Prediabetes: what to eat, with a plate method and a sample day

A prediabetes result can feel like a wall of rules. Most of what you need fits on one dinner plate. This guide is for adults in Raleigh, Durham, Chapel Hill and Cary, and anywhere else you are reading from. It covers what to eat, how the plate method works, what to limit, a sample day, and what the CDC's program shows about lowering your risk.

Two things first. This is general education, not a personal meal plan, and your own doctor or a dietitian can fit it to you. And if you take any diabetes medicine, read the safety note in the doctor section before you change how you eat.

What should you eat if you have prediabetes?

Eat mostly vegetables, with protein and fiber-rich carbohydrate foods, and drink water. The CDC and the American Diabetes Association both point to the same basics: a plate that is half nonstarchy vegetables, quality carbohydrates such as whole grains, fruit and beans, less added sugar, and fewer processed foods.³⁵

Why it matters: the CDC reports that 115.2 million American adults, more than 2 in 5, have prediabetes, and that 8 in 10 adults with prediabetes do not know they have it.⁸ The CDC also says you can have prediabetes for years without clear symptoms.¹ If you do know, you have a useful head start.

Prediabetes is confirmed with blood tests. The NIDDK lists an A1C of 5.7% to 6.4%, a fasting plasma glucose of 100 to 125 mg/dL, or an oral glucose tolerance test result of 140 to 199 mg/dL.⁷ Your own doctor reads those numbers.

Here is the short version of what to build meals from:

• Nonstarchy vegetables: salad, green beans, broccoli, leafy greens, peppers.³⁶
• Lean protein: chicken, tofu, eggs and beans.³
• Whole grains, beans, fruit and low-fat dairy as your carbohydrate choices.³⁵
• Fiber-rich foods and healthy fats. The NIDDK suggests choosing foods with vitamins, calcium, fiber and healthy fats, and the CDC lists nuts and seeds as fiber sources.⁴⁶
• Water or other zero-calorie drinks.⁵

How does the plate method work?

Use a 9-inch plate. Fill half with nonstarchy vegetables, one quarter with a lean protein, and one quarter with carbohydrate foods.³ The CDC says a 9-inch plate is about the length of a business envelope.³ The ADA uses the same layout, starting with half the plate non-starchy vegetables and one quarter lean protein.⁵

What counts as a carbohydrate food? The CDC lists grains, starchy vegetables such as potatoes and peas, rice, pasta, beans, fruit and yogurt. A cup of milk also counts.³ Beans show up in two places on the CDC's page, as a protein choice and as a carbohydrate food, so count them in one quarter or the other.³

Some practical points:

• Vegetables first on the plate. The NIDDK says nonstarchy vegetables, such as leafy greens, peppers, carrots or green beans, should make up half your plate.⁶
• Choose whole over refined. The ADA lists quality carbohydrates such as starchy vegetables, fruit, whole grains and low-fat milk.⁵
• Add fiber slowly. The CDC says the Dietary Guidelines for Americans recommend 22 to 34 grams of fiber a day for adults, depending on age and sex, and that most US adults get about half of what they need.⁴ It suggests choosing whole grains, focusing on nonstarchy vegetables, and adding beans or other legumes, and it advises taking it slow.⁴
• A dietitian can fit the plate to you. The CDC suggests asking your doctor for a referral to diabetes self-management education and support to help build a meal plan.³

Which foods should you limit?

Limit added sugars, refined grains and highly processed foods. The CDC lists added sugars and refined grains such as white bread, rice and pasta, and says to focus on whole foods instead of highly processed foods as much as possible.³

Drinks deserve a look first. The NIDDK advises limiting sweet drinks such as soda, juice, flavored coffee and sports drinks.⁶ The CDC says fruit juice raises blood sugar faster than whole fruit, and suggests water or a low-calorie drink such as unsweetened iced tea with meals.³ Replacing one sweet drink a day is one of the simplest changes you can make.

Other things to plan for less of:

• Foods high in saturated fat and foods high in sodium, which the NIDDK says to plan fewer of.⁶
• Packaged snacks eaten straight from the bag or box. The CDC suggests measuring a snack at home.³
• Large restaurant portions. The CDC suggests asking for half your meal to be wrapped to go, and keeping serving bowls out of reach to avoid second helpings.³

You do not need a list of forbidden foods. A grain swap, a drink swap and an ingredient glance on a few packaged foods go a long way. For a broader look at foods people link with inflammation, see the anti-inflammatory diet food list.

What does a day of eating look like?

Here is one simple day built on the plate method. It is an example, not a prescription. Swap in what you like, and skip anything that does not suit you. No calories are counted here because none are needed to start.

