Diet and Diabetes

Diet and Diabetes

Summary

A good diet is an essential part of managing diabetes. Meals and snacks play a big role in determining an individual’s glucose (blood sugar) levels. The meal choices patients make are crucial to keeping blood glucose from spiking too high or falling too low.

Patients can work with physicians and dietitians to create a meal plan that is well-balanced and that offers a variety of food choices. The right meal plan can help patients:

  • Prevent hyperglycemia and hypoglycemia
  • Lower blood pressure
  • Control cholesterol
  • Achieve a healthy weight and avoid obesity

People with diabetes who achieve these goals are likely to reduce the odds of suffering health problems related to high blood glucose and diabetes, including:

  • High blood pressure, atherosclerosis and heart conditions
  • Diabetic neuropathy
  • Diabetic nephropathy
  • Eye diseases such as diabetic retinopathy and glaucoma
  • Diabetic coma

A diet plan can also help patients to keep an optimal weight, which can increase the body’s ability to use insulin more effectively. Even a modest weight loss of 8 or 10 pounds can pay big dividends when attempting to manage glucose. The American College of Preventative Medicine states that efforts to prevent diabetes can be significantly enhanced by planning a diet adequate in complex carbohydrates (including fiber-rich whole grains, fruits and vegetables), moderate in protein and total fat, and restricted in saturated fat and trans fat.

Patients can greatly enhance the benefits of a well-balanced diet by adding an exercise regimen to their treatment routine, as approved by their physician. In some cases of type 2 diabetes, a combination of diet and exercise alone can allow patients to control their diabetes. In other cases, diet and exercise are an important adjunct to insulin therapy or antidiabetic agents.

About diet and diabetes

Diet is one of the major factors influencing management of diabetes. It has the biggest impact on patients’ glucose (blood sugar). In addition, a healthy weight can prevent or dramatically reduce the odds of developing prediabetes, type 2 diabetes, gestational diabetes and double diabetes. It can also minimize complications in those who already have diabetes.

People often think of diet as a temporary tactic to lose weight. Instead it should be viewed as a lifetime strategy of eating the right kinds and amounts of food at the right times to help feel good and prevent health problems.

Diet planning is a cornerstone of diabetes management. In some cases, changes to diet – along with regular exercise and other lifestyle modifications (e.g., quitting smoking, limiting alcohol) – can be enough to keep diabetes symptoms under control. In other cases, diet may be part of an overall treatment plan that also includes drug therapy with insulin or antidiabetic agents.

Patients with diabetes are generally advised to eat around the same time each day, eat meals that are nutritionally balanced and strive for weight management. Excess weight contributes to insulin resistance not just in people with type 2 diabetes but also in those with type 1 diabetes and other forms of diabetes.

A good diet is well-balanced with foods that provide a variety of nutrients, including vitamins and minerals. Foods that can be part of a sound diet include:

  • Vegetables and legumes
  • Whole grains
  • Fruits
  • Nuts and seeds
  • Low-fat dairy products
  • Fish, poultry and lean meats

In general, people should consume between 1,200 and 2,400 calories a day, depending on their size, gender and energy requirements. In addition, at least eight glasses of water or other nonalcoholic and unsweetened liquids are recommended. Carbohydrates, proteins and fats are the three main categories of nutrients that provide energy to the body. The American Diabetes Association (ADA) recommends that meals contain the following breakdown of nutrients (although recommendations vary slightly for those with high levels of LDLcholesterol):

SourcePercentage of daily calories
FatsNo more than 30 percent, less than 7 percent from saturated fats
Proteins10 percent to 20 percent
Carbohydrates50 percent to 60 percent

Carbohydrates are the body’s main source of energy and provide the greatest influence on a person’s glucose levels. A large serving of carbohydrates in a single sitting, particularly low-fiber, high-sugar foods, is likely to boost glucose levels. For this reason, it is important to include not only carbohydrates but also protein and fats within a meal.

In addition, people with diabetes need to keep close track of the grams of carbohydrates they consume. This will allow patients to adjust insulin levels to best meet the rise in blood glucose brought on by carbohydrate consumption. Patients can track carbohydrate intake through either carbohydrate counting or diabetic food exchange lists.

The ADA’s latest dietary guidelines, issued in 2006, emphasize fiber-rich complex carbohydrates. Its recommendations for people with diabetes include eating nonfried fish at least twice a week, restricting intake of cholesterol to less than 200 milligrams a day and restricting trans fats.

The timing of meals can be almost as important as the content. Diabetic patients are often advised to eat several small meals throughout the day rather than two or three large ones. Patients may be advised to snack before, during or after physical activity because of the interaction between exercise and blood sugar. Some patients are advised to eat in the evening to prevent nocturnal hypoglycemia and the Somogyi effect (rebound hyperglycemia in the morning).

The potential role of diet as a risk factor for diabetes is controversial. Some research has suggested that excessive consumption of sugar can contribute to the development of type 2 diabetes, but organizations such as the ADA state that eating sugar does not cause diabetes. Some research has indicated that consumption of cow’s milk at a young age may be a risk factor for type 1 diabetes, but other scientists have not found any such connection.

Patients should meet with their physician and a registered dietitian for nutrition counseling. No single meal plan is right for everybody, and the most effective plans are those that are tailored most closely to a patient’s needs and dietary preferences. Factors that may be taken into consideration when planning meals include:

  • Glucose levels
  • Blood pressure
  • Weight goals
  • Lifestyle and food preferences
  • Amount of exercise
  • Other health factors (such as unhealthy levels of cholesterol)

Patients should look for dietitians registered with the Commission on Dietetic Registration of the American Dietetic Association. Registered dietitians must complete 75 hours of continuing education every five years.

Some dietitians specialize in the nutritional management of diabetes and become certified diabetes educators (CDEs), a designation granted by the National Certification Board of Diabetes Educators. They can help patients craft a meal plan that will help patients keep body weight and glucose at optimal levels.

Types and differences of diabetic diets

People with diabetes can make use of several methods in creating and monitoring an effective diet plan. Patients should always consult with a physician and a registered dietitian in establishing a diet.

Methods of diet planning that have helped many patients include:

  • Diabetes food pyramid. A system that divides foods into six categories and offers suggestions on how many servings to consume each day. It differs from the U.S. Department of Agriculture’s (USDA) traditional Food Guide Pyramid because foods are classified by their carbohydrate and protein content rather than their food type. Patients are urged to consume more of the foods on the bottom of the pyramid and fewer of the foods on the top. From bottom to top, the listings are:
    • Breads, grains and other carbohydrates (six to 11 servings)
    • Vegetables (at least three to five servings)
    • Fruits (at least two to four servings)
    • Milk (two to three servings)
    • Meat, meat substitutes and other proteins (4 ounces to 6 ounces per day over three meals)
    • Fats and oils, sweets and alcohol (minimal servings)
Diabetes Food Guide Pyramid

The USDA revised its general Food Guide Pyramid in 2005 as a personalized Internet-based MyPyramid system that balances exercise and diet. The American Diabetes Association describes MyPyramid as one useful tool for diabetic patients but emphasizes individual consultation with a registered dietitian or certified diabetes educator.

The National Institutes of Health makes the following general daily dietary recommendations:

 CaloriesCandidatesFoods
1,200-1,600Small woman
who exercises Small or medium
woman who wants
to lose weight Medium woman
who does not
exercise much
6 starches 3 vegetables 2 fruit 2 milk and yogurt 2 meat or meat substitute Up to 3 fats
1,600-2,000Large woman
who wants to
lose weight Small man at
healthy weight Medium man
who does not
exercise much Medium to large
man who wants
to lose weight
8 starches 4 vegetables 3 fruit 2 milk and yogurt 2 meat or meat substitute Up to 4 fats
2,000-2,400Medium to large
man who exercises
a lot or has
physically active job Large man at
a healthy weight Large woman who exercise a lot or
has a physically
active job
11 starches 4 vegetables 3 fruit 2 milk and yogurt 2 meat or meat substitute Up to 5 fats
  • Rating your plate. In this system, patients draw imaginary lines that divide their plates into quarters and aim for:
  • One-fourth carbohydrate foods (rice, pasta, potatoes, corn or peas)
  • One-fourth protein (meat, fish, poultry, egg whites or tofu)
  • One-half nonstarchy vegetables (including broccoli, cucumbers, salad, tomatoes and cauliflower)
  • A glass of nonfat milk and a small roll or piece of fruit
  • One-fourth carbohydrate foods (rice, pasta, potatoes, corn or peas)
  • One-fourth protein (meat, fish, poultry, egg whites or tofu)
  • One-half nonstarchy vegetables (including broccoli, cucumbers, salad, tomatoes and cauliflower)
  • A glass of nonfat milk and a small roll or piece of fruit
  • “Rate your plate” is most often used as an adjunct to more exact methods of monitoring meals, including exchange lists and carbohydrate counting.
  • Exchange lists. A method of categorizing foods into groups that share similar carbohydrate, calorie, protein and fat content. Patients with diabetes can choose items on a food list knowing they are consuming a specific amount of carbohydrates, protein and calories. In this way, patients may substitute certain foods in their diet for other foods from the same list.
  • Carbohydrate counting. This is a method in which people with diabetes carefully count the number of carbohydrates they consume to make sure they meet their recommended levels. Various products can help patients track carbohydrate consumption.  Vegetarians diagnosed with diabetes may find that their dietary preferences have built-in advantages for fighting complications related to diabetes. For example, vegan diets, which exclude animal products:
    • Are cholesterol-free and low in saturated fat
    • Usually include healthy amounts of vegetables, fruits, whole grains and legumes that are high in fiber and phytochemicals (natural chemicals that may protect against diseases)

Less-restrictive plans, such as the fiber-rich HCF diet, also have many of the advantages of a vegetarian diet.

Once patients have a meal plan in place, they need to monitor the results to ensure that the plan is effective in controlling glucose (blood sugar) and promoting good health. Patients should perform glucose monitoring as advised by their physician, such as a couple of hours after eating a meal.

For most people, glucose levels should fall into the following target ranges (measurements are given in milligrams per deciliter):

  • Before meals: 80 mg/dL to 120 mg/dL
  • At bedtime: 100 mg/dL to 140 mg/dL

In addition, patients should schedule regular reviews of their diet with their physician and dietitian.

Tips for healthy diets

For optimal control of glucose (blood sugar) and weight, patients should adhere to the meal plan established with their physician and registered dietitian. In addition, there are several guiding principles patients can follow in planning out their diet. General tips include:

  • Eat breakfast daily.
  • Do not go more than three or four hours without eating. Do not skip meals or snacks.
  • Eat nutritious snacks and have them available throughout the day.
  • Eat meals and snacks at roughly the same time each day.
  • Increase intake of fiber, unless complications such as gastroparesis (form of autonomic neuropathy that hinders digestion) rule this out. Eat plenty of fruits and vegetables.
  • Trim saturated fats and restrict or eliminate artery-clogging artificial trans fats from meal plans. Include adequate amounts of beneficial fats such as olive oil, seeds and nuts.
  • Use foods, not pills, to get a full complement of vitamins and minerals.
  • Drink enough water each day, such as eight glasses, to avoid dehydration, which is particularly dangerous in people with diabetes.
  • Limit sugar, salt and caffeine. Drink alcohol only in moderation and only if approved by a physician.
  • Avoid indulging in fad diets.
  • Make changes gradually, and remember that health benefits such as weight loss will likely come slowly.
  • Do not use diet pills unless diet and exercise alone are inadequate in shedding excess pounds and a physician recommends these drugs and will offer supervision.

A great deal of research is conducted on diet and diabetes. Some studies have shown possible benefits from certain foods, spices, vitamins and minerals in managing or helping to prevent diabetes, including omega-3 fats (from sources including walnuts, flaxseeds and fish), soy protein, black soya beans, whey protein, buckwheat, olive oil, vinegar, cherries, cocoa, cloves, cinnamon, ginger, tumeric, magnesium, zinc, calcium, vitamin B1, vitamin D and chromium. Patients are advised to consult their physician or registered dietitian before taking supplements or consuming large quantities of any food.

