabetic, you should have a quick conversation with your pharmacist about any prescription or over-the-counter drugs you’re taking, to see which might have an effect on your blood sugar. Then work with your provider to decide if the trade-off is worth it.

Sometimes, medications are the reason we’re prediabetic, which puts us in a real pickle if we can’t get off the meds.

We can’t ignore anything that affects our blood sugar. If we do our homework and make changes where we can, it will help us stay on the road that leads out of prediabetes land!


[i] Diabetes Self-Management, Drugs That Can Worsen Diabetes Controlhttps://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/drugs-that-can-worsen-diabetes-control/, (March 7, 2019).

[ii] WedMD, What Medicines Can Make Your Blood Sugar Spike?https://www.webmd.com/diabetes/medicines-blood-sugar-spike, (March 7, 2019).

Prediabetes: FAQ

What is prediabetes?

You have prediabetes when your blood sugar is higher than normal, but not high enough to be in the type 2 diabetes range. This condition puts you at increased risk of developing type 2 diabetes or other health problems, such as heart disease and stroke. Prediabetes should be taken seriously, but it’s not necessarily permanent, as it can be reversed in many cases.

What causes prediabetes?

Many cells in our body like to eat sugar for energy. Carbohydrates turn into sugar when we eat them. In response, the pancreas produces a hormone called insulin, which goes to the cells wanting energy and “unlocks” them, allowing the sugar to enter. If there’s more sugar than insulin, the sugar has nowhere to go and builds up in your blood.

Will I develop type 2 diabetes if I am prediabetic?

You have an excellent chance of stopping the progression to type 2 diabetes. It is not a one-way path, although if you do nothing to combat it, you may develop type 2 diabetes at some point.

What are the risk factors for prediabetes?

Most specialists agree that these are the primary risk factors:

Age 45 and older: Prediabetes can come on at any age, but the older you get the more at risk you are.

Affected family members: If your parents or siblings have type 2 diabetes, that increases your chance of becoming prediabetic.

Weight: Are you chubby, obese, fat? Do you carry that extra weight around the middle? This is one of the biggest risks for prediabetes.

Exercise: Actually, the lack of exercise. If you’re not active at least three times a week, this puts you at risk.

Ethnicity/Race: Although it’s not clear why, if you’re Latinx, African American, Native American, Asian American, or Pacific Islander, you may be at higher risk of developing prediabetes.

PCOS: Polycystic Ovary Syndrome. If you have it, it is a risk factor.

Gestational Diabetes: Developing this during pregnancy, or giving birth to a baby weighing more than nine pounds, increases your risk of developing prediabetes.

Sleep: If your sleep is interrupted or just not good, this is a risk factor.

How do I know if I have prediabetes?

Not everyone has symptoms. The best way to determine if you’re prediabetic is to get a blood test done. There are exceptions to how blood test results are interpreted. Your provider will let you know what they mean for you, but the following is a general picture of what testing is done, and what the results indicate.

The first test snaps a picture of what your blood sugar has been doing for the last two or three months. It’s called the Hemoglobin (A1C) test and is usually the first one providers use when diagnosing prediabetes.

A1C below 5.7 percent is normal

A1C between 5.7 and 6.4 percent is prediabetes

A1C 6.5 percent or higher in tests done on two different days is type 2 diabetes

Next is the Fasting Blood Sugar test. Blood is taken after you’ve been fasting for eight hours or overnight.

Fasting blood sugar below 100 mg/dL is normal

Fasting blood sugar between 100 and 125 mg/dL is prediabetes

Fasting blood sugar 126 mg/dL or higher (in tests done on two different days) is type 2 diabetes

The third test is not used for everyone. It’s called the Oral Glucose Tolerance test. After fasting for eight hours or overnight your blood is tested. You then drink a sugary concoction and two hours later your blood is tested again.

Blood sugar below 140 mg/dL is normal

Blood sugar between 140 and 199 mg/dL is prediabetes

Blood sugar 200 mg/dL or higher is type 2 diabetes

Is prediabetes reversible?

The answer is yes, prediabetes is reversible for some. Three factors play a big part for the majority who reverse their prediabetes diagnosis: weight loss, exercise, and a change in eating habits. Work with your provider and a nutritionist to develop a common-sense plan of action.

