More and more people are discovering that they are pre-diabetic: Their blood sugar levels are high, but not high enough to be diabetic yet. If you're one of them, the good news is that by improving your diet, increasing your activity level and adopting other healthy lifestyle measures, you can avoid developing type 2 diabetes. And if you already have it, there is a lot you can do to manage your condition and lead a full and rewarding life.

The Diabetes Prevention and Management Cookbook by Johanna Burkhard and Barbara Allan was published in co-operation with the Canadian Diabetes Association. It concentrates on the avoidance and management of the most prevalent kind of diabetes, type 2, but the authors note that the nutrition information and menus included can be adapted for people with type 1 and gestational diabetes as well.

We covered the first three steps in Ten steps to diabetes prevention — Part I; now let's look at the next three:

1. Choose healthy fats

"There is no macronutrient more misunderstood or maligned than fat," say Burkhard and Allan. In fact, fat is essential in our diet — but the key is to eat the right kinds of it. Although all fats are high-calorie (about 40 calories per teaspoon), some are healthy and some are not, based on their chemical structure. The ones to look for are monounsaturated and polyunsaturated fats. "This structure may not be important to us as consumers, but knowing the terms will help you seek out foods that contain each type, so you can enjoy the taste and health benefits of both," the authors note.

As well as choosing unsaturated fats (soft margarine, corn oil, olive oil, nut oils) over saturated fats (coconut oil, palm kernel oil, butter, shortening), it's important to aim to avoid trans fats — hydrogenated and partially hydrogenated fats — completely. This is getting easier to do, as manufacturers of processed baked and fried foods (in which trans fats have typically been found) are switching to trans-free fats.

In answer to the "French paradox," which asks why the butter-and-cheese-loving French have lower heart disease rates than North Americans, the authors point out that the French typically eat small portions, little or no pop and very little trans-fat.

2. Eat low-fat protein at every meal

Because protein foods are filling, they build muscles (so they can burn more sugar) and many are good sources of fiber, it's important to include a protein at every meal — including breakfast. Some breakfast protein ideas: cottage cheese and fruit; low-carb protein powder in cereal or a smoothie; nut butter on whole-grain toast; scrambled eggs in a pita, with two whites and one yolk.

But because protein foods are frequently higher in fat, the key is to choose low-fat options, and to limit serving sizes. To make your dinner protein seem like more, the authors suggest:

  • Slicing meat thinly and fanning it out on the plate
  • Stretching it with veggies and beans (in chili) or oatmeal (in meat loaf)
  • Cutting meat into thin strips for a stir-fry
  • Using a smaller plate
  • Eating slowly and chewing well

3. Limit sodium

Salt matters because hypertension (high blood pressure) is a risk factor for diabetes, and lowering your salt intake reduces your risk of hypertension. The authors suggest aiming for an upper limit of 1,500 milligrams (mg) per day. That's only about a quarter-teaspoon, and it includes both what we add in the kitchen or at the table, and what's already in prepared foods.

If you read nutrition labels, you will find salt in unexpected places. You may know about the flavour enhancer monosodium glutamate, but did you know that the baking powder and baking soda — sodium bicarbonate — in cakes and cookies is also a source of salt? And while you would expect that a serving of salted French fries is high-sodium (at 555 mg), so are a pickle (573 mg) and a helping of canned beef stew (875 mg).

According to the authors, 75% of the salt we eat in North America comes from processed and fast foods, 10% comes from the salt that occurs naturally in food, and only 15% comes from what we add at home. "Because most of the sodium we eat is in processed foods," they say, "cooking at home using unprocessed foods is the first step to reducing sodium."

You could start by trying this recipe for low-sodium (467 mg/serving) beef stew:

Old-fashioned slow cooker beef stew (page 248)

Makes 6 servings

What's more comforting than a satisfying stew? With the welcoming herb-infused aroma that wafts through your kitchen, the first forkful confirms that this stew is comfort food at its best.

Large (minimum 5-quart) slow cooker

  • 1½ lbs (750 g) lean stewing beef, cut into 1-inch (2.5 cm) cubes
  • 6 tbsp (90 mL) all-purpose flour, divided
  • 6 tsp (30 mL) canola oil, divided
  • 2 onions, chopped
  • 3 cloves garlic, minced
  • 1 bay leaf
  • 1 tsp (5 mL) dried thyme
  • 1 tsp (5 mL) dried marjoram
  • ¾ tsp (3 mL) salt
  • ½ tsp (2 mL) freshly ground black pepper
  • ½ cup (125 mL) red wine (or additional broth)
  • 1/3 cup (75 mL) no-salt-added tomato paste
  • 2 cups (500 mL) low-sodium or no-salt-added ready-to-use beef broth, divided
  • 2 stalks celery, thickly sliced
  • 1½ lbs (750 g) potatoes (about 5 medium), peeled and quartered
  • 1 lb (500 g) carrots (about 5 medium), peeled and cut into thick slices
  • 12 oz (375 g) green beans, ends trimmed, cut into 2-inch (5 cm) lengths
  • ¼ cup (60 mL) chopped fresh parsley
  1. Pat meat dry with paper towels. In a bowl, toss beef with 2 tbsp (30 mL) of the flour to lightly coat.
  2. In a large pot, heat 2 tsp (10 mL) of the oil over medium-high heat. Add half the beef and cook until nicely browned on all sides. Transfer to slow cooker stoneware. Repeat with 2 tsp (10 mL) oil and the remaining beef.
  3. Reduce heat to medium and add the remaining oil to the pot. Add onions, garlic, bay leaf, thyme, marjoram, salt and pepper; cook, stirring, for 5 minutes or until onions are softened. Add wine and tomato paste; cook, scraping up any brown bits from bottom of pot. Stir in 1½ cups (375 mL) of the broth.
  4. Transfer onion mixture to stoneware and add celery, potatoes and carrots. Cover and cook on Low for 8 hours or until beef is tender.
  5. In a bowl, stir together the remaining flour and the remaining broth until smooth. Stir into stew, along with beans. Cover and cook on High for 30 minutes or until slightly thickened and vegetables are tender. Discard bay leaf. Stir in parsley.

Tips: When purchasing broth, be sure to check the sodium content and choose one with 140 mg or less per 1 cup (250 mL). Four ounces (125 g) raw beef yields 3 oz (90 g) cooked beef (3 Meat & Alternatives Choices).

Recipe excerpted from The Diabetes Prevention & Management Cookbook by Johanna Burkhard & Barbara Allan © 2013 Reprinted with publisher permission.