What is type 2 diabetes?

If you have diabetes, your blood sugar levels are too high. With type 2 diabetes, this happens because your body does not make enough insulin, or it does not use insulin well (this is called insulin resistance). If you are at risk for type 2 diabetes, you might be able to prevent or delay developing it.

Who is at risk for type 2 diabetes?

Many Americans are at risk for type 2 diabetes. Your chances of getting it depend on a combination of risk factors such as your genes and lifestyle. The risk factors include:

• Having prediabetes, which means you have blood sugar levels that are higher than normal but not high enough to be called diabetes
• Being overweight or having obesity
• Being age 45 or older
• A family history of diabetes
• Being African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
• Having high blood pressure
• Having a low level of HDL (good) cholesterol or a high level of triglycerides
• A history of diabetes in pregnancy
• Having given birth to a baby weighing 9 pounds or more
• An inactive lifestyle
• A history of heart disease or stroke
• Having depression
• Having polycystic ovary syndrome (PCOS)
• Having acanthosis nigricans, a skin condition in which your skin becomes dark and thick, especially around your neck or armpits
• Smoking

How can I prevent or delay getting type 2 diabetes?

If you are at risk for diabetes, you may be able to prevent or delay getting it. Most of the things that you need to do involve having a healthier lifestyle. So if you make these changes, you will get other health benefits as well. You may lower your risk of other diseases, and you will probably feel better and have more energy. The changes are:

• Losing weight and keeping it off. Weight control is an important part of diabetes prevention. You may be able to prevent or delay diabetes by losing 5 to 10% of your current weight. For example, if you weigh 200 pounds, your goal would be to lose between 10 to 20 pounds. And once you lose the weight, it is important that you don't gain it back.
• Following a healthy eating plan. It is important to reduce the amount of calories you eat and drink each day, so you can lose weight and keep it off. To do that, your diet should include smaller portions and less fat and sugar. You should also eat a variety of foods from each food group, including plenty of whole grains, fruits, and vegetables. It's also a good idea to limit red meat, and avoid processed meats.
• Get regular exercise. Exercise has many health benefits, including helping you to lose weight and lower your blood sugar levels. These both lower your risk of type 2 diabetes. Try to get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional to figure out which types of exercise are best for you. You can start slowly and work up to your goal.
• Don't smoke. Smoking can contribute to insulin resistance, which can lead to type 2 diabetes. If you already smoke, try to quit.
• Talk to your health care provider to see whether there is anything else you can do to delay or to prevent type 2 diabetes. If you are at high risk, your provider may suggest that you take one of a few types of diabetes medicines.

What is type 2 diabetes?

If you have diabetes, your blood sugar levels are too high. With type 2 diabetes, this happens because your body does not make enough insulin, or it does not use insulin well (this is called insulin resistance). If you are at risk for type 2 diabetes, you might be able to prevent or delay developing it.

Who is at risk for type 2 diabetes?

Many Americans are at risk for type 2 diabetes. Your chances of getting it depend on a combination of risk factors such as your genes and lifestyle. The risk factors include

• Having prediabetes, which means you have blood sugar levels that are higher than normal but not high enough to be called diabetes
• Being overweight or having obesity
• Being age 45 or older
• A family history of diabetes
• Being African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
• Having high blood pressure
• Having a low level of HDL (good) cholesterol or a high level of triglycerides
• A history of diabetes in pregnancy
• Having given birth to a baby weighing 9 pounds or more
• An inactive lifestyle
• A history of heart disease or stroke
• Having depression
• Having polycystic ovary syndrome (PCOS)
• Having acanthosis nigricans, a skin condition in which your skin becomes dark and thick, especially around your neck or armpits
• Smoking

Type 2 diabetes prevention is proven, possible, and powerful. Taking small steps, such as eating less and moving more to lose weight, can help you prevent or delay type 2 diabetes and related health problems. The information below is based on the NIH-sponsored Diabetes Prevention Program (DPP) research study, which showed that people could prevent or delay type 2 diabetes even if they were at high risk for the disease.

Follow these steps to get started on your game plan.

Set a weight loss goal

If you are overweight, set a weight-loss goal that you can reach. Try to lose at least 5 to 10 percent of your current weight. For example, if you weigh 200 pounds, a 10-percent weight-loss goal means that you will try to lose 20 pounds.

Follow a healthy eating plan for weight loss

Research shows that you can prevent or delay type 2 diabetes by losing weight by following a reduced-calorie eating plan and being more active each day.

Move more

Find ways to be active every day. Start slowly and add more activity until you get to at least 30 minutes of physical activity, like a brisk walk, 5 days a week.

Track your progress

Keep track of your progress to help you reach your goals. Use your phone, a printed log, online tracker, app, or other device to record your weight, what you eat and drink, and how long you are active.

Talk with your health care team

Ask your health care team about steps you can take to prevent type 2 diabetes. Learn about other ways to help reach your goal, such as taking the medicine metformin. Also, ask if your health insurance covers services for weight loss or physical activity.

Get support for changing your lifestyle

It’s not easy to make and stick to lifelong changes in what you eat and how often you are active. Get your friends and family involved by asking them to support your changes. You can also join a diabetes prevention program to meet other people who are making similar changes.

Set a weight-loss goal

If you are overweight, the keys to preventing type 2 diabetes are to lose weight by choosing foods and drinks that are lower in calories, and to be more active. Set a weight-loss goal that you can reach. Try to lose at least 5 to 10 percent of your current weight within 6 months. For example, if you weigh 200 pounds, a 10 percent weight-loss goal means that you will try to lose 20 pounds. A good short-term goal is to lose 1 to 2 pounds per week.

Find your weight-loss goal

Find your current weight in the first column to see how much weight you would need to lose for a 5-, 7-, or 10-percent weight loss. For example, if you weigh 200 pounds and want to lose 5 percent of your current weight, then you would need to lose 10 pounds.