Is there treatment for prediabetes?

In addition to weight loss, exercise, and a change of eating habits, healthcare professionals will sometimes recommend metformin, a drug that helps your body control its high blood sugar levels. If you are able to reverse your prediabetes, you’re typically taken off of metformin.

Exercise and Blood Sugar Levels

As prediabetics, our goal is to stay far away from type 2 diabetes, and to eventually get out of prediabetes land.

We’re working on our weight and changing what we eat. Do we really need to exercise, too?

It’s worth taking a look. If we can’t reach our goal without adding exercise to our lives, we need to know that so we can make an informed choice.

Cochrane[i] published an update[ii] in December 2017 of an earlier Cochrane Review from 2008. The review searches for an answer to our question: Is exercise necessary to lower blood sugar levels?

Here’s how they set up their review:

For their search methods, they, “searched the CENTRAL, MEDLINE, Embase, ClinicalTrials.gov, ICTRP Search Portal and reference lists of systematic reviews, articles and health technology assessment reports. The date of the last search of all databases was January 2017.”

And for their selection criteria they, “included randomised controlled trials (RCTs) with a duration of two years or more.”

OK, sounds good. Let’s see what they found.

Although they make it clear that more research needs to be done, at this time there doesn’t appear to be a definitive answer as to whether just changing one’s diet and not exercising, or just exercising and not changing one’s diet, affects the chances of developing type 2 diabetes.

But, there is some evidence that for prediabetics, changing one’s diet and increasing physical activity may reduce the chance of developing type 2 diabetes.

What kind of exercise are we talking about?

Before we get into that, be aware that exercise can change blood sugar levels. The direction isn’t always down. Under the right conditions, blood sugar levels will rise with exercise. Or the levels might go too low. They’re fickle.

Check with your healthcare provider before starting any exercise regime to determine what’s safe for you.

There are multiple studies about exercise and the reduction of blood sugar levels. It isn’t yet clear how vigorous that exercise must be to show a benefit, although low intensity exercise doesn’t seem to do much to lower blood sugar levels.

Basically, we’re talking about low, moderate, and high intensity exercise.

Low intensity: walking, stretching, housework – if you can talk and sing without running out of breath, you’re exercising at a low intensity.

Moderate intensity: jogging, cycling uphill, lifting weights – if you can talk, but you can’t sing more than a few notes without running out of breath, you’re exercising at a moderate intensity.

High intensity: running, a rapid set of jump squats, jumping rope as fast as you can – if you can’t say more than a handful of words without becoming breathless, you’re exercising at a high intensity.

Another way to measure the intensity of a workout is to monitor your maximum heart rate (MHR). Low intensity gets you to 40 to 50 percent of your MHR, moderate intensity gets you to 50 to 70 percent of your MHR, and high intensity gets you to 70 to 85 percent of your MHR.[iii]

There’s quite a formula to finding your MHR and personal percentages. The talk method is an easier way to monitor exercise intensity.

Looking at some of the various studies completed so far, it seems that short bursts of high intensity exercise may do more to lower blood sugar levels than longer sessions of moderate intensity exercise.

There is no certain answer yet as to level of exercise needed to do the job, but it’s pretty clear that changing eating habits and exercising is the way to go.

Check with your healthcare provider before making any changes to your eating or exercise habits. It’s important to get healthy, but we don’t want to accidently harm ourselves along the way.


[i] Cochrane, https://www.cochrane.org/, (March 9, 2019).

[ii] Cochrane Library, Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitushttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003054.pub4/full, (March 9, 2019).

[iii] Mayo Clinic, Exercise intensity: How to measure ithttps://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/exercise-intensity/art-20046887, (March 10, 2019).

Chow Time

Where do we start when we’re chubby and prediabetic?

There is no one right answer, but for today, let’s start with introducing meal choices that are tasty and not loaded with lots of carbs.

Changing our diet to be less carb-heavy is critical, but we also want to count our calories. Losing weight and reducing carbs will help us get out of prediabetes land.

Remember, we’re prediabetic, but we’re all different. Your healthcare provider or nutritionist will work with you to figure out a reasonable daily calorie and carb count that’s appropriate for you.

Can’t say this enough: check with your healthcare provider before making any changes to your diet.

