By Michael Schroeder, AARP, May 2023
How can I lower my blood sugar? Here's 7 simple says to lower your blood sugar.
And how to bring your A1C back to a healthy range and avoid type 2 diabetes. Plus, could ice cream help?
In the United States today, approximately 96 million adults have prediabetes — and up to 70 percent of those who have elevated blood sugar will go on to develop type 2 diabetes, according to an American Diabetes Association expert panel. That’s in addition to more than 37 million who already have the chronic disease.
Naturally, then, it might feel daunting to try to get high blood sugar under control. But fortunately experts say a number of simple (read: straightforward, not necessarily all easy, but doable) steps can bring glucose levels back into a healthy range. You also have plenty of reasons beyond diabetes prevention to do just that.
People with prediabetes have a higher risk of suffering from a heart attack or stroke in the future — along with other heart disease issues — “even without full-blown diabetes,” says Zhenqi Liu, M.D., James M. Moss professor of diabetes at the University of Virginia School of Medicine.
Here are steps you can take to reduce your risk and lower your blood sugar.
1. Know your numbers
To start, you need to know where you stand. The vast majority with prediabetes — more than 80 percent — don’t know they have it, according to the Centers for Disease Control and Prevention.
The U.S. Preventive Services Task Force recommends people ages 35 to 70 who are overweight or obese get screened for prediabetes and diabetes. The American Diabetes Association (ADA) recommends screening for all people 45 and up and testing blood sugar earlier in those at higher risk for diabetes. You can assess your individual risk using an online tool provided by the ADA, answering questions about risk factors ranging from age and immediate family history of diabetes to activity level and race.
What’s considered a healthy blood sugar number depends on the test. For example, with a fasting blood sugar test, anything below 100 milligrams per deciliter is considered healthy. A glucose level of 100 to 125 mg/dL is considered prediabetes and 126 mg/dL or higher is diabetes. Another test, hemoglobin A1C, measures a person’s average blood sugar over two to three months as a percentage. A result of 5.7 to 6.4 percent is considered prediabetes and 6.5 percent or higher is diabetes. For more about testing, see Your Prediabetes Questions Answered.
Many with diabetes who rely on insulin to help with blood sugar control use continuous glucose monitors — wearable devices that provide ongoing data on blood sugar — to track their levels. While some people who don’t have diabetes use the technology as well to keep tabs on their blood sugar, there is currently no strong data on the effectiveness of this strategy for people with prediabetes.
If you’ve been diagnosed with prediabetes or diabetes, talk to your doctor about how to best monitor your blood sugar as you make lifestyle changes.
2. Don’t complicate exercise
Lifestyle changes needn’t be overly involved or difficult to be effective — like with incorporating regular physical activity. “You have to exercise 150 minutes a week,” says Elbert Huang, M.D., general internist and director of the Center for Chronic Disease Research and Policy at the University of Chicago. That needs to be at least a brisk walk, he notes, but it doesn’t have to be more strenuous than that. Experts say the key is to pick a routine you’re likely to stick with, rather than one with onerous requirements you’re not likely to follow. It could be any form of exercise, said Minna Woo, M.D., a clinician scientist and endocrinologist at Toronto General Hospital, and director of the Banting and Best Diabetes Centre. You don’t need a gym membership, she adds. To optimize the benefits, consider taking that walk after you eat. Research suggests exercising 30 minutes after a meal may be optimal to help with blood glucose control.
3. Get professional help
Doctors and dietitians who regularly work with patients who have diabetes can help a person with prediabetes create a road map for getting blood sugar back in a healthy range. Sudipa Sarkar, an endocrinologist and assistant professor of medicine at Johns Hopkins University School of Medicine, recommends talking with your doctor to see if you’re eligible for the research-backed National Diabetes Prevention Program, a public-private partnership that’s been shown to help prevent the progression to diabetes.
4. Cut back not just on sugar but on all ultraprocessed foods
Obvious blood sugar spikers like cookies and cake should be consumed in moderation. But you’ll also want to be circumspect about other foods that can cause glucose levels to rise quickly.
In particular, go easy on all those processed carbs. “When people talk about diabetes and sugar, most people think it’s the sweets they need to avoid, and that’s of course true. But really what’s more common is the starchy carbohydrates,” Woo says. That includes things like bread, pasta, noodles and white rice. “These are the most deadly culprits that will raise their sugar levels,” she says.
Supplements for diabetes prevention
It might be tempting to try supplements, such as vitamin D, omega-3s and berberine, in hopes of lowering blood glucose. But despite a few promising studies, there isn’t yet proof that taking supplements will help prevent diabetes in someone with prediabetes. If you are considering taking a supplement, Amy Hess-Fischl, a registered dietitian and diabetes educator at the University of Chicago Medical Center, advises talking with your doctor first to make sure that it doesn’t interact with other medications, like those taken for high blood pressure or cholesterol.
What is the glycemic index?
Chances are, if you’re paying closer attention to which foods spike your blood sugar, you’ve heard of the glycemic index. This is used to rate foods containing carbohydrates by how quickly they can cause blood sugar to rise. The scale starts at zero and goes up to 100 for pure sugar. The glycemic index was designed as a research tool. But while it allows for easy categorization, Hess-Fischl notes that the same food doesn’t affect everyone’s glucose level in the same way. How foods are prepared or if they’ve been combined with other foods can also affect blood sugar. So if you’re meal planning, try to avoid separating foods, like sweet potatoes and white potatoes, into “good” and “bad” categories, respectively. “White potatoes can be healthful if they eat them with the skins,” Hess-Fischl says, adding that their glycemic index is not too dissimilar from that of sweet potatoes (see below).
