According to Registered Dietitian and Certified Diabetes Educator Tracy Garrett, research shows almost FIFTY PERCENT of individuals 65 years of age and older are pre-diabetic, many without even realizing it. No symptoms, no idea of the damage happening to their body. 

In this video from the Center For Health & Wellbeing, Tracy outlines important information everyone should be aware of. You’ll learn what diabetes and pre-diabetes are, how to know if you are at risk, and specific actions you can take.

(Prefer to read? A transcript of Tracy’s presentation is below the video.)




Introduction to Pre-Diabetes & Diabetes Prevention by Tracy Garrett

This informative and life-changing educational seminar is instructive for those who might be at risk for diabetes. In this presentation, Sun Health’s Registered Dietitian and Certified Diabetes Educator, Tracy Garrett, provides a plethora of useful and timely information about pre-diabetes, and diabetes prevention or mitigation. For more information about Sun Health’s Center for Health and Wellbeing education offerings, please contact us at 623-832-9355.

My name is Tracy Garrett and I’m a Registered Dietician and Certified Diabetes Educator here at our beautiful Sun Health Center for Health and Wellbeing.

I want to welcome you all to our center today! I see some familiar faces and there are some new faces here, so welcome to each and every one of you.

Today we are going to be talking about pre-diabetes, doing an introduction on pre-diabetes, giving you a little background about it and, hopefully, you’ll find some good information in what we talk about today.

So we are going to start by really talking about what pre-diabetes is. We are going to talk about how pre-diabetes is diagnosed, the risk factors for developing Type II diabetes and important yet simple lifestyle modifications that you can do to help to prevent or delay developing Type II diabetes. We are going to talk about screening recommendations and then we are going to talk about here at our Sun Health Center for Health and Wellbeing how we can assist you in keeping you well and having a wonderful and healthy life.

To begin with, sometimes when we talk about chronic diseases such as diabetes, it can be a little bit of a downer, so I always like to have a little bit of humor. In your packet as well as on the screen, there’s a little cartoon. There is a gentleman at his doctor’s office, sitting on the table and the doctor just gave him a shot. The doctor says, “It wasn’t really insulin, you don’t have diabetes yet. This was just a warning shot.”

For some people, finding out they are classified as pre-diabetes can be that warning shot, so we want to know if, in fact, we are in a pre-diabetic state.

Pre-diabetes is a medical condition that occurs when the blood glucose – also referred to as blood sugar – levels are higher than normal, but not yet high enough to be considered diabetic.

The big thing is this to understand: without intervention, many individuals who are classified as a pre-diabetic will go on to develop Type II diabetes. The good news that we know is that there’s been lots of research about this and we have some things that we can get to keep ourselves healthy, but being in a state of pre-diabetes is not without risk. A lot of people think if a doctor tells them that they are pre-diabetic that, yes, they might have that warning sign, but they’ll wait until they actually become diabetic before they make changes.

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Let me tell you this, if you considered pre-diabetic, damage is going on already.
Now is the time to act. Now is the time to say, “What can I do NOW to prevent or delay diabetes from occurring?”

When we talk about pre-diabetes, there are some other names sometimes used:

• impaired fasting glucose,
• impaired glucose tolerance,
• insulin resistance,
• at risk for diabetes,
• borderline diabetic, or even
• “have a touch of sugar”

Any of those terms mean the individual is classified as pre-diabetic.

When we look at the research, the research shows that individuals who are 65 years of age and older, about 50% of them are pre-diabetic.

If I went through this group here and I said, “Okay 50 percent, yes, no, yes, no, yes, no, yes, no” – pointing at every other person – that’ll be the occurrence of individuals who really do have pre-diabetes.

This is the thing: in our West Valley location here, a lot of the individuals in our community are 65 years and older, so that means a lot of the people – half of the people or so – really are in that pre-diabetic state, that state when there is damage going on, but they may not know the damage is going on.

The thing about pre-diabetes is most of those individuals are undiagnosed, they don’t know they are pre-diabetic.