Calculate your weight-loss goal

Use the example below to learn how to calculate your exact weight-loss goal. In this example, the goal is for a 240-pound person to lose 5 percent of his or her weight.

As shown in the example below, a 240-pound person who wants to lose 5 percent of his or her weight would lose 12 pounds and weigh 228 pounds.

Follow a healthy eating plan for weight loss

Research shows that you can prevent or delay type 2 diabetes by losing weight by following a low-fat, reduced-calorie eating plan and by being more active. Following an eating plan can help you reach your weight-loss goal. There are many ways to do this. Remember that the key to losing weight and preventing type 2 diabetes is to make lifelong changes that work for you. Many popular weight-loss plans promise “quick fixes” and haven’t been proven to work long-term or to prevent type 2 diabetes.

The four most important steps to eating healthy for weight loss are:

1. Eat smaller portions than you currently eat of foods that are high in calories, fat, and sugar.
2. Eat healthier foods in place of less-healthy choices.
3. Choose foods with less trans fat, saturated fat, and added sugars.
4. Drink water instead of drinks with sugar such as soda, sports drinks, and fruit juice.

Pay attention to portion sizes

Using the plate method can help you manage your portion sizes. Fill half of your plate with fruits and vegetables. Fill one quarter with a lean protein, such as chicken or turkey without the skin, or beans. Fill one quarter with a whole grain, such as brown rice or whole-wheat pasta.

You can use everyday objects or your hand to judge the size of a portion. For example:

• 1 serving of meat or poultry is about the size of the palm of your hand or a deck of cards
• 1 3-ounce serving of fish is the size of a checkbook
• 1 serving of cheese is like six dice
• 1/2 cup of cooked rice or pasta is like a rounded handful or a tennis ball
• 2 tablespoons of peanut butter is like a ping-pong ball

Recommended daily calories and fat grams

The table below shows how many calories and fat grams to eat each day to lose weight. Your needs may be different, but these are good starting points. The amounts are based on the eating patterns used in the Diabetes Prevention Program research study.

*Eating less than 1,200 calories a day is not advised. Source: DPP Lifestyle Manual of Operations

How to read the food label

When making food choices, use the Nutrition Facts Label on food packages to see how many calories and fat grams are in the foods you choose.

Eat foods from each food group

Your eating plan should include a variety of foods from each food group. Use this chart from the U.S. Department of Agriculture to learn more about which foods to eat.

Eating tips for weight loss

• Try to get as close as possible to your daily calorie and fat gram goals.
• Eat meals and snacks at about the same time each day to keep from getting too hungry.
• Eat your meals on smaller plates and put your drinks in smaller glasses to make portions look bigger. Don’t worry about cleaning your plate.
• Eat slowly. It takes 20 minutes for your stomach to send a signal to your brain that you are full.
• Limit alcoholic beverages. If you drink alcohol, choose light beer or wine instead of mixed drinks.

Here are more tips on healthy eating.

Tips for eating at home

• Use low-fat, light, or fat-free sour cream, cream cheese, mayonnaise, cheese, and salad dressing.
• Cook with a mix of spices instead of salt.
• Refrigerate extra portions of food right after cooking so that you’re less tempted to go back for seconds.
• Freeze extra portions of food to have meals ready on days when you’re too busy or too tired to cook.
• Share a bowl of fruit with family and friends instead of cookies or chips.
• Eat fat-free or low-fat frozen yogurt or sherbet instead of ice cream.

Tips for eating at work or on the run

• Take your lunch to work or meetings to stay in charge of what you eat.
• Pack your lunch the night before so it’s ready to go when you are.
• Make a sandwich on whole-grain bread with turkey or lean beef.
• Use mustard or hummus instead of mayonnaise as a sandwich spread.
• Add carrots and celery sticks to your lunch instead of chips.
• Drink water instead of juice or regular soda.
• Pack a snack like an apple or fat-free yogurt to eat if you get hungry.

Tips for eating in-between meals

• Eat fruits, vegetables, or a small handful of unsalted nuts instead of chips or candy.
• To reduce calories, drink water instead of regular soda, sports drinks, or juice.
• Chew sugar-free gum between meals to help reduce your urge to snack.

Tips for food shopping

• Make a list of what you need before going to the store, and stick to your list.
• Eat a healthy snack or meal before shopping for food. Don’t shop on an empty stomach.
• Compare nutrition facts on food labels and choose foods that are lower in calories, saturated fat, trans fats, and sodium.
• Buy a new fruit or vegetable to try each time you go to the store. Use it to add flavor and color to soups, stews, or salads.
• Buy reduced-fat or light versions of mayonnaise, cheese, and salad dressing.
• Buy fat-free, low-fat, or soy milk instead of whole milk.

Tips for eating when dining out

• When possible, plan ahead by looking at the menu and nutrition information online.
• Take time when reading the menu to choose healthier meal options.
• Order from a menu instead of a buffet, where it is harder to control how much you eat.
• Ask about the portion size, amount of fat, and number of calories in menu items when deciding what to order.
• Ask to have your meal prepared with less fat, salt, or added sugars.
• Choose foods that are baked, steamed, grilled, or broiled instead of fried.
• Choose healthier foods at fast food restaurants. Eat grilled chicken (without the skin) instead of a cheeseburger.
• Order a salad for starters, and share your main dish with a friend or have the other half wrapped to go.
• Order sauces, salad dressing, or spreads on the side to reduce the amount used on your meal.
• Ask to have the amount you don’t want to eat put in a take-home container.
• It’s okay to have a small portion of high-calorie foods once in a while. Just keep your weight-loss goal in mind.

Move more

When you move more every day, you will burn more calories. This can help you reach your weight-loss goal and keep the weight off. Even if you don’t lose weight, being more active may help you prevent or delay type 2 diabetes.

Find ways to be active for at least 30 minutes, 5 days a week. Walking is recommended for most people. Check with your health care team about other exercise programs.

