Pre-diabetes and Diabetes

*Note: The information below is specific to Type II Diabetes. Type I Diabetes has a completely different mechanism and is managed very differently.

Can You Relate?

So, you got your labs done and you were shocked to hear that you are either pre-diabetic or diabetic. You know people with diabetes, maybe in your own family, but you’ve always eaten a healthy diet and never thought you’d hear your doctor say those words! You may have been offered a medication to help control your blood sugar. You likely got some generic advice like “eat less sugar” and “start exercising regularly”, but you have more questions. For starters, what in the world is an “A1c”? Naturally, you go home and look online for more tips on how to turn things around.  You probably have questions, including:

• What should I eat?
• How much should I eat?
• What types of exercise should I do?
• How quickly can I fix this?
• Can I ever be “cured” from diabetes?
• Will the medication actually help?
• Will I be on medication forever?

I’m glad you found us. Let’s go through your questions in detail and help make the road ahead less daunting.

Quick, yet essential, side note:

It is important to first understand what a Hemoglobin A1c (often called an A1c) test tells you. The Hemoglobin A1c is a blood test that correlates to your average blood sugar levels over the past two to three months. Hemoglobin is a protein found in red blood cells that carries oxygen throughout the body. When glucose (sugar) is in the bloodstream, some of it can bind to hemoglobin. The HbA1c test measures the percentage of hemoglobin that has glucose attached to it and provides an indication of a person's long-term blood sugar control.

In short, the A1c can look at a red blood cell and see how much sugar is stuck to it. The normal range varies by lab, but typical ranges are as follows:

• 4.8% - 5.7% = Normal
  • 5.8-6.4% = Pre-diabetes
  • 6.5% and above = Diabetes

Let’s Start With What Pre-diabetes and Diabetes Actually Are:

Whether you have been diagnosed with pre-diabetes or diabetes, the root of the problem can be boiled down to one thing: insulin resistance.

We want you to think of insulin resistance and sensitivity on a spectrum. On one end of the spectrum, you have a highly insulin sensitive person. For example, they have fasting blood sugar levels in the 70’s and 80’s and a Hemoglobin A1c in the low 5s.

On the other end of the spectrum, you have folks who are highly insulin resistant. These individuals may have blood sugars up into the 200’s or even 300’s, and their hemoglobin A1C can be well over 10%.

What do we mean by “insulin sensitive” and "insulin resistant”?

When you eat a meal, your body breaks down that food into various nutrients. Protein is broken down into amino acids, fat is broken down into fatty acids, and carbohydrates are broken down into sugar.

 When you eat sugar or carbs, your blood sugar naturally goes up. In order to bring it down, your pancreas secretes a hormone called insulin. Insulin helps your body to remove sugar from your blood stream and take it into your cells. When you are insulin sensitive this process works smoothly. Blood sugar goes up, insulin brings it back down, your cells get energy, and all is well.

The problem…

Issues arise over time when blood sugar levels are spiked over and over from high carbohydrate and high sugar meals. Your body essentially gets less impressed with the insulin your pancreas sends out, and you end up having to secrete more and more insulin to keep blood sugar in the normal range. Just like you can build a tolerance to medications, spicy food, or pain, your body can build a tolerance to insulin.

Over time, these higher and higher amounts of insulin still can’t do the job of lowering your blood sugar to normal levels and your blood sugar starts to climb. At a certain point, your blood sugars rise to the point that you are diagnosed with Prediabetes or Type II Diabetes. Even worse, at a certain point your pancreatic cells that secrete insulin can become overworked to the point that they actually die and stop producing insulin altogether. Not good! So, if you are early on in your diagnosis, now is the time to make some big changes.

The takeaway

The good news is that you can take simple and repeatable steps to lower your A1c and improve your insulin sensitivity. Believe it or not… it is possible for a type II diabetic to manage their blood sugar without medication.

Diabetes isn’t something you can catch and certainly isn’t something you just wake up with one day. It takes time to become insulin resistant.

This is the reason we recommend everyone request an HbA1c level as a part of their annual screening. An A1c of 5.9% is not a “your labs look OK see you next year” conversation, rather it is an alarm bell that means some changes need to be made.

So, what can be done?

Let’s Get to the Meat and Potatoes: How Does Diet Affect Blood Sugar?

If you are looking to lower your blood sugar the most important things to focus on in the diet are carbohydrates and sugars. In most cases, there is great benefit to decreasing your intake of these things.

Carbohydrates come in many forms, but the most common sources of carbs in our diet are:

• Pasta
• Breads, muffins, rolls, bagels
• Grains
• Rice
• Starchy vegetables like corn, winter squash, potatoes, peas
• Beans and Lentils (Kidney beans, Black beans, Pinto beans)
• Snack foods like crackers, chips, and pretzels

These types of processed carbohydrates all convert quickly to sugar in our body and cause rapid rises in blood sugar. We want to avoid this. When this sugar is not being used for fuel (for example during exercise) it can either be stored in the muscles (called glycogen) or it converts to fat and is stored throughout the body. Either way, your body knows it needs to get the sugar out of the bloodstream.

