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Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT)
Occurs when hyperglycemia is present but diabetes has not been diagnosed
Behan KJ. New ADA guidelines for diagnosis, screening of diabetes. Laboratory.2011;20 (1):2. http://laboratory-manager.advanceweb.com/Archives/Article-
Archives/New-ADA-Guidelines-for-Diagnosis-Screening-of-Diabetes.aspx
. Accessed October 16, 2013.

States with Highest Percentages of U.S. Adults Who
Have Ever Been Told They Have Pre-diabetes, 2010
State
Tennessee
California
Hawaii
Idaho
Kentucky
Alabama , Alaska
New Hampshire
Mississippi
Minnesota
Percentage
7.2
7.0
6.8
6.7
6.6
10.2
8.0
7.5
7.3

States with Lowest Percentages of U.S. Adults Who
Have Ever Been Told They Have Pre-diabetes, 2010
State
Vermont
Wyoming, Massachusetts
Montana
Utah
South Dakota
Ohio, Connecticut
Iowa, Nebraska
New York, Illinois, D.C.
Percentage
5.2
5.3
5.4
5.5
4.4
4.8
4.7
5.1

Tennessee - Percentage of Adults (aged 18 years or older) Reporting Pre-diabetes, 2008 - 2010

Under Normal Conditions
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Liver makes basal level of glucose
Body is able to sense changes in basal BG level and is adjusted
When you eat:

Insulin increases

Blood glucose decreases

Pre-diabetes/Diabetes


Take in more CHOs than insulin is able to clear
Extra calories stored as visceral fat


Visceral fat releases chemicals

Insulin increases

Gluconeogenesis increases
Kidney is unable to clear excess glucose



3 P’s
Excess glucose stored as visceral fat
FFA released

Acanthosis nigricans

Mr. H

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51 y/o, AA, M
Past Medical History:
GERD, Colonic polys, Chronic arthritis, smoking, ETOH, marijuana use
Medical Diagnosis: Pre-diabetes
Referred to Nutrition Copper clinic due to A1C of 6.2 and the
3 P’s

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Anthropometrics:
Ht: 68 in.
Wt:144.3 lbs
DBW: 138 – 169 lbs
% DBW: 94%
Recent Weight Changes: -2 lbs since last visit with PCP
BMI 21.9 (normal)

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Pertinent Labs: A1C of 6.2 % , all other labs WNL
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Pertinent Medications: Omeprazole

Physical Activity : None

Diet History:
Breakfast Lunch
Nothing Nothing
Dinner
"country meal“
 Proteins: baked chicken
 Vegetables: mashed potatoes, lima beans
 Grains: roll, cornbread
Snacks
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
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Snack cakes
(oatmeal cream pies) candy bars
(Paydays, Kit-
Kats) pork rinds (after dinner)
Beverages
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
Water
Cranberry juice (
4-5 8 oz servings daily)
≤ 1 soda per day

Imbalance of nutrients related to meal inconsistency and frequent intake of calorically dense snacks as evidenced by
A1C of 6.2% at last PCP visit.

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Concern about improving blood glucose to prevent diabetes
Desire to eat healthier foods
Concern about vision
Sleep
Patient mentioned fasting for religious reasons for up to 7 days at a time

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

Patient was educated on how hyperglycemia can negatively affect organs
Patient was introduced to the importance of maintaining blood glucose through meal consistency
Handouts provided:

Nutrition Goals

NUTRITION PRESCRIPTION:
Decrease blood glucose to A1C ≤ 5.7 %
NUTRITION INTERVENTION:
1.
Meal consistency a. aim for three meals/snacks daily
2. Choose foods that you like for these meals
3. Reduce juice to ≤ 4-8oz. servings/day

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
Lab values WNL - A1C at goal of ≤ 5.7 %
Comply with appropriate diet - meal or snack three times daily

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Disease Prognosis
“Without lifestyle changes to improve their health, 15% to
30% of people with pre-diabetes will develop type 2 diabetes within five years.”
Center for Disease Control and Prevention

Nutrition Prognosis

Comprehension : Good

Expected Compliance : Fair – the patient seemed to understand the importance of changing his diet but not ready to make big changes

Q & A

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American Diabetes Association. Prediabetes. Diabetes Basics webpage. Available at http://www.diabetes.org/diabetes-basics/prevention/pre-diabetes/ . Accessed October 14, 2013.
Center for Disease Control and Prevention. Diabetes Report Card 2012:National and State Profile of
Diabetes and its Complications. Diabetes webpage. Available at http://www.cdc.gov/diabetes/pubs/reportcard/prediabetes.htm. August 12, 2012. Accessed October
14, 2013.
Center for Disease Control and Prevention. Prediabetes. Diabetes webpage. Available at http://www.cdc.gov/diabetes/consumer/prediabetes.htm
. August 13, 2012. Accessed October 14,
2013.
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
Prediabetes: What You Need to Know. Available at http://diabetes.niddk.nih.gov/dm/pubs/prediabetes_ES/ . July 24, 2013. Accessed October 14, 2013.
Center for Disease Control and Prevention. Diabetes Data and Trends. Diabetes webpage. Available at http://apps.nccd.cdc.gov/DDTSTRS/Index.aspx?stateId=47&state=Tennessee&cat=riskfactorsfordiab etes&Data=data&view=TO&trend=Prediabetes&id=27 . Accessed October 16, 2013.
Center for Disease Control and Prevention. 2011 National Diabetes Fact Sheet. Diabetes webpage.
Available at http://www.cdc.gov/diabetes/pubs/general11.htm
. May 20, 2011. Accessed October 16,
2013.