What is diabetes?

Diabetes causes blood glucose levels to be above normal. People with diabetes have problems converting food to energy. After food is eaten, it is broken down into a sugar called glucose. Glucose is then carried by the blood to cells throughout the body. The hormone insulin, made in the pancreas, helps the body change blood glucose into energy. People with diabetes, however, either no longer make enough insulin, or their insulin doesn’t work properly, or both.

Type 2 diabetes

Type 2 diabetes is the most common type in American Indians. This type of diabetes can occur at any age, even during childhood. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body cannot make enough insulin. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, blindness, kidney failure, and amputation.

Other kinds of diabetes

Type 1 diabetes

Type 1 diabetes is rare in American Indians. People develop type 1 diabetes when their bodies no longer make any insulin. Type 1 is usually first diagnosed in children or young adults but can develop at any age.

Gestational diabetes

Gestational diabetes is first diagnosed during pregnancy. It occurs when the body doesn’t use insulin properly. Having an American Indian family background raises the risk of developing gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.

What are the signs and symptoms of type 2 diabetes?

Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.

What does prediabetes mean?

Prediabetes means your blood glucose is higher than normal but not high enough for a diagnosis of diabetes. Having prediabetes also means you’re at risk for getting type 2 diabetes and heart disease. There are no visible symptoms of prediabetes. However, you can reduce the risk of getting diabetes and even return blood glucose levels to normal with modest weight loss through healthy eating and moderate physical activity.

What factors increase my risk for type 2 diabetes?

If you have certain conditions, you’re more likely to develop type 2 diabetes. The more of these conditions you have, the higher your risk. Check each item that is true for you. Then show this list to your health care provider.

“I didn’t know I had diabetes until I had a blood test at the clinic.”

Should I be tested for diabetes?

Anyone 45 years of age or older should consider getting tested for diabetes. If you are 45 or older and overweight, getting tested is strongly recommended. Ask your health care provider for an A1C test, a fasting blood glucose test, or an oral glucose tolerance test. Your health care provider will tell you if you have normal blood glucose, prediabetes, or diabetes. If you are told you have prediabetes, have your blood glucose checked again in 1 year.

How can I lower my risk for diabetes?

You can do a lot to lower your risk. The small steps you take can lead to big rewards.

• Reach and maintain a reasonable body weight.
• Make wise food choices most of the time.
• Be physically active every day.
• Take your prescribed medicines.

Doing these things can reduce your risk of developing type 2 diabetes. Keeping your blood pressure and cholesterol on target also helps you stay healthy.

“My great grandmother told me to breastfeed my child so the baby would be healthy.”

 

Make Wise Food Choices Most of The Time
What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood glucose, blood pressure, and cholesterol.

• Keep track of what you eat and drink. People who keep track are more successful in losing weight. You can use the Daily Food and Drink Tracker to write down what you eat and drink.
• Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses, meat, desserts, and other foods high in fat. Increase the amount of fruits and vegetables at every meal. Below is a chart for choosing sensible serving sizes using your hand as a measuring guide. Because your hand is proportioned to the rest of your body, it can be used to measure a healthy serving size for your body. Remember, the chart is only a guide. Choose your serving sizes and foods wisely.
• Limit your fat intake to about 25 percent of your total calories. Your health care provider or dietitian can help you figure out how many grams of fat to have every day. You can check food labels for fat content. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. See Ways to Lower The Amount of Fat in Your Meals and Snacks.
• Cut down on calories by eating smaller servings and by cutting back on fat. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories. Your health care provider or dietitian can work with you to develop a meal plan that helps you lose weight.
• Choose healthy commodity foods (items provided by the government to help people consume a nutritious diet), including those lower in fat.
• When you meet your goal, reward yourself with something special, like a new outfit or a movie.

"Having fruit for dessert instead of sweets has helped me lose weight."

Choose Sensible Serving Sizes

Amount of food	Types of food	Size of one serving (the same size as:)
3 ounces	meat, chicken, turkey, or fish	the palm of a hand or a deck of cards
1 cup	cooked vegetables salads casseroles or stews, such as chili with beans milk	an average-sized fist
1/2 cup	fruit or fruit juice starchy vegetables, such as potatoes or corn pinto beans and other dried beans rice or noodles cereal	half of an average-sized fist
1 ounce	snack food	one handful
1 Tablespoon	salad dressing	the tip of a thumb
1 teaspoon	margarine	a fingertip

Ways to Lower The Amount of Fat in Your Meals and Snacks

1. Choose lower-fat foods.
   Example:
   Instead of sunflower seeds (20 grams of fat),
   choose pretzels (1 gram).
   Savings: 19 grams.
   
   
2. Use low-fat versions of foods.
   Example:
   Instead of regular margarine (5 grams of fat),
   use low-fat margarine (2 grams).
   Savings: 3 grams.
   
   
3. Use low-fat seasonings.
   Example:
   Instead of putting butter and sour cream on your baked potato
   (20 grams of fat), have salsa (0 grams).
   Savings: 20 grams.
   
   
4. Cook with less fat.
   Example:
   Instead of making fried chicken (31 grams of fat),
   roast or grill the chicken (9 grams).
   Savings: 22 grams.