Breakfast

Breakfast Cookies

These cookies are full of eggs, almond flour, sausage, and other goodies. You bake them up and store them in the refrigerator or freezer. Grab-and-go food is perfect for work mornings.

Cottage Cheese Bowls

The protein in cottage cheese helps fill you up. Toss in some berries and nuts, bacon and avocado, tomatoes and basil, or other bits to boost the flavor and nutrition.

Smoked Salmon Sandwich

This is higher in calories and takes some prep, but good for a weekend morning.

Cinnamon Cereal

This takes some time to prepare, but you can make a big batch.

Hazelnut Chocolate Chip Scones

Another breakfast that’s not a super low calorie choice. Bake and freeze, pulling one out occasionally for a low carb breakfast option.

Lunch

Peachy Pork Lettuce Wraps

Easy lunch for home or work. You’ll need to use your carb app to find out the number of carbs and calories.

Shawarma Chicken Bowls

Put in a little prep time and you’re going to have a filling and tasty lunch with plenty of protein and veg.

Stuffed Avocados

You’ll need your carb app again to get the nutritional values, but this is a simple throw-it-together lunch option. Easy to adjust to your personal taste unless you don’t like avocados, in which case this is a nonstarter.

BLT Chicken Salad

The name says it all. Plus, it’s low carb and low calorie.

Eggplant Rollatini

Sliced eggplant with cheese and spinach, plus a few other ingredients – perfect. This recipe makes plenty of leftovers, too.

Dinner

Stuffed Chicken Breasts

A simple recipe that allows for swapping out vegetables for whatever you like. Easy to fix, and low carb/calorie.

Garlic Shrimp

Add a side salad and you’re good for dinner. Yummy dish with a great cream sauce.

Jambalaya

We would cut back on the amount of rice in the dish. And use your carb app to get an accurate idea of the carb and calorie count. Nice dish for the weekend.

Philly Cheese Steak Zucchini Boats

The name says it all. You’ll have to get out the carb app again, but the list of ingredients looks low carb and low calorie.

Spaghetti Squash Lasagna

We couldn’t leave out spaghetti squash. The trick is to make sure it’s dry enough when it’s cooked, or you’ll have soggy food. Once you can do that, you will go back to this squash over and over.

Add your low carb links or recipes in the comments. Sharing is good!

About Your Diet Q&A With Paulette McMillan

Paulette McMillan, MS, RD, LDN, CDE, L.Ac., Dipl.OM, is the co-founder of the Center for Health and Wellness.

She is a registered dietitian and licensed dietitian/nutritionist, a certified diabetes educator, a licensed acupuncturist, and is board certified in oriental medicine with a master’s degree in Human Nutrition and Functional Medicine.

Ms. McMillan recently took time from her practice to chat about prediabetes from the viewpoint of a nutritionist and diabetes educator.

What’s the difference between an RDN (Registered Dietician Nutritionist and a CDE (Certified Diabetes Educator) when it comes to the dietary needs of a prediabetic?

Both are qualified to work with people with prediabetes. The difference is someone who’s a certified diabetes educator has to have a degree in heath care to qualify for the certification. Most CDEs are registered dietitians and nurses. However, there are pharmacists, social workers, medical doctors and other healthcare professionals.

An RDN has at least an undergraduate degree in nutrition and has completed a practice program, or internship, to qualify to take the RD exam. About half of RDNs also have master’s degrees. But they do not have to have a specialty in diabetes education.

Do you consider them equal in their expertise when it comes to instructing prediabetics on food choices?

Depends on the individual, depends on the experience that person has. One doesn’t have to be a CDE to have worked in a clinic where there might be a lot of people with diabetes or prediabetes. So it really depends on their clinical experience.

Should prediabetics visit an RDN or CDE to get guidance on their prediabetes journey and if so, why? 

I would say absolutely. Because prediabetes is reversible and if you wait until you have diabetes, which is sometimes the case, you really can’t reverse diabetes. By then the pancreas is already weakened to the point that they may be able to control it with diet and lifestyle but they will always have diabetes.

This is how I explain it to people: If you don’t have diabetes you can eat a piece of cake and your blood sugar will stay normal. If you have diabetes, even though you have controlled it by eating a low carb diet and now you have great numbers, as soon as you eat a piece of cake, your blood sugars go out of normal range.

