Prediabetes & Type 2 Diabetes: A Growing Epidemic Prediabetes

• Comes before type 2 diabetes • Blood glucose higher than normal but not yet diabetes • Sometimes referred to as “borderline diabetes”; some say “sugar up a bit” • You can have prediabetes and not know it Diagnosing Prediabetes and Diabetes

Prediabetes  Fasting blood glucose: 100-125 mg/dL  OGTT: 140-199 mg/dL  A1c: 5.7-6.4%

Diabetes  Fasting blood glucose: 126 mg/dL or higher *  OGTT: 200 mg/dL or higher *  A1c: 6.5% or higher *

* On 2 different tests per the ADA 2019 Standards of Medical Care Risk Factors for Developing Prediabetes

 Being overweight  Age: 45 yrs. or older  Family history of type 2 diabetes  Physical inactivity  History of Gestational diabetes and/or baby weighing ≥ 9 lbs.  High blood pressure  Polycystic ovary syndrome (PCOS)  Ethnicity: African American, Hispanic/Latino, American Indian, Asian, Alaska Native, Pacific Islander Empower Yourself

Know your numbers!!!

ABC A1c or lab glucose Blood pressure Cholesterol Prevalence of Prediabetes

 84.1 million US adults

 33.9% of population

 Only 11.6% are aware that they have prediabetes

 If left untreated, progresses to diabetes at a rate of 15% to 30% per year→ Shocking!!! Prediabetes Risk Assessment

 https://www.youtube.com/watch?v=s020q-FE0H4 Diabetes Prevention Program (DPP) Research Study

 Lifestyle change program Loss of 5-7% body weight Physical activity ≥ 150 minutes/week

 Results (compared to placebo group) Reduced risk of getting type 2 diabetes by 58% in all ages Participants ≥ 60 years lowered their risk by 71% You Can Often Prevent or Delay Your Risk of Getting Type 2 Diabetes by:

Knowing your risk factors Knowing if you have prediabetes→ ask your provider Lose weight: 5-10% of your body weight Increase your activity: ≥ 30 minutes 5 days/week or 150 minutes a week Weight loss Diabetes Prevention Program at SJMC Prevent T2

 Free (starts June 5th)  CDC Lifestyle change program  Qualify  ≥ 18 yrs.  BMI: ≥ 25, ≥ 24 if Asian  No previous history of type 1 or type 2 diabetes AND one of the below:  Diagnosis of prediabetes by lab work (can be self reported)  History of gestational diabetes  Positive risk assessment for prediabetes Prevent T2 Program  16 weekly classes given over 1st 6 months, then bimonthly→ monthly classes the last 6 months  Each participant is given binder with weekly material, CalorieKing book, pedometer and eligible for drawings for prizes  Weekly requirements: private weigh-ins, track exercise and strongly encouraged to keep food log Goal of Program  Lose 5-7% of weight within 1st 6 months and keep off or lose more the remaining 6 months  Activity: 150 minutes or more/week  Prevent or delay type 2 diabetes Diabetes

What is Diabetes?

•Blood glucose (sugar) levels higher than normal •Not enough insulin to allow glucose to enter cells to be used for energy

Often you don’t know you have diabetes National Diabetes Statistics Report, 2017 CDC

 30.3 million people have diabetes = 9.4% of population

 23.1 million people are diagnosed

 7.2 million are undiagnosed

 23.8% of people with diabetes are undiagnosed

 An increase from 7.2% of population in 2015 to 9.4% in 2019

CDC predicts 1: 3 with have diabetes in 2050 Types of Diabetes

 Gestational diabetes  Occurs during pregnancy  50% of GDMs convert to type 2 diabetes within 10-20 yrs.  Type 1 diabetes  5-10% of population  Usually diagnosed in children and young adults but can occur in older adults  Autoimmune destruction of insulin producing cells, requires insulin to live  Type 2 diabetes  Most common form, 90-95% of population, related to lifestyle→ overweight & inactivity  There is not enough insulin and/or the insulin is not being used as well as it used to→ insulin resistance Diabetes Symptoms (none but as BS increases can get the following symptoms)

 Excess thirst: wake up with dry mouth, as time goes on drinking more  Excess urination  Less energy  Blurred vision  Women→ vaginal yeast infections  Reoccurring infections  Men→ ED Complications  Can cause damage to ALL body organs, often without you knowing it  Can effect head → toes Type 2 Diabetes is Devastating

 Diabetes is the 7th leading cause of death in the U.S.