Studies report that only about one-in-six individuals know that they are in a pre-diabetic state, so if your doctor has told you that you are pre-diabetic, you have an advantage over all of those other individuals who do not know that their blood sugar is higher than desired. Knowledge is power.

If we understand that it is very widespread, if we understand what the diagnosis is, if we understand that there are things that we can do to prevent or delay the progression into Type II diabetes, it is very, very powerful. Would you agree with that? Yes, okay, wonderful.

We need to take pre-diabetes seriously. It’s something that we can impact and we want to do that. If somebody is clinically diagnosed as pre-diabetic, they are at a 50% increased risk of having a heart attack or stroke before they even become diabetic. We know that heart disease is the number one killer in America, so if your numbers are just slightly elevated, some people think, “Oh, no big deal” – but it’s serious. Fifty percent increased risk and there are about 79 million people in the United States who have pre-diabetes. Many of these people will go on to develop Type II diabetes if they do not make lifestyle changes.

If they do not make lifestyle changes, well, then we talk about diabetes and what it really is.



The foods and beverages with carbohydrates that we are consuming are converted in our bodies into glucose and used for energy. When somebody has an altered metabolism of glucose where their body cannot break it down as effectively to absorb it, allowing it to leave the bloodstream and go into the cells, they’re at risk of diabetes. There’s a problem, and the blood sugar goes higher and higher.

So when we talk about diabetes, Type II diabetes really, it’s a problem related to the pancreas and the insulin that is available or how the insulin is working. With Type II diabetes, the body either resists the effects of insulin, so we may have enough insulin especially early on.

That’s where we get the idea of insulin resistance – we have enough insulin in our bloodstream, but because the cells are receptive to the insulin, the glucose is not transported from the bloodstream into the cell. When it remains in the bloodstream versus absorbing into the cell, that’s when we have complications, that’s when we have our symptoms, and so either the body is resistance to the effect of the insulin or the body doesn’t produce enough of the insulin. When the body doesn’t produce enough of the insulin, the blood vessels have too much of the glucose (also referred to as blood sugar) and that energy stays in the blood stream, instead of being allowed to come into the cells where it nourishes us and we feel good and we have energy and we can have that high quality of life. There is a problem with that.

Type II diabetes was once known as adult onset or non-insulin-dependent diabetes. When we talk about Type II diabetes, there are some risk factors. So I want all of you to think about this and say, “Do I fit into any of these categories?”

The first one is that if you are 45 years of age or older, you are at risk for developing Type II diabetes.

What about a family history of diabetes – did your parents have diabetes” Did your aunt, brother or sister? Having a family history of diabetes will increase your risk because we do know that there is a heredity factor there.

What about having a history of gestational diabetes? If you’re a female or giving birth to a baby that weigh more than nine pounds, if that was you, you have a greater risk. Or if you know somebody who did fall into that category, they have a greater risk.

There are some genetic risk factors – ethnic or minority groups that are at higher risk for diabetes.

We don’t have control over some of these, and we don’t have control over aging as time marches on and as we get older. We don’t have control over the fact that we may have been born into a family where there are more individuals who have diabetes, or born into ethnic groups. But there are risk factors that WE DO have control over, and this is where we want to really focus on.

The first one is high blood pressure. How many people were aware of that if you have high blood pressure, it increases your risk for developing Type II diabetes? Absolutely and, again it’s because diabetes is a disease of the metabolism, things in the body start to get off a little bit.

What about if you have low ”HDL”, ”HDL” – a high density lipoprotein also referred to as healthy cholesterol? If somebody has low HDL-cholesterol and high triglycerides, that can also be a risk factor, a warning sign – and oftentimes people who do have diabetes have high triglycerides.

What about weight? If somebody carries more weight, they are at risk of developing diabetes as well and we know that individuals who are overweight are in the majority. We know that 60 to 70% of individuals right here in our community are overweight, placing them at risk for developing Type II diabetes.

And lastly, lack of physical activity.

