Topic: Insulin Resistance and Prediabetes
Question: What to do for Insulin Resistance and Prediabetes ?
Answer: Adopting healthy eating habits can help people lose a modest amount of weight and reverse insulin resistance. Experts encourage people to slowly adopt healthy eating habits that they can maintain, rather than trying extreme weight-loss solutions. People may need to get help from a dietitian or join a weight-loss program for support.
                
In general, people should lose weight by choosing healthy foods, controlling portions, eating less fat, and increasing physical activity. People are better able to lose weight and keep it off when they learn how to adapt their favorite foods to a healthy eating plan.
                
The DASH (Dietary Approaches to Stop Hypertension) eating plan, developed by the NIH, has been shown to be effective in decreasing insulin resistance when combined with weight loss and physical activity. More information on DASH is available at www.nhlbi.nih.gov/health/health-topics/topics/dash.
                
The U.S. Dietary Guidelines for Americans also offers healthy eating advice and tools for changing eating habits at www.choosemyplate.gov.
                
Dietary Supplements
                
Vitamin D studies show a link between people's ability to maintain healthy blood glucose levels and having enough vitamin D in their blood. However, studies to determine the proper vitamin D levels for preventing diabetes are ongoing; no special recommendations have been made about vitamin D levels or supplements for people with prediabetes.
                
Currently, the Institute of Medicine (IOM), the agency that recommends supplementation levels based on current science, provides the following guidelines for daily vitamin D intake:
                
- People ages 1 to 70 years may require 600 International Units (IUs).  - People ages 71 and older may require as much as 800 IUs.
                
The IOM also recommended that no more than 4,000 IUs of vitamin D be taken per day.
                
To help ensure coordinated and safe care, people should discuss use of complementary and alternative medicine practices, including the use of dietary supplements, with their health care provider.
                
More information about using dietary supplements to help with diabetes is provided in the NIDDK health topic, Complementary and Alternative Medical Therapies for Diabetes.
                

                
Physical Activity
                
Regular physical activity tackles several risk factors at once. Regular physical activity helps the body use insulin properly.
                
Regular physical activity also helps a person
                
- lose weight  - control blood glucose levels  - control blood pressure  - control cholesterol levels
                
People in the DPP who were physically active for 30 minutes a day, 5 days a week, reduced their risk of type 2 diabetes. Many chose brisk walking as their physical activity.
                
Most people should aim for at least 30 minutes of exercise most days of the week. For best results, people should do both aerobic activities, which use large muscle groups and make the heart beat faster, and muscle strengthening activities.
                
Aerobic activities include brisk walking, climbing stairs, swimming, dancing, and other activities that increase the heart rate.
                
Muscle strengthening activities include lifting weights and doing sit-ups or push-ups.
                
People who haven't been physically active recently should talk with their health care provider about which activities are best for them and have a checkup before starting an exercise program.
                
Not Smoking
                
Those who smoke should quit. A health care provider can help people find ways to quit smoking. Studies show that people who get help have a better chance of quitting.
                
For more information about how to reverse insulin resistance and prediabetes with diet and increased physical activity, see the following National Diabetes Education Program publications at www.yourdiabetesinfo.org:    - Get Real! You Don't Have to Knock Yourself Out to Prevent Diabetes!   - More Than 50 Ways to Prevent Diabetes   - Small Steps. Big Rewards. Your Game Plan to Prevent Type 2 Diabetes.
                
Medication
                
The medication metformin is recommended for treatment of some individuals at very high risk of developing type 2 diabetes. In the DPP, metformin was shown to be most effective in preventing or delaying the development of type 2 diabetes in younger, heavier people with prediabetes. In general, metformin is recommend for those who are younger than age 60 and have
                
- combined IGT and IFG  - A1C above 6 percent  - low HDL cholesterol  - elevated triglycerides  - a parent or sibling with diabetes  - a BMI of at least 35
                
Metformin also lowers the risk of diabetes in women who have had gestational diabetes. People at high risk should ask their health care provider if they should take metformin to prevent type 2 diabetes.
                
Several medications have been shown to reduce type 2 diabetes risk to varying degrees, but the only medication recommended by the ADA for type 2 diabetes prevention is metformin. Other medications that have delayed diabetes have side effects or haven't shown long-lasting benefits. No medication, including metformin, is approved by the U.S. Food and Drug Administration to treat insulin resistance or prediabetes or to prevent type 2 diabetes.
(Source: NIDDK)