Diabetes is a chronic (long-lasting) health condition that affects how your body turns food into energy.

Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy.

If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heartdisease, vision loss, and kidney disease.

There isn’t a cure yet for diabetes, but losing weight, eating healthy food, and being active can really help. Taking medicine as needed, getting diabetes self-management education and support, and keeping health care appointments can also reduce the impact of diabetes on your life.

Diabetes by the Numbers

• 34.2 million US adults have diabetes, and 1 in 5 of them don’t know they have it.
• Diabetes is the seventh leading cause of death in the United States.
• Diabetes is the No. 1 cause of kidney failure, lower-limb amputations, and adult blindness.
• In the last 20 years, the number of adults diagnosed with diabetes has more than doubled.

There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant).

Type 1 Diabetes

Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake) that stops your body from making insulin. Approximately 5-10% of the people who have diabetes have type 1. Symptoms of type 1 diabetes often develop quickly. It’s usually diagnosed in children, teens, and young adults. If you have type 1 diabetes, you’ll need to take insulin every day to survive. Currently, no one knows how to prevent type 1 diabetes.

Type 2 Diabetes

With type 2 diabetes, your body doesn’t use insulin well and can’t keep blood sugar at normal levels. About 90-95% of people with diabetes have type 2. It develops over many years and is usually diagnosed in adults (but more and more in children, teens, and young adults). You may not notice any symptoms, so it’s important to get your blood sugar tested if you’re at risk. Type 2 diabetes can be prevented or delayed with healthy lifestyle changes, such as losing weight, eating healthy food, and being active.

Gestational Diabetes

Gestational diabetes develops in pregnant women who have never had diabetes. If you have gestational diabetes, your baby could be at higher risk for health problems. Gestational diabetes usually goes away after your baby is born but increases your risk for type 2 diabetes later in life. Your baby is more likely to have obesity as a child or teen, and more likely to develop type 2 diabetes later in life too.

Prediabetes

In the United States, 88 million adults—more than 1 in 3—have prediabetes. What’s more, more than 84% of them don’t know they have it. With prediabetes, blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Prediabetes raises your risk for type 2 diabetes, heart disease, and stroke. The good news is if you have prediabetes, a CDC-recognized lifestyle change program can help you take healthy steps to reverse it.

If you have any of the following diabetes symptoms, see your doctor about getting your blood sugar tested:

• Urinate (pee) a lot, often at night
• Are very thirsty
• Lose weight without trying
• Are very hungry
• Have blurry vision
• Have numb or tingling hands or feet
• Feel very tired
• Have very dry skin
• Have sores that heal slowly
• Have more infections than usual

Symptoms of Type 1 Diabetes

People who have type 1 diabetes may also have nausea, vomiting, or stomach pains. Type 1 diabetes symptoms can develop in just a few weeks or months and can be severe. Type 1 diabetes usually starts when you’re a child, teen, or young adult but can happen at any age.

Symptoms of Type 2 Diabetes

Type 2 diabetes symptoms often develop over several years and can go on for a long time without being noticed (sometimes there aren’t any noticeable symptoms at all). Type 2 diabetes usually starts when you’re an adult, though more and more children, teens, and young adults are developing it. Because symptoms are hard to spot, it’s important to know the risk factors for type 2 diabetes and visit your doctor if you have any of them.

Symptoms of Gestational Diabetes

Gestational diabetes (diabetes during pregnancy) usually shows up in the middle of the pregnancy and typically doesn’t have any symptoms. If you’re pregnant, you should be tested for gestational diabetes between 24 and 28 weeks of pregnancy so you can make changes if needed to protect your health and your baby’s health.

It’s real. It’s common. And most importantly, it’s reversible. You can prevent or delay prediabetes from developing into type 2 diabetes with simple, proven lifestyle changes.

Amazing but true: approximately 88 million American adults—1 in 3—have prediabetes. What’s more, more than 84% of people with prediabetes don’t know they have it. Could this be you? Read on to find out the facts and what you can do to stay healthy.

Prediabetes Is a Big Deal

Don’t let the “pre” fool you—prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes puts you at increased risk of developing type 2 diabetes, heart disease, and stroke.

Type 1 and Type 2: Not the Same

Many people don’t realize that type 1 and type 2 are different kinds of diabetes.

• About 90%-95% of people with diabetes have type 2; about 5% have type 1.
• Type 1 is caused by an immune reaction and can’t yet be prevented; type 2 can be prevented or delayed through lifestyle changes.
• Type 1 often starts quickly and has severe symptoms; type 2 is a gradual disease that develops over many years.
• Type 1 occurs most often in children, teens, and young adults; type 2 occurs most often in older people (though increasingly children, teens, and young adults are developing the disease).
• People with type 1 must use insulin every day to survive.
• Prediabetes can develop into type 2 diabetes, but not type 1.