Use these tips to get started, and keep moving:

• Dress to move. Wear walking shoes that fit your feet and provide comfort and support. Your clothes should allow you to move and should keep you dry and comfortable. Look for fabrics that take sweat away from your skin to keep you cool.
• Start slowly. Start by taking a 5-10 minute walk (or doing another activity that you like) on most days of the week. Slowly, add more time until you reach at least 30 minutes of moderate-intensity activity 5 days a week. Moderate-intensity activity will increase your heart rate and breathing. To check your intensity, use the Talk Test: a person doing moderate-intensity activity is able to talk but not sing.
• Add more movement to your day. There are many ways you can add more movement to your day. If you have a dog, take your dog for a brisk walk in the morning or evening. When going shopping, park further away from the store’s entrance to increase your walk time. If you ride the bus, get off one stop early and walk the rest of the way if it is safe.
• Try to sit less in your day. Get up every hour and move. When you watch TV, walk or dance around the room, march in place, or stretch.
• Move more at work. Take a “movement break” during the day. Go for a walk during lunchtime. Deliver a message in person to a coworker instead of sending an email. Walk around your workplace while talking on the telephone. Take the stairs instead of the elevator to your workplace. Use the alarm on your phone, watch, or other device to remind you to take “movement breaks.”
• Count your steps. You may be surprised to learn how much walking you already do every day. Use a pedometer or other wearable device to keep track of your steps. A pedometer is a gadget that counts the number of steps you take. Work up to 7, 000-10,000 steps per day.
• Keep your muscles strong. Do activities to strengthen your muscles, such as lifting weights or using resistance bands 2 or more days a week.
• Stretch it out. If your body aches or is sore, you are less likely to move more. To reduce stiff or sore muscles or joints, consider stretching after being active. Don’t bounce when you stretch. Perform slow movements and stretch only as far as you feel comfortable.
• Make it social. When you bring other people into your activities, you are more likely to stick to your plan. Make walking “dates” with friends or family members throughout the week. For family fun, play soccer, basketball, or tag with your children. Take a class at a local gym or recreation center to be active with other people. Start a walking group with your neighbors, at work, or where you worship.
• Have fun. Being active doesn’t have to be boring or painful. Turn up the music and dance while cleaning the house. Go dancing with friends and family members. Play sports with your kids or grandkids. Try swimming, biking, walking, jogging, or any activity that you enjoy that gets you moving. Find different ways to be active so you won’t get bored.
• Keep at it. Reward yourself with nonfood treats, such as watching a movie, to celebrate your small successes. The longer you keep at it, the better you’ll feel. Making changes is never easy, but being more active is one small step toward a big reward: a healthier life.

Track your progress

Research shows that people who keep track of their weight and activity reach their goals more often than those who don’t. Weigh yourself at least once a week. Keep track of what you eat and drink, how many minutes of activity you get each day, and your weight.

The examples below show how to record your daily activity and food intake.

Talk with your health care team

People are usually more successful at weight loss and being more active if they have regular contact and support from health professionals. Talk with your health care team about the changes you want to make to prevent type 2 diabetes.

• Tell your health care team about your progress with weight loss and activity, and if you are having trouble sticking with your plan.
• Ask your health care team if you should take a medicine called metformin. Research shows that taking metformin can help prevent or delay type 2 diabetes. It is most helpful in younger people who are overweight and have prediabetes, and for women who have had gestational diabetes, a type of diabetes that develops during pregnancy.
• Contact your health insurance provider to learn what benefits are offered for weight-loss programs, diabetes-prevention programs, nutrition counseling, or fitness programs.
  • Some people with Medicare may be eligible for Intensive Behavioral Therapy for Obesity. This service includes up to 1 year of in-person weight-loss counseling visits with a health care professional.

If you smoke or use other tobacco products, you should stop. Even though quitting smoking can make it hard to manage your weight, it is a very important step to improve your health. Ask your health care team to help you create a plan for quitting. You can start by calling the national quitline at 1-800-QUITNOW (1-800-784-8669). For tips on quitting, go to SmokeFree.gov.

Get support for changing your lifestyle

Making big changes in your life is hard. You don’t have to change everything at once. You can make it easier by taking these steps:

1. Think about what is important to your health. What are you willing and able to do?
   Example: I know that being more active can help me lose some weight.
2. Decide what your goals are. Choose one goal to work on first.
   Example: I want to see if I can work up to getting 30 minutes of walking in a day on at least 5 days of the week.
3. Decide what steps will help you reach your goal.

   Steps to reach your goal	Example
   Set a time frame and deadline for making lifestyle changes.	I’ll start this week by walking for 10 minutes at lunch time.
   Plan what you need to get ready.	I need to take walking shoes to work.
   Think about what might prevent you from reaching your goals.	In bad weather, I won’t want to walk outside. I can walk inside instead.
   Decide how you will reward yourself when you do what you have planned.	If I stick with my plans this week, I’ll watch a movie.

4. Pick one step to try this week.

Add one or two healthy changes every week. Don’t get upset with yourself if you have a setback or lose control of your plan. Everyone has slips. Injury, illness, or being too busy can make it hard to stick to your plan. It’s not easy to make lifelong changes in what you eat and drink and in how often you are active. The important thing is to review your Game Plan and get back on track as soon as possible.

You don’t have to do it alone

Find family and friends who will support and encourage you in preventing type 2 diabetes. Join with a neighbor or coworker in changing your lifestyle. Talk with your health care team to learn about programs that may help, such as the National Diabetes Prevention Program.

Yes! You can prevent or delay type 2 diabetes with proven, achievable lifestyle changes even if you’re at high risk.

What is Prediabetes?

Before developing type 2 diabetes, most people have prediabetes; their blood sugar is higher than normal but not high enough yet for a diabetes diagnosis. Prediabetes is really common—more than 88 million US adults have it, though more than 80% of them don’t know they do. The good news is that prediabetes can be reversed.