Taking it all with a grain of salt — or, say, a sugar molecule — here’s where some foods fall on the glycemic index:
Low (55 or less)
Oatmeal
Apples, oranges and grapes
Carrots and other non-starchy veggies
Quinoa
Most nuts and beans
Skim milk
White potato, boiled (54)
Medium (56 to 69)
Cherries, cantaloupe and raisins
Sweet potato, boiled (61)
Pumpkin
Macaroni and cheese
Bagel
Couscous
Honey
High (70 and higher)
Watermelon
White potato, mashed (83)
Rutabaga
Cheerios, corn flakes and many other cereals
White bread
Gluten-free bread
Rice cakes
5. Get with the guidelines for a balanced diet
A balanced diet that cuts carbs could help with weight loss — which itself is protective against diabetes — and quickly bring blood sugar back into a healthy range, according to findings published in JAMA Network Open.
Aim for an eating pattern that’s similar to the Mediterranean diet with a well-balanced plate:
Fill half your plate with veggies
Megan Kristan, M.D., endocrinologist and assistant professor of medicine at the University of Minnesota, recommends a plate loaded up with vegetables. You can’t go wrong with dark leafy greens like spinach as well as pulses, such as chickpeas and beans, which have all been linked to lower blood sugar levels.
Carbs should cover only one-quarter of your plate
This macronutrient, like the others — protein and fat — has a place in a healthy diet. But carbs shouldn’t cover half your plate — which is typical with the Western diet, Kristan emphasizes.
Swap in healthy carbs
Try to have more foods like quinoa or farro and fewer processed carbs.
Get your daily recommended fiber
The American Diabetes Association recommends that people with diabetes and those at risk for it eat at least 14 grams of fiber per 1,000 calories (or 28 grams for a 2,000-calorie diet), following the Dietary Guidelines for Americans for everyone. AARP’s Whole Body Reset, based on the latest research in people age 50 and over, recommends 20 to 25 grams a day for women and 30 grams for men.
Get fiber from a variety of foods
Vegetables like lentils, nuts and fruits, especially those with edible skin, such as apples and pears, and edible seeds including berries are good sources of fiber, according to the ADA.
Don’t villainize foods
Instead, understand where they fit on your plate. Starchy favorites like corn or potatoes will raise your blood sugar and go in the carbs category, rather than that half of your plate that’s devoted to veggies, Kristan says.
6. Sleep on it
Tired of the daily grind? Take it lying down.
“Adequate sleep is critical not only for diabetes management but in terms of all metabolic diseases including weight management,” Kristan says. Conversely, not getting at least seven hours of shut-eye nightly is associated with insulin resistance, according to a review of research. When that happens, the cells don’t respond to that hormone like they should — to efficiently take in sugar from the blood and convert it to energy — and blood glucose rises.
Plus, being sleep-deprived can make it harder to handle stress, which also contributes to the stew of toxic hormones like cortisol linked to insulin resistance. Think about being overtired and overstressed. “Those two are so interrelated,” Kristan says. She adds that when more insulin is produced, in response, that increases hunger and you eat more calories.
Here are some tips to put the spiral to bed.
7. Lifestyle changes alone not enough? Consider medication
For certain patients, medication like metformin may also be helpful to lower blood sugar.
“Some people are going to have a really difficult time making lifestyle changes, and some people will tell you I’m more likely to take my medicines every single day to control the prediabetes,” Huang says.
While lifestyle changes are part of a comprehensive approach, experts say what’s most important is doing whatever it takes — and not waiting — to lower blood sugar so you can live a longer, healthier life.
Can eating ice cream prevent diabetes?
In a delicious odyssey, an Atlantic article recently dealt with a swirling controversy around an “inconvenient” finding replicated in various nutrition studies: Consuming not only dairy, but ice cream in particular, has been linked with a lower risk of diabetes.
As detailed in "Nutrition Science’s Most Preposterous Result,” not only individual studies but analysis of decades of research has failed to dispense with this clearly consumer-approved but scientifically improbable association. A 2016 paper published in The American Journal of Clinical Nutrition summarizing data from about a dozen studies found that tucking into at least half a cup of the dairy dessert per week was associated with a 19 percent decrease in diabetes risk (even higher than the 14 percent risk reduction seen with yogurt).
But, as noted in the story, the authors of that paper, like other experts, wrote off the findings to what’s called “reverse causation” — in essence that the link between ice cream and diabetes wasn’t going in the direction you’d think. That is to say, for instance, people who are healthy and already at lower risk for developing diabetes might have felt more at ease having rocky road, while those who were already at higher risk for developing the chronic disease might have had less.
The key takeaway in all of this, buried about 3,300 words into the sweetly self-indulgent exposé, is sadly vanilla: “To be clear, none of the experts interviewed for this article is inclined to believe that the ice-cream effect is real.”
Mark Pereira, an epidemiologist at the University of Minnesota, has long wrestled with the ice cream–diabetes risk reduction correlation in his own research. “I don’t think I’ve ever experienced anything like this finding in my career because it’s completely unexpected,” he told AARP. “The Atlantic article was really good journalism,” added Pereira, who was interviewed for that story.
But even lacking an explanation for the link, Pereira isn’t about to advise people to make soft serve a feature of their daily diet in the name of diabetes prevention.
“There could be something there that’s causal,” Pereira acknowledges, giving at least a glimmer of hope to gelato apologists the world over. “But that’s a far cry from saying, ‘Oh, I would recommend that people with prediabetes increase their ice cream intake.’ I mean there’s so many other ways that you could change your diet and improve your physical activity to reduce your A1C [a measure of blood sugar] and prevent diabetes.”
Scooped another way: There’s still no proven reason to expect ice cream will protect you from diabetes. So, for now at least, experts still suggest savoring ice cream in moderation — and not for prevention.
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