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I Can Lower My Risk for Type 2 Diabetes: A Guide for American Indians

On this page:

Research Gives Hope Diabetes Can Be Prevented

Photo of the face of a smiling American Indian woman.
"After I started exercising and watching what I eat, my blood glucose levels returned to normal."

Although people with diabetes can prevent or delay complications by keeping blood glucose (also called blood sugar) levels close to normal, preventing or delaying the development of type 2 diabetes in the first place is even better. The results of a major federally funded study, the Diabetes Prevention Program (DPP), prove that we can prevent or delay the disease. This study of 3,234 people at high risk for diabetes showed that moderate diet and exercise, resulting in a 5- to 7-percent weight loss, can delay and possibly prevent type 2 diabetes. More than 170 American Indians participated in the DPP.

The DPP tested three approaches to preventing diabetes: making lifestyle changes, taking a diabetes pill, or following the standard diabetes education approach. People in the lifestyle change group exercised about 30 minutes a day, 5 days a week, usually by walking, and they lowered their intake of fat and calories. Those who took the diabetes pill metformin received standard information on exercise and diet, as is done in an Indian Health Service clinic or tribal physician's office. These approaches were compared with the third group who only received the standard information on exercise and diet and took a placebo—a pill without medicine in it.

The DPP results showed that people in the lifestyle change group reduced their risk of getting type 2 diabetes by 58 percent. Average weight loss in the first year of the study was 15 pounds. Lifestyle change was even more effective in those 60 years and older. They reduced their risk by 71 percent. People who took metformin and received standard information on exercise and diet reduced their risk by 31 percent.

The Diabetes Prevention Program Outcomes Study (DPPOS) has continued to follow most DPP participants since the DPP ended in 2001. The DPPOS has shown that the benefits of weight loss and metformin last for at least 10 years. Ten years after they enrolled in the DPP, people in the lifestyle change group had reduced their risk for developing diabetes by 34 percent. Those in the lifestyle change group age 60 or older had reduced their risk of developing diabetes by 49 percent.

Participants in the lifestyle change group also had fewer heart and blood vessel disease risk factors, including lower blood pressure and triglyceride levels, even though they took fewer drugs to control their heart disease risk. The metformin group had reduced their risk of developing diabetes by 18 percent. Even though controlling your weight with lifestyle changes is challenging, it produces long-term health rewards by lowering your risk for type 2 diabetes, lowering your blood glucose levels, and reducing other risk factors for heart disease.


What is diabetes?

Diabetes causes blood glucose levels to be above normal. People with diabetes have problems converting food to energy. After food is eaten, it is broken down into a sugar called glucose. Glucose is then carried by the blood to cells throughout the body. The hormone insulin, made in the pancreas, helps the body change blood glucose into energy. People with diabetes, however, either no longer make enough insulin, or their insulin doesn't work properly, or both.

Type 2 diabetes

Type 2 diabetes is the most common type in American Indians. This type of diabetes can occur at any age, even during childhood. People develop type 2 diabetes because the cells in the muscles, liver, and fat do not use insulin properly. Eventually, the body cannot make enough insulin. As a result, the amount of glucose in the blood increases while the cells are starved of energy. Over time, high blood glucose damages nerves and blood vessels, leading to problems such as heart disease, stroke, blindness, kidney failure, and amputation.

Other kinds of diabetes

Type 1 diabetes

Type 1 diabetes is rare in American Indians. People develop type 1 diabetes when their bodies no longer make any insulin. Type 1 is usually first diagnosed in children or young adults but can develop at any age.

Gestational diabetes

Gestational diabetes is first diagnosed during pregnancy. It occurs when the body doesn't use insulin properly. Having an American Indian family background raises the risk of developing gestational diabetes. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life.


What are the signs and symptoms of type 2 diabetes?

Many people have no visible signs or symptoms of diabetes. Symptoms can also be so mild that you might not notice them. More than 5 million people in the United States have type 2 diabetes and do not know it.

Look for
  • increased thirst
  • increased hunger
  • fatigue
  • increased urination, especially at night
  • unexplained weight loss
  • blurred vision
  • sores that do not heal


What does prediabetes mean?

