Overview of Diabetes

Type 2 diabetes is a medical condition where your body does not use insulin (a hormone) properly (American Diabetes Association, n.d.). This results in hyperglycemia, or too much glucose (sugar) in your blood. Over 1 in 10 adults have Type 2 diabetes and 1 in 3 adults have pre-diabetes (Centers for Disease Control and Prevention 2020). Diabetes is the 7th leading cause of death among adults (Xu et al. 2018).

High blood glucose over time increases the risk for:

• Heart disease

• Kidney disease

• Nerve damage

• Lower-extremity amputations

• Blindness

This publication describes the modifiable risk factors for type 2 diabetes and tips to reduce your risk for diabetes.

Risk Factors for Developing Diabetes

Being Overweight or Obese

Being overweight or obese increases your risk for diabetes. Discuss your current weight and how your weight has changed over time with your healthcare provider. Losing just 7% of your body weight can cut your risk of type 2 diabetes in half (Knowler et al. 2002). Your waist circumference is also important. Keeping your waistline less than 35 inches for women and less than 40 inches for men lowers the risk of diabetes (National Heart, Lung, and Blood Institute, n.d.).

Dietary Habits

Dietary habits may contribute to risk of diabetes (Liu et al. 2018; Malik et al. 2010; Sami et al. 2017), especially if you consume:

• High amounts of added sugars (e.g., cakes, candy, sugar-sweetened beverages such as soda, sweet tea, and sports drinks)

• Low amounts of fruits and vegetables, legumes, and whole grains

• High amounts of saturated fats, which are typically from animal sources including meat and dairy

Lifestyle

Lifestyle behaviors may increase your risk for diabetes include:

• Drinking more than 1 alcoholic beverage per day for women or more than 2 per day for men.

• Lack of physical activity such as walking, running, or swimming less than 150 minutes per week.

• Smoking (Campagna et al. 2019).

Beverage amounts equal to one serving (USDA 2015):

• 5 ounces of wine

• 12 ounces beer

• 8 ounces of 7% alcohol malt liquor

• 1.5 ounces of distilled spirits or liquor

Reduce Your Risk for Diabetes

A healthy lifestyle can reduce your risk for type 2 diabetes and help those with diabetes live a healthier life. Start today with these tips!

1. Focus on maintaining a healthy weight or losing weight gradually toward your optimal weight range.

Skip the diets! Focus on making lasting lifestyle changes that you can continue for life.

2. Follow the Diabetes Meal Plate (Hamilton 2015) for maintaining blood glucose levels.

A diet high in unrefined carbohydrates (whole grains, vegetables, beans) and fiber (found only in plant foods) can help you improve your blood glucose levels (McMaken and Shah 2017). Fill ½ of a 9-inch plate with nonstarchy vegetables such as leafy greens or carrots, ¼ with whole grains or starchy foods such as peas or potatoes, and the remaining ¼ with lean proteins such as chicken or beans. Have a piece of fruit and dairy on the side. For further inspiration see the recipe ideas below.

3. Exercise can improve your blood glucose levels.

Include at least 30 minutes of moderate physical activity at least 5 days per week. Try to include strength training (weights, yoga, resistance bands) 2–3 times per week.

4. Be sure to talk with your doctor about your goals and plans for change.

Your doctor may need to adjust your medications as you make lifestyle changes.

5. Aim to sleep 7–9 hours each night.

People who sleep for at least 7 hours per night maintain their body weight and have better control of their blood glucose levels (Watson 2015).

6. Start simple. Set a goal each week to make small changes towards health.

Try a goal such as eating at least one piece of fruit or ½ cup of beans daily for a week.

Breakfast Ideas

Breakfast Smoothie

Recipe by author Madison Woodard

Prep time: 5 minutes

Cook time: 0 minutes

Servings: 4 servings

Carbohydrates: 26 g/serving

($1.26 per serving based on national retailer's prices)

Ingredients:

• 2 cups of frozen sliced bananas (2 large bananas)

• 2 cups of frozen whole strawberries (about 16)

• 3 cups of chopped spinach (prechopped)

• 2 cups 2% milk

Directions:

(bag preparation for multiple servings)

1. Line baking sheet with parchment paper. Evenly spread out 2 cups of sliced bananas. Place in freezer for about 2 hours or until completely frozen. Repeat with strawberries.

2. Next, take 4 quart-size freezer bags and write the date.

3. Add ½ cup of frozen bananas slices, ½ cup of frozen strawberries, and a handful of spinach.

4. Be sure to squeeze out as much air as possible before sealing the bag to prevent freezer burn. Seal and place in freezer.

(for single serving)

1. Empty the contents of one smoothie bag into a blender.

2. Add ½ cup of milk.

3. Blend on high for about 1 minute or until everything is completely blended.

Triple Berry Oatmeal Cups

Recipe modified from Healthy Liv: https://www.healthy-liv.com/mixed-berry-baked-oatmeal-cups/

Prep Time: 10 minutes

Cook time: 20 minutes

Servings: 12 oatmeal cups

Carbohydrates: 20 g/serving

($0.36 per serving based on national retailer's prices)

Ingredients:

• 1 medium-ripe banana

• 2 large eggs

• 1 teaspoon vanilla extract

• ¼ cup honey

• ½ cup 2% milk

• 1 tablespoon canola oil

• 2 cups quick-cooking oats

• 1 teaspoon baking powder

• 1 teaspoon ground cinnamon

• 1 ½ cup mixed frozen berries

• ? teaspoon salt

Directions:

1. Preheat oven to 350°F and spray muffin tin with nonstick spray. Set aside.

2. Place ripe banana in a medium-size bowl and mash. Then, whisk in eggs, vanilla extract, honey, and 2% milk.

3. Then, in a large bowl, mix together oats, baking powder, cinnamon, and salt.

4. Combine wet ingredients with dry ingredients and then add in the canola oil and mix again. Finally, add berries and mix until combined.

5. Transfer batter to muffin tin, filling each muffin to the top.

6. Bake at 350°F for 18–20 minutes.

Spinach and Tomato Omelet

Recipe by author Madison Woodard

Prep time: 5 minutes

Cook time: 8 minutes

Servings: 1 omelet

Carbohydrates: 8 g/serving

($1.56 per serving based on national retailer's prices)

Ingredients:

• 2 eggs, lightly beaten

• 1 medium tomato, chopped

• ½ cup fresh spinach, chopped

Directions:

1. Spray large skillet with cooking spray. Pour eggs into into skillet and heat at medium to high heat. Add chopped tomato and spinach evenly over eggs.

2. Allow eggs to cook until completely set, around 5–8 minutes.

3. Use spatula to flip sides of eggs into an omelet and transfer to large plate.

*To add more flavor, add parsley or any desired herbs. Serve with 2 slices of whole wheat toast for carbohydrates.

3-Ingredient Banana Pancakes

Recipe from author Madison Woodard

Prep time: 5 minutes

Cook time: 10 minutes

Servings: 4 pancakes

Carbohydrates: 14 g/serving

($0.34 per serving based on national retailer's prices)

Ingredients:

• 4 large eggs

• 2 large ripe bananas

• 1 teaspoon cinnamon

Directions:

1. Using a fork, mash bananas in a medium-size bowl. Mash until there are no lumps.

2. Whisk in eggs and cinnamon until eggs are completely beaten.

3. Heat a large pan over low-medium heat. Spray pan with cooking spray.

4. Once the pan is evenly heated, add ½ cup of batter to the pan. Cook 3–4 minutes on both sides until the bottom is golden. Ensure pancakes are cooked through.

*Add 2 tablespoons of peanut butter for protein, if desired!

Lunch Ideas

Turkey Chili

Recipe modified from Food Faith and Fitness: https://www.foodfaithfitness.com/no-bean-low-carb-keto-turkey-chili/

Prep time: 10 minutes

Cook time: 60 minutes

Servings: 6 servings

Carbohydrates: 7 g/serving

($2.59 per serving based on national retailer's prices)

Ingredients:

• 1 ½ pounds 93% lean 7% fat ground turkey

• 1 yellow onion, diced

• 1 green pepper, diced

• 1 jalapeño, diced (optional)

• 1 clove garlic, minced

• ¼ cup tomato paste (unsalted)

• 15 ounces canned, low-sodium, diced tomatoes

• 2 cups water

• 2 tablespoons chili powder

• 2 teaspoons ground cumin

Directions:

1. Add ground turkey, onion, and green pepper to a large deep pot and cook over medium heat, breaking up the turkey as it cooks. When turkey is cooked through, drain any fat from pan.

2. Add the jalapeño, garlic, tomato paste, diced tomatoes, water, chili powder, cumin, and stir.

3. Bring to a boil and reduce to a simmer. Simmer for at least 20 minutes, preferably an hour for the best taste and texture.

*If you want to make this a vegan chili and to increase carbohydrates, replace the ground turkey with 2 15-ounce cans of kidney beans!

Mexican Chicken Wraps

Recipe by author Madison Woodard

Prep time: 20 minutes

Cook time: 10 minutes

Servings: 4 servings

Carbohydrates: 47 g/serving

($1.87 per serving based on national retailer's prices)

Ingredients:

• 1 pound cooked skinless chicken breasts, shredded

• 1 tablespoon olive oil

• 15-ounce can low-sodium black beans (rinsed and drained)

• ¼ cup chopped jalapeño peppers (optional)

• 1 teaspoon chili powder

• 1 teaspoon ground cumin

• ½ teaspoon garlic powder

• ½ teaspoon dried ground oregano

• 8 6" corn tortillas

Directions:

1. To make shredded chicken, oil and heat a large pan and place chicken in the skillet. Add ¾ cup of water, cover skillet with a lid, and cook for 7–10 minutes, ensuring that the center of the chicken is 165°F. Remove chicken from pan and shred. You can shred using two forks to pull apart the meat.

2. In a large mixing bowl, combine all remaining ingredients and mix well.

3. Spread out the tortillas. In the center of each, add ½ cup of the filling mixture. Add jalapenos, if desired, and roll up.

*If interested, for a low-carb option, serve in a wrap style on a piece of romaine lettuce.

Dill-Yogurt Chicken Sandwich

Recipe by authors Jeanette Andrade and Madison Woodard

Prep time: 5 minutes

Cook time: 1.5–2 hours

Servings: 4 servings

Carbohydrates: 27 g/serving

($2.31 per serving based on national retailer's prices)

Ingredients:

• 1 pound skinless chicken breasts

• ½ cup 0% plain Greek yogurt

• 1 teaspoon dried dill

• ½ teaspoon onion powder

• ½ teaspoon garlic powder

• 4 100% whole wheat English muffins

Directions:

1. Place chicken breasts in a slow cooker.

2. Turn to high and cook for 1.5–2 hours until chicken breasts have fully cooked.

3. Remove and use 2 forks to shred. Place in refrigerator to cool.

4. Mix Greek yogurt, dill, and the onion and garlic powders with a spoon in a medium-sized bowl. Cover bowl with aluminum foil and place in refrigerator.

5. Once chicken has cooled, place 3 ounces (size of medium-sized palm) on the English muffin. Spread 1 tablespoon of Greek yogurt spice mix on other half of the English muffin. Place that English muffin half on the half with the chicken and enjoy!

*Need vegetables? Add some spinach or romaine lettuce to the sandwich. Serve with a side of chopped carrots and celery sticks.

Chicken Taco Soup

Recipe modified from Kitchn: https://www.thekitchn.com/recipe-chicken-taco-soup-248133

Prep time: 5 minutes

Cook time: 4 hours

Servings: 4 servings

Carbohydrates: 7 g/serving

($1.87 per serving based on national retailer's prices)

Ingredients:

• 1 pound chicken breast

• ½ cup diced yellow onion

• 4 cloves garlic, minced

• 1 tablespoon cumin

• ½ teaspoon chili powder

• ½ teaspoon paprika

• 2 tablespoons lemon juice

• 1 tablespoon lime juice

• 2 cups low-sodium chicken broth

Directions:

1. Add the chicken, onion, garlic, cumin, chili powder, paprika, lemon juice, lime juice, and chicken broth in a slow cooker.

2. Cover and cook on low for 4 hours.

3. Remove chicken from slow cooker and shred with two forks.

4. Add the chicken back to the slow cooker and use a ladle to dish out the soup.

*Add crackers or break up 2 hard corn tortilla shells into the soup for more carbohydrates.

Chicken Curry

Recipe modified from 4 Sons 'R' Us: https://4sonrus.com/quick-easy-greek-yogurt-chicken-curry/

Prep time: 15 minutes

Cook time: 12–16 minutes

Servings: 8 servings

Carbohydrates: 4 g/serving

($1.59 per serving based on national retailer's prices)

Ingredients:

• 2 pounds skinless chicken breast

• 1 ½ tablespoons olive oil

• ½ cup chopped yellow onion

• 1 teaspoon ground ginger

• 2 tablespoons minced garlic

• 2 tablespoons curry powder

• ½ cup plain Greek yogurt (low-fat)

• ¾ cup low-fat canned coconut milk

• 1 15-ounce can low-sodium canned tomatoes

• ½ cup roughly chopped cilantro

• 1 cup water

• 1 tablespoon lemon juice (optional)

Directions:

1. Cut chicken into 1-inch chunks.

2. In a skillet, sauté onion, ginger, and garlic in oil until onions are nicely translucent, about 3 minutes.

3. Add curry powder and a few tablespoons of water to help the spices sauté. Cook the spices on low, adding in a few tablespoons water until fragrant (about 1 minute).

4. Add chicken and cook for 5–7 minutes or until chicken is cooked thoroughly.

5. Then add yogurt, coconut milk, lemon juice, and fresh herbs to mixture. Stir well to combine.

6. Lastly, add water and stir well.

7. Let the mixture come to a simmer and continue cooking for at least 3–5 minutes. Stir in the tomatoes and remove from skillet. Sprinkle with any remaining cilantro and serve.

*Serve with ½ cup brown rice for more carbohydrates.

Italian Stuffed Peppers

Recipe modified from Cookin Canuck: https://www.cookincanuck.com/italian-vegetarian-stuffed-peppers/

Prep time: 15 minutes

Cook time: 2 hours and 30 minutes

Servings: 6 servings

Carbohydrates: 13 g/serving

($2.21 per serving based on national retailer's prices)

Ingredients:

• 1 pound 93% lean 7% fat ground turkey

• ½ medium yellow onion, chopped

• ½ large carrot

• 1 ½ cloves garlic, minced

• ½ tablespoon Italian seasoning

• ½ cup uncooked brown rice

• 1 tablespoon tomato paste (unsalted)

• ½ teaspoon black pepper to taste

• 6 green peppers

• 1 cup water

• ½ cup tomato sauce (low-sodium)

Directions:

1. Arrange a rack in the middle of your oven and preheat to 375°F degrees.

2. Cut off the tops of the green peppers. Remove and discard any seeds and membranes from the insides. Cut a small flat piece off the bottom of each pepper to prevent them from falling over while cooking.

3. In a large bowl, combine ground turkey, onion, carrot, garlic, Italian seasoning, rice, tomato paste, and pepper. Mix well. Stuff each pepper very full and arrange them in a large pot standing up.

4. Pour tomato sauce over the peppers. Add more water if needed; there should be enough water to come about halfway up the peppers.

5. Cover the pot with a lid or aluminum foil and bake for 1 ½ hours covered. Remove the lid and continue to bake for another 45 minutes to an hour uncovered. The green peppers are ready when you insert a fork in a pepper and it goes easily through the pepper skin and the turkey, and the rice is cooked.