With prediabetes you could actually reverse it and conserve your pancreas, your beta cell function.

The other point I want to say about prediabetes is that, once you have prediabetes, you are now at higher risk for cardiovascular disease, so you definitely want to reverse this risk.

What is your definition of the keto diet? (how many carbs a day)

You know I don’t have that on the top of my head but, bottom line, it is a diet that has no more than 20 to 30 grams of net carbs, and most of the calories come from fat. There are specific ratios you’re supposed to use to do the ketogenic diet properly.

What are your thoughts on the ketogenic diet for prediabetics?

When somebody walks into my office and they’re prediabetic and they’re morbidly obese, and they tell me that nothing they do works to lose weight, the keto diet might be a great option for them. If they’re willing to do it.

If the client is truly motivated to start keto, I explain to them that they must commit to the diet for a certain amount of time, like 3 to 6 months, because it takes at least 3 weeks before the body starts burning body fat as energy. So if they choose to play games and go in and out of ketosis, they are not really doing themselves any favors metabolically.  They will actually lose a greater percentage of muscle.

After that, I explain to them that if they’re someone who is truly sensitive to carbohydrates, they may never be able to eat the amount of carbs that someone who has no problem metabolizing carbohydrates can eat. So if they’re in keto at 30 grams of net carbs daily, they might be able to get up to a 100 or 130 grams of carbs a day, and that might be where they have to stay to maintain a healthier weight. In comparison, a man who is not prediabetic might eat 300 carbs or more a day, and a woman might eat 250 carbs a day.

What is your definition of a low carb diet? (how many carbs)

I give someone 150 grams of carbs a day, and I don’t count the carbs in nonstarchy vegetables, like broccoli or spinach, but I would definitely count the carbs in starchy vegetables like potatoes or corn.

I ask them to spread the 150 carbs evenly throughout the day, so they can’t save them up and eat them all at one or two meals. Think of it like this, if you have prediabetes that means your pancreas isn’t working at 100%.  It’s kind of like weightlifting, you might be able to do 15 reps of 30 pounds each but can’t lift all 450 lbs at once.

If they’re comfortable going a little lower, 100 to 130 carbs a day, that’s fine.  It’s just so individual and it’s not just about the quantity of carb but also the quality.  If you’re eating a piece of cake or a piece of white bread it’s not the same as eating a whole grain or sweet potato or something more natural and less processed.

What are your thoughts on a low carb diet for prediabetics? 

I think it’s a good place to start with clients, to help them understand carbohydrates. We want them to understand carbs. However, with prediabetes it’s not just carbohydrates that we’re talking about. If they’re overeating, the first defense is to feed the body proper amounts. If they’re sedentary they have to get moving. If they don’t get moving, they’re going to stay insulin resistant and stay prediabetic. These two things are very important. 

Weight loss is recommended, if they’re overweight. Not all prediabetics are overweight. As people age, they’re more susceptible to prediabetes.

Is there another way of eating, besides keto or low carb, that you prefer to recommend to prediabetics?

Yes, a Mediterranean style of eating and I do give them guidelines on what that means. I do like this approach a lot because there’s a lot of variety. It is an anti-inflammatory and nutrient dense way of eating.

Is it important to have a balance between carbs, proteins, and fats at each meal or snack? Why? 

From a practical standpoint, people won’t maintain just chicken and a salad and some fat for lunch. I find that they make up for the deficit in their meal with their snacks. Often, people are eating more calories in their snacks than in their meals. When there is a balance in their meals of carbs, fat, and protein, most of the time people are more sated and they’re not looking for more food.

What are your top three general recommendations for those working to reverse their prediabetes?

It’s individual. Who is the person sitting in front of me?  What is their motivation level, knowledge base and abilities?

Are they sedentary? How much activity do they do on a regular basis?

People need to get moving and the minimum requirements are 150 minutes a week of aerobic activity which is moderate walking not a stroll, two to three days of strength training per week, in addition to cardio, because we need to build up muscle mass. Muscle helps our bodies respond to insulin signals and metabolize sugar.

If they’re overweight, aim to lose five to seven % of body weight to start.

Teaching them about carb quality and balance throughout the day.

Any last suggestions for prediabetics that you’d like to share?

Look into the CDC National Diabetes Prevention Program, find a local community group who’s using it.