Most of us tend to be sedentary. The way life has progressed, we have the little remote control for the TV, many things are automated and we are not as active as we once were. Would you agree with that? Yes absolutely. We don’t have to do those things. Life has gotten easier and we are not as active as our grandparents were. I think about my grandparents on the farm and they were up, moving all the time. Our jobs aren’t like that anymore, our lives aren’t necessary like that anymore. We don’t even have to lift up the garage door, we just push a button and the garage door opens. As a society, we are not as physically active as we once were.

So what are some of the common signs and symptoms of Type II diabetes? Individuals who have pre-diabetes may be starting to see the signs of diabetes as well, so I want you to be thinking about it and say, “Does this relate to me? Have I had some of these symptoms?”

• UNUSUAL THIRST: If somebody is thirsty a lot, that can indicate an alteration in blood sugar metabolism or blood sugar levels. Although as we get older, our sense of thirst diminishes and that can actually get us into trouble, especially here in Arizona. We may not feel thirsty and our bodies need water before we feel thirsty. Make sure you’re drinking before you have that thirst.

• FREQUENT URINATION: When the blood sugar is higher, the body tries to get back into balance, one of the ways it does that is by excreting extra glucose through the urine. Somebody may be having more frequent trips to the restroom, because of increased urination. People may just attribute that to getting older, but it may not be. It may be due to blood sugars being out of control. Increased use of the restroom also can cause dehydration and make us thirsty, but the good news is this: is if you are making more trips to the restroom to urinate because of your blood sugar been out of control, it improvise as it gets in better control. That’s good.

• BLURRED VISION: Diabetes can affect eyesight.

• EXTREME FATIGUE: We often associate fatigue with getting older, but it could be that glucose, that energy is still in our blood vessels – it’s not in our cells to give us that energy that we need to feel great and to function.

Other symptoms include cuts and bruises that are slow to heal, tingling or numbness in the hands and feet, re-occurring skin or gallbladder infections.

You may actually have no symptoms at all. No symptoms at all.



According to the American Diabetes Association, adults who do not have any of these symptoms but who are overweight and have one or more additional risk factors should be screened for diabetes.
If somebody does not have any risk factors, testing should begin at age 45, and if the tests are normal, test should be repeated at least every three years.

Your physician may recommend additional testing as well.



We may not have symptoms – we may not go in to the doctor and say, “Hey Doc, I’m feeling really tired and urinating all the time. I have wounds not healing.” Those things would indicate to the doctor to check your blood sugar. Sometimes there’s no symptoms, so the way that pre-diabetes and diabetes are diagnosed clinically through blood tests.

There are a couple different test that are used; the first one is called the A1C test. There is also the fasting plasma glucose test, and the oral glucose tolerance test, where you drink a sugary sweet beverage, then they check your blood sugar for changes in the blood sugar.

In your handouts and on the screen here, you can see the clinical criteria for each test, the normal range, if they are clinically pre-diabetic or if they are clinically diabetic.

I am not diagnosing anyone – we leave the diagnosing to the physicians – but these are the criteria that would be used. If you have lab sheets, lab reports, look at those lab reports, talk to your physician.

Clinically, if somebody was to have their blood drawn, glucose levels less than 100 would be normal, between 100 and 125 would be pre-diabetic, and 126 or greater would be the criteria for a diabetic state.

Understand again that doctors are the ones who make the diagnoses and we like to have a repeat test to verify. If you get one test that is high, typically they verify that result in an additional test.
For the A1C – and A1C is different than the fasting blood sugar – fasting blood sugar is that one split second time, it changes you know over time – the A1C is an average of how the blood sugars have been running for the last 60-to-90 days. A normal A1C would be less than 5.7%, pre-diabetic would be greater than 5.7 up to 6.5 or so, and 6.5 and above would be clinically defined as diabetes.
And then we have the oral glucose tolerance test. The numbers there would be 139 and below for normal, 140-199 would be pre-diabetic, and 2oo or greater are in the diabetic category.

