Discover how you can manage pre-diabetes with simple diet and exercise changes!

Pre-diabetes is a condition where a person’s blood glucose levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. Pre-diabetes can increase your risk of developing type 2 diabetes by as much as 20 times. 

However, research shows that the onset of type 2 diabetes can be delayed or prevented in up to 58% of cases. To maximise your chances of doing that it’s important to have a healthy diet and do regular physical activity.

Understanding pre-diabetes: what is pre-diabetes and why is it important to manage?

Glucose is the body’s main source of energy. When we eat or drink, it enters our bloodstream, causing the pancreas to release the hormone insulin, which controls the amount of glucose in the blood. If the insulin isn’t working properly, the amount of glucose in the blood can rise to the level that is described as pre-diabetes.

The risk factors of pre-diabetes are similar to those for type 2 diabetes. They can be split into two groups: 

  1. modifiable (can be changed)
  2. non-modifiable (can’t be changed).

Modifiable risk factors include your weight and waist circumference, both of which are influenced by your diet and the amount of exercise you do. Non-modifiable risk factors include your age, ethnicity and your family medical history.

Pre-diabetes often has no warning signs or symptoms. However, the high blood glucose levels that it’s associated with do. These include:

  • increased thirst and frequent urination
  • unintended weight loss
  • blurry vision
  • frequent infections
  • numbness or tingling in feet or hands.

If you experience any of the above, you should speak to your doctor.

Diagnosis and treatment of pre-diabetes

It is recommended that adults check their diabetes risk every three years from the age of 40, using the Australian type 2 diabetes risk assessment tool. Annual screening with your GP from 18 years of age is recommended for Aboriginal and Torres Strait Islander peoples.

As there are no reliable signs or symptoms of pre-diabetes, it is usually diagnosed when a person’s doctor is concerned that they have the symptoms of having elevated blood glucose and sends them for a blood test. The test to confirm pre-diabetes (and diabetes) is a fasting glucose test (FGT)/random blood glucose test. This is where a blood sample is taken to show the level of glucose in your blood after fasting (not eating or drinking anything other than water) for eight to ten hours, or at a random time during the day.

If the results suggest pre-diabetes, your doctor will ask you to have an oral glucose tolerance test (OGTT). Again, the level of glucose in your blood is checked after fasting for eight to ten hours. You then have a glucose drink and another blood sample is taken after one or two hours. This test shows how your body responds to glucose.

You may then be asked to take an HbA1c test, which is useful for diagnosing pre-diabetes as it gives a picture of your average blood glucose level over the past three or four months.

Lifestyle changes for managing pre-diabetes

As we have seen, it is possible to delay or prevent the onset of type 2 diabetes by making lifestyle modifications. As well as making sure that you do regular physical activity and eat a balanced, nutritious diet, it’s also helpful to manage your stress levels, get good-quality sleep and, if you smoke, to quit. 

Diet and the management of pre-diabetes: tips for creating a healthy eating plan

For people who are living with pre-diabetes, a nutritious diet will help to keep their blood glucose levels within a healthy range. The Australian Dietary Guidelines and the Australian Guide to Healthy Eating provide information and advice about what a healthy diet is.

The Australian Dietary Guidelines provide a framework for healthy eating. These are: 

  1. To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.
  2. Enjoy a wide variety of nutritious foods from the five food groups every day. And drink plenty of water.
  3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
  4. Encourage, support and promote breastfeeding.
  5. Care for your food; prepare and store it safely.

The five food groups mentioned in the second guideline are:

  1. Vegetables and legumes/beans, aiming for a wide variety. 
  2. Fruit, aiming for a wide variety. 
  3. Grain and cereal foods, aiming for mostly wholegrains, low-GI and/or high-fibre varieties. 
  4. Lean meat and poultry, fish, eggs, tofu, nuts, seeds, legumes and beans. 
  5. Milk, yoghurt, cheese and/or alternatives, aiming for mostly reduced fat and fortified alternatives.

The Australian Guide to Healthy Eating shows the proportions of the five food groups we should eat every day.

People who are living with pre-diabetes should eat a wide range of foods from these groups that are high in fibre and low in the glycaemic index (GI). The glycaemic index shows how quickly the carbohydrates in a food are broken down and absorbed into the bloodstream. Foods with a high GI cause a rapid rise in blood glucose levels. Foods with a low GI result in a slower rise. These rapid rises and falls in blood glucose leads to increased insulin release from the pancreas and may promote more cravings, hunger, and overeating. 

Foods that are high in fibre can also help regulate blood glucose levels by slowing down the absorption of glucose into the bloodstream.

According to the Australian Government’s Healthdirect website, foods that are both low GI and high in fibre include:

  • oats (rolled, steel-cut or oat bran)
  • grains (for example, pasta, rice, noodles, quinoa, barley)
  • legumes (for example, lentils, split peas and chickpeas)
  • most types of fruits.

Foods to avoid include:

  • sugary drinks such as fruit juice and sports drinks
  • biscuits, cakes and pies
  • processed snacks such as chips and crackers
  • white bread, white rice and white pasta
  • foods containing trans fats such as frozen pizza and commercially fried food.

Even with healthy food, portion control is important. Eating smaller, more frequent meals can also help prevent blood glucose spikes or drops.

The importance of exercise in managing pre-diabetes: effective workouts and physical activities

Exercise can be very beneficial for people with pre-diabetes. It can improve insulin sensitivity, reduce blood glucose levels, and enhance mobility and mental wellbeing. Regular exercise can help maintain a healthy weight, lower blood pressure and reduce the risk of heart disease. It also promotes mental health by reducing and/or managing stress more effectively and improving sleep quality. 

The Australian Government guidelines recommend that adults do at least 30 minutes of moderate intensity physical activity most days. Moderate intensity exercise is any activity that causes your heart to beat faster and makes you breathe harder. A way to measure this could be feeling like you are at between four and six out of ten, with ten being your maximum effort. Examples are:

  • cycling
  • brisk walking
  • gardening
  • mowing the lawn. 

As an alternative, you could do three short bursts of 10–15 minutes of activity, which provide similar benefits in a time-efficient way. 

Resistance training also supports weight management by improving the body’s muscle mass and increasing your metabolism. Resistance training is any activity that makes your muscles work harder than usual, increasing their strength, size, power and endurance.

Resistance training can also bring the following health benefits:

  • improved stamina
  • improved flexibility and balance
  • bone density
  • reduced symptoms of depression and anxiety
  • improved sleep.

Don’t forget to speak to your doctor or a physical activity health professional (Exercise Physiologist/Physiotherapist) before starting any new type of physical activity. If you’re not used to doing exercise, start gently and gradually build up or maintain any activity that you can do.

Tips for incorporating exercise into your daily life until it becomes a habit include: