Chong points to previous research in Circulation that describes the underlying mechanisms of sleep apnea. In people with sleep apnea, activation of the sympathetic nervous system — including increased heart rate, increased blood pressure, and constriction of blood vessels — all led to a higher risk of heart attack and stroke, which can be compounded in people who have type 2 diabetes (and thus already have a higher risk of heart disease).
Dehydration (the loss of body water and salt), which may cause you to feel dizzy, faint, lightheaded, or weak, especially when you stand up (orthostatic hypotension). You may be at a higher risk of dehydration if you have low blood pressure; take medicines to lower your blood pressure, including water pills (diuretics); are 65 years of age or older; are on a low salt diet, or have kidney problems
Sometimes pills for diabetes — even when combined with diet and exercise — aren't enough to keep blood sugar levels under control. Some people with type 2 diabetes also have to take insulin. The only way to get insulin into the body now is by injection with a needle or with an insulin pump. If someone tried to take insulin as a pill, the acids and digestive juices in the stomach and intestines would break down the medicine, and it wouldn't work.
There is much you can do with lifestyle alone to prevent diabetes. In a landmark study, the NIH-sponsored Diabetes Prevention Program, scientists tracked 3,234 pre-diabetic men and women for three years. A third of them adopted lifestyle changes. Another third took a drug – metformin (Glucophage®). The remaining third, the control group, took a placebo. Those on the lifestyle-change plan reduced the progression to full-blown Type 2 diabetes by 58% compared to the control group. The reduction was even greater – 71% – among adults aged 60 and older. Treatment with the drug metformin reduced the progression of Type 2 diabetes by just 31%.
The attempts to adhere to the conventional food measurements in order to comply with prescriptions of the so-called ‘diabetic diet’ usually result in unnecessary restrictions, overindulgence, or monotonous consumption of certain food items, e.g., unripe plantain/beans. This is a consequence of illiteracy, poverty, and cultural misconceptions about the role of diet in the management of diabetes. This is usually the most problematic aspect of diabetes care. The usually recommended daily energy intake for the non-obese diabetic patient is between 1500 and 2500 calories per day, the average allowance being 2000 k calories per day. The recommendation for the overweight diabetic patient is between 800 and 1500 k calories per day, while the underweight (including growing children and adolescents) should be allowed at least 2500 k calories/day.[16,17]
A common recommendation for preventing diabetes is “eat healthy and lose weight.” But that advice is extremely broad. What does that even mean? One person’s interpretation of how to eat healthy could be entirely different from the next. And some tactics people might try in order to lose weight can be counterproductive and increase the risk of diabetes instead.
Bladder cancer. In studies of FARXIGA in people with diabetes, bladder cancer occurred in a few more people who were taking FARXIGA than in people who were taking other diabetes medications. There were too few cases of bladder cancer to know if bladder cancer was related to FARXIGA. Tell your healthcare provider right away if you have blood or a red color in your urine or pain while you urinate
Charlene Crawford has spent more than half of her life with diabetes. At 14, she was diagnosed with prediabetes. By 18, she had type 2. She was prescribed medication, which she barely took, and advised to make lifestyle changes, which she didn't do. But when she got pregnant, her priorities shifted. "Having a child makes you see things differently," says Crawford, a mother of two. "I wanted to be there for him and not be so tired and be active when he needed me."
The medications only hide the blood sugar by cramming it into the engorged body. The diabetes looks better, since you can only see the blood sugars. Doctors can congratulate themselves on a illusion of a job well done, even as the patient gets continually sicker. Patients require ever increasing doses of medications and yet still suffer with heart attacks, congestive heart failure, strokes, kidney failure, amputations and blindness. “Oh well” the doctor tells himself, “It’s a chronic, progressive disease”.
Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.
Talk to your friends and family beforehand about your reasons for eating healthy. Tell them it's important to your long-term health that you stay on your healthy eating plan and ask them not to encourage you to eat things that aren't good for you. Friends and family are often just trying to demonstrate their love by wanting you to enjoy a dessert, however mistaken that is. Help them understand they can best help you by not making it more difficult to stay on track and by supporting you in your efforts to take good care of yourself.
Eat smaller portions of foods and remember that your lunch and dinner plate should be 1/4 protein, 1/4 starch (including potatoes), and 1/2 vegetables. Eat 3 balanced meals per day (no more than 6 hours apart), and don't skip meals; snack with fruit between meals. Choose foods lower in fat and sugar; choose low GI index foods whenever possible; avoid “white” foods (white flour and white sugar).