Okay, so we’ve talked about how pre-diabetes can be dangerous and that many people are in that state without being aware of it, so the first thing is being tested to find out what category you are in, how close you are to being diabetic, and what to do if you are in a pre-diabetic state. If you do find out you are in a diabetic state, there are actions and interventions that can be done.



Scientific research has conclusively revealed that individuals with pre-diabetes can prevent or delay the development of Type II diabetes by following a couple of recommendations.

The first one is that if an individual is considered overweight, having a BMI greater than 25, losing weight can prevent or delay the onset of diabetes.

Secondly, increasing the level of physical activity can prevent or delay diabetes.

Body Mass Index (BMI) is a correlation between height and weight. I’ve passed out a BMI chart and along the left-hand column, it gives the height in inches. Then, if you find your height in inches and you proceed to the right and find the weight that is most closely correlated to your current weight and then you go up the column, it will tell you what your BMI is. If anyone has a challenge finding that, I can definitely help them after class.

What research shows is this: just 30 minutes a day of moderate physical activity is recommended. For most people, that’s pretty achievable.

If you are inactive at this time, we always recommend that people start with where they are at. Talk to your doctor to make sure there is not a reason preventing you from becoming physically active. Some people may need to pursue things like physical therapy and conditioning to build their bodies up – we don’t want people who have not been physically active for a long time to think that they need to go out today and do 30 minutes, then they get worn out and say this is way too hard. We want to encourage people to start with where they are at, and increase from there.

Thirty minutes a day of moderate physical activity plus a seven percent reduction in body weight are two combined criteria shown in scientific research to equal a 58% reduction in developing diabetes. Fifty eight percent!

I know many of the individuals in this room are over 60 years of age. If you’re over 60 and do that 30 minutes of moderate exercise a day AND you reduce your weight by about seven percent, there is a 71% reduction in the risk of developing diabetes.

Those are pretty good odds, wouldn’t you say? Really good, so that is something to be happy about. That’s the good news that we want to really hold onto there.

The next slide is the BMI chart and I wanted all of you to be able to figure out whether you are over that 25 percent of body fat criteria. If you are, a 7% weight loss can be a positive intervention in helping to prevent or delay diabetes by over 70% for those over 60.

Personal weight loss goals and weight loss necessary to mitigate risk of diabetes aren’t always the same thing. People say, “I don’t want to just lose 14 pounds, I want to lose 30 pounds.” That’s great, however before you reach your personal goal, you’ve already started to reduce your risk of developing diabetes, so that’s something to really hold onto.

I’ve included this CDC pre-diabetes screening test, and I don’t know if you all had a chance to look over this before we began or not, but I’m going to give you a couple of minutes here. Does everyone have one? Okay. I’m going to give you a couple minutes to answer these few questions and it will help to determine if you are at risk, if you could potentially have pre-diabetes and what it is.

It’s a point system. For example, if you’re a woman who has had a baby weighed more than 9 pounds at birth, you get one point. If you’ve had a brother or sister who has had diabetes, you get another point. Parent with diabetes; that equals one point. If you are above the noted weight for your height, you get five points. If you are younger than 65 years of age and get little or no exercise on a typical day, you get five points. If you are between 45 and 64 years old, you get a five points. And the last one is, if you are 65 years of age or older you get nine points.

So if you’ve answered those different questions and add them up, the key is on the back. It says that if you score between three and eight points, currently you have a pretty low risk of developing pre-diabetes or having it now. If you do have a lower risk, you want to keep it there. We want to keep you active and keep your weight in a healthy range. If you scored nine or more points, you have a much higher risk of having pre-diabetes or developing Type II diabetes, so we need to look at that further to see what we can do. We want to know what our risk is, what our lab values are and what our risks are, as far as that scale.

If any of you just took this test and you said, “Oh my goodness, I am pre-diabetic or I have a great risk of being pre-diabetic!” Or just had a fasting blood sugar test done last week that was 134, meeting the criteria of pre-diabetes – again the good news is that there are things we can do to help prevent or delay becoming Type II diabetic.

The first one is going to be maintained on an optimal weight or lose weight if necessary. You can follow a healthy diet and get regular physical activity.

