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Expert Q&A: A Healthy Diet for Type 2 Diabetes

An interview with Hope Warshaw, MMSc, RD.

What is prediabetes and what should people do if they're diagnosed with it?

Prediabetes is an in-between stage -- blood glucose is higher than normal but not high enough to fit the diagnosis of diabetes. The diagnosis of prediabetes should be a clear message that you're currently on the road to type 2 diabetes. If you don't take action now, you have a greater than 70% chance of developing type 2.

But this doesn't need to happen. Results from several studies, including the Diabetes Prevention Program, suggest that a small amount of weight loss -- 5% to 7% of your body weight combined with 150 minutes a week of physical activity -- can help slow down the progression. If you catch it early and do something, you can really have an impact on either preventing or delaying the onset of type 2.

What is the relationship between being overweight and type 2 diabetes?

It's a pretty direct relationship. About 80% of people with type 2 diabetes are overweight. Excess weight leads to insulin resistance, and insulin resistance leads to elevated blood pressure, abnormal blood lipids and diabetes.

Do people with type 2 diabetes need to eat snacks throughout the day to control their glucose?

No, but there's a lot of confusion about this. Experts used to tell people to eat snacks because the only medications we had to treat high blood glucose levels could cause the side effect of hypoglycemia, or low blood glucose. Regular meals and scheduled snacks were a way of limiting the problem. But now there are several newer medicines that lower blood glucose without that side effect. Plus, people have blood glucose meters and can check their glucose at any time.

If snacking is your natural way of eating, there's nothing wrong with one or two snacks a day. For instance, if a healthy snack in the afternoon -- like an apple and some reduced-fat cheese -- prevents you from being so famished at dinner that you gorge yourself, go ahead.

But people with diabetes should ditch the idea that they need to eat snacks. It can be counterproductive. Some people find all the snacks really inconvenient. Other people sit down for a snack and overeat, or they make unhealthy choices because they don't have anything better around.

Can people with type 2 diabetes eat sweets?

Yes, people with diabetes can enjoy sweets. There's an old idea that sweets are verboten for those with diabetes, but that's no longer correct.

It's true that the carbohydrates in sweets can raise your glucose levels, but an equal amount of starch would have similar effect. I don't think people with diabetes need to run around looking for sugar-free candies or insist that their families bake them sugar-free deserts.

However, you have to be smart about sugary foods and sweets. Sweets pack in a lot of calories and they tend to be high in fat, particularly in unhealthy saturated fat. So anyone with diabetes needs to be careful about how many they eat.

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If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.

People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.

Congratulations on taking steps to manage your health.

However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.

Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.

Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.

One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.

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