Grocery List for all above Recipes

Produce

• Bananas

• Carrots

• Cilantro

• Garlic cloves

• Green peppers

• Jalapeños (optional)

• Spinach

• Tomato

• Yellow onions

Refrigerated/Frozen Goods

• Chicken, boneless/skinless breast

• Eggs

• Frozen strawberries

• Frozen mixed berries

• 93% lean 7% fat ground turkey

• 0% fat plain Greek yogurt

• 2% milk

Bottled/Canned/Dry Goods

• Brown rice

• Corn tortillas

• 100% whole wheat English muffins

• Canned low-sodium black beans

• Canned low-sodium diced tomatoes

• Lemon juice

• Lime juice

• Low-sodium chicken broth

• Low-fat canned coconut milk

• Low-sodium tomato sauce

• Rolled oats

• Tomato paste (unsalted)

From Your Pantry

• Baking powder

• Canola oil

• Chili powder

• Cinnamon

• Curry powder

• Dried dill

• Dried oregano

• Garlic powder

• Ground cumin

• Ground ginger

• Honey

• Italian seasoning blend

• Olive oil

• Onion powder

• Paprika

• Black pepper

• Salt

• Vanilla extract

For further recipes or meal plan ideas, check out:

American Diabetes Association https://www.diabetesfoodhub.org/

USDA ChooseMyPlate https://www.choosemyplate.gov/eathealthy/budget/budget-recipes

References

American Diabetes Association. n.d. "Type 2 Diabetes: Life Doesn't End with Type 2 Diabetes." https://www.diabetes.org/diabetes/type-2. Accessed June 11, 2020.

Campagna, D., A. Alamo, A. Di Pino, C. Russo, A. E. Calogero, F. Purrello, and R. Polosa. 2019. "Smoking and Diabetes: Dangerous Liaisons and Confusing Relationships." Diabetol Metab Syndr. 11 (85): 1–12.

Centers for Disease Control and Prevention. 2020. National Diabetes Statistics Report, 2020. Atlanta: Centers for Disease Control and Prevention, US Department of Health and Human Services.

Hamilton, L. 2015. "What Is the Plate Method?" Diabetes Forecast. http://www.diabetesforecast.org/2015/adm/diabetes-plate-method/what-is-the-plate-method.html. Accessed April 17, 2020.

Knowler, W. C., E. Barrett-Connor, S. E. Fowler, R. F. Hamman, J. M. Lachin, E. A. Walker, D. M. Nathan, and the Diabetes Prevention Program Research Group. 2002. "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin." N Engl J Med. 346 (6): 393–403.

Liu, G., G. Zong, K. Wu, Y. Hu, Y. Li, W. C. Willett, D. M. Eisenberg, F. B. Hu, and Q. Sun. 2018. "Meat Cooking Methods and Risk of Type 2 Diabetes: Results from Three Prospective Cohort Studies." Diabetes Care 41 (5): 1049–60.

Malik, V. S., B. M. Popkin, G. A. Bray, J. P. Després, and F. B. Hu. 2010. "Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk. Circulation 121 (11): 1356–64.

McMacken, M., and S. Shah. 2017. "A Plant-Based Diet for the Prevention and Treatment of Type 2 Diabetes." Journal of Geriatric Cardiology 14 (5): 342–354. doi:10.11909/j.issn.1671-5411.2017.05.009

National Heart, Lung, and Blood Institute. n.d. "Aim for a Healthy Weight." https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm. Accessed June 12, 2020.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015. 2015–2020 Dietary Guidelines for Americans. 8^th Ed. Washington, DC.

Wagas, S., T. Ansari, N. Shafique Butt, and M. Ab Hamid. 2017. "Effect of Diet on Type 2 Diabetes: A Review." Int J Health Sci. 11 (2): 65–71.

Watson, N. F., and E. Tasali. 2015. "Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society." Sleep 38 (6): 843–844.

Xu, J. Q., S. L. Murphy, K. D. Kochanek, and E. Arias. 2020. Mortality in the United States, 2018. NCHS Data Brief, no 355. Hyattsville, MD: National Center for Health Statistics.