We want to make sure that we understand and watch for these symptoms.

We’ve talked about these symptoms, the increase of thirst, the increase of urination, the blurry vision and types of tests, and also to make sure that you’re having a regular checkups with your primary care provider.

There’s another little cartoon humor, while we talk about something that is very serious. It says this lady is talking to her doctor and she said, “I think diabetes is affecting my eyesight. I’m having trouble seeing the consequence of my poor food choices.”

There is so much involved in understanding these types of conditions and it can be very scary. A lot of times, we can be in denial and prefer not to know, but what I tell people is this, ‘ what you don’t know can hurt you.” If you know you are at risk, that can be a very strong motivator to help you get off the couch and do that walk. It can allow you to change what you are putting into your body.

So when we talk about some of the aspects of healthy eating to prevent diabetes and lose that 7% of excess weight, there are some ideas here. There are some interventions that all of us can do on to become healthier.

The first one is learn to read food labels. Right here at our Center for Health and Wellbeing, I’ve taught many classes on label reading. Come and join us for a class!

One of the aspects research has shown to be very helpful is the limiting of the total amount of dietary fat that we consume. It’s very concentrated in calories, so small amounts of fat have a much higher calorie content than something that has protein or carbohydrates. By decreasing the quantity of fat in our diet, we can very effectively decrease overall calories.

Another idea is eating smaller, more frequent meals – decrease the portion sizes.

Let me ask you this: Do you eat regular meals? Do you eat breakfast, lunch, dinner, and maybe have healthy snack in between? When I’m reviewing food diaries for the individuals we serve here, people skip meals. Do skipping meals ever result in losing weight? No. Research shows that if we skip breakfast or lunch, we typically eat more later in the day. If we skip meals, our hunger goes up and we are out of control what we eat. We want to want to make sure that we are controlling our hunger.

When I talk about that hunger being really high, being excessively hungry because were not eating on regular intervals, I call that caveman hunger. I’ve been there myself – you don’t care what you’re eating, you just need food and you need it now. We want to prevent that caveman hunger.
We want to eat more vegetables. How many people here have vegetables every day? Okay, how many people here have vegetables at least twice a day at lunch and dinner? Okay, so most of you are very good, that is one of my most common recommendations. I will look at people’s diaries and they aren’t eating vegetables.

Vegetables have so many positive aspects in our health and well-being, not just in our weight, so that is one of the things we can look at is increasing the vegetables that we are consuming and keeping portions reasonable. Smaller portions, looking at the methods we used to cook our foods – boiling, steaming, baking or grilling versus frying foods – learn how to eat out, yeah!

I see the heads shaking. A lot of people eat out – that’s part of what happened in our modern society, people enjoy it, they are busy so they eat out. But how do you suppose the nutrient quality of the meals are when you eat out, versus when you prepare it yourself? Higher! Higher and what? Salt, fat, calories, sodium, all those things, all those things, that’s why the food tastes so good, but we pay a price, don’t we? We pay a price for eating out, because we often overeat and get too much fat, too much sodium, too many calories.

The effect shows on our body, but there are ways to make healthier choices when we eat out, and we need think about that.

And lastly on this list, I have the idea of identifying true hunger.

How many of us only eat for hunger? Do we also eat sometimes because we are bored? Yes! Do we eat because we are celebrating? Or triggers in the environment? I always say if somebody came in here with a hot platter of white chocolate cookies, how many of us would take a cookie even though we may not truly be hungry? We need to start to think about those things as part of this lifestyle modification, this behavior modification that can result in us being healthier, having higher qualities of life, feeling better and preventing chronic disease. It’s all very, very exciting when we think about what we can do.

Let’s talk about physical activity.



Physical activity is highly correlated with improved blood sugars, so if you are at risk for diabetes, one way to bring down your glucose is walking, being physically active.

