Healthy Eating for people at

risk of diabetes or with prediabetes

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WHAT IS PREDIABETES / AT RISK OF DIABETES Some patients have a blood sugar level which is higher than normal but not high enough to be called diabetes. This is called prediabetes and can be identified by blood sugar (glucose) tests. It means raised blood sugar and a higher risk of getting diabetes and heart disease. Making changes to your lifestyle can delay or even prevent the development of type 2 diabetes and reduce the risk of heart disease too. This has now been proven in several large research studies. People with prediabetes do not usually have any symptoms and it can be diagnosed by your practice nurse or general practitioner using a blood test. WHAT IS DIABETES? As you may know, diabetes comes in two types (type 1 and type 2). Type 2 diabetes is more common and likely to develop as one gets older around 3 out of every 100 people develop it. It can develop either because patients with type 2 diabetes have something called ‘insulin resistance’. This means that their body does not respond normally to insulin (a hormone produced by the pancreas gland). Insulin controls the level of sugar (glucose) in your blood. Over time, if your blood sugar is high, this damages your blood vessels and your heart. Or it may develop because the body is not producing enough insulin.

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DIETARY ADVICE The main things to consider are; • Lose weight if you are overweight or maintain a healthy

weight. • Reduce the total amount of fat in your diet. • Replace saturated (animal) fat with monounsaturated fat

(olive, rapeseed and vegetable oils and spreads). These should still be used sparingly if overweight.

• Include at least one or two portions of oily fish each week. • Have five or more portions of fruit and vegetables each

day. • Choose sugar free, diet or No Added Sugar drinks. • Limit sugary foods. • Eat 3 meals daily including something starchy such as

bread, potatoes, rice, pasta or breakfast cereals. • Choose starchy carbohydrate foods with a low Glycaemic

index (GI). (See page 6) • Reduce salt and salty foods. Flavour foods with pepper,

herbs and spices instead.

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FOOD AND DRINK HIGH IN FAT AND / OR SUGAR • Sugar and alcohol are high in calories so cut

down on these particularly if you are overweight. Avoid adding sugar to cereals and drinks. Choose sugar free or diet varieties of drinks and yoghurts and reduced sugar jams.

• Try to avoid adding extra fats and oils to cooking. Limit fried food, cakes, pastries, sweets, chocolate, biscuits, crisps, cream and ice cream. Choose lower fat and reduced sugar alternatives e.g. Teacake/currant buns.

• Choose an oil/spread containing mostly monounsaturated fats. Use sparingly if overweight.

• Try oil free dressings, vinegar and lemon juice on salads. Avoid mayonnaise and salad creams. ALL FATS SHOULD BE REDUCED IF OVERWEIGHT

FRUIT & VEGETABLES • Choose a wide variety - at least 5

servings every day. A serving is 2-3 tbsp veg, small bowl salad, 1 large fruit, 2 medium fruit, 1 handful grapes or berries, 1 tbsp of dried fruit, 150ml fruit juice.

• “Fill-up” on vegetables, cooked or raw as salads.

• Use fruit for snacks and desserts - fresh, stewed or canned in natural juice.

MEAT, FISH, EGGS, BEANS AND OTHER NON-DAIRY SOURCES OF PROTEIN • Choose lean meats, fish, chicken and

turkey, eggs, beans or pulses. Trim off visible fat from meat, remove skin from chicken.

• Cook without fat or oil. • Limit sausages, burgers, bacon, pies

and processed cold meats. • Include unsalted nuts in moderation. • Include 2-3 portions daily- • 1 portion is equal to 60–90g lean meat/poultry, 120–150g white fish, 2 eggs (up to 7 per week), 3 tablespoons beans/lentils or dhal, 2 tablespoons nuts/peanut butter. • For variety, and to protect the heart,

include some OILY FISH. Aim for at least 1 serving (100-150g) per week. 0.5gram (500mg) /day of omega-3 supplements may be taken, if you do not like oily fish.

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BREAD, RICE, POTATOES, PASTA AND OTHER STARCHY FOODS • Include low GI options with

every meal. • Choose multigrain bread and

bran, or oat based cereals. • Choose basmati rice and

durum wheat or wholegrain pasta (cook al dente).

• Choose new potatoes over older varieties. Try sweet potato for a change.

