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Food for Thought Food for Thought

Reduce Your Risk for Pre-Diabetes

October 23, 2014

By Erin Krzeski, B.S.
Brigham and Women's Hospital

There's a good chance you know a family member, friend or acquaintance who is struggling with diabetes. According to the Centers for Disease Control and Prevention, 25.8 million people — 8.3% of Americans — are affected by diabetes. Research also suggests that there are over 79 million people in the United States who have pre-diabetes.

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What is Pre-Diabetes?

Pre-diabetes is a condition in which a person's blood sugar levels are higher than normal. They're not high enough to be considered diabetes. But they increase your risk for diabetes.

Blood sugar tests diagnose pre-diabetes. Your doctor will use one of two tests:

  • Fasting glucose – Pre-diabetes is between 100 and 125 milligrams per deciliter (mg/dL).
  • Two-hour oral glucose – Pre-diabetes is between 140 and 199 mg/dL.

An elevated hemoglobin A1C (HgbA1C) in the range of 5.7% to 6.4% is also an indicator of pre-diabetes.

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Tests To Check for Pre-Diabetes?

Here's a guide to the tests that doctors use to diagnose pre-diabetes.

Impaired Glucose Tolerance: A blood sugar level that is 140-199 mg/dL after a two-hour oral glucose tolerance test

Impaired fasting glucose: A blood sugar level that is 100-125 mg/dL after an overnight fast

Hemoglobin A1c (HbA1c): A blood test that gives an average amount of glucose in the blood over the past three months

Oral glucose tolerance: A blood test that checks the blood glucose level after an overnight fast and again two hours after drinking a glucose-rich drink

Fasting plasma glucose: Requires fasting overnight and a person's blood glucose is checked in the morning before eating.

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Risk Factors

The risk factors for pre-diabetes and ultimately, type 2 diabetes include:

  • Being overweight or obese
  • Being age 45 or older
  • Physical inactivity
  • Family history of diabetes
  • Being African American, Alaskan, American Indian, Asian American, Hispanic/Latino or Pacific Islander
  • A history of gestational diabetes (diabetes during pregnancy)
  • High blood pressure –140/90 mmHg or above
  • Low levels of HDL ("good" cholesterol) – below 35 mg/dL
  • Triglyceride level above 250 mg/dL
  • Polycystic ovary syndrome
  • A history of heart disease

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Changes You Can Make

You can't change your race, age and family history of diabetes, but there are many risk factors you can control.

Studies show that 50% of the people who have pre-diabetes are likely to develop type 2 diabetes. However, you can decrease your risk as much as 58% by losing 7% of your body weight (that's 15 pounds for a 200-pound person) and exercising moderately (brisk walking) 30 minutes a day, five days a week.

Other things you can do to get your blood sugar under control include:

  • Eating more fruits and vegetables
  • Not skipping meals

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Balance Your Carbs and Protein

It's important to get the right balance between carbohydrates and protein in your meals and snacks. This allows the carbohydrates to be more slowly absorbed into the blood stream and prevent rapid spikes in blood sugar levels.

Choose whole-grain products (i.e. brown rice, whole grain bread, whole-wheat pasta) over processed grains (i.e. white rolls, bread, bagels and white rice). The fiber in whole-grain products acts to slow the absorption of sugar into the blood as well.

Avoid concentrated sugars (soda, candy, juice). They spike blood sugar quickly. The excess sugar that the body can't use is then stored as fat in the form of triglycerides.

For breakfast, aim for 50% of calories from protein and 50% from fruit and carbohydrate.

For lunch and dinner, aim for 50% of calories from vegetables, 25% from protein and 25% from carbohydrate. Here are some sample meals:



Carbohydrates (grams)

Protein (grams)

2 scrambled eggs, 2 pieces of whole-wheat toast
2 slices of low-fat cheese, an English muffin


3 ounces of lean ground beef, 1 cup of whole-wheat pasta with 1 cup of tomato sauce with veggies
3 ounce salmon filet, ½ cup brown or wild rice, 1 cup cooked asparagus

Finding healthy snacks is always a challenge. Many snack foods consist of only carbohydrates. Here are some healthy balanced snacks to keep your blood sugars under control throughout the day.



Carbohydrates (grams)

Protein (grams)

Medium apple with 2 tablespoons of peanut butter
Greek yogurt (flavored) with 1 ounce of walnuts
String cheese, ½ cup of cantaloupe
½ cup of low-fat cottage cheese with ½ cup of strawberries

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Erin Krzeski is a dietetic intern at Brigham and Women's Hospital. She graduated from Virginia Tech with a B.S. in Dietetics and a M.S. in Human Nutrition, Foods and Exercise with a concentration in Behavioral and Community Nutrition.


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