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I Can Lower My Risk for Type 2 Diabetes
A Guide for American Indians
On this page:
- What is diabetes?
- What are the signs and symptoms of type 2 diabetes?
- What does prediabetes mean?
- What factors increase my risk for type 2 diabetes?
- Should I be tested for diabetes?
- How can I lower my risk for diabetes?
- Hope through Research
- Daily Food and Drink Tracker
- Daily Physical Activity Tracker
Research Gives Hope Diabetes Can Be Prevented
“After I started exercising
and watching what I eat, my
blood glucose levels returned
Although people with diabetes can prevent or delay complications by keeping blood glucose (also called blood sugar) levels close to normal, preventing or delaying the development of type 2 diabetes in the first place is even better. The results of a major federally funded study, the Diabetes Prevention Program (DPP), prove that we can prevent or delay the disease. This study of 3,234 people at high risk for diabetes showed that moderate diet and exercise, resulting in a 5- to 7-percent weight loss, can delay and possibly prevent type 2 diabetes. More than 170 American Indians participated in the DPP.
The DPP tested three approaches to preventing diabetes: making lifestyle changes, taking a diabetes pill, or following the standard diabetes education approach. People in the lifestyle change group exercised about 30 minutes a day, 5 days a week, usually by walking, and they lowered their intake of fat and calories. Those who took the diabetes pill metformin received standard information on exercise and diet, as is done in an Indian Health Service clinic or tribal physician’s office. These approaches were compared with the third group who only received the standard information on exercise and diet and took a placebo—a pill without medicine in it.
The DPP results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. Average weight loss in the first year of the study was 15 pounds. Lifestyle change was even more effective in those 60 years and older. They reduced their risk by 71 percent. People who took metformin and received standard information on exercise and diet reduced their risk by 31 percent.
The Diabetes Prevention Program Outcomes Study (DPPOS) has continued to follow most DPP participants since the DPP ended in 2001. The DPPOS has shown that the benefits of weight loss and metformin last for at least 10 years. Ten years after they enrolled in the DPP, people in the lifestyle change group had reduced their risk for developing diabetes by 34 percent. Those in the lifestyle change group age 60 or older had reduced their risk of developing diabetes by 49 percent.
Participants in the lifestyle change group also had fewer heart and blood vessel disease risk factors, including lower blood pressure and triglyceride levels, even though they took fewer drugs to control their heart disease risk. The metformin group had reduced their risk of developing diabetes by 18 percent. Even though controlling your weight with lifestyle changes is challenging, it produces long-term health rewards by lowering your risk for type 2 diabetes, lowering your blood glucose levels, and reducing other risk factors for heart disease.
What is diabetes?
Diabetes causes blood glucose levels to be above normal. People with diabetes have problems converting food to energy. After food is eaten, it is broken down into a sugar called glucose. Glucose is then carried by the blood to cells throughout the body. The hormone insulin, made in the pancreas, helps the body change blood glucose into energy. People with diabetes, however, either no longer make enough insulin, or their insulin doesn’t work properly, or both.
Type 2 diabetes
Type 2 diabetes is the most common type in American Indians. This type of diabetes can occur at any age, even during childhood. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body cannot make enough insulin. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, blindness, kidney failure, and amputation.
Other kinds of diabetes
Type 1 diabetes
Type 1 diabetes is rare in American Indians. People develop type 1 diabetes when their bodies no longer make any insulin. Type 1 is usually first diagnosed in children or young adults but can develop at any age.
Gestational diabetes is first diagnosed during pregnancy. It occurs when the body doesn’t use insulin properly. Having an American Indian family background raises the risk of developing gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.[Top]
What are the signs and symptoms of type 2 diabetes?
Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.
What does prediabetes mean?
Prediabetes means your blood glucose is higher than normal but not high enough for a diagnosis of diabetes. Having prediabetes also means you’re at risk for getting type 2 diabetes and heart disease. There are no visible symptoms of prediabetes. However, you can reduce the risk of getting diabetes and even return blood glucose levels to normal with modest weight loss through healthy eating and moderate physical activity.[Top]
What factors increase my risk for type 2 diabetes?