Also, I’d use an app like My Fitness Pal to track carbs and calories that way, whatever works for them.

And you should look at supplements. Fish oil for omega-3 fatty acids, zinc, magnesium, vitamin D – they’re important for prediabetes and for all of us.

Food and PreD

Most of us are prediabetic because our food choices aren’t healthy, and we don’t get enough exercise. It’s a lifestyle thing.

Multiple studies[1] show that, if you are prediabetic, one of the better ways to reset your body is to lose weight, change your diet, and exercise.

Before going any further, let’s pause for a minute to say: talk to your healthcare provider before changing what you eat or how much you move.

Today, we’re going to talk about food. We’ll save exercise for another time.

Research[2] suggests that when it comes to what we eat, a lower carb regimen of 20-50 net carbs a day is one way to get those blood sugar levels down.

As we launch into this topic, it’s important to remember that what works for one person may not work for another. This journey of resetting what you eat will most likely be a trial-and-error effort for the first few months.

Diet, when used as a verb, isn’t fun. We start out in a negative place when we go on a diet. It seems like work, and that we’re giving up enjoyable foods for foods that are bleh.

It’s not a journey that we begin with a smile.

Diet, when used as a noun, simply means the food and drink one typically eats.

No negatives there, right?

We’re talking about your diet (what you eat and how that might change) but not about you going on a diet, with all of the negative “celery sticks and rice cakes” connotations.

Most of us don’t like to weigh or measure food, or follow set recipes that don’t even feature foods that we prefer.

We just want to eat and let nutrition figure itself out.

That’s what we want to do, but hey, we put in the work to get ourselves to this chubby and prediabetic state. Now we have to do some work to get out of this mess.

We can lose weight by simply not eating as much food each day. Slash those calories and say bye-bye to a few pounds.

However, unless we also change what we eat[3], we’re less likely to leave prediabetes in the dust.

We can do this. Together, we can trial-and-error ourselves out of prediabetes land.

There is no one-size-fits-all way of eating that will lower your blood sugar and help you lose weight.

You need a personal plan that includes foods you like and leaves out foods you don’t like. Talk to your healthcare provider and get a referral to see a registered dietician or certified diabetes educator. Your local hospital or health clinic may provide this service free of charge.

Until you get the advice of a professional, there are some basics you can follow that apply to most of us.

Do a bit of homework. CDC explains carb basics,[4] and websites like endocrineweb.com[5] and diabetesfoodhub.org[6] can start you on a path toward restructuring your diet.

Eat to your meter. The amount of carbs you should eat in a day will be different from the amount another prediabetic should eat. An expert can help you design a diet, but you’ll need to use a meter and test various foods to see what affects you and what doesn’t.

Don’t give up. If you’re disciplined about the trial-and-error approach, you will end up with a way of eating that you like and that (usually) keeps your blood sugar levels in the normal range.

It’s not only about your diet. Other factors can affect your blood sugar, like certain medications[7], stress, lack of sleep, and illness­­—all of which may keep your numbers elevated even if you’ve reduced your carb intake.


[1] Harvard School of Public Health/The Nutrition Source, Simple Steps to Preventing Diabeteshttps://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/#diet, (May 2, 2019).

[2] PLOS ONE, A Randomized Pilot Trial of a Moderate Carbohydrate Diet Compared to a Very Low Carbohydrate Diet in Overweight or Obese Individuals with Type 2 Diabetes Mellitus or Prediabeteshttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0091027&type=printable, (May 24, 2019).

[3] BMJ Journals/BMJ Open Diabetes Research & Care, Remission of pre-diabetes to normal glucose tolerance in obese adults with high protein versus high carbohydrate diet: randomized control trialhttps://drc.bmj.com/content/4/1/e000258?cpetoc, (June 12, 2019).

[4] CDC Centers for Disease Control and Prevention/Diabetes, Diabetes and Carbohydrateshttps://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbohydrates.html, (June 24, 2019).

[5] Endocrineweb, Diabetes Diet: The Best Way to Eat for Type 2 Diabetes, https://www.endocrineweb.com/conditions/diabetes/diabetes-diet-best-way-eat-type-2-diabetes, (June 24, 2019).

[6] American Diabetes Association/Diabetes FoodHub, https://www.diabetesfoodhub.org/, (June 24, 2019).

