The simple five point plan to help you avoid avoid prediabetes… and it doesn’t involve a punishing exercise regime
A diagnosis of prediabetes can come as a shock, particularly if you haven’t ever considered you might need to lose weight. But it also presents you with an opportunity.
It is not inevitable that everyone with prediabetes will go on to develop type 2 diabetes – the evidence overwhelmingly proves that by making diet tweaks, losing weight if needed and getting more active, you can not only slash your risk but also improve your health overall.
The good news is that it doesn’t have to involve starving yourself on a strict diet or denying yourself the foods you love. All the experts agree that making small, simple changes to your daily routine, and sticking with them, is often all that’s required.
Here are five top tips to turn around prediabetes.
1: Knowing your numbers will set you on the right path
The first step is to recognise whether you’re in the at-risk bracket. For most of us, it’s excess weight that will cause our blood glucose levels to start to rise, which means having a body mass index (BMI) score of over 25 if you’re white, or 23 if you’re Asian..
BMI is a weight versus height formula that doctors use to work out whether a person is carrying excess fat. But there are other factors too, including whether you have a close family member with type 2 diabetes, your age, ethnicity and whether you have high blood pressure.
The simplest way to work out your prediabetes and type 2 diabetes risk is by completing Diabetes UK’s Know Your Risk calculator (diabetes.org.uk). You’ll need to know your weight and height – it uses these to calculate your BMI – and your waist measurement and at the end it will give you a risk score from 0 to 47. A score over 25 is high risk, and between 16 and 24 is moderate. In both cases it will recommend that you see your GP to take a diabetes blood test.
One of these, known as a fasting plasma glucose test, involves eating nothing and drinking nothing except water for eight to ten hours before a sample of blood is taken. Those with prediabetes will have a higher than normal reading.
BMI is a weight versus height formula that doctors use to work out whether a person is carrying excess fat. But there are other factors too, including whether you have a close family member with type 2 diabetes, your age, ethnicity and whether you have high blood pressure
Blood sugar is measured in millimols per litre, which is written mmol/l – but most people just remember the number.
A result from 5.5 to 6.9 indicates prediabetes, and over seven generally means type 2 diabetes – but this test gives only a snapshot of blood sugar at that moment.
A better indicator is a blood test known as HbA1c (see Page 53). This gives a person’s average blood sugar levels over the preceding two to three months. The test looks for what is known as glycated haemoglobin, a compound created when glucose in the circulation sticks to red blood cells, and the result can tell doctors if you have prediabetes or type 2.
What we also know is that you don’t have to be overweight to be at risk of type 2.
Research shows that 13.5 per cent of people who have a normal BMI, who would be less likely to be picked up by risk calculators, also have poor glucose control, which is linked to where they store their body fat.
It’s well established that the greatest risk comes from so-called ectopic fat, which is stored in the liver and pancreas.
To check how well you’re controlling your blood sugar, you can ask your GP for a blood test. Or you could buy a do-it-yourself HbA1c kit from a pharmacist or online. This involves using a lancet to take a blood sample from your finger. Just like Covid at-home PCR kits, the samples have to be sent to a laboratory and the results will be available within a couple of days.
However, the kits should not be used to replace official tests.
For a definitive diagnosis, see your GP.
2: Get with the programme
If blood tests show you have prediabetes, your GP can refer you to the free Healthier You NHS Diabetes Prevention Programme. More than a million people have now been referred to the programme, which involves attending local groups for support and advice on eating, exercise and lifestyle changes. It’s also possible to do it remotely using video calls.
You can also refer yourself, via a web form, without a blood test result, if the risk calculator on the website (preventing-diabetes.co.uk) flags you up as moderate or high risk.
Since its launch in 2016, the programme has reduced the number of new type 2 diagnoses across the country by seven per cent. ‘If you feel you might be at risk, do the risk score, or get checked out at the GP surgery or take a test, and if you are at risk get referred on to the programme,’ says NHS England diabetes chief Professor Jonathan Valabhji.
‘We’ve got capacity and we know it works.’
3: Find a way which works for you
Experts are unanimous: the best way to reduce your risk of diabetes is to lose about five per cent of your body weight.