Interventional studies showed that high carbohydrate and high monounsaturated fat diets improve insulin sensitivity, whereas glucose disposal dietary measures comprise the first line intervention for control of dyslipidemia in diabetic patients.78 Several dietary interventional studies recommended nutrition therapy and lifestyle changes as the initial treatment for dyslipidemia.79,80 Metabolic control can be considered as the cornerstone in diabetes management and its complications. Acquiring HbA1c target minimizes the risk for developing microvascular complications and may also protect CVD, particularly in newly diagnosed patients.81 Carbohydrate intake has a direct effect on postprandial glucose levels in people with diabetes and is the principal macronutrient of worry in glycemic management.82 In addition, an individual’s food choices and energy balance have an effect on body weight, blood pressure, and lipid levels directly. Through the mutual efforts, health-care professionals can help their patients in achieving health goals by individualizing their nutrition interventions and continuing the support for changes.83-85 A study suggested that intake of virgin olive oil diet in the Mediterranean area has a beneficial effect on the reduction of progression of T2DM retinopathy.86 Dietary habits are essential elements of individual cardiovascular and metabolic risk.87 Numerous health benefits have been observed to the Mediterranean diet over the last decades, which contains abundant intake of fruit and vegetables. The beneficial effects of using fish and olive oil have been reported to be associated with improved glucose metabolism and decreased risk of T2DM, obesity and CVD.88
The process of type 2 diabetes begins years or even decades before the diagnosis of diabetes, with insulin resistance. Insulin resistance is the beginning of the body not dealing well with sugar, which is the breakdown product of all carbohydrates. Insulin tells certain body cells to open up and store glucose as fat. When the cells stop responding your blood sugar rises, which triggers the release of more insulin in a vicious cycle. Insulin resistance is associated with abdominal obesity, high blood pressure, high triglycerides, and low HDL ("good cholesterol"). When these occur together, it is known as metabolic syndrome or pre-diabetes. It is a risk factor for heart disease and type 2 diabetes.

If you are at risk for diabetes or insulin resistance, be sure to get an annual testing for fasting blood glucose and hemoglobin A1c. If you see these rising over time, this is a sign that your body is having more trouble processing sugar. Your healthcare provider can provide further recommendations for medication and lifestyle changes that can reduce your risk of progressing to type 2 diabetes.


Up your soluble fiber intake: There are two types of fiber – the type that does not dissolve in water (insoluble fiber) and the kind that does (soluble fiber). Insoluble fiber can help manage weight and prevent constipation by moving quickly through the digestive tract and adding bulk to stool. Soluble fiber, on the other hand, absorbs water and turns into a gel-like consistency during digestion. This process slows down digestion and nutrient absorption. Soluble fiber can also lower blood sugar and cholesterol levels: because it isn’t well absorbed, it doesn’t contribute to blood sugar spikes and can help manage type 2 diabetes.

Hemoglobin A1c or HbA1c is a protein on the surface of red blood cells. The HbA1c test is used to monitor blood sugar levels in people with type 1 and type 2 diabetes over time. Normal HbA1c levels are 6% or less. HbA1c levels can be affected by insulin use, fasting, glucose intake (oral or IV), or a combination of these and other factors. High hemoglobin A1c levels in the blood increases the risk of microvascular complications, for example, diabetic neuropathy, eye, and kidney disease.
And finally, behavioral changes that set up environments for success are extremely helpful. These may include daily food/beverage/activity/glucose logging, and food-proofing environments. Logging can now be completed easily with electronic applications and website support, such as www.choosemyplate.gov . Food-proofing takes more doing and family/significant other assistance. Environments to review may include home, shopping, work, driving, and social. Review foods in each environment that sabotage efforts to manage blood glucose, and develop strategies to cope. For instance, when driving, bring a planned carb-controlled snack (e.g. small apple, 3 graham cracker squares, sparkling calorie-free water), in case travels extend past expected times; and check driving patterns, since some automatic routes may go past a favorite fast food place that magically pulls the car in!
The evidence is growing stronger that eating red meat (beef, pork, lamb) and processed red meat (bacon, hot dogs, deli meats) increases the risk of diabetes, even among people who consume only small amounts. The latest support comes from a “meta analysis,” or statistical summary, that combined findings from the long-running Nurses’ Health Study I and II and the Health Professionals Follow-Up Study with those of six other long-term studies. The researchers looked at data from roughly 440,000 people, about 28,000 of whom developed diabetes during the course of the study. (43) They found that eating just one daily 3-ounce serving of red meat—say, a steak that’s about the size of a deck of cards—increased the risk of type 2 diabetes by 20 percent. Eating even smaller amounts of processed red meat each day—just two slices of bacon, one hot dog, or the like—increased diabetes risk by 51 percent.
