Pre-diabetes. Time to change direction? No Diabetes. Diabetes. Contact Details. Dietitian. Telephone Number. Useful contacts

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1 Useful contacts Free support for smokers who want to stop: New Leaf Nottinghamshire The British Dietetic Association: Diabetes UK: British Heart Foundation: NHS Choices: Department of Nutrition and Dietetics Pre-diabetes No Diabetes Contact Details Diabetes Dietitian Telephone Number Review December 2016 Time to change direction? Read by Nottinghamshire Plain Language Group 20

2 What is pre-diabetes? Pre-diabetes is a condition where glucose (sugar) levels in the blood are higher than normal, but not high enough to be classed as diabetes. Smoking Stopping smoking will also reduce your risk of type 2 diabetes and heart disease. Pre-diabetes includes two conditions called Impaired Fasting Glycaemia and Impaired Glucose Tolerance. Both conditions can be a serious problem and increase the risk of developing diabetes and heart disease. If no action is taken, 1/3 of people with pre-diabetes will develop type 2 diabetes. What is diabetes? Carbohydrates in the food we eat are broken down to glucose and absorbed into the blood stream. Glucose is our fuel and is transported to the body's cells to be used as energy. It is advised that you see your doctor on an annual basis to monitor your condition. However, they can also support you with your prevention plan by referring you to local exercise on prescription schemes, smoking cessation support or appropriate healthcare professionals. Remember pre-diabetes is a warning sign, and gives you a chance to make changes to your eating and lifestyle habits to reduce your risk of developing diabetes and heart disease. Insulin, a hormone produced by the pancreas, is the key that unlocks the door and allows glucose to pass into the cell. 2 19

3 The table below may help you get started: Goal 1 2 In type 2 diabetes the lock may become more difficult to open. This is called insulin resistance. To improve my diet I will: A barrier to this may be: I will overcome this barrier by: To improve my activity I will: A barrier to this may be: I will overcome this barrier by: Remember to think SMART, keep goals Specific, Measurable, Achievable, Relevant and Time specific. Insulin resistance means the insulin does not work as well as it should. The pancreas therefore has to work harder to produce more insulin. In time, the pancreas becomes exhausted and needs extra help, in the form of medication or insulin injections. Once diagnosed with diabetes, it is a progressive condition and can lead to long term complications to the eyes, kidneys, nerves, heart and major blood vessels. Can I reduce my chances of developing diabetes? The good news is that diabetes can be prevented. Pre-diabetes is a warning sign, and gives you a chance to make changes to your eating and lifestyle habits to reduce your risk of developing diabetes and heart disease. 18 3

4 What is your risk? Below is a list of risk factors for developing type 2 diabetes. Tick all that apply to you. The more ticks you have, the greater your risk. You have pre-diabetes You smoke You are inactive You are overweight (see page 5) You carry too much fat around your middle (see page 6) You are white and over 40 years old You are Black, Asian or from a minority ethnic group and over 25 years A close member of your family has type 2 diabetes You have high blood pressure or have had a heart attack or a stroke You have raised lipid (cholesterol) levels You are a woman with polycystic ovary syndrome You have had diabetes in pregnancy Step counters (pedometers) can be a useful way of monitoring and then increasing the number of steps you take a day. Contact your local council for information on local exercise facilities and classes. What now? Now it s over to you. If you choose not to make changes you have a 1 in 3 risk of developing type 2 diabetes. You can significantly reduce this risk, but you have to take action now. Take time to consider your prevention plan, remember to set realistic goals, and build on these. Small steps, big rewards. It may take several attempts to change habits that have built up over a lifetime. Do not be put off if you don t succeed at first, learn from the experience and plan how to do it better next time. 4 17

5 What counts as physical activity? Are you overweight? Be as active as possible, as often as you can. You should aim to work up to at least 30 minutes of moderate intensity activity, five days of the week. Moderate activity would make you slightly out of breath, but able to hold a conversation. Your body mass index (BMI) tells you if you are a healthy weight for your height. Check your BMI on the chart below. If at first this target seems impossible; spread it throughout the day, and work up gradually. Remember any activity is better than none at all. Try to build activity into your daily routine, use others for support and above all, find something you enjoy. Here are some suggestions to get you started: doing the housework to music tackling the garden going for a walk at lunchtime taking the stairs finding the furthest space in the car park 16 5