Prediabetes Flies Under the Radar

You can have prediabetes for years but have no clear symptoms, so it often goes undetected until serious health problems show up. That’s why it’s important to talk to your doctor about getting your blood sugar tested if you have any of the risk factors for prediabetes, which include:

• Being overweight
• Being 45 years or older
• Having a parent, brother, or sister with type 2 diabetes
• Being physically active less than 3 times a week
• Ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby that weighed more than 9 pounds

Race and ethnicity are also a factor: African Americans, Hispanic/Latino Americans, American Indians, Pacific Islanders, and some Asian Americans are at higher risk.

Diabetes Is Harder to Live with Than Prediabetes

Though people with prediabetes are already at a higher risk of heart disease and stroke, they don’t yet have to manage the serious health problems that come with diabetes.

Diabetes affects every major organ in the body. People with diabetes often develop major complications, such as kidney failure, blindness, and nerve damage (nerve damage can lead to amputation of a toe, foot, or leg). Some studies suggest that diabetes doubles the risk of depression, and that risk increases as more diabetes-related health problems develop. All can sharply reduce quality of life.

Prediabetes = Preventdiabetes

Think of prediabetes as a fork in the road: Ignore it, and your risk for type 2 diabetes goes up. Lose a modest amount of weight and get regular physical activity, and your risk goes down. Modest weight loss means 5% to 7% of body weight, just 10 to 14 pounds for a 200-pound person. Regular physical activity means getting at least 150 minutes a week of brisk walking or similar activity. That’s just 30 minutes a day, five days a week.

The CDC-led National Diabetes Prevention Program has been proven to help people make the lifestyle changes needed to prevent or delay type 2 diabetes. Through the program, participants:

• Work with a trained coach to make lasting lifestyle changes.
• Discover how to eat healthy and add more physical activity into their day.
• Find out how to manage stress, stay motivated, and solve problems that can slow progress.

If you’re told you have prediabetes, ask your doctor or nurse if there is a National Diabetes Prevention Program offered in your community. The best time to prevent type 2 diabetes is now.

At a Glance

• A study found that biological risk factors—including weight and fat around the abdomen—are primarily responsible for higher rates of diabetes for black Americans compared with white Americans.
• The study suggests that making positive changes in known risk factors, like losing excess weight, can help reduce the racial health disparity for developing diabetes.

Diabetes is a disease that occurs when your blood glucose (also called blood sugar) is too high. Blood glucose is the body’s main source of energy. Insulin, a hormone made by the pancreas, helps glucose get into your cells to be used for energy. In type 2 diabetes, your body doesn’t make enough insulin or doesn’t use insulin well. Too much glucose then stays in your blood, and not enough reaches your cells. Over time, too much glucose in your blood can cause health problems, such as heart disease, nerve damage, eye problems, and kidney disease.

You can develop type 2 diabetes at any age. However, type 2 diabetes occurs most often in middle-aged and older people. You’re more likely to develop type 2 diabetes if you are 45 or older, have a family history of diabetes, or are overweight or obese. In the U.S., black adults are nearly twice as likely as white adults to develop type 2 diabetes. This racial disparity has been rising over the last 30 years.

To investigate potential causes for this health disparity, a team led by Dr. Mercedes R. Carnethon at Northwestern University Feinberg School of Medicine analyzed data collected from more than 4,200 participants in the CARDIA (Coronary Artery Risk Development in Young Adults) study. The research was supported in part by NIH’s National Heart, Lung, and Blood Institute (NHLBI). Results were published in JAMA on December 26, 2017.

Study participants were recruited at ages 18 to 30 years from Birmingham, Alabama; Chicago, Illinois; Minneapolis, Minnesota; and Oakland, California. About 49% of participants were black; 54% were women. The researchers collected information from participants about different risk factors for diabetes over 30 years. They gathered personal and family medical history, as well as information about participants’ weight and health habits like smoking, drinking, and diet. They also tracked information about participants’ neighborhoods, education level, ability to pay bills, and employment status throughout young adulthood.

The study found that the chance of developed diabetes was significantly higher for black adults than for white adults (about 66 more cases of diabetes per 1,000 people). The greatest difference was between black women and white women.

The researchers used statistical analyses to determine how biological, neighborhood, psychosocial, socioeconomic, and behavioral risk factors contributed to rates of diabetes. They found that biological risk factors accounted for most of the health disparity. These factors included a combination of body mass index, waist measurement, fasting glucose levels, lipids, blood pressure, and lung function. Differences between blacks and whites in neighborhood, psychosocial, socioeconomic, and behavioral factors were also linked with diabetes, although to a lesser degree.

“Obesity is driving these differences,” Carnethon says. “The findings surprised us, because for the past 20 years there was a narrative that there must be something we haven’t found that was causing this higher rate.... We now know there is no mystery to these higher rates. Our efforts to control the traditional risk factors can work to reduce the disparities we observe in diabetes incidence.”

—by Tianna Hicklin, Ph.D.

People with diabetes have high levels of blood sugar (or blood glucose). When blood sugar builds up too high, it causes harmful effects.

A study found that African Americans with disrupted sleep have higher blood sugar levels. Previous studies have also found this link in European and Asian populations.

Researchers looked at data from about 800 African American men and women who had home sleep apnea testing. Sleep apnea is a condition where breathing stops or gets very shallow for periods during sleep. The people in the study wore a device that measured when they were awake or asleep for a week. They also kept a sleep diary.

