What is pre-diabetes and diabetes?
When your blood glucose levels are elevated but are not high enough to be classified as diabetes. It can be diagnosed with an oral glucose tolerance test that confirms impaired glucose tolerance, impaired fasting glucose or HbA1c of 6-6.4%. Having pre-diabetes means you have a higher risk of developing diabetes and heart disease, with 1 in 3 Australians with pre-diabetes developing type 2 diabetes.
The good news is that pre-diabetes is reversible. It’s not too late! Diet and lifestyle changes can reduce your risk of developing type 2 diabetes by up to 60%. Some medications can also be prescribed by your health professional to help reduce your risk.
When your body can’t keep your blood glucose levels within healthy levels.
When blood glucose levels go too high, it damages your nerves and organs. Over time, this can cause you to be 4x more likely to have heart disease, 3x more likely to have kidney failure and it can damage the nerves in your eyes leading to blindness. Don’t trust anyone that promises a “diabetes cure.”
Diabetes is a chronic condition that is not reversible, however, remission is achievable.
When blood glucose levels remain within healthy ranges without the use of diabetes medication. Partial remission is often defined as HbA1c under 6.5% without medication for at least a year with complete remission considered HbA1c under 5.7% without medication for a year[i] It is important that even in remission, that regular health check-ups are obtained to protect against the long-term effects of diabetes.
How do you achieve diabetes remission?
1. Set realistic weight loss goals
Currently, research shows that the best predictor of diabetes remission is weight loss.
There are many options available with intensive weight loss often prescribed, BUT, it’s not the only option.
Reducing total body weight loss by 10% or more increases your chances of achieving remission, if you’ve recently been diagnosed with type 2 diabetes diagnosis (within 5 years). The amount of weight loss to achieve remission varies between individuals, with studies reporting remission with between 5 – 20kg of weight loss in a year. While this can be achievable for some through diet and lifestyle changes alone, others may benefit from medications and surgery.
Remember, weight loss is rarely ever linear, and weight fluctuates on a daily basis. Don’t get discouraged by weight plateaus and don’t be afraid to reach out for help. Getting started early gives you the best chance of achieving remission.
It’s also important to work closely with your healthcare team to ensure that you lose weight safely and your medication can be adjusted to prevent hypoglycaemic episodes (when your blood sugar levels drop too low). They can also help you find the best strategy for you and your lifestyle.
A recent study investigating the factors that were associated with people successfully achieving remission from diabetes after bariatric surgery is: younger age (under 50y old), recently diagnosed with diabetes, on fewer oral hypoglycaemic agents, not on insulin, lower HbA1c pre-operation (better control of BGL). 
2. Remember that there is more than one way to achieve your goals
No two bodies are the same, therefore, it’s important to take an individualised approach. There has been research supporting the use of Mediterranean, low-carb, high protein and low GI and plant-based diets in improving HbA1c, blood glucose levels, improving cholesterol levels. These approaches are all different and should also be adapted by a dietitian to your personal situation and nutritional needs.[ii]
|Mediterranean||resulted in the greater weight loss than low GI, high protein, vegetarian and vegan diets.|
healthy fats for heart healthmore food variety for gut health
|may not be suitable for vegetarian/vegans as it contains small amounts of fish, eggs and other animal products (however, can be adapted)|
|Low carb||rapid weight loss in the beginning may be motivating|
Diabetes Australia highlights that there is reliable evidence that low-carb can help lower blood glucose levels for up to 6 months.
|very low carb diets require medical supervision|
may experience symptoms of low energy, dizziness
not suitable for individuals on medications that can cause hypoglycaemia (may need adjustments to medications)
may be low in fibre and disrupt regular bowel movements. may also impact long-term gut health
|Low-fat, plant-based diet/strong||more food volume to help with satiety|
increases in fiber and phytonutrients for gut health
reduce saturated gut for heart health
|naturally lower in protein which can help with satiety|
may miss out on healthy fats
may feel too restrictive
|Low GI||focus on wholegrains is good for heart health and gut health|
|requires understanding of low glycaemic index foods|
not all low GI foods are healthy and some high GI foods can be healthy
|High Protein||Increased satiety and fullness|
Helps build and retain muscle
|Can be expensive|
Excessive intake of red meat and processed meats can increase risk of bowel cancer
Mediterranean diets are renowned for their focus on healthy fats from fatty fish, olive oil, nuts and seeds. If you aren’t someone who eats fish at least once per week, you may benefit from an omega 3 supplement. The standard omega 3 supplements are made from fish oil, but vegan algae supplements are also available for individuals on a plant-based diet.
The Nordic Naturals Ultimate Omega 3 has 650mg of EPA and 450mg of DHA which meets the recommended amounts by the Heart Foundation. For prevention of heart disease and heart failure, the Heart Foundation recommends 250-500mg of combined EPA + DHA a day from either marine sources or supplementation. 
Ovega-3 also makes an algae-based omega 3 supplement that is suitable for vegetarians and vegans. It contains 270mg of EPA and 135mg of DHA per serving.
How do you reduce your risk of developing type 2 diabetes?
1. Half a plate of non-starchy veggies (as part of your meal)
Non-starchy vegetables are low in carbohydrates and low in calories so they help keep you feeling fuller without raising your blood glucose levels. Don’t be mistaken, they aren’t the whole meal. You would be hungry very soon after eating if you just ate a bowl of non-starchy vegetables by themselves. However, they are an important part of every main meal.
They add vitamins, minerals, antioxidants and more food volume to signal to your brain that you’re full now.
Starchy veg = potato, sweet potato, pumpkin, corn, beans, lentils, pea, cassava, plantain
Non starchy veg = every other type vegetable e.g. all your leafy greens, asparagus, broccoli, carrot, capsicum, cucumber, eggplant, mushroom, sugar snap pea, tomato
2. Pick plant protein over animal protein
It’s important to pair your veggies with protein to help maintain your muscle and feel full.
A systematic review and meta-analysis of random controlled trials found that replacing animal protein with plant protein resulted in improved HbA1c, fasting glucose and fasting insulin levels in individuals with type 1 and type 2 diabetes. It was concluded that replacing approximately 35% of total protein with plant protein was beneficial in improving control of blood glucose level.
You can start by having one plant-protein powered main meal a day.
Build your own vegan poke bowl for lunch by making Edamame beans, tofu or tempeh the main protein. My favourite combo for edamame beans is brown rice, leafy greens, red cabbage, carrot, avocado and roasted sesame dressing.
Edamame beans are easy to find in the freezer section at your local Asian grocery store, Coles or Woolworths.
Even halving the amount of beef mince in a recipe and replacing with legumes and beans can make a world of difference for your health. Experiment with adding black beans, red beans and lentils to your nachos, chili con carne, lasagne and other tomato-based dishes.
Move your body for more than 4 hours/ week
Exercise helps with controlling blood sugar levels by making your body better at responding to insulin for up to 24 hours after exercise. Moving your body daily, in any way that you find enjoyable, is important in the prevention and management of diabetes. It also helps with manage stress, lower your blood pressure and improve your sleep. A recent study found that long walks (45-60minutes) every day is an effective at improving weight loss, blood pressure and insulin sensitivity.[iii] Strength training can also be an enjoyable way to improve appetite regulation and weight management by sustaining fat loss and building muscle.