And how you do that, they also agree, doesn’t matter – it’s about finding something that works for you and that you can stick to.
The UK Health Security Agency says the average adult consumes about 300 calories more a day than the recommended totals – 2,500 a day for men and 2,000 for women.
In general, if you cut 500 to 1,000 calories a day from your typical diet, you’ll lose about 1 lb a week.
According to Prof Valabhji: ‘In my own clinical practice, I’m not in any way dictatorial about the kind of diet people should follow. And I’m aware that some diets work really well for some people and not so well for others.’
In general, if you cut 500 to 1,000 calories a day from your typical diet, you’ll lose about 1 lb a week
The best evidence shows that while low-carb or low-fat plans do shift weight fast, they have no advantages over other methods in the longer term and are harder to maintain with high drop-out rates.
There is also some evidence that very low-carb diets – often recommended for reducing diabetes risk because of an unproven theory that carbs raise the amount of insulin in the body – can increase cholesterol and therefore heart disease risk because more of your calories come from fat.
The groundbreaking DiRECT trial proved it was possible to put type 2 diabetes into remission by losing up to 33 lb by following a strict low-calorie diet. But it has proved hard for some to stick to. It involves 12 to 20 weeks consuming just over 800 calories a day using meal-replacement shakes, before beginning a ‘maintenance phase’ on a healthy, Mediterranean-style diet.
Half of the participants were in remission from type 2 diabetes – not needing medication – after two years.
But four years on, the latest evidence shows almost two-thirds of them gained weight after returning to normal food.
The best way to approach weight loss for those in the prediabetic range is by making ‘small, sustainable changes’ to your normal diet, says Glasgow-based obesity expert Professor Naveed Sattar.
He says: ‘Stop having sugar in your tea, or having syrup in your takeaway coffee.
‘If you have a daily biscuit or cake with a cuppa, you don’t have to cut them out altogether, but reduce them by half.’
He admits he’s trained himself to just have a single finger of KitKat.
University of Oxford diabetes researcher Dr Nicola Guess adds: ‘One practical thing most people could do is just not have an afternoon snack. It’s such a habit – we’re not actually hungry but we go and grab a biscuit or some crisps to keep us going.
‘Cut out these behaviours and you’ll have an impact over the course of weeks and months.’
Include protein two to three times a day to keep you feeling full. That can include lean meat, fish, eggs and beans, says dietician Nicola Clarke of NKC Nutrition.
And fill up on foods high in fibre by switching from white to wholegrain bread, or from white to brown rice, and by including lots of vegetables, salad and fruit.
And don’t avoid carbs, she adds. ‘They are not the enemy and provide you with important energy. By choosing foods such as brown rice, sweet potato, bulgur wheat, yam, rye or sourdough bread, you’ll keep your blood sugar steady.’
She also recommends gradually reducing your portion size. ‘You must allow your body to adapt to smaller amounts.
‘If you need to snack after a meal, it’s a sign you may not have eaten enough. Fill your plate with more vegetables or add beans or pulses to bulk it out.’
Dietician Douglas Twenefour, Diabetes UK’s deputy head of care, says: ‘Weight loss is important, but there’s also good evidence that some foods can be protective while others are less healthy. We know that sugary drinks, energy drinks, refined carbohydrates – so cakes, biscuits, pizza, chips, that sort of thing – red meat and processed meat are associated with risk of type 2 diabetes.
On the other hand, foods associated with lower risk are fruits and vegetables, especially green leafy vegetables, whole grains and dairy like cheese and yogurt.
‘What’s important is finding the approach that’s right for you to help you reduce the amount of calories you’re consuming to lose weight.’
4: Try walking it off
The crucial next stage is to sustain any weight loss, and the best way to do that is by being more active.
It not only helps keep weight off but it improves muscle mass and can improve the way the body uses insulin, helping keep blood sugar levels lower.
But it needn’t be all that much. Prof Sattar says: ‘Can you walk an extra 500 steps a day, which is only about five minutes’ walking? That’ll help maintain and strengthen your muscle mass, you’ll sleep better – which will help restrain your appetite – and your mental health will improve.’