Join a Lifestyle Change Program

If your blood test confirms you have prediabetes, join a CDC-recognized National Diabetes Prevention Program (National DPP) lifestyle change program to learn how to make lasting lifestyle changes to prevent or delay type 2 diabetes:

• Work with a trained lifestyle coach, who will help you take small, manageable steps that fit in your schedule and in your life.
• Discover how to eat healthy and add more physical activity into your day.
• Find out how to manage stress, stay motivated, and solve problems that can slow your progress.

Prevention Tips for Parents

Not long ago, it was almost unheard of for young children or teens to get type 2 diabetes. Now, about one-third of American youth are overweight, which is directly related to the increase in kids who have type 2 diabetes, some as young as 10 years old.

Parents have the power to make healthy changes that give kids the best chance to prevent type 2 diabetes. And when the whole family makes changes together, it’s easier to create healthy habits that stick. Get started with these simple but effective tips for healthy eating and being active family style.

How do they work? These pills help your body digest sugar more slowly.

Some Things To Think About

• These medicines are not likely to cause weight gain or blood sugar that is too low
• Before you start taking this drug, tell your doctor if:
  • you have heart, liver, or kidney problems
  • you are pregnant or breastfeeding

Common Side Effects

• Stomach Pain
• Diarrhea
• Gas
• Abnormal Liver Tests

Ask your healthcare provider to tell you the best way to take your medicines. They can also tell you about your medicine’s side effects and warnings. This guide does not give all side effects or warnings for each medicine.

More than 37 million people in the United States have diabetes, and 1 in 5 of them don’t know they have it. About 96 million American adults have prediabetes, and more than 80% of them don’t know they have it. Why aren’t more people getting tested?

One reason is that prediabetes and type 2 diabetes often don’t have any symptoms (compared with type 1 diabetes symptoms, which can develop quickly and can be severe). That’s why people with any risk factors are urged to visit their doctor to get screened (getting tested when they don’t have any symptoms). Catching prediabetes early can help people prevent or delay type 2 diabetes, and finding out they have type 2 diabetes—and taking appropriate action—can help people prevent or delay serious health complications.

Getting tested is simple and quick. Your blood will be drawn at your doctor’s office or at a clinic so your blood sugar can be tested. Results are usually available quickly.

Screening is also available at some walk-in labs for a small fee. A word of caution: walk-in screenings often aren’t accurate because people haven’t fasted (not eaten) 8 to 10 hours before the test. Make sure you know how to prepare ahead of time.

Did You Know?

People covered by Medicare can get up to two free screenings a year if they have certain risk factors for diabetes, such as high blood pressure or obesity.

Prediabetes is when your blood glucose, also called blood sugar, levels are higher than normal, but not high enough to be called diabetes. Having prediabetes is serious because it raises your chance of developing type 2 diabetes. Many of the same factors that raise your chance of developing type 2 diabetes put you at risk for prediabetes.

Other names for prediabetes include impaired fasting glucose or impaired glucose tolerance. Some people call prediabetes “borderline diabetes.”

About 1 in 3 Americans has prediabetes, according to recent diabetes statistics from the Centers for Disease Control and Prevention. You won’t know if you have prediabetes unless you are tested.

If you have prediabetes, you can lower your chance of developing type 2 diabetes. Lose weight if you need to, become more physically active, and follow a reduced-calorie eating plan.

Gestational diabetes is a type of diabetes that develops during pregnancy. Most of the time, gestational diabetes goes away after your baby is born. Even if your gestational diabetes goes away, you still have a greater chance of developing type 2 diabetes within 5 to 10 years. Your child may also be more likely to become obese and develop type 2 diabetes later in life. Making healthy choices helps the whole family and may protect your child from becoming obese or developing diabetes.

Here are steps you should take for yourself and your child if you had gestational diabetes:

• Get tested for diabetes 6 to 12 weeks after your baby is born. If your blood glucose is still high, you may have type 2 diabetes. If your blood glucose is normal, you should get tested every 3 years to see if you have developed type 2 diabetes.
• Be more active and make healthy food choices to get back to a healthy weight.
• Breastfeed your baby. Breastfeeding gives your baby the right balance of nutrients and helps you burn calories.
• Ask your doctor if you should take the diabetes drug metformin to help prevent type 2 diabetes.

Perhaps you have learned that you have a high chance of developing type 2 diabetes, the most common type of diabetes. You might be overweight or have a parent, brother, or sister with type 2 diabetes. Maybe you had gestational diabetes, which is diabetes that develops during pregnancy. These are just a few examples of factors that can raise your chances of developing type 2 diabetes.

Diabetes can cause serious health problems, such as heart disease, stroke, and eye and foot problems. Prediabetes also can cause health problems. The good news is that type 2 diabetes can be delayed or even prevented. The longer you have diabetes, the more likely you are to develop health problems, so delaying diabetes by even a few years will benefit your health. You can help prevent or delay type 2 diabetes by losing a modest amount of weight by following a reduced-calorie eating plan and being physically active most days of the week. Ask your doctor if you should take the diabetes drug metformin to help prevent or delay type 2 diabetes.

How can I lower my chances of developing type 2 diabetes?

Research such as the Diabetes Prevention Program shows that you can do a lot to reduce your chances of developing type 2 diabetes. Here are some things you can change to lower your risk:

• Lose weight and keep it off. You may be able to prevent or delay diabetes by losing 5 to 7 percent of your starting weight. For instance, if you weigh 200 pounds, your goal would be to lose about 10 to 14 pounds.
• Move more. Get at least 30 minutes of physical activity 5 days a week. If you have not been active, talk with your health care professional about which activities are best. Start slowly to build up to your goal.
• Eat healthy foods most of the time. Eat smaller portions to reduce the amount of calories you eat each day and help you lose weight. Choosing foods with less fat is another way to reduce calories. Drink water instead of sweetened beverages.

