It is estimated that more than 21 million Americans have diabetes. To understand diabetes, you need to know how your body normally uses glucose. Glucose is vitally important to your health because it is the main source of fuel for your muscles and tissues. You need the hormone insulin, one of the hormones produced by your pancreas, to be present in adequate amounts in your blood to use the glucose properly.

Diabetes comes in different forms. Type 1 is when your pancreas produces little or no insulin and insulin needs to be replaced. Type 2 is when your pancreas is producing insulin, but your cells have become resistant to it, or when, with age, your pancreas is not producing as much insulin.

It is now believed that more than 54 million Americans may have pre-diabetes, a condition in which your blood sugar is higher than normal, but not high enough to be considered Type 2 diabetes. Within the next 10 years, these people could develop Type 2 diabetes if they do not make lifestyle changes

Pre-diabetes may go unnoticed. There are no signs and symptoms. Here's what you can do to help prevent it:

* If there is a family history of diabetes, ask your doctor for diabetes screening blood tests. Fasting blood glucose levels between 100 to 125 mg/dl are considered pre-diabetes.

* If you are overweight or obese, try to lose weight.

* If you carry excess fatty tissue around your abdomen, try to shed some pounds as well. A woman's waistline is healthiest at less than 35 inches, a man's at less than 40 inches.

* If you are sedentary, become more active. Any increased activity will stimulate the cells to utilize glucose, make your cells more sensitive to the insulin and build muscle mass. More muscle causes more glucose uptake and more fuel burned.

* If you were diagnosed with gestational diabetes or delivered a baby weighing more than 9 pounds, you are at increased risk. Best to keep the weight down.

* If you are taking prednisone for long-term use or taking some medications for high blood pressure, these have been associated with increased blood sugars. Have your blood sugar tested more often.

* Consult with your doctor about risk factors if there is blood history of American Indian, black-American, Hispanic/Latino, native Hawaiian, some Asian-American and Pacific Islander-American; if you have polycystic ovary syndrome, if your triglycerides are high, or if your "good" cholesterol is low and your "bad" cholesterol is high. All put you at greater risk.

* If you are 45 years or older and never been tested, consult with your doctor.

The keys to preventing the onset of diabetes are weight loss, increased activity, healthy food choices and smaller portion sizes. Other healthy changes are reducing your sodium intake and watching your total fat intake.

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Claudette M. Novak is a registered dietitian with Nutrition for Health in Amesbury. You can reach her at eatright100@comcast.net.