Pre-Diabetes & DiabetesAre You at Risk?

Margaret Eckler, MS, RD, CDEMary Friesz, PhD, RD, CDERoger Warn, MS, RD, CDE

What is pre-diabetes?

• Pre-diabetes is a condition where blood glucose levels, or the hemoglobin A1C, is higher than normal but not high enough to be classified as diabetes.

What’s blood glucose?

• Glucose is not a bad thing – it is the body’s main energy source – it becomes “bad” when there’s too much in the blood

• Insulin is required in order for cells to get glucose from the blood

• If there is not enough insulin or the insulin does not work as well, glucose stays in the blood resulting in higher than normal blood glucose levels

Why is pre-diabetes something to be worried about?

• 86 million people (35% of the US population) have pre-diabetes

• Of these 86 million, up to 30% will develop type 2 diabetes within 5 years

• And if that’s not bad enough…… Those with pre-diabetes have a increased risk of heart

disease & stroke

& believe it or not …. 9 out of 10 people with pre-diabetes do not even know they have it!

Why are so many people at risk for pre-diabetes & diabetes?

Obesity Trends* Among U.S. AdultsBRFSS, 1990

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14%

Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% ≥20%

Obesity Trends* Among U.S. AdultsBRFSS, 2009

(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

Why focus on pre-diabetes?

• Those with pre-diabetes make up a very large group

• When one has pre-diabetes, the time is ripe for intervention

• Education is key……

Risk factors for pre-diabetes

• Being overweight (#1 factor)• Family history of diabetes• Over 45 years of age• High blood pressure• Being sedentary• History of gestational diabetes• History of PCOS• Certain ethnicities (African American, American Indian, Hispanic,

Asian American or Pacific Islander decent)

Are YOU at Risk?

Add up your points on the following risk factors to determine whether you are at risk of developing Type 2 diabetes……..

How old are you?

Younger than 40 years (0 points)40—49 years (1 point)50—59 years (2 points)60 years or older (3 points)

Are you male or female?

Male (1 point) Female (0 points)

For women only

Have you ever been diagnosed with gestational diabetes or had a baby that weighed more than 9 pounds at birth?

Yes (1 point) No (0 points)

Your Family History

Do you have a mother, father, sister, orbrother with diabetes?

Yes (1 point) No (0 points)

Your Blood Pressure

Have you ever been diagnosed with highblood pressure/hypertension?

Yes (1 point) No (0 points)

Your Activity Level

Are you moderately active; do you exercise for at least 30 minutes on most days of the week?

Yes (0 points) No (1 point)

What is your weight? Height Weight (lbs.)

4’ 10” 119-142 143-190 191+ 4’ 11” 124-147 148-197 198+ 5’ 0” 128-152 153-203 204+ 5’ 1” 132-157 158-210 211+ 5’ 2” 136-163 164-217 218+ 5’ 3” 141-168 169-224 225+ 5’ 4” 145-173 174-231 232+ 5’ 5” 150-179 180-239 240+ 5’ 6” 155-185 186-246 247+ 5’ 7” 159-190 191-254 255+ 5’ 8” 164-196 197-261 262+ 5’ 9” 169-202 203-269 270+ 5’ 10” 174-208 209-277 278+ 5’ 11” 179-214 215-285 286+ 6’ 0” 184-220 221-293 294+ 6’ 1” 189-226 227-301 302+ 6’ 2” 194-232 233-310 311+ 6’ 3” 200-239 240-318 319+

(1 Point) (2 Points) (3 Points) If you weigh less than the amount in the left column (0 points)

How Did You Score?

If you scored 5 or higher:

You are at increased risk for having type 2 diabetes. However, only your doctor can tell for sure if you do have type 2 diabetes or pre-diabetes. Talk to your doctor to see if additional testing is needed.

How to know for sure….Normal Pre-Diabetes Diabetes

Fasting Glucose <100 100 to 125 126 +

Hemoglobin A1C <5.7 5.8 to 6.4 6.5 +

The Good News

• The progression from pre-diabetes to diabetes is not inevitable

• People may be able to prevent or at least delay the development

BUT …..

It does require some work….