Consuming sugar on its own has the exact same effect as carbohydrates, only quicker! Sugar can come in many forms , so it will be important to read food labels and familiarize yourself with the different ways sugar can find its way into your food.

The key point here is that as blood sugar goes up, so does insulin. To improve our metabolic health, we need to keep both down, and the way to do that is by minimizing blood sugar spikes.

We recommend you work with your doctor or a nutritionist to set a daily carbohydrate goal that fits your needs. For many people, this is below 100-150 grams of carbohydrates per day. In terms of sugar, the American Diabetic Association recommends keeping your “added” daily sugar intakebelow 50 grams per day. With our clients we typically cut that in half and ask them to keep “added” sugar below 25 grams per day if at all possible. The less added sugar in your diet the better!

You’ll notice next time you look at a label it will list “total sugar” and “added sugar”. “Added sugar” is exactly what it sounds like. It is any sugar (often as a sweetener) that is added on top of the naturally occurring sugar in whatever you are consuming, usually fructose (fruit) or lactose (dairy). The only purpose of added sugar is to increase sweetness and taste. Some may argue the added sugar is to make the food more addictive, but that is a whole other conversation.

Helpful hint:

There are so many apps that can help you count carbs. We suggest utilizing these apps to help you track your intake. It feels way less daunting this way!  AND… some will even subtract carbs for you after adding in your work outs!

My Doctor Says I Need to Exercise More…

One of the most important ways we can keep our blood sugar and insulin down is through physical activity. During exercise our muscles have the amazing ability to lower our blood sugar without the help of insulin. This process, called “insulin independent glucose uptake”,  makes exercise the most potent tool in our toolkit. You can eat right, take your medications as prescribed, and take all the supplements you like, but if you are not taking time to move your body then you are missing out on enormous benefits.

So, what are the different types of exercise that can be helpful?

Zone 2 exercise:

Zone 2 exercise is one of our favorite forms of exercise, not only because it has wide ranging benefits but also because it is easy to do. So, what is it? Zone 2 exercise essentially boils down to low intensity aerobic exercise.

We love Zone 2 exercise so much we have a dedicated write up to explain more about it. It has such potent health benefits. Click on the link about Zone 2 exercise in much greater detail.

To sum it up very simply, Zone 2 exercise is the point of exertion during exercise where our muscles are burning the maximum amount of fat, while minimizing the amount of sugar we are burning.

You may ask, isn’t burning sugar a good thing? Not always. In the case of Zone 2 exercise, we want to keep sugar burning to a minimum because as we burn sugar, our liver responds by sending out a continuous stream of sugar to fuel our muscles.

What then goes up as a result? Insulin. It is for this reason that Zone 2 exercise is hands down our favorite form of cardio. You burn fat while you keep blood sugar and insulin down, all while reaping the benefits of non-insulin dependent glucose uptake.

Click here to read our full post on Zone 2 Exercise and how to find your own personal zone 2. You won’t regret it!

Weight training:

Another great form of exercise is weight training. While weight training carries the same benefits regarding non-insulin dependent glucose reduction, weight training has wonderful benefits in terms of metabolism. As you commit to weight training, you start to build more lean muscle. Muscles use a lot of energy, which means the more muscle you build the more energy you burn at rest. Translation? Weightlifting can increase your metabolism! This means that even while sitting on the couch, you are burning calories in the form of fat and sugar. Building muscle also helps your body store excess sugar in the form of glycogen, which your muscles can use for fuel later.

A good mantra we like is: The bigger the fire (muscles) the more fuel you burn (fat and sugar).

Please see our dedicated post on Resistance Training to learn more.

Post meal walks:

One thing we recommend for all of our clients is a post-meal walk after each meal. Even walks as short as two minutes after a meal can keep blood sugar spikes down and stabilize insulin levels as a result. The level of glucose reduction varies by each individual, and exact percentages depend on the study you look at, but it is a simple and powerful way to help keep blood sugar down.

One study, published in 2022, found that a short walk (2-15 minutes) in the 60–90 minute window after a meal reduced blood sugar by an average of 17%. That’s a powerful effect for 2 minutes of effort!

A Powerful Lifestyle Change to Consider: Fasting

Fasting is a great way to help support a healthy metabolism and keep blood sugar and insulin levels down. We strongly recommend you work with your doctor to make sure it is safe for you to attempt any method of fasting, especially if you are on any medications. That said, there are a couple of methods often used to integrate fasting into the daily routine.