Five Actions to Reduce Diabetes Risk

Introduction

These are the top five actions I’d give to friends or family members to prevent, delay, or mitigate their risk from diabetes. These actions can dramatically improve your outcomes whether you are overweight, pre-diabetic, or a diabetic already.

Check out my diabetes page for more resources and the video and detailed descriptions below this top five list.

Five Actions Overview

Do you really want to reduce your risk? Then reduce the carbs you eat and/or fast. These actions dramatically reduce your insulin needs. Both are 100x risk reductions relative to most advice you’ll receive. The other actions are important complements but you cannot out-run, out-exercise, or out-medicate the wrong diet. And if you’re at-risk from diabetes eating too much, too often, or too many carbs (or really any carbs except vegetables) are the wrong diet.

#1 Reduce carbs and insulincarbs showing fast, high blood glucose impact, protein moderate, slow impact and fat minimal impact– Reduce insulin by eating less carbs.
– Eliminate starch, sugar, and fruit.
– Eat mostly protein, veg, and fat.
#2 Reduce feeding window +/- fastClock showing eights hours to eat and sixteen hours to fast– Your “feeding window” is how long from your first to last food or calories in a day (ex. 7am-11pm=16 hours.
– Start with a 12h feeding window.
– Gradually reduce to 10h, 8h, 4h, etc.
– Then fast for multiple days with medical support for any conditions.
#3 Walk more, move moreStick figure walking– Walk for 5 minutes every 1-2 hours.
– Go for a long walk (30+min) daily.
– Substitue biking, rowing, swimming, or any movement at a low intensity.
#4 Add more musclewoman squatting– Lifts weight 2x/week or more.
– Focus on compound, functional movements and growing leg strength.
– Example: 1-5 sets of weighted squats, pullups, burpees.
#5 Measure, monitor, actreset button– Monitor A1c and glucose regularly and carbs, body fat%, sleep, stress if they’re not optimal.
– Diabetics, also monitor insulin per day and time in range and standard deviation with a cgm.
– If you see issues, plan, act, measure results, and repeat until optimal. Find a specialist to help.

Video with Actions Explained

Below is a video with my current top five ways to reduce diabetes risk whether you’re already a diabetic, pre-diabetic, overweight, or have a family history of diabetes. If you’re motivated to change, implementing these actions will add years to your life, prevent diabetes if you don’t have it, and significantly reduce your risk of complications if you do. With that said, it’s a long video. So don’t watch it for fun. Watch it because you need to learn more and up your diabetes game like I did in the last few years.

If you want to skip directly to a specific action (and maybe just watch one), use these direct links.

Hearing some of this information is hard so be prepared. I accepted the harsh truth that I would likely live a shorter life and deal with awful complications from diabetes if I wasn’t uber-motivated to avoid them and took action every day to reduce the risk. If you’re not there, you might not like what you find. Come back when you’re ready.

I’ve lived almost twenty-five years free of major diabetes complications. My A1c is down to 5.5% from a 6% lifetime average with less than 3% time low from these actions. And most importantly my glucose is stable and more predictable. I don’t waste as much time high or low. I spend less time thinking about diabetes. I have less headaches. My sleep is better. Life is better.

#1 – Reduce carbs and insulin

Carbs aren’t bad. For normal people. For diabetics, pre-diabetics, and those at high risk of diabetes, carbs are bad. At least sugars and starches are bad. Whole wheat, whole grain, whole anything raises glucose quickly. As does potatoes. I love potatoes. But they don’t love me.

And I hate to say it but most fruit acts the same as sugar and starches in terms of raising blood glucose. Even with a little extra fiber fruits break down quickly and spikes your glucose and insulin levels. A few berries per day won’t kill you. A few bananas every day for years might. No one eats a few bananas every day. You might eat a banana, orange juice, some dried fruit, a smoothie, and evil grapes. Eating all that on the same day is not good. If you’re at risk from diabetes, fruit is not your friend.

For the rest of this post, assume carbs are sugar and starches (and even fruit). Vegetables are good. They don’t impact your blood glucose much. Read more on why food choices are never as simple as good or bad. I’m breaking my own rule by simplifying things because, for diabetics and those at-risk, the world is complex enough. Read Bernstein’s the diabetic versus the nondiabetic for more on the differences in metabolizing foods and The Law of Small Numbers on why diabetics should eat fewer carbs.

The image in the table shows the affect of the three macronutrients (carbs, protein, and fat) on blood glucose. Carbs have the fastest impact with the highest peak. This means carbs required more insulin to keep your glucose levels normal when you eat carbs. Unless you make zero insulin like me, you don’t know exactly how much insulin your body requires in response to carbs. Even if you inject insulin if your body still makes some insulin, you will not know how much insulin your body generates in response to carbs. Carbs require insulin. More insulin leads to more fat. More fat increases your diabetes risk. And for Type 1s more carbs increases glucose variabilities, meaning more highs and more lows, more cellular damage, more long-term complications.