Nothing Comes Easy

• What are the 3 most important things one can do to help prevent – or at least delay – the development of Type 2 Diabetes??

#1 Decrease food intake

• Eat fewer calories to lose weight – ie: eat smaller portions than you are use to

• Make ½ your plate vegetables, with fruit sparingly, to help fill your belly with fewer calories

• Ditch the “sugar water” – your body loves water best

Use the Plate!

• Fill half of the plate with BRIGHT, COLORFUL vegetables/salad

• ¼ Lean Protein (use your palm)• ¼ Starch or Grains

(a fist full)

• NO second helpings

Why weight loss is a key

• If one is overweight, losing just 5 to 7% of body weight can help prevent (or at least delay) Type 2 Diabetes

5 to 7% is just 10 to 14 lbs. for someone who weighs 200 lbs.

#2 Choose your foods wisely

Choose healthy foods more often Build meals around more vegetables, whole grains,

legumes, fish, lean meats & skim dairy products Limit added fats (ie: butter, margarine, mayo,

cooking oils); instead choose healthy fats in moderation (nuts, olives, avocado)

Limit simple sugars (ie: juice, soda, sweet drinks) Limit processed foods; choose foods closer to their

natural states

Be aware

Be more aware of portions Monitor portion sizes conducive to weight

loss

Compare food labels to help you pick the healthier options in their appropriate portions

Size it Up• 2-3 cups = size of your open hands (salad, raw

veggies)• 1 cup = size of a baseball (potato/rice/pasta,

cooked veg• 2 T = size of a golf ball (dips, whipped topping)• 1T = size of a small thumb (salad dressing,

spreads)• 3 ounces = size of a deck of cards

#3 Be more active

• If you already have an exercise program, try to maintain it

• If you do not exercise regularly, check with your doctor first

• Start gradually

Exercise Can Help You

• Control blood sugar levels• Increase metabolic rate – burn more calories• Reduce stress• Increase energy• Look better• Reduce medication requirements• Save money• Increase enjoyment of life !!

• Choose an activity (example: brisk walking)• Set a long-term goal - at least 30 minutes a day, 3-5

days a week• Buy comfortable walking shoes• Make an appointment for you & your exercise• Get a partner, if necessary

Getting Started

Be more active

• Doing just 30 minutes of walking daily can help big time!

• Have difficulty walking? Try arm chair exercises, marching in place, & water exercises

**No more excuses – Just do something!

Exercise Options• Brisk walking (talk/sing test)• Stair climbing• Exercise equipment• TV show or exercise DVD• Dancing• Wii Fit or active video games• Water walking or swimming• “Chair” exercise using light weights, bands, etc.

Stay Motivated

• Remind yourself of the benefits• Think “I want to”, not “ I have to”• Have a variety of choices• Enlist a partner• Set realistic goals, with rewards• Make it a lifestyle

• Okay – now it’s your turn…..

Diabetes is caused by:

• Eating too much sugar & carbohydrates

• Being overweight & sedentary

• Catching it from someone else

• A virus

• It’s in your genes

When someone has diabetes:

• His/her pancreas has stopped making insulin• His/her liver is making too much sugar

(glucose)• His/her insulin is not working properly• He/she has insulin resistance

Risk Factors for Diabetes:

• Family history, getting older, high blood pressure

• Being Hispanic, high triglycerides, underweight

• Drinking alcohol, smoking, not getting enough sleep

• Being overweight, being over 40, having a fair complexion

Signs of High Blood Glucose

• Weight gain & blurry vision

• Weight loss & excessive tiredness

• Hair loss & frequent urination

• Dry mouth & skin rashes

True or False?:

• “Borderline” diabetes is not too serious

• Diabetes increases the risk for heart attack

• A person can have hyperglycemia (high glucose levels) but not have diabetes

• People with diabetes should avoid all sweets

The Best Ways to Manage Diabetes:

• Medications

• Herbs & supplements

• Meal planning & exercise

• Fluids & rest

True or false ?

• Only people who have a family history of diabetes need to be tested

• People diagnosed with pre-diabetes are not very likely to get diabetes

• You have diabetes when your blood sugar level is higher than 140

Questions?