Ask your health care professional about what other changes you can make to prevent or delay type 2 diabetes.

Most often, your best chance for preventing type 2 diabetes is to make lifestyle changes that work for you long term.

If you’re interested in preventing type 2 diabetes, this guide can help you get started. Congratulations on taking the first step! By reading this, you’re already on your way.

Prediabetes puts you on the road to possibly getting type 2 diabetes. If your results shows you’re at high risk for type 2 diabetes, talk to your doctor about getting a simple blood sugar test to confirm it. Then, if you’re diagnosed with prediabetes, consider joining a lifestyle change program offered by the National Diabetes Prevention Program (National DPP). This program is proven to cut the risk for type 2 diabetes in half.

Not quite ready to join a lifestyle change program? Or want a jumpstart before your program begins? Use this guide to help you take the first steps toward preventing type 2 diabetes.

Why is prevention so important? Because type 2 diabetes is a serious, chronic health condition that can lead to other serious health issues such as heart disease, stroke, blindness, and kidney failure. If you can prevent or even delay getting type 2 diabetes, you can lower your risk for all those other conditions.

This guide will help you take small, practical steps that add up to a healthy lifestyle you can stick with and enjoy, including:

• Starting point: Assess where you stand with eating and your activity level right now.
• First stop: Make a nutrition plan for healthier eating.
• Keep moving: Set a fitness goal for healthier movement.
• Track your progress: Watch yourself succeed with a few easy steps.
• Prepare for the long run: Understand the support you have to keep you going.

By making some healthy changes, including eating healthier and getting active, you can prevent or delay type 2 diabetes and improve your physical and mental health overall.

And you don’t have to wait to feel the benefits—when you start making healthy changes, you get rewards right away. After taking just one walk, your blood sugar goes down. Make physical activity a habit and see how your sleep improves. Enjoy the taste of fresh, healthy food. Figure out what to do with all of your extra energy. Maybe even get closer to friends and family if you invite them along for the ride!

Starting Point: Assess Where You Are and Where You Need to Go

Let’s assess where you stand right now when it comes to nutrition and physical activity. Write down your answers to these questions to make it easier for you to figure out which of your habits are helpful and which habits you might want to work on.

Think About How You …

Eat in a Typical Week

• Do other people, such as friends, family, or coworkers, influence what you eat?
• Do you prepare your meals ahead of time, or decide in the moment what to eat?
• How comfortable are you with reading a nutrition label?
• How often do you eat out and where?
• What makes it easier for you to eat healthier? What makes it harder?

Move in a Typical Week

• How much of your commute is spent walking or biking?
• How much time do you make for physical activity around the house, such as walking the dog, cleaning the house, or gardening?
• How often do you dedicate 30 minutes per day for physical activity, such as walking, biking, or swimming?
• What are your favorite ways to be active?
• What makes it easier or more enjoyable for you to move more? What makes it harder?

Set a Weight Loss Goal

With your starting point in mind, set a weight loss goal. If you are overweight and have prediabetes, shedding just 5% of your weight can help reverse prediabetes.

Here’s an example to help calculate a weight loss goal of 5%.

Now that you’ve assessed your habits and preferences around eating and being active and have set a healthy weight loss goal, you’re better prepared to hit the road on your way to wellness.

First Stop: Make a Nutrition Plan for Healthier Eating

Winning Habits: Make over your meals with a plan, the right ingredients, and life hacks.

Make a plan.

You’ve probably noticed that someone who follows a popular diet plan might quickly lose weight, but has a hard time keeping it off long term. This is common and discouraging, so let’s design a plan that you can follow for life. It doesn’t need to be popular or have a name.

Your plan only needs two key ingredients to work:

1. It should be based on healthy eating.
2. It should be something you can keep doing.

People often need to try different things to create a plan that works for them. Some may cut back on sugar and eat more protein to stay fuller longer. Others may focus on crowding out unhealthy food with extra fruits and vegetables. Still others take the guesswork and temptation out of life by sticking to just a few breakfast and lunch choices that they know are nutritious. The details will depend on what you like and what fits in best with your life.

Eat well. Good food in the right amounts does so much more for you than just helping you lose the pounds; it helps you feel better and even think better. All good things! Read more in our Eat Well section.

Some basics to get started:

Choose these foods and drinks more often:

• Non-starchy vegetables such as peppers, mushrooms, asparagus, broccoli, and spinach
• Fruits
• Lean protein such as fish, chicken, turkey, tofu, eggs, and yogurt
• Whole grains such as quinoa, brown rice, and steel-cut oatmeal
• Water and unsweetened beverages

Choose these foods and drinks less often:

• Processed foods such as packaged snacks, packaged meat, chips, granola bars, sweets, and fast foods
• Trans fat, found in things such as margarine, snack food, packaged baked goods, and many fried foods
• Sugary drinks such as fruit juice, sports drinks, and soda
• Alcohol

Master Portion Sizes

Size it up: get a handle on portion size. Most of us don’t know just how much we’re eating. One way to help manage portion size is by using the plate method. If you’re not using a plate, this “handy” guide will help you estimate portion size

Choose the Best Foods: Decoding Food Labels, Eating a Healthy Variety, and Quality Calories

Use the Nutrition Facts label to make healthier choices.

Put foods that don’t have labels first on your grocery list. Visit the produce section to stock up on fresh veggies and fruit. (Just watch out for packaged food tucked away between the apples and asparagus, such as salad toppings and snack foods.) Then, shop the outside aisles of the store for dairy, eggs, and lean meat. Some packaged food will be on your list. Use the Nutrition Facts label to see how many calories and grams of carbs, sugars, and fat are in the food you choose.

Eat a variety of healthy foods. Eat all kinds of different foods from the major food groups: veggies, fruits, grains, dairy or dairy alternatives such as low-fat or fat-free milk, yogurt, and other products made from soy, almonds, and cashews, and lean protein. Eating a variety of foods helps to make sure you get the vitamins and minerals you need. You don’t need to eat all food groups at each meal.