[7] Diabetes in Control, 390 Drugs That Can Affect Blood Glucose Levelshttp://www.diabetesincontrol.com/drugs-that-can-affect-blood-glucose-levels/, (June 24, 2019).

Eat to Your Meter

Diabetics test their blood sugar several times a day. They do this to check that medications are working as they should, and to see if their blood sugar is too high or too low.[1]

If blood sugar levels are too far outside the norm for a diabetic, that can be a serious health risk.

Why would someone diagnosed with prediabetes choose to self-monitor? It’s not a standard recommendation, but maybe it should be.

If you’ve been diagnosed as prediabetic, you probably get your A1C[2] tested every few months or annually to see if you’ve developed type 2 diabetes. You go to the lab, get a blood draw, and you’re done.

Kind of important to know if you’ve moved from prediabetes to type 2 diabetes.

But, the A1C test is not the only test that is used to diagnose diabetes.

After all, according to the experts, you only need two days of fasting plasma glucose at or greater than 126 mg/dL to be diagnosed diabetic.[3]

It’s possible to be prediabetic and develop full-blown diabetes between those occasional A1C tests.

Self-monitoring your blood sugar can alert you to full-blown diabetes, or that you’re dangerously close to it. This awareness gives you time to immediately stop what you’re doing and try to correct course.

It also helps you to learn what your body tolerates in the way of food and drink, and it shows you what exercise does to your blood sugar levels.

Self-monitoring allows you to learn at a granular level just what’s happening with your blood sugar, and what you can do to affect it.

Use a blood sugar monitor (also called a meter) to discover exactly where your blood sugar is – if you’re prediabetic, normal, or officially a type 2 diabetic.

If you believe you have developed full-blown diabetes, you’ll want to have that confirmed by your healthcare provider, and a medical plan will be put into place.

“Eat to your meter” is a phrase you may hear when chatting to other prediabetics. It means you use the meter to guide you away from foods that make your blood sugar levels go up. Or conversely, toward foods that sustain you and don’t throw your blood sugar out of whack.

Since the goal is to get your blood sugar to stay down in the normal range, rather than the prediabetic range (and definitely not in the diabetic range), it’s necessary to eat more of this and less of that. What “this” and “that” is depends on your body, and that’s what eating to a meter can help you figure out.

Some prediabetics can eat carbs from, say, a carrot or even a carrot cake, and their blood sugar blips up then back down. Other prediabetics will get a big long-lasting bounce in their blood sugar if they eat carbs from the same sources.

Because prediabetes can cause some of the same problems as full-blown diabetes, it’s time to get aggressive in the fight against elevated blood sugar.

According to a thoroughly unscientific interview process performed through an online support group, prediabetics who choose to use a meter seem to find that they use it a lot early on. After a few months, they don’t use it as much because they’ve learned what works for them and what doesn’t.

Changes in lifestyle (food choices, exercise levels, weight control) based on what the meter is saying help them move toward normal levels of blood sugar, and soon they find they don’t need to use a meter to know what they should be eating and how much they should be exercising.

If you decide to start using a meter, you can buy one over the counter in your local pharmacy.

Be aware that insurance doesn’t always cover the cost of the meter and the strips.

Each meter will be slightly different so read the instructions before use, but these are the basic steps to using a meter:

  • Wash and dry your hands and then, if possible, use an alcohol wipe on the pad and sides of a fingertip. This is for infection control and to remove any substance which might affect the test results.
  • Insert a strip into the meter.
  • Use the included needle to poke the pad or side of your fingertip. No need to aggressively stab yourself. Keep it shallow, just enough to draw a tiny bit of blood. Squeeze around the hole to get a drop of blood if it isn’t immediately evident.
  • Touch the strip as indicated to the drop of blood, and your meter should tell you your blood sugar level after a few seconds.

Talk with your healthcare provider about what numbers you should be looking for, but generally speaking, as prediabetics our goal is to have numbers in the normal (rather than prediabetic) range:

  • before a meal the meter should read between 70 and 99 mg/dl (3.9–5.5 mmol/L) for normal blood sugar levels
  • two hours after a meal the meter should read less than 140 mg/dl (7.8 mmol/L) for normal blood sugar levels

It’ll be helpful to note what you’re eating. This makes it easier for you to remember foods and amounts that work for you.