When you are physically active, the body demands glucose. It demands energy when you’re swimming, when you’re biking, when you’re hiking, all of those things – and it’s going to get it from the bloodstream. It’s going to pull glucose out of the bloodstream into the cells to give you energy and every time you do that, every time you take a walk, every time you get on that stationary bike or you go to the fitness center, you are helping change the outcome of your life. You are pulling extra glucose out of your blood system into those cells and you are helping to prevent or delay the occurrence of diabetes – or if an individual does have diabetes, they are helping prevent complications of diabetes and many, many other things.

There are things we can do to help prevent this, again talking to the doctor. Most doctors will be thrilled if you discuss a walking program, or becoming more active.

The idea is to start with where you’re at and increase up to that 30 minutes per day. A common question we get is, “Does the 30 minutes have to be at one time?” No, it can be broken down into shorter time segments. A 10-minute walk a couple of times a day will benefit you, but it really needs to be continual motion. If you’ve got a dog and they take 10 steps and stop, and 10 steps and stop, you may want to do that walk without the dog.

What are some ideal exercises to decrease the blood sugar and prevent diabetes? Walking, what else? Dancing, swimming, water walking, all those things are amazing, breaking them down into at least 10-15 minute sessions, two to three times a day is fantastic.

In this cartoon, this couple are riding their bike and she says, “Goodbye, pre-diabetes – hello, health!” That’s the attitude that I want everyone to take. As you are doing something, you are leaving those chronic diseases behind. You are improving your health, no matter what state you are in.



If you’ve ever been told that you have pre-diabetes or that you are at risk for diabetes, you should be having an annual exam. Most people do this with their primary care doctor. You can talk to your doctor, and they can order lab tests and talk about concerns that you have.

One thing about these recommendations that I’ve talked about, these lifestyle recommendations, these behavior modifications, is that we all listen to them and we say yes, we may need to lose weight, we may need to be physically active, but it’s easier said than done. There are certain ways that we can make ourselves more successful with this.

Some people are able to do it by themselves and that is fantastic, but there is research that shows that people who do lifestyle modifications in groups have a better overall success rate. I see some nodding here. The idea is this: if you are able to do this by yourself, more power to you, but at Sun Health, we do have different programs that can assist you.

I am a certified diabetes educator. I love that. I love teaching people how to be healthy, so if you or someone you know has diabetes, programs at our center might be covered by insurance, with no out-of-pocket costs.

Secondly for those individuals who are in that pre-diabetic category, we are proud to offer the National Diabetes Prevention Program at the Center for Health and Wellbeing. We have a track record of the individuals who have been in those programs and they have lost the weight, they have increased their physical activity and their blood sugars have gone down – not only their blood sugars, but their cholesterol, blood pressure and lots of other things. There are some individuals who want group support and a supportive environment where they get re-focused on their goals.

And then for some individuals, they may say, “I don’t really want to do a group setting, I would prefer to meet one-on-one with a dietitian and talk about how to adjust my eating habits, and have somebody look at my lifestyle.” They want someone to say, “You know what, how about if we made a tweak here or a change there, and let set some goals to move you forward?” Everybody is different and we know that, but because we do know that the need is great, there’s a lot of people who this affects and we know that there are things we can do to help prevent and delay the occurrence of diabetes, we want to encourage and empower each person in this class/ O get excited about this and say, “go tell your neighbors, your friends, spouses and family to be checked. Have them take the risks test to determine are they are at risk. Let’s rein it in now, before we have complications.



At the Center For Health and Wellbeing, our new dietitian, Margaret, and I are here to teach classes and do nutrition consults. We also have Rhonda, our wonderful exercise physiologist and she teaches exercise classes. We have exercise classes in this very room and other centers that are located over in Boswell and at La Loma Village, our beautiful community in Litchfield Park.

Our mission is to help individuals feel great and have a high quality of life. I hope that all of you take on that challenge, and that some of the things I’ve talked about today have you thinking about some things that you should be looking at, or maybe making changes so to continue having a high quality of life.

Thank you everybody.

For information about these services and more, please contact the Center For Health & Wellbeing at 623-832-9355 or visit us online at


(Originally published Aug. 28, 2015; last updated Jan. 6, 2019.)

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