Count what counts.

Don’t get too hung up on calories, but definitely count them in. Cutting calories from your meals and adding physical activity to your routine can help you lose weight. But don’t cut back too far. If you get too hungry, you won’t stay on your plan. And remember, if you’re more active, you’re burning more calories.

The National Institutes of Health offers an interactive Body Weight Planner that can help you determine the number of calories you should eat each day to get you to your goal weight and to maintain it.

Make Work, Home, Grocery Stores, and Restaurants Work for You

• Take the work out of eating at work.
  Bring a healthy lunch from home instead of eating out. Keep fruit and vegetables in the fridge at work for snacks. Package high-power snacks like nuts in small containers so you don’t eat too much.
• Make home your healthy place.
  Cook while you’re doing another enjoyable activity, such as listening to music or catching up on your favorite show. Keep a few healthy snacks on hand in case food cravings hit.
• Create a grocery store game plan.
  Shop on a full stomach so you’re not tempted to buy unhealthy food.
• Restaurants: Order with ease.
  Decide what you’re going to order before you go to a restaurant so you’re not tempted by the look and smell of less healthy choices.

Keep Moving: Set a Fitness Goal for Healthier Movement

Get active. Our bodies are made to move, and we feel better when we do. That said, getting started can be a challenge. One thing is for sure—you won’t stick with something that you don’t like doing, and you shouldn’t have to.

There are lots of ways to get moving; for example, walking is a great physical activity, and just about anyone can do it. Just be sure to check with your doctor about which activities are best for you and if there are any you should avoid.

So, set a goal that works for you! And gradually work up to being active at a moderate intensity at least 150 minutes per week. One way to do this is to aim for 30 minutes, 5 days a week. Moderate-intensity activities are those that make you breathe harder and make your heart beat faster, such as a brisk walk. Below is an example goal chart.

Make a Plan! Put it on the calendar and choose the same time or location for your daily activity. The more regular you are being physically active, the quicker it becomes a habit.

Find some healthy tips for being active.

Track Your Progress: Watch Yourself Succeed With a Few Easy Steps

The best way to stick with your goals and keep building on them is to measure them! Research shows that people who keep track of their food, activity, and weight reach their goals more often than people who don’t.

There are lots of free tracking apps for your phone or tablet. Good old-fashioned pen and paper work too. Some people swear by taking photos of everything they eat and drink to keep them accountable.

Prepare for the Long Run: Get Support and Look Ahead

Get support.

Share your healthy goals and why they’re important with your friends and family. Having their support and encouragement can help you stay on track.

Consider these few examples of support:

• Ask if a friend would like to walk with you after dinner.
• Invite your kids to cook a healthy meal with you, or make a date night out of cooking with a partner.
• Talk to friends about struggles you’re having and ask if they have advice.
• Share your successes with people you can trust to encourage you.

Who knows, you could even be helping someone you care about prevent type 2 diabetes along with you.

Go online.

There are lots of free online resources that can boost your motivation and confidence too. A quick Internet search will show you no-cost communities with people who share your goals and challenges, and who could learn from your experience (and you from theirs). If you share your health goals with others, you’ll be more likely to stick to them.

Remember, your doctor, physician assistant, or nurse practitioner can help you meet your goals.

If you retake the risk test and find that you’re at a higher risk, or just feel like you’re struggling and not seeing the results you want, consider asking for your health care provider’s advice and direction. They could also refer you to specialists, such as a registered dietitian or mental health counselor, who can help you deal with a specific challenge. If you have prediabetes, ask your doctor if joining the National DPP might be a helpful step for you.

Look ahead.

We hope this guide has helped you get started down the road to not only preventing type 2 diabetes, but also having more energy, better checkups, and better mental health.

Making lifestyle changes can take time, but if you add in small steps towards your goals every week, you can start to make living healthy a habit.

Sisters Together: Move More, Eat Better is a national health awareness program of the NIDDK that encourages black women ages 18 and older to reach and maintain a healthy weight by being more physically active and making healthier food choices.

Anyone who sees a need in his or her community and wants to help can start a Sisters Together program. This recently updated guide outlines six steps to help you start your program.

Six Steps to Help You Start Your Program

1. Get Started
   Learn about your community’s needs to shape your program.

2. Set Goals, Create a Budget
   Create specific, realistic goals and deadlines to plan your program.

3. Identify Community Resources
   Find out how resources and partners in your community can help.

4. Plan Activities
   Decide on core activities and events to promote your message.

5. Spread the Word about Sisters Together
   Use media outlets to promote your program and attract participants.

6. Measure Success, Keep Your Program Going
   Track your program’s progress and keep it running over the long haul.

Included in the guide are sample forms, letters, emails, and social media posts you can copy and modify to suit your specific needs. These resources were designed for black women ages 18 and older, and you can adapt them for other groups.

Overweight and obesity are serious health problems. More than 1 in 3 U.S. adults has obesity, and more than 1 in 2 U.S. black women has obesity. Excess weight increases the risk of health conditions such as diabetes, kidney disease, and heart disease. This guide and its tools and resources can help you promote the “move more, eat better” message and improve the health of your community.

Reduce Portion Sizes

Portion size is the amount of food you eat, such as 1 cup of fruit or 6 ounces of meat. If you are trying to eat smaller portions, eat a half of a bagel instead of a whole bagel or have a 3-ounce hamburger instead of a 6-ounce hamburger. Three ounces is about the size of your fist or a deck of cards.

Put less on your plate, Nate.

1. Drink a large glass of water 10 minutes before your meal so you feel less hungry.

2. Keep meat, chicken, turkey, and fish portions to about 3 ounces.

3. Share one dessert.

Eat a small meal, Lucille.