 Costs: Direct and indirect cost of diabetes in 2012: $245 billion and continues to grow at rapid pace Management of Diabetes

 Eat healthy diet  Maintain healthy weight  Be active: at least 150 minutes/week  Medications  Type 1: insulin: multiple injections/daily or insulin pump  Type 2: none→ oral medications→ oral medication & non-insulin injectables→ insulin  Monitor Blood Sugar (ADA BS targets for most but should be individualized)  Fasting/before meals: 80-130  2 hrs. after start of meal: < 180 mg/dL  A1c < 7%  BP < 140/90  Cholesterol levels on target You Can Manage Diabetes

Get the support you need Healthcare provider Diabetes Self-Management Education Organizations: ADA, AADE, CDC Support Groups Family

This Photo by Unknown Author is licensed under CC BY-ND Diabetes Prevention: Healthy Diet and Exercise Goals for Prevention through Lifestyle

• Aim for a healthy weight • Weight loss of 7-10% of body weight (if overweight or obese) • Increase physical activity to at least 150 minutes per week of moderate-intensity exercise such as walking • Results from the Diabetes Prevention Program confirm that lifestyle modification was nearly twice as effective as medication in diabetes prevention Aim for a healthy weight

BMI Classification

18.5 – 24.9 Normal weight 25.0 – 29.9 Overweight 30.0 – 34.9 Class I obesity 35.0 – 39.9 Class II obesity 40.0 or greater Class III obesity Normal weight Overweight Obese General Tips for Weight loss

• Don’t skip meals! • Stop eating when you are full • Drink plenty of calorie-free drinks • Pick lean meats, low-fat or fat-free dairy • Bump up the fiber • Cut back on sugar • Limit alcohol General Tips for Weight loss

• Plan meals ahead of time • Navigate the grocery store wisely • Try cooking methods that cut calories • Store extra food (for leftovers) immediately after cooking • Don’t go to the grocery store or cook while hungry!! Mealtimes

• Drink a glass of water before you eat • Use smaller plates, bowls, glasses, and serving spoons • Do not put serving dishes on the table (“family style”) • Eat slowly • Enjoy fruit for dessert instead of cake, pie, or other sweets. Snacking

• Plan ahead • Keep low-calorie snacks in a special part of the refrigerator • Reduced-fat string cheese, low-calorie yogurt, and fat-free milk. • Washed, bite-size pieces of raw vegetables, such as carrots, celery, pepper strips, cucumbers, broccoli, and cauliflower. Serve with low-calorie dips. • Fresh fruit. Eating and Emotions

• Call a friend for support. • Use inspirational quotes to help you avoid the temptation to eat. • Take a warm bath or shower. • Listen to music or a relaxation CD. • Take a walk. • Try activities that keep you from eating. For example, it’s hard to eat while you’re exercising. If you are gardening, you probably won’t eat while your hands are covered in soil. Weight Loss Cooking Tips • Carbohydrates • Choose whole grains. • Reduce the amount of sugar in recipes; it can often be cut in half. • Use non-caloric sweeteners in drinks • Dried peas, beans, and lentils are rich in fiber and are a good meat substitute. Weight Loss Cooking Tips

• Proteins • Choose fish higher in Omega 3’s • Choose lean cuts of pork and beef • Cut away fat and remove skin from chicken and other poultry • When scrambling eggs, throw away some of the yolks to reduce the calories in your meal. All the fat and most of the calories are in the yolks. • Have some meatless meals. Substitute beans, egg whites, tofu Weight Loss Cooking Tips

• Fats • All fats and oils are high in calories • Select low fat or fat free cheese and milk products • Flavor with lemon juice or herbs instead of butter, margarine, or oil • Choose reduced-fat salad dressings Cooking Methods

• Sauté foods in a small amount of wine, broth, or juice instead of using fat or oil. • Bake, broil, grill, roast, or stew instead of frying in fat. • Place meat on a rack while cooking so grease will drain off. • When making stews or soups, refrigerate the broth and skim hardened fat off the top before reheating and serving. • Use a nonstick cooking spray • Use a nonstick skillet. Less or no oil is required to prevent sticking. Exercise Benefits

• Burns extra body fat • Strengthens muscles and bones • Lowers blood pressure • Lowers LDL (“lousy”) cholesterol • Raises HDL (“healthy”) cholesterol • Improves blood flow • Makes heart disease and stroke less likely • Boosts energy and mood • Helps with stress How Much Exercise?

• Talk to your doctor before starting any exercise! • Recommendation for adults with pre-diabetes or diabetes • 150 minutes of moderate intensity exercise per week • Brisk walk, biking, swimming • OR 75 minutes of vigorous activity per week • Jogging or running, shoveling, digging, biking (uphill), dancing • Resistance exercise is recommended 2 times per week • Weights, crunches, resistance bands Track Your Steps

• Another approach: • 10,000 Steps Program Thank you!

Nutrition & Diabetes Center St. Joseph Medical Center 410-337-1382