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10 min read

Prediabetes Diets: How To Deal With Insulin Resistance

Medically reviewed by Dr. Michael Ruscio — Written by Catherine Day onApril 19, 2020

Written by Catherine Day on April 19, 2020

• Is Prediabetes Really Serious?|
• Risk Factors|
• Prediabetes Diet|
• What Can You Eat|
• Prediabetic Diet Alternatives|
• Keto Diet|
• DPP Diet|

Everyone knows what diabetes is. Even if they mistakenly think that diabetes always “sentences” you to a life on insulin, they do understand that it’s serious and requires big dietary changes.

Many people aren’t familiar with “prediabetes,” though, at least until their doctor drops the ominous word on them at what they thought would be an ordinary office visit. Most do understand that it’s something they must deal with, once they’re told that their blood sugar levels are way too high. And they realize that unless they change their ways, they could soon be dealing with full-fledged diabetes and everything it entails.

The doctor may use the term “insulin resistance” instead of prediabetes, but he’s basically saying the same thing. Insulin is the hormone that the body produces to process the glucose in your food. If your body isn’t able to properly utilize that insulin, naturally, your blood glucose levels can rise to unhealthy levels. That problem is called insulin resistance, and the condition it causes is called prediabetes. When glucose levels rise even higher, that’s when diabetes is diagnosed.

Nearly all medical professionals will suggest some form of a prediabetes diet after a diagnosis, but there isn’t widespread agreement on what that means. Some basically urge their prediabetic patients to get exercise, adopt a healthy eating plan and ditch the unhealthy lifestyle habits. Others prescribe a much more rigorous diet plan in order to ensure their patients shed some weight and get their blood sugar under control.

Is a drastic prediabetes diet really necessary? Or can adopting a common-sense approach to diet and lifestyle be enough?

Let’s look at the possibilities, after shedding a little more light on the ominous-sounding diagnosis of prediabetes.

Is Prediabetes Really Serious?

Yes, it is. 5-10% of those with prediabetes contract type 2 diabetes (which is the adult type, not the one that used to be called “juvenile diabetes”) every year. And experts say that as many as 70% of those diagnosed as prediabetic will progress to full-fledged diabetes in their lifetime. [1]

While we’re looking at statistics, here are a couple of other startling numbers. About one-third of American adults have prediabetes, and 90% of those who have it don’t know that they do. [2]

It’s no secret that contracting diabetes can drastically change your life. Even if you don’t have to endure daily insulin shots, you still have to spend a lot of time learning about glucose levels, glycemic indexes and the warning signs of diabetic shock and diabetic coma – and most who have to deal with those details and potential medical problems usually have them front-of-mind all the time. That’s not exactly a prescription for a stress-free life.

Even worse, diabetes can lead to a number of other serious health issues including high blood pressure and heart disease, stroke and kidney disease, and nerve, eye, skin and foot problems. [3]

If you knew that all of those scary problems were likely to be on the horizon, wouldn’t you do everything you could to avoid them and prevent your progression to diabetes? Of course you would, and that’s why the smartest way to approach a prediabetes diagnosis is by considering it a flashing red light, telling you that some big changes are in order.

That’s definitely possible, because you can reverse prediabetes with the right diet plan, lifestyle changes and regular exercise.

Risk Factors for Prediabetes

You’ll only know if you’re actually prediabetic after your doctor runs blood tests to determine your blood glucose levels.

(Just so you know when your blood tests are in the danger zone, prediabetes is usually diagnosed when fasting blood sugar levels are between 100 and 125 mg/dl, oral glucose tolerance is between 140 and 199 ml/dl, or A1C is between 5.7% and 6.4%.)

Before getting to that point, though, there are definite risk factors which are (mostly) under your control. [4]

• Age, ethnicity, and genetics: These are the ones you can’t control; those over the age of 45 are more likely to become prediabetic, as are African-Americans, Hispanic/Latino-Americans, Native Americans, and some Asian Americans, and those for whom diabetes runs in the family.
• Weight: If your weight and body mass index (BMI) are above recommended levels for your height and physical build, you have an increased risk.
• Poor diet: Eating too many starches, fats and too much sugar are all problematic, because they pump more glucose into your body than it needs and more than it can reasonably process.
• Not enough exercise: Even 30 minutes of moderate exertion (like walking) can reduce the risk of developing prediabetes.
• Smoking and heavy alcohol use: You probably already expected this one to be here, and it is.
• Stress and not enough sleep: Prediabetes and diabetes are among the many conditions which can be worsened by these lifestyle issues.
• High blood pressure and high cholesterol: These can be byproducts of diabetes, but they can make you more susceptible to both prediabetes and diabetes as well.
• Gestational diabetes: Women who develop this condition during pregnancy are more at risk for prediabetes and diabetes later in life.

Adjusting your lifestyle is an important first step toward avoiding or reversing prediabetes. But the most important change you can make is getting down to a healthy weight. And that requires a smart eating plan.

Eating a Prediabetes Diet

Many authoritative diabetes educators and medical organizations, like the American Diabetes Association, make general recommendations for prediabetics. They pretty much boil down to weight loss, a healthy diet, and a good amount of physical activity.

