As a supermarket dietitian, I get quite a few questions about those who may have been diagnosed as prediabetic. What exactly does that mean?

Prediabetes means that your blood sugar level is higher than normal (typically over 100 when fasting) but not yet high enough to be classified as Type 2 diabetes (a blood glucose level of 126 or higher when fasting). Without intervention, prediabetes is likely to become Type 2 diabetes in 10 years or less.

If you have prediabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.

The good news is that prediabetes can be an opportunity to make some changes — a wake-up call. However, progression from prediabetes to Type 2 diabetes isn’t inevitable.

The exact cause of prediabetes is unknown, although family history and genetics appear to play an important role, according to researchers at Mayo Clinic. Researchers have discovered some genes that are related to insulin resistance.

Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of prediabetes.

What is clear is that people who have prediabetes aren’t quite processing sugar (glucose) properly anymore. This causes sugar to build up in the bloodstream instead of doing its normal job of fueling the cells that make up muscles and other tissues.

Most of the glucose in your body comes from the foods you eat, specifically foods that contain carbohydrates. Any food that contains carbohydrates can affect your blood sugar levels, not just sweet foods. During digestion, sugar enters your bloodstream, and with the help of insulin, it enters the body’s cells, where it is utilized as a source of energy.

When you eat, your pancreas secretes insulin into your bloodstream. As insulin circulates, it acts like a key that allows sugar to enter cells. Insulin lowers the amount of sugar in your bloodstream. As blood sugar levels drop, so does the secretion of insulin from your pancreas.

When you have prediabetes, this process begins to work improperly. Instead of fueling cells, sugar builds up in the bloodstream. This occurs when the pancreas doesn’t make enough insulin or cells become resistant to insulin (or both).

One possible sign you may be at risk of Type 2 diabetes is darkened skin on certain parts of the body. This condition is called acanthosis nigricans. Common areas affected include the neck, armpits, elbows, knees and knuckles.

Classic red flags that suggest someone has moved from prediabetes to Type 2 diabetes include:

» Increased thirst

» Frequent urination

» Fatigue

» Blurred vision

Risk factors for prediabetes may include:

» Being overweight, with a body mass index above 25

» Being inactive

» Being age 45 or older

» Having a family history of Type 2 diabetes

» Being African American, Hispanic, American Indian, Asian American or Pacific Islander

» Having an earlier diagnosis of gestational diabetes when pregnant or gave birth to a baby who weighed more than 9 pounds (4.1 kilograms)

» Having polycystic ovary syndrome, a condition characterized by irregular menstrual periods, excess hair growth and obesity

» Having high blood pressure

» Having high-density lipoprotein cholesterol below 35 milligrams per deciliter (mg/dL) or a triglyceride level above 250 mg/dL

The bottom line is that with healthy lifestyle changes — such as eating healthy foods, including physical activity in a daily routine and maintaining a healthy weight — most blood sugars can be brought back to normal.


Q: I love picnics, but it seems that all the traditional favorites are so unhealthy. Is there a way to keep the fun parts and make the meal healthy, too?

A: Start by looking at the basic proportion of foods in the meal: How many different vegetable and fruit dishes are there compared to starchy dishes (like potatoes, breads, rice and pasta), meats and packaged snack foods?

Grain products are nutritious, especially if they’re whole-grain, but many picnics are overladen with starchy foods and low on fruits and vegetables. Add trays of raw fruits or vegetables and experiment with different vegetable salads for more variety. If you like to grill, load the grill with vegetables, which gives these nutritious, low-calorie foods great flavor.

You can put a new twist on potato or pasta salad by substituting a variety of chopped vegetables for some of the potatoes or pasta. This is a great way to work an additional serving of vegetables into a meal while reducing calories and increasing nutrients.

Most picnics include meat or poultry, like fried chicken, grilled meat or cold cuts in sandwiches. If you’re contributing to the picnic fare, an easy option is the rotisserie chicken available at most supermarkets. You can also choose lean, unprocessed meats and keep your portion to deck-of-cards size. If there are multiple meat options, choose one and enjoy another some other time.

Healthy eating can include some desserts, too. Have a dish of fruit salad with a dollop of ice cream or whipped cream. If brownies are a must-have, cut them in 2-inch square pieces, which supply 100 to 150 calories each. That makes it easier for those who are watching calories.

The irony of picnics is that although they are held at the height of fresh fruit and vegetable season, these nutrient-rich foods are often the smallest part of the meal. An updated picnic can have all the traditional foods but include more of the season’s bountiful produce.

American Institute for Cancer Research

Grilled Chicken & Nectarine Chopped Salad

Here’s a great salad to celebrate summer: grilled chicken and nectarine chopped salad. It’s from Eating Well magazine, and offers a quick, healthy, light lunch or dinner. It also offers a nutrition bonus of vitamins A and C.


» 2 ripe nectarines, halved and pitted

» 3 teaspoons plus ¼ cup extra virgin olive oil, divided

» 1 pound boneless, skinless chicken breasts, trimmed

» ½ teaspoon salt, divided

» ¼ teaspoon freshly ground black pepper

» 3 tablespoons red wine vinegar

» 1½ tablespoons water

» 2 teaspoon Dijon mustard

» 2 teaspoons honey

» 6 cups chopped romaine lettuce

» 2 cups finely chopped radicchio

» 1 cup assorted cherry tomatoes, chopped

» ¾ cup crumbled goat cheese


Preheat grill to medium or use a stovetop grill pan. Brush nectarine halves lightly with 1 teaspoon oil. Season chicken on both sides with ¼ teaspoon each salt and pepper and lightly brush with 2 teaspoons oil.

Grill the chicken, turning once or twice, until cooked through, 12 to 18 minutes. Grill the nectarines until lightly charred and softened, 2 to 3 minutes per side. Let the chicken and nectarines cool on a clean cutting board for about 10 minutes and then chop into bite-size pieces.

Meanwhile, whisk the remaining ¼ cup oil, vinegar, water, mustard, honey and the remaining ¼ teaspoon salt in a large bowl. Add lettuce, radicchio, tomatoes, cheese, the chicken and nectarines.

Toss well to combine. Season with pepper.


Serves 5, about 2 cups each

Per serving: 341 calories; 24 grams protein; 13 grams carbohydrate; 22 grams fat; 64 milligrams cholesterol; 3 grams fiber; 302 milligrams sodium

— Charlyn Fargo Ware is a registered dietitian at Hy-Vee in Springfield, Ill., and the media representative for the Illinois Academy of Nutrition and Dietetics. Contact her at, or follow her on Twitter: @NutritionRd, or click here for additional columns. The opinions expressed are her own.

Charlyn Fargo Ware is a registered dietitian with SIU School of Medicine in Springfield, Illinois, and the current president of the Illinois Academy of Nutrition and Dietetics. Contact her at, and follow her on Twitter: @NutritionRd. The opinions expressed are her own.