The researchers examined how long people slept, how often they woke up during the night, and changes in their sleep patterns. They compared these findings with blood glucose levels taken in a clinic.

About a third of participants had sleep apnea. Most were not receiving treatment for the condition.

Those with either sleep apnea or disrupted sleep patterns had higher blood glucose levels. People with the most severe sleep apnea had 14% higher blood glucose levels than those without it.

Many people with sleep apnea don’t know they have the condition. “Our results reaffirm the need to improve the screening and diagnosis of sleep apnea, both in African Americans and other groups,” explains Dr. Yuichiro Yano from Duke University, who led the study.

You’ll need to get your blood sugar tested to find out for sure if you have prediabetes or type 1, type 2, or gestational diabetes. Testing is simple, and results are usually available quickly.

Tests for Type 1 Diabetes, Type 2 Diabetes, and Prediabetes

Your doctor will have you take one or more of the following blood tests to confirm the diagnosis:

A1C Test

The A1C test measures your average blood sugar level over the past 2 or 3 months. An A1C below 5.7% is normal, between 5.7 and 6.4% indicates you have prediabetes, and 6.5% or higher indicates you have diabetes.

Fasting Blood Sugar Test

This measures your blood sugar after an overnight fast (not eating). A fasting blood sugar level of 99 mg/dL or lower is normal, 100 to 125 mg/dL indicates you have prediabetes, and 126 mg/dL or higher indicates you have diabetes.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. At 2 hours, a blood sugar level of 140 mg/dL or lower is considered normal, 140 to 199 mg/dL indicates you have prediabetes, and 200 mg/dL or higher indicates you have diabetes.

Random Blood Sugar Test

This measures your blood sugar at the time you’re tested. You can take this test at any time and don’t need to fast (not eat) first. A blood sugar level of 200 mg/dL or higher indicates you have diabetes.

*Results for gestational diabetes can differ. Ask your health care provider what your results mean if you’re being tested for gestational diabetes.
Source: American Diabetes Association

If your doctor thinks you have type 1 diabetes, your blood may also tested for autoantibodies (substances that indicate your body is attacking itself) that are often present in type 1 diabetes but not in type 2 diabetes. You may have your urine tested for ketones (produced when your body burns fat for energy), which also indicate type 1 diabetes instead of type 2 diabetes.

Tests for Gestational Diabetes

Gestational diabetes is diagnosed using blood tests. You’ll probably be tested between 24 and 28 weeks of pregnancy. If your risk is higher for getting gestational diabetes (due to having more risk factors), your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes.

Glucose Screening Test

This measures your blood sugar at the time you’re tested. You’ll drink a liquid that contains glucose, and then 1 hour later your blood will be drawn to check your blood sugar level. A normal result is 140 mg/dL or lower. If your level is higher than 140 mg/dL, you’ll need to take a glucose tolerance test.

Glucose Tolerance Test

This measures your blood sugar before and after you drink a liquid that contains glucose. You’ll fast (not eat) overnight before the test and have your blood drawn to determine your fasting blood sugar level. Then you’ll drink the liquid and have your blood sugar level checked 1 hour, 2 hours, and possibly 3 hours afterward. Results can differ depending on the size of the glucose drink and how often your blood sugar is tested. Ask your doctor what your test results mean.

Prevent Type 2 Diabetes

If your test results show you have prediabetes, ask your doctor or nurse if there is a lifestyle change program offered through the CDC-led National Diabetes Prevention Program in your community. You can also search for an online or in-person program. Having prediabetes puts you at greater risk for developing type 2 diabetes, but participating in the program can lower your risk by as much as 58% (71% if you’re over age 60).

Diabetes Treatment Plan

If your test results show you have type 1, type 2, or gestational diabetes, talk with your doctor or nurse about a detailed treatment plan—including diabetes self-management education and support services—and specific steps you can take to be your healthiest.

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.

You could have prediabetes for years without any clear symptoms. In fact, around 96 million American adults have prediabetes, but more than 80% of them don’t even know it. With prediabetes, blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Having prediabetes increases the risk for type 2 diabetes, heart disease, and stroke.

People who have any prediabetes risk factors are urged to talk to their doctor about getting their blood sugar tested. If you don’t have a doctor or are concerned about expense, there are free or low-cost options available as a first step:

• Free screenings
  Free blood sugar testing is offered at some health fairs, community centers, and pharmacies.
• Medicare coverage
  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.
• Low-cost health centers and labs
  Federally funded community health centers provide low-cost blood sugar testing on a sliding scale based on income. Testing is also available at some walk-in labs for a small fee.

A word of caution: Free blood sugar screenings often aren’t accurate because people haven’t fasted 8 to 10 hours before the test. Make sure you know how to prepare ahead of time.

One of the fastest ways to determine your risk: take the quiz at DoIHavePrediabetes.org. If your results show you’re likely to have prediabetes, it’s time to talk to a doctor about getting your blood sugar tested. A doctor can also connect you with the CDC-led National Diabetes Prevention Program to help you make lifestyle changes that can prevent or delay 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.

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.