Prediabetes means your blood glucose is higher than normal but not high enough for a diagnosis of diabetes. Having prediabetes also means you're at risk for getting type 2 diabetes and heart disease. There are no visible symptoms of prediabetes. However, you can reduce the risk of getting diabetes and even return blood glucose levels to normal with modest weight loss through healthy eating and moderate physical activity.


What factors increase my risk for type 2 diabetes?

If you have certain conditions, you're more likely to develop type 2 diabetes. The more of these conditions you have, the higher your risk. Check each item that is true for you. Then show this list to your health care provider. 
  • My mother had diabetes when I was born.
  • I am overweight.
  • I have a parent, brother, or sister with diabetes.
  • My family background is American Indian.
  • I have had gestational diabetes, or I gave birth to at least one baby weighing more than 9 pounds.
  • My blood pressure is 140/90 mmHg or higher, or I have been told that I have high blood pressure.
  • My cholesterol levels are higher than normal. My HDL cholesterol—"good" cholesterol—is below 35 mg/dL, or my triglyceride level is above 250 mg/dL.
  • I am fairly inactive. I exercise fewer than three times a week.

Photo of a young American Indian man's face.
"I didn't know I had diabetes until I had a blood test at the clinic."


Should I be tested for diabetes?

Anyone 45 years of age or older should consider getting tested for diabetes. If you are 45 or older and overweight, getting tested is strongly recommended. Ask your health care provider for an A1C test, a fasting blood glucose test, or an oral glucose tolerance test. Your health care provider will tell you if you have normal blood glucose, prediabetes, or diabetes. If you are told you have prediabetes, have your blood glucose checked again in 1 year.


How can I lower my risk for diabetes?

You can do a lot to lower your risk. The small steps you take can lead to big rewards.
  • Reach and maintain a reasonable body weight.
  • Make wise food choices most of the time.
  • Be physically active every day.
  • Take your prescribed medicines.

Doing these things can reduce your risk of developing type 2 diabetes. Keeping your blood pressure and cholesterol on target also helps you stay healthy.

Photo of an older American Indian woman's face.
"My great grandmother told me to breastfeed my child so the baby would be healthy."

If you are pregnant, plan to breastfeed your baby. Ask your health care provider for the names of people to call for help learning to breastfeed. Besides being good for your baby, breastfeeding is good for you. Studies done with the help of Pima Indian volunteers have shown that breastfeeding may lower the baby's risk of becoming overweight and getting diabetes.

Getting Started.

Making changes in your life such as eating less can be hard. You can make the changes easier by taking these steps:

  • Make a plan to change something that you do.
  • Decide exactly what you will do and when you will do it.
  • Plan what you need to get ready.
  • Think about what might prevent you from reaching your goal.
  • Find family and friends who will support and encourage you.
  • Decide how you will reward yourself—with a nonfood item or activity—when you do what you have planned.

Your health care provider, a registered dietitian, or a counselor can help you make a plan.

Reach and Maintain a Reasonable Body Weight.

Your weight affects your health in many ways. Being overweight can keep your body from making and using insulin correctly. The extra weight may also cause high blood pressure. The DPP study showed that losing even a few pounds can help lower your risk of developing type 2 diabetes, because weight loss helps your body use insulin more effectively. Every pound you lose lowers your risk of getting diabetes. In the DPP, people who lost 5 to 7 percent of their body weight lowered their risk of developing type 2 diabetes. They had less than half the risk of developing diabetes as people who didn't make lifestyle changes. A 5- to 7-percent weight loss for a 150-pound person, for example, would be about 7 to 10 pounds. If you're overweight, choose sensible ways to lose weight.

  • Don't use crash diets. Instead, eat smaller servings of the foods you usually have, and limit the amount of fat you eat.
  • Increase your physical activity. Aim for at least 30 minutes of exercise most days of the week. Do something you enjoy, like biking or walking with a friend.
  • Set a reasonable weight-loss goal, such as losing about a pound a week. Aim for a long-term goal of losing the number of pounds that's right for you.

Choosing My Weight Loss Goal.

Losing 5 to 7 percent of your total weight can help lower your risk of getting type 2 diabetes. You are more likely to lose weight if:

  • you're physically active
  • you cut down on fat and calories
  • Use these steps to choose a goal. Talk with your health care provider and your dietitian about your goal and how to reach it.