Foods might sometimes appear to be packaged into individual serving sizes even though they contain two or more servings per package. To determine that, look at "serving size" and "servings per container" at the top of any food label. For example, if a serving size is 1 and there are 2 servings per container, you will need to double all of the nutrient values on the label in order to get a clear picture of the value of the entire container.
Hot liquids fill you up better than most anything else – coffee, teas, non-fat hot chocolate. I have become a big fan of soup. I make it myself by browning onions in non-stick cooking spray (to bring out the flavor), then add whatever vegetables I have around with some broth (vegetable or chicken). When the veggies are soft, cool slightly, then blend in small batches. Season with S&P, or experiment with turmeric or cardamon. Makes a lovely thick, creamy soup without the calories. I use sweet potatoes, carrots, broccoli, cauliflower, whatever.
Food can be powerful in preventing and reversing diabetes. However, dietary approaches have changed as we have learned more about the disease. The traditional approach to diabetes focuses on limiting refined sugars and foods that release sugars during digestion-starches, breads, fruits, etc. With carbohydrates reduced, the diet may contain an unhealthful amount of fat and protein. Therefore, diabetes experts have taken care to limit fats- especially saturated fats that can raise cholesterol levels, and to limit protein for people with impaired kidney function. The new approach focuses more attention on fat. Fat is a problem for people with diabetes. The more fat there is in the diet, the harder time insulin has in getting glucose into the cells. Conversely, minimizing fat intake and reducing body fat help insulin do its job much better. Newer treatment programs drastically reduce meats, high-fat dairy products, and oils.[46,47,48,49,50] At the same time, they increase grains, legumes, fruits, and vegetables. The study found that patients on oral medications and patients on insulin were able to get off of their medications after some days on a near-vegetarian diet and exercise program. During 2 and 3-year follow-ups, most people with diabetes treated with this regimen have retained their gains. The dietary changes are simple, but profound, and they work.[51,52,53]
When adjusted for family history, the benefits of exercise can be evaluated based on previous studies. Of note, for every 500 kcal burned weekly through exercise, there is a 6% decrease in relative risk for the development of diabetes. This data is from a study done in men who were followed over a period of 10 years. The study also notes a greater benefit in men who were heavier at baseline. There have been similar reports on the effects of exercise in women.
I think the best response to a one sentence question that includes the words diet and control is Mindfulness. Get knowledgeable about this topic so that you realize that eating is a continuum. There are so many decisions that go into what and how much we eat, that if we do not elevate intention to the priority level it requires to attain control, we will flounder in reaching our goals. Food choices, eating, and time management are so complex in our lives that clarifying our specific goals related to food and our health is imperative to approach control in a positive way.
In addition, as early as in 2008, the Swedish Board of Health and Welfare examined and approved advice on LCHF within the health care system. Advice on LCHF is, according to the Swedish Board of Health and Welfare’s review, in accordance with science and proven knowledge. In other words, certified healthcare professionals, who give such advice (for example myself) can feel completely confident.
Hyperglycemia or high blood sugar is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms of high blood sugar may include increased thirst, headaches, blurred vision, and frequent urination.Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.
Choose carbs wisely: The glycemic index (GI) is a value assigned to foods based on how quickly or slowly they spike your blood sugar levels. For someone with diabetes, high GI foods (like refined sugar or other simple carbohydrates like white rice and bread) can cause blood glucose levels to shoot up rapidly. Make sure that your carbs are high-fiber, whole grains – like legumes, brown rice, or quinoa – as these foods are high in nutrients and break down slowly into the bloodstream.