MILK AND DAIRY FOODS • Use semi-skimmed or skimmed

milk. • Buy reduced fat hard cheeses,

reduced fat cheese spreads or cottage cheese.

• Replace cream/icecream with diet/light yoghurts.

• Try to include at least 3 portions daily, to ensure adequate calcium intake.

• 1 portion is equal to:- 200ml (1/3rd pint) milk, small pot of yoghurt/fromage frais 25g (1 oz) cheese.

FOOD AND DRINK HIGH IN FAT AND / OR

Sugar and alcohol are high in calories so cut down on these particularly if you are overweight. Avoid adding sugar to cereals and drinks. Choose sugar free or diet varieties of drinks and yoghurts and reduced sugar jams. Try to avoid adding extra fats and oils to cooking. Limit fried food, cakes, pastries, sweets, chocolate, biscuits, crisps, cream and ice cream. Choose lower fat and reduced sugar alternatives e.g. Teacake/currant buns. Choose an oil/spread containing mostly monounsaturated fats. Use sparingly if

Try oil free dressings, vinegar and lemon juice on salads. Avoid mayonnaise and salad creams. ALL FATS SHOULD BE REDUCED IF

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HOW TO CHOOSE LOW GI FOODS Foods with a low glycaemic index (GI) are carbohydrate foods which are broken down slowly by the body resulting in a more gradual rise in blood glucose. The glycaemic index is a measure of how much a food will raise your blood glucose after eating it. There are many lists of GI foods available and this can become confusing since the GI value may differ depending on where the food tests have been carried out. The following tips will help you to make the right choice: • Choose breakfast cereals based on oats or bran.

• Choose wholegrain breads with plenty of visible seeds or grains.

• Eat plenty of fruit and vegetables - aim for at least five portions per day. Spread fruit portions throughout the day.

• Include plenty of pulses in your meals, add beans and lentils to casseroles and other dishes.

• Finish a meal with a piece of fruit or a diet yoghurt.

• Avoid foods which have glucose, maltose or dextrose listed as one of the first four ingredients.

• Choose durum wheat and wholegrain pasta, and cook al-dente. Choose basmati rice. Avoid excessive portions of rice or pasta.

• Choose new potato or sweet potatoes (moderate portion) over older varieties.

• If you plan to eat a high GI food, try to eat with a low GI food and this will reduce the GI of the overall meal e.g. add baked beans to a jacket potato.

• Choose less processed and less refined foods.

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PHYSICAL ACTIVITY There is evidence that 30 minutes of physical activity 5 days a week can help improve your insulin sensitivity and reduce your risk of developing diabetes and heart disease. If usually inactive check with your doctor, then try to find ways of including more physical activity during the day. Try walking upstairs instead of using lifts or elevators or walking instead of using the car for short journeys. All activity is beneficial try walking, cycling, swimming and even housework and gardening. Increasing your physical activity can also help you to lose weight and maintain any weight that is lost. WEIGHT LOSS TIPS There is evidence that for every kilo of weight loss there is a significant reduction in the risk of developing diabetes. Following the advice in this leaflet can help you to lose weight at a slow and steady rate of 0.5-1kg (1 - 2lb) per week. The following additional tips will help you further: • Eat 3 regular meals a day—never miss breakfast. • Watch your portion sizes– try using a smaller plate. • Limit alcohol as it is high in calories. • If you comfort eat or nibble, work out your danger periods/

nibbling times and do something pleasant to distract you from food e.g. read a book, phone a friend, go for a walk or have a relaxing bath.

• Pre-plan meals and shop from a list to stop impulse buys. • Try not to shop for food if you are hungry. Write a shopping

list and stick to it. • If you want snacks between meals, fruit and diet/light

yogurts are the best choices.

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SMOKING Smoking is a major factor contributing to heart disease, stroke and other health problems. If you are keen to stop smoking, book in to the stopping smoking clinic at York House Medical Centre on 01299 827171 or contact Worcestershire Smoking Advice Service can help. Tel:- 01905 - 760222. 'The Eatwell plate is reproduced with the kind permission of the Food Standards Agency. This Crown copyright material is reproduced with the permission of the Controller of HMSO and Queen's Printer for Scotland.'

Adapted from a document kindly produced by: The Nutrition & Dietetic Department/ Diabetes Team

Worcestershire Acute Hospitals NHS Trust RD

Date of Production March 2012 Date of Review March 2014