Your client has been waking up to urinate in the middle of the night and has been feeling sluggish after meals. What gives? If they've got a family history of diabetes or a history of gestational diabetes, take note. Their risk for developing diabetes is higher than someone without these risks, but may be avoidable. Studies show that losing just 5-7% of body weight and getting regular exercise may reduce the risk of diabetes by 58%. For a 200 lb. person, that’s roughly 10-14 lbs. of weight. 1
What is considered “high” anyway? A fasting (nothing to eat/drink for at least 8 hours) blood sugar over 100 mg/dL is considered elevated. What an individual forgot to fast and added cream or sugar in your AM coffee? Welcome to the non-fasting state. In this case, blood sugar should be below 140 mg/dL within two hours of eating or drinking anything with calories to be considered normal. Other numbers to consider- if two blood sugar readings in a row are over 126 mg/dL or a a random blood sugar reading is 200 mg/dL or higher, a diabetes diagnosis may be given. 2
A post-prandial (after meal) glucose test may also be performed to check for gestational diabetes. This is the test administered to pregnant women between the 24th to 28th week of pregnancy. In this situation, a woman fasts overnight, then is given a 75 gram “load” of sugar, typically through a syrupy, soda-like beverage. Blood sugar is then checked after 2 hours or more frequent intervals. A level below 140 mg/dL is considered normal in this case. It’s estimated that a woman with gestational diabetes is 7 times as likely to develop type 2 diabetes in her lifetime than someone without diabetes. 3
As some people have increased risk of diabetes, their doctor may suggest having a Hga1c done to evaluate blood sugar. A Hga1c is a measure of what your average blood sugar has been running for the past 3 months. A normal level is below 5.7 mg/dL. Pre-diabetes is defined as a Hga1c of 5.7-6.4%. This means your blood sugar is higher than normal, but not quite diagnostic of diabetes. A Hga1c above 6.4% is diagnostic of diabetes. If no lifestyle changes are made (diet, activity), about 25% of people with pre-diabetes may develop diabetes within 2-3 years, according to the CDC. 2
Diabetes is not just an issue with blood sugar. People with diabetes have higher rates of heart disease and stroke. Diabetes impacts circulation to every organ in your body. It’s the leading cause of blindness as well as kidney disease. 4
So, how can you help your clients prevent diabetes? Most experts point to weight reduction for starters. Losing weight improves insulin sensitivity as fat cells can become resistant to insulin over time. For sustainable weight loss, it’s important not to go on any crash diets, though reducing intake of processed or refined carbohydrates will help with both weight loss and blood sugar reduction. Limit intake of cake, cookies, regular soda, candy, ice cream and other high calorie/high fat desserts. Don’t forget about other common processed carbs including potato chips, pretzels, and sports drinks.
Swapping whole grains for refined grains will also aid in glucose control. Whole grains contain fiber as well as selenium, two nutrients found to aid in blood sugar management. Dietitians can advise clients to choose brown over white rice, quinoa, farro, and bulgur. Whole grain breads and cereals over more processed varieties like white bread and pasta are optimal choices. Increased vegetable intake may also be beneficial since vegetables are low in calories and carbohydrate and may take the place of higher calorie foods that lead to weight gain.
Regular physical activity cannot be stressed enough for both the prevention and treatment of diabetes. Exercise not only aids in weight loss, but walking for 10-15 minutes after meals has been found to lower post-prandial blood sugar. However, the larger the meal and potential increase in glucose, the more intense an exercise may need to be to have an impact on blood sugar. In theory, it may be easier to eat less to control blood sugar than to try to “outrun or outwalk” a bad diet. 5
- Erickson ML1, Little JP2, Gay JL3, McCully KK4, Jenkins NT4. Effects of postmeal exercise on postprandial glucose excursions in people with type 2 diabetes treated with add-on hypoglycemic agents. Diabetes Res Clin Pract.2017 Apr;126:240-247
Submitted by Lisa Andrews, MEd, RD, LD