To find your weight loss goal for losing about 5 to 7 percent of your weight, find the weight closest to yours on the chart below. Follow the row across to see how many pounds you need to lose.

Your weight in pounds 5 percent loss in pounds* 7 percent loss in pounds**
150 8 11
175 9 12
200 10 14
225 11 16
250 13 18
275 14 19
300 15 21
325 16 23
350 18 25

*To find your exact weight loss goal in pounds for a 5 percent loss, multiply your weight by .05.

**To find your exact weight loss goal in pounds for a 7 percent loss, multiply your weight by .07.

Write your weight loss goal here:

To lower my risk of getting type 2 diabetes, my goal is to lose about ___________ pounds.

Write down what you will do to lose weight. I will:

Choose a date to start your plan for losing weight and write it here:

Start date: ___________________

Look ahead to when you think you can meet your goal. Allow about a week for each pound or half-pound you'd like to lose. Write the date for meeting your goal here:

End date: ___________________

Make Wise Food Choices Most of The Time

What you eat has a big impact on your health. By making wise food choices, you can help control your body weight, blood glucose, blood pressure, and cholesterol.

  • Keep track of what you eat and drink. People who keep track are more successful in losing weight. You can use the Daily Food and Drink Tracker to write down what you eat and drink.
  • Take a look at the serving sizes of the foods you eat. Reduce serving sizes of main courses, meat, desserts, and other foods high in fat. Increase the amount of fruits and vegetables at every meal. Below is a chart for choosing sensible serving sizes using your hand as a measuring guide. Because your hand is proportioned to the rest of your body, it can be used to measure a healthy serving size for your body. Remember, the chart is only a guide. Choose your serving sizes and foods wisely.
  • Limit your fat intake to about 25 percent of your total calories. Your health care provider or dietitian can help you figure out how many grams of fat to have every day. You can check food labels for fat content. For example, if your food choices add up to about 2,000 calories a day, try to eat no more than 56 grams of fat. See Ways to Lower The Amount of Fat in Your Meals and Snacks.
  • Cut down on calories by eating smaller servings and by cutting back on fat. People in the DPP lifestyle change group lowered their daily calorie total by an average of about 450 calories.
  • Your health care provider or dietitian can work with you to develop a meal plan that helps you lose weight.
  • Choose healthy commodity foods (items provided by the government to help people consume a nutritious diet), including those lower in fat.
  • When you meet your goal, reward yourself with something special, like a new outfit or a movie.

Having fruit for dessert instead of sweets has helped me lose weight.
"Having fruit for dessert instead of sweets has helped me lose weight."

Choose Sensible Serving Sizes

Amount of food Types of food Size of one serving (the same size as:)
3 ounces meat, chicken, turkey, or fish the palm of a hand or a deck of cards
Drawing of an open hand, palm side up, with a circle around the palm area to show the size of a 3-ounce serving.
1 cup cooked vegetables
casseroles or stews, such as chili with beans
an average-sized fist
Drawing of the palm view of a fist, with a circle around the center of the fist to show the size of a 1-cup serving.
1/2 cup fruit or fruit juice
starchy vegetables, such as potatoes or corn
pinto beans and other dried beans
rice or noodles
half of an average-sized fist
Drawing of a fist, with a circle around the bottom two fingers to show the size of a 1/2-cup serving.
1 ounce snack food one handful
Drawing of an open hand with the cupped palm up, with a circle around the palm area to show the size of a 1-ounce serving.
1 Tablespoon salad dressing the tip of a thumb
Drawing of an open hand, palm side up, with a circle around the thumb to show the size of a 1-tablespoon serving.
1 teaspoon margarine a fingertip
Drawing of an open hand, palm side up, with a circle around the tip of the index finger to show the size of a 1-teaspoon serving.

Ways to Lower The Amount of Fat in Your Meals and Snacks

  1. Choose lower-fat foods.
    Instead of sunflower seeds (20 grams of fat),
    choose pretzels (1 gram).
    Savings: 19 grams.
  2. Use low-fat versions of foods.
    Instead of regular margarine (5 grams of fat),
    use low-fat margarine (2 grams).
    Savings: 3 grams.
  3. Use low-fat seasonings.
    Instead of putting butter and sour cream on your baked potato
    (20 grams of fat), have salsa (0 grams).
    Savings: 20 grams.
  4. Cook with less fat.
    Instead of making fried chicken (31 grams of fat),
    roast or grill the chicken (9 grams).
    Savings: 22 grams.

