Zoe Schilling
PharmD. Candidate, 2022
8/31/21
Among the United States population, it is estimated that 34.2 million people of all ages, or 10.5% of the US population in 2018 had a diagnosis of diabetes. Keep in mind that does not even represent those without a diagnosis. Diabetes rates are also increasing every year! To analyze even further, approximately 88 million American adults, or about 33% of the US population have prediabetes.
If you were recently diagnosed with prediabetes, do NOT be scared. You’re not alone and Zoe wants to help you go back to a normal diagnosis. Let’s start with some education.
What is prediabetes:
This is the most common metabolic disorder. Basically, your blood sugar levels are too high over a period of time. This can be very serious and progress to other disease states, but most importantly, being prediabetic is reversible. You can prevent or delay the progression from developing into type 2 diabetes through dietary and fitness lifestyle changes.
(This is where Zoe can greatly help you!)
In general, prediabetes is most commonly diagnosed based on two tests: hemoglobin (A1C) and the impaired glucose tolerance test.
A1C: This test shows your average blood sugar level for the past three months. The test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells called hemoglobin. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level below 5.7% is considered normal. An A1C level between 5.7% and 6.4% is considered prediabetes. An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes.
Impaired glucose tolerance test: A blood sugar level less than 140 mg/dL is considered normal. A blood sugar level from 140 to 199 mg/dL is considered prediabetes. This is sometimes referred to as impaired glucose tolerance test. A blood sugar level of 200 mg/dL or higher can indicate type 2 diabetes.
What does Type 1 versus Type 2 mean?
Diabetes is the metabolic condition in which the body does not properly process food for use as energy. Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. However, with diabetes, there is an impaired response to this process of converting our food to energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies.
Type 1 Diabetes Mellitus (T1DM) occurs when your immune system, the body's system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. People are often born with T1DM and unfortunately, they will need lifelong medications to control for their bodies lack of ability to make insulin.
On the other hand, Type 2 Diabetes Mellitus (T2DM) is typically developed later in life and is largely due to diet and lifestyle. In these patients, their bodies still make some insulin, but it is very little and impaired, as compared to the normal healthy individual. T2DM is more common in the United States and can be well-controlled through oral and/or injection type medications in addition to diet and exercise interventions. There is no known cure for type 2 diabetes. But it CAN be controlled. And in some cases, it goes into remission. For some people, a diabetes-healthy lifestyle is enough to control their blood sugar levels.
How can I control T2DM or REVERSE my prediabetes?
I’m glad you asked! The first step is by educating yourself.
Nutrition. Exercise. But most importantly, MINDSET.
The first step is by adopting a positive mindset, focus on your goals and find your motivation. You can truly accomplish anything because the mind is SO POWERFUL.
Both diet and exercise are extremely important in reversing prediabetes or controlling a T2DM diagnosis. However, if we were to weigh which is more important, then nutrition would win. You can exercise for an hour or two every day, but if you are eating high carbohydrate content, sugary foods that are not nutrient dense, then you will not be lowering you sugar levels or losing weight. “Nutrition is King.” (Exercise is still Queen though).
What is Carbohydrate Counting?
Carbohydrates often get a brain reputation. Carbs are not necessarily the enemy; in fact your brain NEEDS carbs to function and go about everyday life. Carbs are found in almost EVERY food! (Fruits, vegetables, pasta, bread, potatoes, rice, dairy, many more!) However, some foods contain more carbohydrates than others. This is where carb counting plays a major role in managing diabetes.
The main three macronutrients we obtain from our diet are carbohydrates, proteins, and fats. This is why many people “count their macros.” Here is an awesome tool to help you analyze your macros:
Simply type in the food you wish to eat and the protein, carb, and fat content will tell you how many grams are contained in one serving.
My favorite calorie counting / macro counting app is defiantly “My Fitness Pal” (FREE in the app store). I often ask my clients to log a food journal so I am able to get an idea of how many carbohydrates and protein macronutrients they are consuming.
Tracking calories consumed will also help YOU be more AWARE of what you are putting into your body and help you to focus on “nutrient-dense” foods that nourish your body and keep you feeling fuller longer.
How do I “count carbs:”
There are two items on the nutrition facts label that you’ll want to pay attention to when carb counting:
Serving size. The serving size refers to how much a person usually eats or drinks, and all the information on the label is about this specific amount of food. If you eat more, you will need to account for the additional nutrients. For example, eating two or three servings of something, means you will need to double or triple the amount of grams of carbs (and all other nutrients) on the label in your calculations.
Grams of total carbohydrate. This number includes all carbs: sugar, starch and fiber. That’s right: You don’t have to worry about adding on grams of added sugars—they’re included in the number of total carbs!
(It is best to work with a registered dietician or nutrition coach to provide you with the tools and education to be successful with this process)
**Refer to “How to Read a Food Label” Blog for full information on other nutrients and interpretation
If this is overwhelming, let’s try a different approach.
One serving of carbs is about 15g (half-fist)
The following foods have ONE serving of carbohydrates:
Starches
• 1 slice bread (1 ounce)
• 1 tortilla (6-inch size)
• ¼ large bagel (1 ounce)
• 2 taco shells (5-inch size)
• ½ hamburger or hot dog bun (1 ounce)
• ¾ cup ready-to-eat cereal
• ½ cup cooked cereal
• 1 cup broth-based soup
• 4-6 small crackers
• ⅓ cup pasta or rice (cooked)
• ½ cup beans, peas, corn, sweet potatoes, winter squash, or mashed or boiled potatoes (cooked)
• ¼ large baked potato (3 ounces)
• ¾ ounce pretzels, potato chips, or tortilla chips
• 3 cups popcorn (popped)
Fruit
• 1 small fresh fruit (4 ounces)
• ½ cup canned fruit
• ¼ cup dried fruit (2 tablespoons)
• 17 small grapes (3 ounces)
• 1 cup melon or berries
• 2 tablespoons raisins
Dairy
• ½ cup fruit juice Milk
• 1 cup fat-free or reduced-fat milk
• 1 cup soy milk
• ⅔ cup (6 ounces) fat-free yogurt sweetened with sugar-free sweetener
Sweets and Desserts
• 2-inch square cake (unfrosted)
• 2 small cookies (⅔ ounce)
• ½ cup ice cream or frozen yogurt
• ¼ cup sherbet or sorbet
• 1 tablespoon syrup, jam, jelly, table sugar, or honey
• 2 tablespoons light syrup
Other Foods
• Count 1 cup raw vegetables or ½ cup cooked nonstarchy vegetables as zero carbohydrate servings or “free” foods. If you eat 3 or more servings at one meal, count them as 1 carbohydrate serving.
• Foods that have less than 20 calories in each serving also may be counted as zero carbohydrate servings or “free” foods.
• Count 1 cup of casserole or other mixed foods as 2 carbohydrate servings.
Sources:
Carb Counting and Diabetes. Carb Counting and Diabetes | ADA. https://www.diabetes.org/healthy-living/recipes-nutrition/understanding-carbs/carb-counting-and-diabetes. Accessed August 31, 2021.
Carbohydrate Counting: A Practical Meal-Planning Option for People With Diabetes
Karmeen D. Kulkarni | Clinical Diabetes Jul 2005, 23 (3) 120-122; DOI: 10.2337/diaclin.23.3.120
Prediabetes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/prediabetes/diagnosis-treatment/drc-20355284. Published September 22, 2020. Accessed August 31, 2021.