The statistics are staggering: one in three Americans has prediabetes, and 90 percent don’t even know it. Compound that problem with the fact that the typical American diet consists of frequent meal skipping, highly refined and processed foods, too many sugar-sweetened beverages and too little exercise, and we’ve got a recipe for a major diabetes problem on our hands.

That’s the bad news. The good news is that diabetes prevention is almost completely within your control and with a few small changes to your current lifestyle, you could slash your risk of developing diabetes in half. To do this we need to address three key areas: meal timing, food and beverage choices, and exercise.

Meal timing

Breakfast is said to be the “most important meal of the day” for a reason. Break-fast means that you are quite literally breaking the fast. Your body expects (and needs) fuel upon waking. Without it, your body is forced to create its own fuel by releasing stored sugar from your liver into your blood stream. This causes your blood sugar to spike. Skipping breakfast has been shown to cause spikes in blood sugar all day long leading to poor blood sugar control throughout the day. The more out of control your blood sugar, the more insulin your body must produce. And this cycle of too much sugar coupled with too much insulin leads to the progression of diabetes.

Think about it this way: Insulin is like a truck driver, picking up a “load” of sugar from your blood stream and delivering it to your cells where it can be burned for fuel. In diabetes, the truck driver delivers sugar to your cells but the cells are resistant to letting the sugar in — also known as insulin resistance. If the truck driver can’t deliver the load of sugar, the sugar continues to build up in your blood — prediabetes. For a while the body tries to control the ever increasing blood sugar by hiring more truck drivers (making more insulin), but eventually the body can’t keep up and it is like a labor shortage of truck drivers. Now with fewer truck drivers (insulin) the blood sugar goes even higher — diabetes.

So, to encourage the cells to allow the truck driver (insulin) to work, consistent meals and snacks are important. Though there isn’t a hard and fast rule for how many meals or snacks to eat, eating three meals per day is most important. Small, nutritious snacks in between meals are appropriate when hungry. If you find that you are not hungry within five hours of eating your last meal, portion sizes should be reduced. Eating every five hours will ensure that your body has enough fuel coming at regular intervals to lessen the spikes in blood sugar.

Food and beverage choices

This is where things get a little tricky. We humans are creatures of habit and it is often difficult to change our ways. But, achieving better blood sugar control requires eating the right foods at the right time.

Note: The eating pattern below is only an example and may not represent your particular eating habits.

Typical American’s eating pattern:

  • No breakfast
  • Coffee shop drink with sugar/syrup, milk and toppings
  • Quick, grab-n-go lunch: sub sandwich on white bread or fast-food burger on refined bun, fries or chips, soda
  • Last-minute dinner at restaurant or rushed meal at home made with assistance of boxed or pre-made items; soda or alcohol
  • Grazing snacks: chips, crackers, cookies, candy, ice cream

What to do for better blood sugar control:

  • Breakfast of protein/whole grain combo (whole wheat toast with egg, banana with peanut butter, oatmeal with nuts and berries, etc.)
  • Black coffee or tea — regular or decaf if you prefer
  • Lunch with ½ plate vegetables and fruit, ¼ lean protein, ¼ whole grain; water
  • Dinner similar to lunch, including dark leafy greens; water
  • Snacks if hungry including protein/carb combination (apple with peanut butter, whole grain crackers and cheese, veggies and hummus, popcorn and nuts, etc.)

What makes this diet better for blood sugar control?

  • Plenty of vegetables, including leafy greens, and fruit have a stronger presence.
  • Whole grains have replaced refined.
  • Water and black coffee or tea have replaced sugar-sweetened beverages.
  • Meal timing is more consistent.
  • Protein and fiber at each meal/snack help reduce the blood sugar spikes.


While many view exercise as the dreaded “e-word,” those who achieve 150 minutes of moderate physical activity each week are better able to manage their blood sugar, weight and overall health. Being physically active reduces your diabetes risk.

So, start small. Assess your current activity level — what can you do to be more active and start there. Maybe to start it’s parking further away, taking the stairs or going for a walk at lunch and building more exercise into your day. From there, perhaps you invest in a fitness tracking device and aim to increase your steps on a weekly basis. After that maybe you begin to challenge yourself to train for a 5K run/walk or pick up a fitness hobby.

Regardless of what you choose to do, know that increasing physical activity is an intentional act — it won’t just happen — and must be gradual over time. Diving head-first into an exercise routine is rarely sustainable.

While developing diabetes may seem inevitable given the statistics, much of prevention is within our control: meal timing, food and beverage choices and exercise. For more information and to take a quiz evaluating your diabetes risk, visit the American Diabetes Association. If you are concerned about your blood sugar levels, contact your primary care provider to have your A1c tested and discuss the results.

Blueberry toast

Makes: 1 serving


  • 2 slices whole wheat bread
  • ½ pint fresh blueberries*
  • 2 tablespoons nut butter (test recipe used almond butter)*
  • 2 teaspoons honey (optional)


Toast bread. Spread with nut butter and top with fruit. Drizzle with honey if desired.

*NOTE: Recipe can be modified to produce many different flavor profiles. Try these delicious combinations:

  • Peanut butter with fresh sliced grapes
  • Almond butter with fresh sliced strawberries
  • Pecan butter with fresh sliced peaches or nectarines
  • Sunflower seed butter with sliced fresh banana
  • Cashew butter with sliced fresh pear

Nutrition information: Per serving: 450 calories, 20 g fat, 15 g protein, 57 g carbohydrate, 11 g fiber, 300 mg sodium

Pita veggie pizza

Makes: 1 serving


  • 1 whole wheat pita pocket
  • 2 tablespoons favorite pizza sauce
  • ¼ cup part-skim mozzarella, shredded
  • 2 tablespoons red bell pepper, finely diced
  • 1 tablespoon spinach, finely chopped
  • 1 tablespoon black olives, chopped


Preheat oven to 400°F. As the oven is heating, assemble your pizza. Take a full pita and spread the pizza sauce evenly over the top of the pita. Spread the cheese and place your toppings evenly on top.

Bake pizza in the preheated oven for 10 minutes. Enjoy!

NOTE: You can use any vegetable topping if you don’t like the ones noted above to enjoy your own personal pizza!

Nutrition information: Per serving: 190 calories, 7 g fat, 12 g protein, 23 g carbohydrates, 3 g fiber, 560 mg sodium

Marisa Pruitt is a Gundersen Health System registered dietitian.


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