6 What is your waist circumference? Carrying too much fat around the middle (central obesity) also increases the risk of developing type 2 diabetes. To measure your waist circumference, find the halfway point between your bottom rib and the top of your hips then measure around your middle with a tape measure. 1 unit = a single pub measure (25ml) of spirits 2 units = a pint of ordinary strength (3.5%) beer 3 units = a large (250ml) glass of wine Alcohol is also high in calories and can make you feel more hungry, so if you are watching your weight try to limit your alcohol consumption too. Use the table below to see if you are at increased risk: Get active Physical activity not only helps you lose weight and reduces the chances of developing type 2 diabetes, it also: Waist measurement for: At risk High risk European men > 94cm >102cm European women > 80cm > 88cm Asian men > 90cm Asian women World Health Organisation 2008 > 80cm Improves insulin resistance Improves blood pressure and cholesterol levels Improves mobility Reduces depression and stress Increases energy levels and helps you get a good nights sleep Prevents other diseases such as osteoporosis and certain cancers 6 15

7 Alcohol Unless you have been advised otherwise by your healthcare professional, alcohol can be included in moderation as part of a balanced diet. However it is important to stick to the safe limits: How can I reduce my risk of developing type 2 diabetes? 1. Lose weight 2. Eat a healthy diet 3. Get active 4. Stop smoking up to two units per day for women up to three units per day for men Weight Loss The alcohol content of drinks has increased. This means your drink could contain more alcohol than you think. Source: Office for National Statistics For those who are overweight, even losing a small amount of weight can reduce your chance of diabetes by more than half. Weight loss also helps improve blood pressure and cholesterol levels. Losing weight can be difficult. Start by making small changes and build on these. Steady, but sustainable weight loss, aiming for 0.5-1kg (1-2lb) per week is the most effective. 14 7

8 Healthy eating Healthy eating is beneficial for everyone, but mixed messages can make it confusing. Here are some tips for a healthier diet:: However, it is not necessary to follow a strict sugar-free diet. Choose no added sugar foods and drinks where possible, reduce the sugar in baking or have a small portion, after a meal. Artificial sweeteners can be a useful alternative. Eat regularly; aim for three meals a day, including breakfast. Base meals on starchy carbohydrates, especially those that release energy slowly such as oats, granary bread, pasta and basmati rice. Aim for at least 5 portions a day of fruit and vegetables a day. Eat more fish; aim for two portions a week, at least one to be oily fish, such as mackerel, sardines or salmon. Eat fewer sugary foods and drinks. Eat fewer fatty foods, particularly saturated and trans fats (see page 12). Eat less salt and salty foods. If you drink alcohol, do so in moderation. Salt Most of us eat more salt than we need. Too much salt can increase blood pressure. It is recommended to have less than 6g of salt per day. The majority of salt we eat is already added to the foods we buy so it is important to check the nutritional label and choose lower salt alternatives. Try using herbs and spices instead of salt when cooking and don t add salt at the table. 8 13

9 Fats Understanding food labels All types of fat are extremely high in calories, so eating less will help you lose weight. It is especially important to limit saturated and trans fats as these are linked to heart disease. Examples are full fat cheeses, milk and yogurt, fat on meat and poultry, cream and butter, cakes, biscuits, chocolate, pastry, fast foods and takeaways. Replacing these with a small amount of monounsaturated fat can improve cholesterol levels. Monounsaturated fat is found in olive oil and rapeseed oil and spreads made from these. Sugar Added sugar can cause your blood glucose to rise quickly, requiring your pancreas to work harder. Added sugar is found in foods such as cakes, biscuits and sweets and also contributes to weight gain. It is easier to make healthier choices if we regularly check the nutritional information on food labels. Look at the typical values per 100g on the food label. Compare this with the table below to choose products that fall into low or medium categories as much as possible. Per 100g Low - a healthier choice Medium - ok most of the time High -just occasionally Sugars 5g or less 5.1g g More than 22.5g Fat 3g or less g More than 17.5g Saturates 1.5g or less 1.6g - 5g More than 5g Salt 0.30g or less 0.31g - 1.5g More than 1.5g 12 9

10 The Eatwell plate For a diet to be healthy, it must be well balanced. Use the Eatwell plate to help you get the balance right. It shows you how much of what you eat should come from each food group. It shows you how much of what you eat should come from Bread, rice, potatoes, pasta and other starchy foods Fruit and vegetables Milk and dairy foods Meat, fish, eggs, beans and other non dairy sources of protein 10 Food and drinks high in fat and/or sugar Crown copyright Department of Health in association with the Welsh Assembly Government, the Scottish Government and the Food Standards Agency in Northern Ireland. 11

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