The many herbs and other supplements that are sometimes used by alternative practitioners include bitter melon, fenugreek, ginseng, gymnema and vanadium. However, scientific research and information about safe doses are often lacking, and the quality and strength of supplements can vary widely. It should be emphasized that “natural” does not always mean safe.

Patients are advised to consult their physician before trying complementary and alternative methods. Some supplements may interact with insulin, antidiabetic agents, antihypertensives or other medications and may require a physician to alter dosages.

Another controversy involving diet and diabetes is caffeine. Some research has shown that consuming caffeine may raise the risk of diabetes or impair glycemic control, but other studies have found opposite effects. Again, patients are advised to talk with their physician or dietitian.

Diabetic recipes

When cooking or eating out, people with diabetes are generally advised to favor vegetables, high-fiber whole grains, fruits, lean sources of protein, low-fat dairy, monounsaturated fats such as olive oil and omega-3 fats such as cold-water fish and flaxseed. They are generally advised to restrict saturated fats, cholesterol, trans fats, processed starches and sugars.

Cookbooks full of diabetic recipes are available at libraries, bookstores and online. Among those suggested by the American Dietetic Association: 

  • American Dietetic Association Guide to Eating Right When You Have Diabetes (2003)
  • Diabetes & Heart Healthy Cookbook, by the American Diabetes Association and the American Heart Association (2004)
  • Month of Meals: Classic Cooking – Quick & Easy Menus for People With Diabetes, by the American Diabetes Association (2002)
  • Complete Guide to Carb Counting, by the American Diabetes Association (2004)

The American Diabetes Association also offers many other cookbooks and nutritional guides, including:

  • Complete Quick & Hearty Diabetic Cookbook
  • Diabetic Meals in 30 Minutes or Less, 2nd Edition
  • Diabetes Meal Planning Made Easy, 2nd Edition
  • Quick & Easy Low-Carb Cooking for People With Diabetes
  • Healthy Calendar Diabetic Cooking
  • The Healthy Lunchbox
  • Brand Name Diabetic Meals in Minutes
  • Diabetes Quickflip Cookbook
  • Cooking With the Diabetic Chef
  • Diabetic Cooking for Seniors
  • Diabetic Cooking for Latinos (in English and Spanish)
  • New Soul Food Cookbook for People With Diabetes, 2nd Edition
  • Cooking Up Fun for Kids With Diabetes
  • Month of Meals: Vegetarian Pleasures, 3rd Edition
  • How to Cook for People With Diabetes

Books recommended by Joslin Diabetes Center include Staying Healthy with Diabetes – Nutrition & Meal Planning (2006).

The National Diabetes Information Clearinghouse notes that the American Diabetes Association also publishes a monthly magazine, Diabetes Forecast, which includes recipes. In addition, the U.S. National Institutes of Health offers diabetic recipes online through the National Diabetes Education Program.

Questions for your doctor

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about diet and diabetes:

  1. What diet is best for me?
  2. Should I consult a registered dietitian? How often? Can you recommend one?
  3. If I have prediabetes, can diet help me avoid diabetes?
  4. If I have type 1 diabetes, can diet help prevent double diabetes?
  5. If I have type 2 diabetes, can diet avert or reduce my need for antidiabetic agents? If so, how will this be monitored?
  6. Can diet prevent, delay or reduce my need for insulin? If so, how will this be monitored?
  7. Which method is best for me: diabetic food exchange, diabetic food pyramid, glycemic index, carb counting, another strategy or some combination?
  8. Which fats are OK or beneficial in moderation, and which should I avoid?
  9. Are some carbohydrates better for me than others? Should I favor vegetables, fruits and whole grains over sugar and processed starches?
  10. Are there any foods, spices, herbs, vitamins, minerals or supplements that can help control my diabetes? If so, which might you recommend for me? What are reliable sources and appropriate quantities? How will their possible effects on my blood sugar and medication be monitored? Can they have any harmful side effects?
  11. What weight should I try to maintain?
  12. How much exercise should I get? How does exercise affect my diet?
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