Using apps such as the popular Carb Manager (free) or Carb Manager Premium (not free) is a common way to do this. (We are not associated with Carb Manager, but we do use the app.)

There are dozens of helpful apps, so choose one that makes the process of tracking foods and whatever else you want to track the easiest for you.

If you check your blood sugar before eating and it is 105 (a little higher than normal because you’re prediabetic) and two hours after you start eating a banana it is 145, then next time, try eating half a banana. Or cut bananas from your list of foods. For now.

Remember, the goal is to identify how individual foods affect your blood sugar levels, and to stay away from those that make it stay elevated.


[1] Mayo Clinic, Blood sugar testing: Why, when and howhttps://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628, (May 20, 2019).

[2] National Institute of Diabetes and Digestive and Kidney Diseases, Diabetes Tests & Diagnosishttps://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis, (May 20, 2019).

[3] https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis.

Sleep and Prediabetes

Sleep seems an unlikely culprit in the blame game for prediabetes.

Did we really develop prediabetes because we stayed up late surfing the Internet? Well . . . maybe.

Or, was it because we zonked out for too many hours?

Research is showing that both short sleep and long sleep may affect our risk of prediabetes.[i]

That last bit was a surprise. Too much sleep can affect our risk of developing prediabetes? Again, maybe, although the science is not as pronounced on this.[ii]

Studies are indicating that short sleep, typically five or six hours[iii] or less, is a risk factor in developing prediabetes and type 2 diabetes. And yes, some studies indicate that long sleep[iv], typically nine hours or more, may also be a risk factor.

It’s not a straight line from poor sleep to prediabetes. Obesity is linked to sleep loss.[v] Obesity is a risk factor for the development of prediabetes. The line then goes sleep poorly, get fat, develop prediabetes. What caused the prediabetes? The obesity, or the lack of quality sleep?

However curvy the line is between poor quality sleep and prediabetes, the two are connected.

Getting adequate sleep each night (or day, if that’s when you get your sleep), is critical to overall health, and will only help in our journey to get out of prediabetes land.

Here are some tips from the NIH to make sleeping a solid seven or eight hours more doable:

  • Try to keep the same sleep schedule on weeknights and weekends. Limit the
    difference to no more than about an hour. Staying up late and sleeping in late
    on weekends can disrupt your body clock’s sleep–wake rhythm.
  • Use the hour before bed for quiet time. Avoid strenuous exercise and bright
    artificial light, such as from a TV or computer screen. The light may signal
    the brain that it’s time to be awake.
  • Avoid heavy and/or large meals within a couple hours of bedtime. (Having a light
    snack is okay.) Also, avoid alcoholic drinks before bed.
  • Avoid nicotine (for example, cigarettes) and caffeine (including caffeinated soda,
    coffee, tea, and chocolate). Nicotine and caffeine are stimulants, and both
    substances can interfere with sleep. The effects of caffeine can last as long
    as 8 hours. So, a cup of coffee in the late afternoon can make it hard for
    you to fall asleep at night.
  • Spend time outside every day (when possible) and be physically active.
  • Keep your bedroom quiet, cool, and dark (a dim night light is fine, if needed).
  • Take a hot bath or use relaxation techniques before bed.
  • Go to bed and wake up at the same time every day.

We cannot take this information and apply it in undiluted form to our individual case histories. Each body is different, and the sleep requirements to maintain health will be different.

Too much or too little sleep on its own is unlikely to be the reason we developed prediabetes. But every risk factor that we can address and fix, for lack of a better word, is worth looking at.


[i] JAMA Internal Medicine, Association of Sleep Time With Diabetes Mellitus and Impaired Glucose Tolerancehttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486518, (March 11, 2019).

[ii] NCBI NLM/NIH, Sleep disorders and the development of insulin resistance and obesityhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767932/, (March 12, 2019).

[iii] Diabetic Medicine, Association between duration and quality of sleep and the risk of pre-diabetes: evidence from NHANEShttps://onlinelibrary.wiley.com/doi/abs/10.1111/dme.12165, (March 11, 2019).

[iv] https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/486518  (March 11, 2019).

[v] NCBI NLM/NIH, Sleep and Obesityhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3632337/, (March 13, 2019).