Remember that low-fat or fat-free products still contain calories. Be careful about how much you eat. In fact, some low-fat or fat-free products are high in calories. Check the food label

Be Physically Active Every Day

Regular exercise tackles several risk factors at once. Activity helps you lose weight; keeps your blood glucose, blood pressure, and cholesterol under control; and helps your body use insulin. If you are not very active, start an exercise program slowly. Talk with your health care provider first about what kinds of exercise would be safe for you. Then make a plan to increase your regular physical activity.
  • Keep track of what you do for exercise and how long you do it. Use the Daily Physical Activity Tracker to keep track of your physical activity.
  • Aim for at least 30 minutes of physical activity a day most days of the week.
  • Incorporate physical activity into plans with family and friends. Set a good example for your children. Play softball on weekends. Go on a family hike.
  • Be active every day. For example, walk to the store, clean the house, or work in the garden, rather than watch TV.

Photo of an American Indian woman in exercise shorts and a t-shirt walking on a treadmill.
"Walking makes me feel good."

Getting Started on a Walking Routine

Walking is a great way to be physically active. Before you get started, talk with your health care provider about whether it's OK for you to walk for exercise. Then get comfortable shoes that provide good support. You can use the Daily Physical Activity Tracker to start your routine gradually. Try to walk at least 5 times a week. Build up little by little to 30 minutes a day of brisk walking.

My Walking Program

Warm-up time
Walk slowly
Fast walk time
Walk briskly
Cool-down time
Walk slowly
1 5 5 5 15
2 5 8 5 18
3 5 11 5 21
4 5 14 5 24
5 5 17 5 27
6 5 20 5 30
7 5 23 5 33
8 5 26 5 36
9+ 5 30 5 40
Source: Small Steps. Big Rewards. Your Game Plan for Preventing Type 2 Diabetes. A publication of the National Diabetes Education Program.

Take Your Prescribed Medicines

Some people need medicines to help control their blood pressure or cholesterol levels. If you do, take your medicines as directed. Ask your doctor if you should take metformin to prevent type 2 diabetes. Metformin is a medicine that makes insulin work better and can reduce the risk of type 2 diabetes.

Daily Food and Drink Tracker

Use the Daily Food and Drink Tracker to keep track of everything you eat and drink. Make a copy of the form for each day. Write down the time, the name of the food or drink, and how much you had. For a free booklet with information on fat grams and calories, call the National Diabetes Education Program at 1–888–693–NDEP (1–888–693–6337) and request a copy of the Game Plan Fat and Calorie Counter (PDF, 405.05 KB).


 Date    December 1, 2011  Daily Food and Drink Tracker
Time Name Amount Fat Grams Calories
8:00 am oatmeal 1/2 cup 1 80
  fat-free milk 1 cup 0 90

Daily Physical Activity Tracker

Use the Daily Physical Activity Tracker to keep track of your physical activity. Make a copy of the form for each day. Write down what you do and for how long.


 Date    December 1, 2011  Daily Physical Activity Tracker
Type of Activity Minutes
Walking 20
Gardening 10

Daily Food and Drink Tracker

Time Name Amount Fat Grams Calories

Daily Physical Activity Tracker

Type of Activity Minutes


Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov. Consult your health care provider for more information.


This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank:
Donald K. Warne, M.D., C.D.E., M.P.H.; William C. Knowler, M.D., Ph.D., M.P.H.; Mary Hoskin, M.S., R.D.; Tammy L. Brown, M.P.H., R.D., B.C.-A.D.M., C.D.E., Captain, U.S.P.H.S.; Lorraine Valdez, R.N., M.P.A., C.D.E.; Wendy Sandoval, Ph.D., R.D., C.D.E.; Gordon Quam, B.S.N., R.N., C.D.R., U.S.P.H.S.; and Cecelia Shorty of the Indian Health Service

The tribal leaders, American Indian Communities, health care facilities that supported the DPP, and the many American Indians who participated in the DPP. Their generous gifts of time and energy are bringing the message that small steps result in big health rewards for all American Indians.

This information is not copyrighted. The NIDDK encourages people to share this content freely.


August 2011