If you have certain conditions, you’re more likely to develop type 2 diabetes. The more of these conditions you have, the higher your risk. Check each item that is true for you. Then show this list to your health care provider.
Should I be tested for diabetes?
Anyone 45 years of age or older should consider getting tested for diabetes. If you are 45 or older and overweight, getting tested is strongly recommended. Ask your health care provider for an A1C test, a fasting blood glucose test, or an oral glucose tolerance test. Your health care provider will tell you if you have normal blood glucose, prediabetes, or diabetes. If you are told you have prediabetes, have your blood glucose checked again in 1 year.[Top]
How can I lower my risk for diabetes?
You can do a lot to lower your risk. The small steps you take can lead to big rewards.
- Reach and maintain a reasonable body weight.
- Make wise food choices most of the time.
- Be physically active every day.
- Take your prescribed medicines.
Doing these things can reduce your risk of developing type 2 diabetes. Keeping your blood pressure and cholesterol on target also helps you stay healthy.
Make Wise Food Choices Most of The Time
What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood glucose, blood pressure, and cholesterol.
- Keep track of what you eat and drink. People who keep track are more successful in losing weight. You can use the Daily Food and Drink Tracker to write down what you eat and drink.
- Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses, meat, desserts, and other foods high in fat. Increase the amount of fruits and vegetables at every meal. Below is a chart for choosing sensible serving sizes using your hand as a measuring guide. Because your hand is proportioned to the rest of your body, it can be used to measure a healthy serving size for your body. Remember, the chart is only a guide. Choose your serving sizes and foods wisely.
- Limit your fat intake to about 25 percent of your total calories. Your health care provider or dietitian can help you figure out how many grams of fat to have every day. You can check food labels for fat content. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. See Ways to Lower The Amount of Fat in Your Meals and Snacks.
- Cut down on calories by eating smaller servings and by cutting back on fat. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories. Your health care provider or dietitian can work with you to develop a meal plan that helps you lose weight.
- Choose healthy commodity foods (items provided by the government to help people consume a nutritious diet), including those lower in fat.
- When you meet your goal, reward yourself with something special, like a new outfit or a movie.
Choose Sensible Serving Sizes
|Amount of food||Types of food||Size of one serving (the same size as:)|
|3 ounces||meat, chicken, turkey, or fish||the palm of a hand or a deck of cards
|1 cup||cooked vegetables
casseroles or stews, such as chili with beans
|an average-sized fist
|1/2 cup||fruit or fruit juice
starchy vegetables, such as potatoes or corn
pinto beans and other dried beans
rice or noodles
|half of an average-sized fist
|1 ounce||snack food||one handful
|1 Tablespoon||salad dressing||the tip of a thumb
|1 teaspoon||margarine||a fingertip
Ways to Lower The Amount of Fat in Your Meals and Snacks
- Choose lower-fat foods.
Instead of sunflower seeds (20 grams of fat),
choose pretzels (1 gram).
Savings: 19 grams.
- Use low-fat versions of foods.
Instead of regular margarine (5 grams of fat),
use low-fat margarine (2 grams).
Savings: 3 grams.
- Use low-fat seasonings.
Instead of putting butter and sour cream on your baked potato
(20 grams of fat), have salsa (0 grams).
Savings: 20 grams.
- Cook with less fat.
Instead of making fried chicken (31 grams of fat),
roast or grill the chicken (9 grams).
Savings: 22 grams.
Be Physically Active Every DayRegular exercise tackles several risk factors at once. Activity helps you lose weight; keeps your blood glucose, blood pressure, and cholesterol under control; and helps your body use insulin. If you are not very active, start an exercise program slowly. Talk with your health care provider first about what kinds of exercise would be safe for you. Then make a plan to increase your regular physical activity.
- Keep track of what you do for exercise and how long you do it. Use the Daily Physical Activity Tracker to keep track of your physical activity.
- Aim for at least 30 minutes of
physical activity a day most
days of the week.