Breakfast. Scrambled eggs with sautéed spinach and tomatoes, and a slice of whole-grain toast. Or plain yogurt with berries and nuts. Coffee or tea without sweetener, or water.

Lunch. A big salad: leafy greens, cucumber, peppers, chickpeas or grilled chicken, and olive oil and lemon. A small piece of fruit on the side. Here, beans or fruit are your carbohydrate quarter, and the rest is vegetables and protein.

Snack. An apple with a small handful of nuts, or raw vegetables and hummus.

Dinner. Half the plate roasted or steamed vegetables, such as broccoli or green beans. A quarter baked fish, chicken, tofu or eggs. A quarter brown rice, whole-grain pasta or roasted sweet potato.

With meals and between. Water, sparkling water or unsweetened iced tea.³

If you want to eat with the North Carolina seasons, let the market decide the vegetables. Harvard Health says research has not looked at the anti-inflammatory benefits of eating in season, but that in-season produce is generally accepted to be fresher.¹⁰ Its lists include greens like kale and collards in winter, and green beans, zucchini, okra and berries in summer.¹⁰ Use whatever fills the vegetable half.

A few habits make the plan easier to keep:

1. Make the vegetables first, then build around them.
2. Keep fruit, nuts and cut vegetables where you can see them.
3. Put the juice and soda on the "sometimes" shelf, not the daily one.
4. Choose one new swap each week, not five.

How much can lifestyle change lower your risk?

Lifestyle change can lower your risk of developing type 2 diabetes, but it is no promise. The CDC says research showed that people with prediabetes who joined a structured lifestyle change program could cut their risk of developing type 2 diabetes by 58%, or by 71% for people over 60.² The CDC describes its National Diabetes Prevention Program lifestyle change program as research-based, with a focus on healthy eating and physical activity.²

Elsewhere, the CDC says that making lifestyle changes can cut your risk of type 2 diabetes in half.¹ It defines the two main changes this way:

• A small amount of weight loss for people who are overweight, meaning around 5% to 7% of body weight. For a 200-pound person that is about 10 to 14 pounds.¹
• Regular physical activity, meaning at least 150 minutes a week of brisk walking or a similar activity. That is about 30 minutes a day, 5 days a week.¹

The NIDDK adds that in the Diabetes Prevention Program, people at high risk who lost 5% to 7% of their starting weight lowered their chance of developing diabetes.⁷

Keep two things in view. Those figures come from a structured lifestyle change program, not from changing a single food. And they describe groups of people, not what will happen to you. Your own result depends on many things, including your family history and your medicines.

The CDC suggests asking your doctor about CDC-recognized National Diabetes Prevention Program offerings in your community.¹ For more on movement, sleep and stress, see how to lower blood sugar naturally and insulin resistance symptoms. If you would like help seeing where to begin across food, stress, sleep and movement, the Garden Check-in takes about three minutes.

I start with one change, not ten, and I work alongside your own doctor. I never ask anyone to stop a medicine.

When should you see your own doctor?

See your own doctor if you have not had your blood sugar tested and have risk factors, if you already have a prediabetes result, or if you take any diabetes medicine and plan to change how you eat or exercise. The CDC says to talk to your doctor about getting your blood sugar tested if you have any risk factors for prediabetes.¹

Safety note. Anyone who takes insulin or some other diabetes medicines can get low blood sugar when food or activity changes. The NIDDK says low blood glucose can be a side effect of insulin or some other medicines, and that skipping or delaying meals, not eating enough carbohydrates, or raising your activity beyond your usual routine can lower it.⁹ Never stop or change a medicine without your doctor.

Signs of low blood sugar include feeling shaky, hungry, tired, dizzy or irritable, or having a headache.⁹ Tell your doctor if they happen, and ask in advance what to do if they do.

Also talk to your doctor about:

• Strong thirst, frequent urination, being very hungry after eating, blurred vision or sores that are slow to get better, which the NIDDK lists as common diabetes symptoms.¹¹
• Any plan to lose weight quickly, or to cut a whole food group.
• Questions about a referral to a dietitian or the CDC's program.

Call 911 for severe low blood sugar, such as a seizure or losing consciousness. The NIDDK says severe hypoglycemia is dangerous and needs to be treated right away.⁹ Call 911 as well for fruity-smelling breath, trouble breathing, fainting, or abdominal pain, nausea or vomiting. The NIDDK describes these as possible signs of diabetic ketoacidosis, a medical emergency.¹¹

This article is general education from Dr. Maurice Werness, ND, and not a substitute for individual medical advice.