Current guidelines suggest that adults need at least 150 minutes of moderate-intensity exercise a week to stay healthy. That should involve both aerobic activity and strengthening exercises.
Studies show that blood glucose levels fall during exercise and for up to 72 hours afterwards, so it’s important to do it regularly.
Current guidelines suggest that adults need at least 150 minutes of moderate-intensity exercise a week to stay healthy. That should involve both aerobic activity and strengthening exercises
But you don’t have to suddenly take up jogging or yoga. It can be as simple as getting off the bus one stop early or parking further away and briskly walking to your destination, doing some extra gardening or going for a swim. Even housework counts.
‘If someone calls you, go for a walk while you’re on the phone rather than sitting down,’ says Douglas Twenefour. ‘It all adds up.’
The Healthier You NHS Diabetes Prevention Programme recommends individuals add ‘variety and enjoyment’ to their exercise plans, which could mean not always walking or jogging the same route, or listening to a podcast or music. Studies have shown that involving a friend or relative can help keep you motivated, too.
Most smartphones have features that allow you to track how many steps you take in a day, so you could set a target and stick to it.
5: Keep calm and carry on
While stress itself doesn’t cause diabetes, some research suggests it can raise your blood sugar. This is because, when you’re stressed, your body releases the hormones cortisol and adrenaline to prepare you for ‘fight or flight’, which makes you feel alert.
But these hormones might make it harder for insulin to work, which means that the body isn’t absorbing sugar from the bloodstream as well as it should.
Researchers from the University of Birmingham are looking at whether high levels of these stress hormones might interact with body fat to stop insulin-producing cells in the pancreas from working properly.
The evidence for these effects isn’t strong, but people with prediabetes may still benefit from various mindfulness techniques and breathing exercises to avoid stress building up, and strategies are taught as part of the Healthier You NHS Diabetes Prevention Programme.
Researchers from the University of Birmingham are looking at whether high levels of these stress hormones might interact with body fat to stop insulin-producing cells in the pancreas from working properly
This might involve going for a walk without your phone or other distractions and focusing on the surroundings, or choosing a regular time where you sit somewhere quietly with your eyes closed while you slowly breathe in and out, counting to five every time.
It may also help you sleep, and if you’re less tired you’re also less likely to reach for a sugary treat.
The optimum sleep window is between six and eight hours – those who sleep more or less than this have been found to have elevated levels of blood sugar.
Most importantly, don’t get discouraged. Change your goals if necessary and aim for small wins.
As Prof Sattar says: If at first you don’t succeed, try and try again.’
Could you be eligible for weight-loss drugs?
Since October 2020, some overweight NHS patients with prediabetes have had a daily injection of a drug that curbs appetite.
The medicine, liraglutide, slows the emptying of the stomach, keeping them full for longer, while also increasing insulin production to help clear sugar from the blood.
Patients inject themselves in the stomach, thigh or upper arm at the same time every day.
Studies have shown that it can help overweight people lose up to ten per cent of their body mass in six months.
But patients must meet strict criteria to qualify for the drug. Only those with other conditions that compromise heart health, such as high blood pressure or high cholesterol, can get access to it, and their body mass index must be in the obese category of 35 or over. Also, only diabetes specialists can prescribe it, so most patients will have had to have exhausted lifestyle-based interventions first.
If patients haven’t lost at least five per cent of their body weight after three months, they must stop taking the drug, according to guidelines from health watchdog NICE.
Ewan Pearson, professor of diabetic medicine at the University of Dundee, says ‘there is a place for drugs’ in helping people lose weight.
He adds: ‘We shouldn’t dismiss drug treatment. It becomes a very expensive option, but the drug treatment for weight loss now is pretty impressive. Mostly in the context of diabetes, but even just purely in the context of obesity and weight reduction.
‘There are some amazingly effective drugs now causing weight loss. So it may be that drug treatment is right for some people, particularly if they don’t respond to diets, because the point is to just get the weight off in the best way for them.
‘There are some amazing results in people with diabetes using drugs which cause weight loss and switch off appetite. These might be people who’ve struggled with their weight for years. They don’t work for everybody, but we’ve been looking at why in our latest research.’
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