The breakfast should be 1/3 fruit, 1/3 starchy fiber foods (multigrain bread and cereal products), and 1/3 protein (nuts, eggs, tofu, beans, lentils, low-fat dairy products). The lunch and dinner plates should be 1/2 vegetables, 1/4 starchy fiber foods, and 1/4 protein. Choose whole grains, such as whole wheat pasta, whole wheat bread, and brown rice to increase fiber intake. Most of these are low in fat. Choose only lean meat and poultry.[81,82,83,84] Remove skin and trim fat before cooking (50-100 g or 2-4 oz). See the milk fat (MF) of all dairy products. Use skim or 1% milk products and low-fat cheese (less than 20% MF), or choose fortified soy products. Reduce your total fat intake (less than 25% - 35% of your daily calories). To achieve this, always try to choose low fat foods and avoid fried foods. Limit saturated and trans fats to less than 10% of your daily calories. Try to always choose unsaturated fats such as olive and canola oils and non-hydrogenated margarine (in moderation). Saturated and trans fats raise blood cholesterol levels, while unsaturated fats lower blood cholesterol. Saturated fats are solid at room temperature and are usually of animal origin. They are found in meats, whole milk, dairy products, butter, and hard margarines.[85,86,87,88,89,90] Trans fats are found in baked and pre-packaged foods. Hydrogenation is a process that changes liquid vegetable oil into a solid fat such as hard margarine. The hydrogenation process changes some of the good fats into cholesterol-raising saturated and trans fats. People with diabetes are at a greater risk of developing or have already high levels of fats in their heart and blood vessels. Omega-3 fatty acids are found in cold water fish such as herring, mackerel, salmon, trout, sardines and tuna, and in flaxseeds (2 tbsp per day, freshly ground).[90,91,92,93] Three to four servings of fish per week is recommended as part of a healthy, balanced diet. Omega-enriched foods are also available in supermarkets such as omega-3 eggs and omega-3 enriched dairy products. Omega-3 supplements: Always look for the active ingredients DHA and EPA. Recommendations are 600-900 mg/day. Always check with your doctor or registered dietitian before taking any supplements. Increase fiber in your diet by eating more whole grain foods, vegetables, fruits, and legumes.[94,95,96] These foods also contain vitamins, minerals, and antioxidants and have a lower glycemic index. Low glycemic index foods will help to keep your blood sugar levels in the target range.[97,98,99]

We tend to hear much emphasis on calories, carbohydrate counting and the glycemic index when asking about type 2 diabetes management through diet. The most often forgotten nutrient for health is the most important: water. Many of our clients with type 2 diabetes are on the run and may remember to eat, yet do not take adequate time for drinking calorie-free, caffeine-free beverages to rehydrate. Since our bodies are comprised of nearly 70% water, it makes good sense to take in fluids daily to balance out our needs. Sometimes the recommended “8, 8 ounces of water per day” is not enough. A quick assessment of the color of urine coming out, depending on vitamin supplements and medications, can help determine what the right amount of liquid is daily. The lighter the color, the better!
The theory behind a ketogenic diet for prediabetes is that when your body is in ketosis, you can be sure that you do not have excess carbohydrates in your diet. Since carbohydrates in your diet are broken down into glucose that goes into your bloodstream, being in ketosis assures that you are not inundating your bloodstream with excessive amounts of glucose due to the foods you eat.
As a bonus, stress relief may help you sleep better, which is important because studies show that not getting enough sleep can worsen type 2 diabetes. Sleeping less than six hours a night has also been found to contribute to impaired glucose tolerance, a condition that often precedes type 2 diabetes. In fact, a review published in 2015 in Diabetes Care analyzed 10 studies that involved more than 18,000 participants combined and found the lowest risk of type 2 diabetes in the group of participants that slept seven to eight hours per day. That’s the minimum recommended amount of sleep for most adults, according to the National Sleep Foundation.
Those with diabetes should be results oriented. Find the scientist in yourself and track your numbers and push them to your goal ranges: pounds, blood glucose levels, A1c, minutes of moderate exercise every week, etc. Choose what is important to you, and identify concrete strategies to improve your numbers. A dietitian, especially one who is a diabetes educator can assist you to start slow, set goals, and identify sequential steps to reach each goal gradually. They can act as a coach to help you celebrate successes. and move on to another goal or challenge. Along with the other members of your health care them, let them be your cheerleader!
Find safe ways to exercise at home. If you have trouble leaving the house because of your health or lack of transportation, you can still find safe ways to stay active from home. Find workout videos online, or make even ordinary household chores a little more fun by turning on some music. If it’s safe for you to do so, you might try doing strengthening exercises from home.
In general, prediabetes is not associated with any specific symptoms. However, there may be indicators of problems in blood sugar metabolism that can be seen years before the development of overt diabetes. Health-care professionals in the field of endocrinology are now routinely looking at these indicators in patients who are high risk for developing diabetes.
At the close of the DPP trial, investigators offered lifestyle intervention to all 3 groups. Patients in the original metformin group continued to take metformin (with participants unblinded to assignment); patients in the original lifestyle intervention group were offered additional lifestyle support.5 At a median follow-up of 10 years after initial enrollment in the DPP trial, metformin reduced the incidence of overt diabetes by 18% compared with placebo (95% CI, 7%-28%), and lifestyle intervention reduced it by 34% (95% CI, 24%-42%; no statistic of comparison supplied).
Even if you have not been told that you have prediabetes, you could be worried about it, since 90% of the people with prediabetes are unaware that they have it. You are at higher risk if you are over 45 years old, do not get much exercise, have a family history of diabetes, or are African American, Native American, Hispanic/Latino, or Pacific Islander.
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