- Incorporate physical activity
into plans with family and
friends. Set a good example
for your children. Play softball on weekends. Go on a
- Be active every day. For example, walk to the store, clean the house, or work in the garden, rather than watch TV.
Getting Started on a Walking RoutineWalking is a great way to be physically active. Before you get started, talk with your health care provider about whether it’s OK for you to walk for exercise. Then get comfortable shoes that provide good support. You can use the Daily Physical Activity Tracker to start your routine gradually. Try to walk at least 5 times a week. Build up little by little to 30 minutes a day of brisk walking.
My Walking Program
|Fast walk time
Source: Small Steps. Big Rewards. Your Game Plan for Preventing Type 2 Diabetes. A publication of the National Diabetes Education Program.
Take Your Prescribed MedicinesSome people need medicines to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor if you should take metformin to prevent type 2 diabetes. Metformin is a medicine that makes insulin work better and can reduce the risk of type 2 diabetes. [Top]
Hope through Research
With the help and participation of many Pima Indian volunteers over the years, scientists at the National Institutes of Health have been able to identify several ways health care providers can take better care of people with diabetes. We know keeping blood glucose, blood pressure, and blood cholesterol under control is very important. We know pregnant women with diabetes need to keep their blood glucose under control so their babies will be healthy and have a lower risk of getting diabetes. We know breastfeeding, even for a few weeks, helps protect babies from becoming overweight and developing diabetes.
We also know that many people who might otherwise develop type 2 diabetes can prevent it by exercising regularly, lowering the amount of fat and calories they eat, and losing weight. Researchers are also studying the genetic and environmental factors that can lead to prediabetes and diabetes. As they learn more about the events that lead to diabetes, researchers hope to develop more ways to prevent diabetes and take care of those who already have diabetes.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.[Top]
Daily Food and Drink Tracker
Use the Daily Food and Drink Tracker to keep track of everything you eat and drink. Make a copy of the form for each day. Write down the time, the name of the food or drink, and how much you had. For a free booklet with information on fat grams and calories, call the National Diabetes Education Program at 1–888–693–NDEP (1–888–693–6337) and request a copy of the Game Plan Fat and Calorie Counter.
|Date December 1, 2011 Daily Food and Drink Tracker||Time||Name||Amount||Fat Grams||Calories|
|8:00 am||oatmeal||1/2 cup||1||80|
|fat-free milk||1 cup||0||90|
Daily Physical Activity Tracker
Use the Daily Physical Activity Tracker to keep track of your physical activity. Make a copy of the form for each day. Write down what you do and for how long.
|Date December 1, 2011 Daily Physical Activity Tracker||Type of Activity||Minutes|
Daily Food and Drink Tracker
Daily Physical Activity Tracker
|Type of Activity||Minutes|
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was originally reviewed by Donald K. Warne, M.D., C.D.E., M.P.H.; William C. Knowler, M.D., Ph.D., M.P.H.; and Mary Hoskin, M.S., R.D. It was also reviewed by American Indian health care providers who work with the National Diabetes Education Program. Comments from members of the Indian Health Service, the Gila River Indian Community, and other American Indian communities have also been included. Tammy L. Brown, M.P.H., R.D., B.C.-A.D.M., C.D.E., Captain, U.S.P.H.S.; Lorraine Valdez, R.N., M.P.A., C.D.E.; Wendy Sandoval, Ph.D., R.D., C.D.E.; Gordon Quam, B.S.N., R.N., C.D.R., U.S.P.H.S.; and Cecelia Shorty of the Indian Health Service reviewed the updated version of the publication.
National Diabetes Education Program1 Diabetes Way
Bethesda, MD 20814–9692
Phone: 1–888–693–NDEP (1–888–693–6337)
The National Diabetes Education Program is a federally funded program sponsored by the U.S. Department of Health and Human Services’ National Institutes of Health and the Centers for Disease Control and Prevention and includes over 200 partners at the federal, state, and local levels, working together to reduce the morbidity and mortality associated with diabetes.
National Diabetes Information Clearinghouse1 Information Way
Bethesda, MD 20892–3560
The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.
NIH Publication No. 11–5337
Page last updated December 5, 2011