4. Use teaspoons, salad forks, or child-size forks, spoons, and knives to help you take smaller bites and eat less.

5. Make less food look like more by serving your meal on a salad or breakfast plate.

6. Eat slowly. It takes 20 minutes for your stomach to send a signal to your brain that you are full.

7. Listen to music while you eat instead of watching TV (people tend to eat more while watching TV).

How much should I eat?

Try filling your plate like this:

• 1/4 protein
• 1/4 grains
• 1/2 vegetables and fruit
• dairy (low-fat or skim milk)

Move More Each Day

Find ways to be more active each day. Try to be active for at least 30 minutes, 5 days a week. Walking is a great way to get started and you can do it almost anywhere at any time. Bike riding, swimming, and dancing are also good ways to move more.

If you are looking for a safe place to be active, contact your local parks department or health department to ask about walking maps, community centers, and nearby parks.

Dance it away, Faye.

8. Show your kids the dances you used to do when you were their age.

9. Turn up the music and jam while doing household chores.

10. Work out with a video that shows you how to get active.

Let's go, Flo.

11. Deliver a message in person to a co-worker instead of sending an e-mail.

12. Take the stairs to your office. Or take the stairs as far as you can, and then take the elevator the rest of the way.

13. Catch up with friends during a walk instead of by phone.

14. March in place while you watch TV.

15. Choose a place to walk that is safe, such as your local mall.

16. Get off of the bus one stop early and walk the rest of the way home or to work if it is safe.

Make Healthy Food Choices

Find ways to make healthy food choices. This can help you manage your weight and lower your chances of getting type 2 diabetes.

Choose to eat more vegetables, fruits, and whole grains. Cut back on high-fat foods like whole milk, cheeses, and fried foods. This will help you reduce the amount of fat and calories you take in each day.

Snack on a veggie, Reggie.

17. Buy a mix of vegetables when you go food shopping.

18. Choose veggie toppings like spinach, broccoli, and peppers for your pizza.

19. Try eating foods from other countries. Many of these dishes have more vegetables, whole grains, and beans.

20. Buy frozen and low-salt (sodium) canned vegetables. They may cost less and keep longer than fresh ones.

21. Serve your favorite vegetable and a salad with low-fat macaroni and cheese.

Cook with care, Claire.

22. Stir fry, broil, or bake with non-stick spray or low-salt broth. Cook with less oil and butter.

23. Try not to snack while cooking or cleaning the kitchen.

24. Cook with smaller amounts of cured meats (smoked turkey and turkey bacon). They are high in salt.

Cook in style, Kyle.

25. Cook with a mix of spices instead of salt.

26. Try different recipes for baking or broiling meat, chicken, and fish.

27. Choose foods with little or no added sugar to reduce calories.

28. Choose brown rice instead of white rice.

Eat healthy on the go, Jo.

29. Have a big vegetable salad with low-calorie salad dressing when eating out. Share your main dish with a friend or have the other half wrapped to go.

30. Make healthy choices at fast food restaurants. Try grilled chicken (with skin removed) instead of a cheeseburger.

31. Skip the fries and chips and choose a salad.

32. Order a fruit salad instead of ice cream or cake.

Rethink your drink, Linc.

33. Find a water bottle you really like (from a church or club event, favorite sports team, etc.) and drink water from it every day.

34. Peel and eat an orange instead of drinking orange juice.

35. If you drink whole milk, try changing to 2% milk. It has less fat than whole milk. Once you get used to 2% milk, try 1% or fat-free (skim) milk. This will help you reduce the amount of fat and calories you take in each day.

36. Drink water instead of juice and regular soda.

Eat smart, Bart.

37. Make at least half of your grains whole grains, such as whole grain breads and cereals, brown rice, and quinoa.

38. Use whole grain bread for toast and sandwiches.

39. Keep a healthy snack with you, such as fresh fruit, a handful of nuts, and whole grain crackers.

40. Slow down at snack time. Eating a bag of low-fat popcorn takes longer than eating a candy bar.

41. Share a bowl of fruit with family and friends.

42. Eat a healthy snack or meal before shopping for food. Do not shop on an empty stomach.

43. Shop at your local farmers market for fresh, local food.

Keep track, Jack.

44. Make a list of food you need to buy before you go to the store.

45. Keep a written record of what you eat for a week. It can help you see when you tend to overeat or eat foods high in fat or calories.

Read the label, Mabel.

46. Compare food labels on packages.

47. Choose foods lower in saturated fats, trans fats, cholesterol (ko-LESS-tuh-ruhl), calories, salt, and added sugars.

Take Care of Your Mind, Body, and Soul

You can exhale, Gail.

48. Take time to change the way you eat and get active. Try one new food or activity a week.

49. Find ways to relax. Try deep breathing, taking a walk, or listening to your favorite music.

50. Pamper yourself. Read a book, take a long bath, or meditate.

51. Think before you eat. Try not to eat when you are bored, upset, or unhappy.

Be Creative

Honor your health as your most precious gift. There are many more ways to prevent or delay type 2 diabetes by making healthy food choices and moving more. Discover your own and share them with your family, friends, and neighbors.

Make up your own, Tyrone or Simone.

52.

53.

54.

Things to Remember:

• Talk to your doctor about your risk for getting type 2 diabetes and what you can do to lower your chances.
• Take steps to prevent diabetes by making healthy food choices, staying at a healthy weight, and moving more everyday.
• Find ways to stay calm during your day. Being active and reading a good book can help you lower stress.
• Keep track of the many ways you are moving more and eating healthy by writing them down.

We are American Indians and Alaska Natives, and we have the power to prevent type 2 diabetes. Science has proven that we can prevent diabetes if we lose as little as 10 pounds by walking 30 minutes 5 days a week and making healthy food choices

"I know everyone can do it once they make up their mind. A lot of people out there know it runs in their family and they think ‘Okay, I’m going to get it.’ No, it is not so. You can prevent it. If I can do it, so can you."