Some of their suggestions:

• Substitute water or calorie-free drinks for sugary drinks like soda and fruit juice.
• Have one vegetable with dinner each day.
• Proteins should be lean meats or skinless chicken, with fish at least twice a week and one meat-free meal with a plant-based protein each week.
• Eat less processed meat that’s high in sodium and fat.
• Cut back on the fat you use in cooking and use healthy fats like olive oil and vegetable oil instead of those high in saturated fats like butter and shortening.
• Avoid deep- or pan-frying; grill, steam, broil, bake or roast instead.
• Eat fruit instead of sweet desserts; try saving the sweets for special occasions.
• Substitute lower-calorie snacks like popcorn for the usual junk food.
• Eat smaller portions. [5]

Those are excellent suggestions, but may not be sufficient for many people who need rigorous guidelines in order to stick to a meal plan that will work.

You can find many “do’s and don’ts” lists for prediabetics online. To be honest, most people intuitively know the foods they should eliminate like fats, cookies and cake, processed foods, packaged and junk food, and soda. Just reading the ADA’s recommendations should have given you a good feel for that.

So what can you eat?

These are some of the more specific food choices often recommended for a prediabetic eating plan.

• Proteins: Only eat occasional low-fat cuts of red meat or skinless poultry; fish and seafood that’s high in healthy fats should be a staple of your diet. Good examples are salmon, tuna, shrimp, tilapia, mackerel, and crab.
• Vegetables: Your choices should be high in fiber and low in calories. Leafy greens like lettuce and spinach, tomatoes, cucumber, broccoli, zucchini, bell peppers, green beans, onions, celery, mushrooms and eggplants all make the list, as do frozen vegetables without added salt. Many starchy vegetables are also fine, including potatoes and sweet potatoes, corn, peas, and squash.
• Fruit: Again, high-fiber foods are best. Examples are apples, pears, oranges, berries, watermelon, and cantaloupe, as well as frozen fruits without added sugar.
• Carbs: Forget the white bread and white rice; you should be eating whole grains like whole-wheat and whole-grain bread, pasta and cereal, brown rice, and quinoa. Oatmeal is fine, as is popcorn as long as it’s air-popped.
• Legumes and Soy: The food groups most people ignore – consider trying lentils, split peas, types of beans like garbanzo, pinto, and black beans, and soy protein substitutes like tofu and edamame.
• Dairy Products: High-fat dairy is out, reduced- or low-fat dairy high in calcium, vitamin D, and potassium is in. That means sticking to skim milk, low-fat cheese, plain yogurt, and fat-free cottage cheese. Don’t ignore soy milk, either.
• Fats, Oils, Nuts, and Seeds: Vegetable, avocado and olive oil are great options both for cooking and making dressings and marinades. Peanuts, peanut butter, and nut butters are fine, as are most nuts (raw, not roasted) and seeds, which are each good sources of fiber and protein. They contain a good number of calories, however, so go easy on them).
• Beverages: Water or naturally-flavored water should be the go-to choice, with unsweetened tea or coffee (without milk) also fine. Low-calorie drinks should be consumed in moderation, if at all.

In other words, go heavy on the fish, fruits and veggies; choose low-fat and high-fiber whenever possible; keep your mother’s voice in the back of your head as you reach for something you know you shouldn’t eat – and you’ll be on track.

If that type of diet sounds very familiar, it should. It follows the basic guidelines of two of the world’s most popular weight loss and healthy eating programs, the Mediterranean diet and the anti-hypertension DASH diet. The Mediterranean diet places a greater emphasis on veggies and fruit, whole grains, nuts, and healthy oils (plus wine!), while the DASH diet is a little closer to most people’s natural diets by allowing more animal proteins and sweets. Both are proven to work and validated by research.

If you want to follow this type of prediabetic diet but also need recipe suggestions, the thousands of Mediterranean and DASH diet cookbooks or websites will provide more than enough breakfast, lunch and dinner suggestions to keep you satisfied for a long, long time.

Other Prediabetic Diet Alternatives

There are several other approaches which can help those with prediabetes lose weight and improve their health.

Keto Diet

Everyone knows the keto diet: it’s the one that stops you from eating most carbs but encourages you to eat lots of protein and fat. The goal is to put your body into a state of “ketosis,” in which the lack of carbs forces the body to burn fat to produce energy. This also reduces blood glucose levels and insulin levels (you’ll remember those from our earlier discussion of diabetes and prediabetes), and often leads to rapid weight loss.

There’s been a good amount of research showing that the Keto Diet works well for type 2 diabetics and prediabetics who need to lower both their weight and blood sugar. However, there are possible dangers as well, like glucose levels that can go too low and cause hypoglycemia, and the lack of sufficient nutrients in the diet.

It’s very important for prediabetics to get medical clearance from their doctor and/or a dietitian before trying Keto – but it’s an excellent choice for many.

DPP Diet

The U.S. Centers for Disease Control (CDC) has partnered with state and local authorities, companies like WW (which used to be Weight Watchers), insurance companies and universities to promote the prediabetic program and diet that they’ve created. It’s called the National Diabetes Prevention Program (DPP) and it encourages both lifestyle changes and healthy eating. [6]

The program runs for a full year and can be followed either by attending in-person meetings or over digitally-delivered media. The DPP focuses more on exercise and lifestyle issues, while providing diabetes-friendly eating guidelines similar to the ones we’ve listed above. Some partners also provide coaches to help diabetic and prediabetic participants get their weight and health in shape.

The effectiveness of the DPP has been tested and proven, and it’s a good way for those who need more person-to-person help and encouragement to make sure their prediabetes is reversed, instead of turning into type 2 diabetes.