Learn how the four healthy pillars of managing diet, exercise, sleep habits, and stress can significantly reduce your chance of developing prediabetes or progressing from prediabetes to diabetes.

1. Pre-Diabetes & Diabetes
Are You at Risk?
Margaret Eckler, MS, RD, CDE
Mary Friesz, PhD, RD, CDE
Roger Warn, MS, RD, CDE

2. What is pre-diabetes?
• Pre-diabetes is a condition where blood
glucose levels, or the hemoglobin A1C, is
higher than normal but not high enough
to be classified as diabetes.

3. What’s blood glucose?
• Glucose is not a bad thing – it is the body’s main
energy source – it becomes “bad” when there’s
too much in the blood
• Insulin is required in order for cells to get
glucose from the blood
• If there is not enough insulin or the insulin
does not work as well, glucose stays in the
blood resulting in higher than normal blood
glucose levels

4. Why is pre-diabetes something
to be worried about?
• 86 million people (35% of the US population) have
pre-diabetes
• Of these 86 million, up to 30% will develop type 2
diabetes within 5 years
• And if that’s not bad enough……
 Those with pre-diabetes have a increased risk of
heart disease & stroke
& believe it or not …. 9 out of 10 people with
pre-diabetes do not even know they have it!

5. Why are so many people at risk
for pre-diabetes & diabetes?

6. Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

7. Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

8. Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

9. 1999
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2009
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

10. Why focus on pre-diabetes?
• Those with pre-diabetes make up a very
large group
• When one has pre-diabetes, the time is
ripe for intervention
• Education is key……

11. Risk factors for pre-diabetes
• Being overweight (#1 factor)
• Family history of diabetes
• Over 45 years of age
• High blood pressure
• Being sedentary
• History of gestational diabetes
• History of PCOS
• Certain ethnicities (African American, American Indian,
Hispanic, Asian American or Pacific Islander decent)

12. Are YOU at Risk?
Add up your points on the following risk factors
to determine whether you are at risk of
developing Type 2 diabetes……..

13. How old are you?
Younger than 40 years (0 points)
40—49 years (1 point)
50—59 years (2 points)
60 years or older (3 points)

14. Are you male or female?
Male (1 point) Female (0 points)

15. For women only
Have you ever been diagnosed with
gestational diabetes or had a baby that
weighed more than 9 pounds at birth?
Yes (1 point) No (0 points)

16. Your Family History
Do you have a mother, father, sister, or
brother with diabetes?
Yes (1 point) No (0 points)

17. Your Blood Pressure
Have you ever been diagnosed with high
blood pressure/hypertension?
Yes (1 point) No (0 points)

18. Your Activity Level
Are you moderately active; do you exercise
for at least 30 minutes on most days of the
week?
Yes (0 points) No (1 point)

19. What is your weight?
Height Weight (lbs.)
4’ 10” 119-142 143-190 191+
4’ 11” 124-147 148-197 198+
5’ 0” 128-152 153-203 204+
5’ 1” 132-157 158-210 211+
5’ 2” 136-163 164-217 218+
5’ 3” 141-168 169-224 225+
5’ 4” 145-173 174-231 232+
5’ 5” 150-179 180-239 240+
5’ 6” 155-185 186-246 247+
5’ 7” 159-190 191-254 255+
5’ 8” 164-196 197-261 262+
5’ 9” 169-202 203-269 270+
5’ 10” 174-208 209-277 278+
5’ 11” 179-214 215-285 286+
6’ 0” 184-220 221-293 294+
6’ 1” 189-226 227-301 302+
6’ 2” 194-232 233-310 311+
6’ 3” 200-239 240-318 319+
(1 Point) (2 Points) (3 Points)
If you weigh less than the amount in the left column (0 points)

20. How Did You Score?
If you scored 5 or higher:
You are at increased risk for having type 2
diabetes. However, only your doctor can tell for
sure if you do have type 2 diabetes or pre-
diabetes. Talk to your doctor to see if additional
testing is needed.

21. How to know for sure….
Normal Pre-Diabetes Diabetes
Fasting Glucose <100 100 to 125 126 +
Hemoglobin A1C <5.7 5.8 to 6.4 6.5 +

22. The Good News
• The progression from pre-diabetes to
diabetes is not inevitable
• People may be able to prevent or at least
delay the development
BUT …..
It does require some work….