Glenda Thomas Fifer
Gila River Indian Community and Diabetes Prevention Program Participant

Here are 7 powerful steps you can take to get started today:

1. Move More. Get up, get out, and get moving. Walk, dance, bike ride, swim, or play ball with your friendsor family. It doesn’t matter what you do as long as you enjoy it. Try different things to keep it fun.

   "I found ways to work activity into my day. I walk for 10 minutes every morning. At night, my wife and I walkwith our daughter."
   Tom John
   Seneca

2. Make Healthy Food Choices. Focus on eating less. Eat fiber-rich fruits and vegetables each day. Choosewhole grain foods such as whole wheat bread and crackers, oatmeal, brown rice, and cereals. Cut down on fatty and friedfoods. You still can have foods you enjoy, just eat smaller servings. Choose water to drink.

   “I used to always go back for second helpings. Now, I leave the leftovers for another day. I think it’s working.”
   Josephine Malemute, RN
   Athabascan

3. Take Off Some Weight. Once you start eating less and moving more, you will lose weight. By losing just10 pounds, you can cut your chances of getting diabetes.

   “Since losing a few pounds, I feel better and have more energy to do the things I enjoy.”
   Loreli Decora
   Wimmebago Tribe of Nebraska

4. Set Goals You Can Meet. Start by making small changes. Try being active for 15 minutes a day this week.Then each week add 5 minutes until you build up to at least 30 minutes 5 days a week. Try to cut 150 calories out of yourdiet each day (that’s one can of soda!). Slowly reduce your calories over time. Talk to your health care team aboutyour goals.

   “When I first started walking, I could only go for about 10 minutes. Now I feel stronger and am able to walk 45minutes every day”
   Jonathan Feather
   Eastern Band of Cherokee Indians

5. Record Your Progress. Write down all the things you eat and drink and the number of minutes you areactive. Keeping a diary is one of the best ways to stay focused and reach your goals.

   Keeping track of my activity allows me to see how I’m doing. By walking for 10 minutes at least 3 times a day,I’m able to get my 30 minutes in.”
   Lorraine Valdez, RN
   Isleta/Laguna Pueblos

6. Seek Help. You don’t have to prevent diabetes alone. Ask your family and friends to help you out.Involve them in your activities. You can help each other move more, eat less, and live a healthy life. Go for a walktogether or play a pick-up game of basketball. Join a support group in your area to help you stay on track.

   “After dinner I often take a walk with my family instead of watching TV.”
   Kelly Moore, MD
   Creek Nation of Oklahoma

7. Keep at It. Making even small changes is hard in the beginning. Try to add one new change a week. If youget off track, start again and keep at it.

   “When I don’t think I have time to exercise, I just remember how important it is to be around for my family.”
   Ralph Forquera
   Juaneño Band of California Indians

   We have the power to help our people and the generations to come. We have the Power to PreventDiabetes."Yvette Roubideaux, MD
   Rosebud Sioux

Take your first step today. Talk to your healthcare team about your risk for type 2 diabetes and the small steps you can take to prevent it.

This tip sheet can help Asian Americans and Pacific Islanders at risk for type 2 diabetes move more and eat less to lower their risk for diabetes.

Take these small steps now to prevent diabetes.

Find out if you are at risk.

Asian Americans and Pacific Islanders who are overweight are at high risk for type 2 diabetes or prediabetes - that means a person’s blood glucose levels are higher than normal, but not yet high enough to be called diabetes. Talk with your doctor about YOUR risk. To learn more, take the risk test on the other side of this tip sheet.

Lose a small amount of weight.

The weight you think is normal for you may not be a healthy weight. Check the chart on the other side to see if your weight puts you at risk for diabetes. You can prevent or delay type 2 diabetes by losing as little as 10 pounds.

Be more physically active.

Choose an activity you enjoy. Ask family members or friends to be active with you. Take a walk, swim, bike ride, dance, or play ball — together. Be active at least 30 minutes a day, 5 days a week to help you lose weight and stay healthy.

Make healthy food choices.

Choose more fruits and vegetables, fish, lean meats, whole grain rice, and low-fat or skim milk and cheese. Make healthy food choices as a family. Keep healthy snacks such as fruit in the house. Eat fewer fatty and fried foods. Serve smaller portions. Choose water to drink.

Record your progress.

Every day write down all the foods you eat and drink and the number of minutes you are active. Review it every day. Keeping a diary is one of the best ways to stay focused and reach your goals. USDA's Choose My Plate can help.

Keep at it.

Add one new change each week. If you or your family members get off track, start again and keep going.

The rewards will last a lifetime.

Are you at risk for type 2 diabetes?

To find out about your risk for diabetes, check each item that applies to you.

• I am 45 years of age or older.
• My weight puts me at risk for diabetes.
• I have a parent, brother, or sister with diabetes.
• I am Asian American or Pacific Islander.
• I am fairly inactive. I am physically active less than three times a week.
• I have been told that I have polycystic ovary syndrome (PCOS).
• I have had diabetes while I was pregnant (this is called gestational diabetes) or I gave birth to a baby weighing 9 pounds or more.
• I have been told that my glucose levels are higher than normal.
• My blood pressure is 140/90 or higher, or I have been told that I have high blood pressure.
• My cholesterol (lipid) levels are not normal. My HDL cholesterol (“good” cholesterol) is less than 35 or my triglyceride level is higher than 250.
• Patches of skin around my neck and armpits appear dark, thick, and velvety. This is called acanthosis nigricans.
• I have been told I have blood vessel problems affecting my heart, brain, or legs.

Keep in mind: As people get older, their risk for type 2 diabetes increases.

At-Risk Weight Charts

Find your height in the correct chart. If your weight is equal to or greater than the weight listed, you are at increased risk for type 2 diabetes.

If You Are Asian American At Risk BMI ≥ 23

If You Are Pacific Islander At Risk BMI ≥ 26

If You Are Not Asian American or Pacific Islander At Risk BMI ≥ 25

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report