Instead of eating carbs, eat mostly protein, fat, and vegetables. Remember, eating fat does not make you fat. The world has grown more obese since we started eating more sugar and less fat. Most people become healthier from eating more fat and fewer carbohydrates. Some are better off limiting saturated fat but can still eat more fat overall. Most are fine if they eat more saturated fat when they reduce their carb intake.

If you want to learn more on why eating more fat is fine for most people check out Good Calories Bad Calories by Gary Taubes. Read, listen, or watch Dr. Peter Attia’s cholesterol posts including The Straight Dope on Cholesterol. Or just watch this one Attia presentation on the studies that led the US to start eating less fat (and more carbs). Feel free to send me studies, articles, videos showing the opposite perspective. I’ll consume them with an open mind. My life depends on it.

Remove the sugar and starch. You’ll live longer and feel better.

#2 – Reduce feeding window +/- fast

Intermittent fasting. Time-restricted feeding. Whatever you call it, it works. It enhances insulin sensitivity. If I eat 10g of carbs after eating all day, I need 1 unit of insulin. If I eat 10g of carbs after fasting all day, I need 0-.5 units of insulin. My glycogen stores are low. My body just fills them back up.

Plus, your body begins to tap into your fat stores after a half-day to a day of not eating. This is good. That’s what we all want, right? Less fat. Let your body do the work. Easy to say. Hard to do.

Do not go from eating from the time you wake up to when you go to bed (16-hour feeding window) to fasting all-day (0-1 hour feeding window). That’s the most painful way to do it and risky. Gradually reduce your eating window over time. Twelve hours is a good target eating window to start. Then reduce to ten hours, eight hours, four hours, and lower if you want.

Your body needs to learn to tap into your body fat stores and use them for fuel. This can take weeks of adaptation, months if you’re not consistent. If you go the full-keto route, most say it takes two disciplined weeks. You’re doing something similar to keto here tapping into your fat stores and starting to burn ketones in the latter part of your fasting window. But your body is not great at using that energy when you first do this so you may be extra hungry, cranky, and tired. So start slow.

You don’t need to do this every day. Target a couple of days per week to start. Maybe work up to five to seven days if you want. But you get benefits from doing it even once per week. Besides insulin sensitivity, you also give your digestive system a break. And every system (besides the heart and lungs) needs a break once in a while.

And remember you should expect to feel hungry. When I fast I feel hungry every day in the late afternoon for a few hours. Then the hunger goes away. But if you feel lethargic of have other symptoms from not eating, eat. You can always try again.

Once you’re relatively comfortable with limiting your feeding window to four hours or less, try fasting for a day or two or three. If you’re overweight or have significant trunk fat, this is your ticket to lose fat and lead a longer, healthier, happier life. But it’s hard. Work with a medical professional when you get to this level, particularly if you have medical conditions. If I had Type 2 diabetes, multi-day fasting is what I’d do. Read about my first multi-day fast. Check out the Dr. Fung books and podcast linked on my diabetes page for more expert advice.

#3 – Walk more, move more

Movement increases insulin sensitivity. So move more often. Longer walks burn glucose. So take a long walk whenever possible. I take work calls on my walks when I don’t need to present anything. You can substitute other low to moderate intensity movements like biking, swimming, rowing, even bodyweight exercises, gardening, cleaning. Just move more.

Watch moving too fast or too intense. High-intensity training is good. There’s nothing wrong with being an athlete. But frequent short low-intensity movement and long duration sessions are important too. They train different energy systems than high-intensity. Don’t skip this.

Twenty minutes of walking normally burn 10-20 mg/dL of blood glucose for me. Everyone is a little different. Every day is a little different. I can see that data since I have a continuous glucose sensor. Most people don’t have those but you can trust that you’ll burn glucose from long low-intensity activity. This is good.

And there are many physiological, mental health, and creative benefits from walking. So walk. Walk when it’s cold. Grab a jacket. Walk when it’s hot. Grab some water. Walk when it rains. Keep an umbrella by your door. Just walk. Just move.

#4 – Add more muscle

More muscle makes you more insulin sensitive. Are you noticing a theme here? We like insulin sensitivity. You get immediate benefits in the hours after your workout, sometimes prolonged benefits in the days after your workout as your body rebuilds muscle. You get long-term benefits from higher insulin sensitivity and a larger storage depot in your muscles for glycogen. Plus, reducing or maintaining your body fat level and weight becomes easier with more muscle. And of course, you’ll feel better with more muscle. Weight training feels great immediately afterward and it’s nice to see muscles on your body like a suit of armor. Ladies, don’t worry. You will not get bulky. Unless you take steroids or train like a banshee.