23. Nothing Comes Easy
• What are the 3 most important things
one can do to help prevent – or at least
delay – the development of Type 2
Diabetes??

24. #1 Decrease food intake
• Eat fewer calories to lose weight – ie: eat
smaller portions than you are use to
• Make ½ your plate vegetables, with fruit
sparingly, to help fill your belly with fewer
calories
• Ditch the “sugar water” – your body loves
water best

25. Use the Plate!
• Fill half of the plate
with BRIGHT,
COLORFUL
vegetables/salad
• ¼ Lean Protein
(use your palm)
• ¼ Starch or Grains
(a fist full)
• NO second helpings

26. Why weight loss is a key
• If one is overweight, losing just 5 to 7% of body
weight can help prevent (or at least delay)
Type 2 Diabetes
 5 to 7% is just 10 to 14 lbs. for someone who weighs
200 lbs.

27. #2 Choose your foods wisely
Choose healthy foods more often
 Build meals around more vegetables, whole
grains, legumes, fish, lean meats & skim dairy
products
 Limit added fats (ie: butter, margarine, mayo,
cooking oils); instead choose healthy fats in
moderation (nuts, olives, avocado)
 Limit simple sugars (ie: juice, soda, sweet
drinks)
 Limit processed foods; choose foods closer to
their natural states

28. Be aware
Be more aware of portions
 Monitor portion sizes conducive to weight
loss
Compare food labels to help you pick the
healthier options in their appropriate
portions

29. Size it Up
• 2-3 cups = size of your open hands (salad, raw
veggies)
• 1 cup = size of a baseball (potato/rice/pasta,
cooked veg
• 2 T = size of a golf ball (dips, whipped topping)
• 1T = size of a small thumb (salad dressing,
spreads)
• 3 ounces = size of a deck of cards

30. #3 Be more active
• If you already have an exercise program, try to
maintain it
• If you do not exercise regularly, check with
your doctor first
• Start gradually

31. Exercise Can Help You
• Control blood sugar levels
• Increase metabolic rate – burn more calories
• Reduce stress
• Increase energy
• Look better
• Reduce medication requirements
• Save money
• Increase enjoyment of life !!

32. • Choose an activity (example: brisk walking)
• Set a long-term goal - at least 30 minutes a day, 3-5
days a week
• Buy comfortable walking shoes
• Make an appointment for you
& your exercise
• Get a partner, if necessary
Getting Started

33. Be more active
• Doing just 30 minutes of walking daily can help
big time!
• Have difficulty walking? Try arm chair
exercises, marching in place, & water exercises
**No more excuses – Just do something! 

34. Exercise Options
• Brisk walking (talk/sing test)
• Stair climbing
• Exercise equipment
• TV show or exercise DVD
• Dancing
• Wii Fit or active video games
• Water walking or swimming
• “Chair” exercise using light weights, bands, etc.

35. Stay Motivated
• Remind yourself of the benefits
• Think “I want to”, not “ I have to”
• Have a variety of choices
• Enlist a partner
• Set realistic goals, with rewards
• Make it a lifestyle

36. • Okay – now it’s your turn…..

37. Diabetes is caused by:
• Eating too much sugar & carbohydrates
• Being overweight & sedentary
• Catching it from someone else
• A virus
• It’s in your genes

38. When someone has diabetes:
• His/her pancreas has stopped making insulin
• His/her liver is making too much sugar
(glucose)
• His/her insulin is not working properly
• He/she has insulin resistance

39. Risk Factors for Diabetes:
• Family history, getting older, high blood
pressure
• Being Hispanic, high triglycerides,
underweight
• Drinking alcohol, smoking, not getting enough
sleep
• Being overweight, being over 40, having a fair
complexion

40. Signs of High Blood Glucose
• Weight gain & blurry vision
• Weight loss & excessive tiredness
• Hair loss & frequent urination
• Dry mouth & skin rashes

41. True or False?:
• “Borderline” diabetes is not too serious
• Diabetes increases the risk for heart attack
• A person can have hyperglycemia (high
glucose levels) but not have diabetes
• People with diabetes should avoid all
sweets

42. The Best Ways to Manage Diabetes:
• Medications
• Herbs & supplements
• Meal planning & exercise
• Fluids & rest

43. True or false ?
• Only people who have a family history of
diabetes need to be tested
• People diagnosed with pre-diabetes are not
very likely to get diabetes
• You have diabetes when your blood sugar
level is higher than 140

44. Questions?