Be Physically Active Every Day

Regular exercise tackles several risk factors at once. Activity helps you lose weight; keeps your blood glucose, blood pressure, and cholesterol under control; and helps your body use insulin. If you are not very active, start an exercise program slowly. Talk with your health care provider first about what kinds of exercise would be safe for you. Then make a plan to increase your regular physical activity.

• Keep track of what you do for exercise and how long you do it. Use the Daily Physical Activity Tracker to keep track of your physical activity.
• Aim for at least 30 minutes of physical activity a day most days of the week.
  
• Incorporate physical activity into plans with family and friends. Set a good example for your children. Play softball on weekends. Go on a family hike.
  
• Be active every day. For example, walk to the store, clean the house, or work in the garden, rather than watch TV.

"Walking makes me feel good."

Getting Started on a Walking Routine

Walking is a great way to be physically active. Before you get started, talk with your health care provider about whether it’s OK for you to walk for exercise. Then get comfortable shoes that provide good support. You can use the Daily Physical Activity Tracker to start your routine gradually. Try to walk at least 5 times a week. Build up little by little to 30 minutes a day of brisk walking.

My Walking Program

Week number	Warm-up time (minutes) Walk slowly	Fast walk time (minutes) Walk briskly	Cool-down time (minutes) Walk slowly	Total (minutes)
1	5	5	5	15
2	5	8	5	18
3	5	11	5	21
4	5	14	5	24
5	5	17	5	27
6	5	20	5	30
7	5	23	5	33
8	5	26	5	36
9+	5	30	5	40

Source: Small Steps. Big Rewards. Your Game Plan for Preventing Type 2 Diabetes. A publication of the National Diabetes Education Program.

Take Your Prescribed Medicines

Some people need medicines to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor if you should take metformin to prevent type 2 diabetes. Metformin is a medicine that makes insulin work better and can reduce the risk of type 2 diabetes.

Hope through Research

With the help and participation of many Pima Indian volunteers over the years, scientists at the National Institutes of Health have been able to identify several ways health care providers can take better care of people with diabetes. We know keeping blood glucose, blood pressure, and blood cholesterol under control is very important. We know pregnant women with diabetes need to keep their blood glucose under control so their babies will be healthy and have a lower risk of getting diabetes. We know breastfeeding, even for a few weeks, helps protect babies from becoming overweight and developing diabetes.

We also know that many people who might otherwise develop type 2 diabetes can prevent it by exercising regularly, lowering the amount of fat and calories they eat, and losing weight. Researchers are also studying the genetic and environmental factors that can lead to prediabetes and diabetes. As they learn more about the events that lead to diabetes, researchers hope to develop more ways to prevent diabetes and take care of those who already have diabetes.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

Daily Food and Drink Tracker

Use the Daily Food and Drink Tracker to keep track of everything you eat and drink. Make a copy of the form for each day. Write down the time, the name of the food or drink, and how much you had. For a free booklet with information on fat grams and calories, call the National Diabetes Education Program at 1-888-693-NDEP (1-888-693-6337) and request a copy of the Game Plan Fat and Calorie Counter.

Sample

Date        December 1, 2011    Daily Food and Drink Tracker
Time	Name	Amount	Fat Grams	Calories
8:00 am	oatmeal	1/2 cup	1	80
	fat-free milk	1 cup	0	90

Daily Physical Activity Tracker

Use the Daily Physical Activity Tracker to keep track of your physical activity. Make a copy of the form for each day. Write down what you do and for how long.

Sample

Date        December 1, 2011    Daily Physical Activity Tracker
Type of Activity	Minutes
Walking	20
Gardening	10

Daily Food and Drink Tracker

Date
Time	Name	Amount	Fat Grams	Calories
TOTALS

Daily Physical Activity Tracker

Date
Type of Activity	Minutes
TOTAL

Acknowledgments

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was originally reviewed by Donald K. Warne, M.D., C.D.E., M.P.H.; William C. Knowler, M.D., Ph.D., M.P.H.; and Mary Hoskin, M.S., R.D. It was also reviewed by American Indian health care providers who work with the National Diabetes Education Program. Comments from members of the Indian Health Service, the Gila River Indian Community, and other American Indian communities have also been included. Tammy L. Brown, M.P.H., R.D., B.C.-A.D.M., C.D.E., Captain, U.S.P.H.S.; Lorraine Valdez, R.N., M.P.A., C.D.E.; Wendy Sandoval, Ph.D., R.D., C.D.E.; Gordon Quam, B.S.N., R.N., C.D.R., U.S.P.H.S.; and Cecelia Shorty of the Indian Health Service reviewed the updated version of the publication.

National Diabetes Education Program

1 Diabetes Way
Bethesda, MD 20814-9692
Phone: 1-888-693-NDEP (1-888-693-6337)
TTY: 1-866-569-1162
Fax: 703-738-4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov
www.yourdiabetesinfo.org

The National Diabetes Education Program is a federally funded program sponsored by the U.S. Department of Health and Human Services’ National Institutes of Health and the Centers for Disease Control and Prevention and includes over 200 partners at the federal, state, and local levels, working together to reduce the morbidity and mortality associated with diabetes.

National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1-866-569-1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

NIH Publication No. 11–5337
August 2011

Page last updated: December 5, 2011