Any weightlifting program will do. Some are bad. It’s good to learn the fundamentals from a coach. Hire someone for a session or two or ask a knowledgable friend. Take a class. Get educated. Learn leg exercises like squats and deadlift and how to complete them safely and effectively. To maximize the benefits from adding muscle, you need to focus on growing leg strength.

After learning the basics, focus on compound, functional movements like squats, deadlifts, lunges, presses, rows, pull-ups, burpees, etc. There are people who do nothing but one, two, or three exercises like squats, pullups, and burpees and are fitter than 99% of the population. When in doubt, keep it simple. Learning new programs and exercises takes time. Invest the time in energy in doing the work not learning something to keep things fresh. If you can stand it. Just don’t quit because of how much time it takes. Lifting doesn’t take much time if you keep it simple.

Whatever you do, do something. Any muscle-building program is better than no program.

#5 – Measure, Monitor, Act

We’re using the principle of what gets measured gets managed here. I can’t give you all the ways to fix issues you might have with all the things we’re measuring here. That would be too long. You wouldn’t read it. And I’m not that good. But if you see an issue, I trust you’ll research it, analyze it, and take action to resolve it. You may need to run multiple experiments. But in time you’ll fix it.

So this last action is a catch-all for all the things you should monitor with cgm, standard deviation, and cgm glucose data most important for diabetics or pre-diabetics willing to invest in their health via a continuous glucose monitor (cgm). Sleep, stress, and body fat % only need focus if they’re major issues for you since they all can impact blood sugar in a significantly negative way. You may want to listen to AMA: Losing fat and gaining fat, the lessons of fat flux if you’re Type 2 or at-risk and things like fasting, carb restriction, adding muscle haven’t worked. Dr Attia makes a great point that most patients of his dealing with Type 2 risk need to fix multiple issues with multiple tactics including sleep, stress, cortisol, thyroid, and other hormonal issues, carb restriction, prolonged fasting, etc. The podcast doesn’t give your tactics for everything but it’s helpful to know you likely need to take a multi-pronged approach. And if you’ve worked hard at a single tactic in the past and it hasn’t work, it might help to know it’s not only you. Most people need multiple tactics and massive action to improve their risk.

All would benefit from a yearly HbA1c. If you see the A1c going up year over year like this image, take aggressive action to reduce your risk. Note that you may have a normal A1c and still have a high risk for diabetes.

A1c does not measure how much insulin your body produces to keep your blood sugar levels normal. If your body is working overtime to produce insulin, you may eventually lose these cells or develop insulin resistance. Many future diabetics have a normal A1c for ten years while their body produces insulin on overtime. Higher insulin eventually leads to excess body fat stored in organs like your liver and pancreas. Then your A1c goes up but a lot of damage has been done in those ten years. It’s not just blood glucose that drives mortality higher. It’s insulin. Read the Fung book or the Bernstein book I recommend for more on this. Talk to your doctor about tests like OGTT, C-peptide, or other ways to assess high insulin production. I’m not a doctor. There may be a better way of assessing your risk. Just don’t assume that a normal A1c means you have normal risk. If you’re overweight or have trunk fat, your risk is higher. Use fasting and low-carb to decrease insulin levels and burn excess fat.

And of course diabetics should monitor how much insulin they’re using per day and diabetics and pre-diabetics should monitor how many carbs they’re eating per days. There’s a direct correlation between the amount of carbs you eat and the amount of insulin you use. If you’re eating more carbs, you’re using more insulin. Go back to action number one. Do not pass go. Do not think you won’t become a diabetic if you’re at-risk and eating donuts (or even bananas).

Final Recommendations

Don’t try to implement these all at the same time. I’d start with number one or number two. Those are the highest impact changes. You can’t outrun or outexercise a bad diet. Both reducing your carbs or fasting directly improve your diet to dramatically reduce your diabetes risk. Pair those changes by monitoring the right inputs like carbs per day or outputs like A1c, glucose levels, etc. Increase your activity levels in parallel if you want but don’t take on so much that it backfires and you give up on everything.

Change is hard. Make it simpler. Focus. Try one new thing. Then do it again. And again. And again. You will fail. You will succeed. And in a few years, you will look back and be glad you did because every success means you’re getting healthier. You’re getting stronger. If you’re at risk from diabetes, your life depends on the choices you make every day in an amplified way. There’s less room for error.

With these actions in time, you will feel much better. You will look better. And you will be happier. At least happier than a life with needles, unpredictable glucose, and complications. At most much happier from a renewed sense of health and vitality. It’s out there. Get after it.

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