Diabetes Diet

Description

Alternative Names

General Dietary Guidelines

The treatment goals for a diabetes diet are the following:

• To achieve near normal blood glucose levels. People with type 1 diabetes and people with type 2 diabetes who are taking insulin or oral medication must coordinate calorie intake with medication or insulin administration, exercise, and other variables to control blood glucose levels. New forms of insulin are now allowing more flexibility in timing meals.
• To protect the heart and aim for healthy lipid (cholesterol and triglyceride) levels and control of blood pressure.
• To achieve reasonable weight. Overweight type 2 diabetics who are not taking medication should aim for a diet that controls both weight and glucose. A reasonable weight is usually defined as what is achievable and sustainable, rather than one that is culturally defined as desirable or ideal. Children, pregnant women, and people recovering from illness should be sure to maintain adequate calories for health.
• To manage or prevent complications of diabetes. People with diabetes, whether type 1 or 2, are at risk for a number of medical complications, including heart and kidney disease. Dietary requirements for diabetes must take these disorders into consideration.
• To promote overall health.

Overall Guidelines. There is no longer a single diabetes diet that will suit everyone. The overall approach is based on the U.S. Dietary Guidelines for healthy eating for all Americans, and includes the following:

• Overall, experts recommend that foods containing carbohydrate from whole grains, nuts, fruits, vegetables, and low- or non-fat milk should be included in any healthy diet.
• Carbohydrates and monounsaturated fat should provide 60 to 70% of calories, but the mix should depend on calorie intake needed for weight loss or maintenance.
• Avoid saturated fats (found in animal products) and trans fatty acids (hard margarines, commercial products, fast foods). In selecting fats or oils, prefer monounsaturated fats (virgin olive oil, canola oil), although also include polyunsaturated oils as well (sunflower, rapeseed). Different studies have reported an association between type 2 diabetes and both saturated fats and trans fatty acids.
• Limit protein. Protein should provide 15% to 20% total calories (less in people with nephropathy). In selecting proteins, eat in moderation and prefer fish or soy protein to poultry or meat. (Avoid, in any case, high-fat meats.)
• When choosing foods with sugar, choose fresh fruits, but do so in moderation.

Some Dietary Approaches for Type 1 or Type 2 Diabetes

Patients should meet with a professional dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs. There is no single diet that meets all the needs of everyone with diabetes. For instance, a type 2 diabetic who is overweight and insulin-resistant may need to have a different carbohydrate-protein balance than a thin type 1 diabetic in danger of kidney disease. If one of these approaches works in controlling glucose levels, there is no reason to choose another. Each of them can be effective, but because regulating diabetes is an individual situation, everyone with this condition should get help from a dietary professional in selecting the best method.

Healthy eating habits along with good control of blood glucose are the basic goals in managing this complex disease, and several good dietary methods are available to meet them:

General Dietary Guidelines for Type 2 Diabetes. A simple heart-healthy diet with weight control may be sufficient for people with type 2 diabetes. One study of people with type 2 diabetes compared several diet plans:

• A high-carbohydrate/high-fiber diet.
• A low-fat diet.
• A weight management diet.

After 18 months all groups experienced similar and improved glycolated hemoglobin and cholesterol levels. The researchers concluded that the positive benefits of the diets were derived not from the specific regimens, but because the people in the study were attentive and focused. In other words, any healthy diet works if patients work at it.

On the other hand, the so-called Western diet (higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts) poses a high risk for type 2 diabetes. (Of note: in a 2003 study, people with type 2 diabetes who used sucralose (a sugar substitute) and a fat replacer (derived from oats) as part of a low-calorie diet achieved better weight and glucose control than those on a standard diabetic diet.)

General Dietary Guidelines for Type 1 and Insulin-Dependent Type 2 Diabetes. Intricate dietary methods are available for control of blood sugar in type 1 and insulin-dependent type 2 diabetes.

• The most common method for controlling blood sugar is the use of The Diabetic Exchange Lists.
• More sophisticated methods include counting carbohydrate grams and using the so-called glycemic index to determine the impact of carbohydrates on blood sugar.

Monitoring

Tests for Glucose Levels. Both hypoglycemia and hyperglycemia are of concern for patients who are receiving insulin. It is important, therefore, to monitor blood glucose levels carefully. Patients should aim for the following measurements:

• Pre-meal glucose levels of between 80 and 120 mg/dL.
• Bedtime levels of between 100 and 140 mg/dL.

In general, patients who are tightly controlling glucose levels need to take readings four or more times a day. Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day. Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions.

Tests for Glycosylated Hemoglobin. Another test examines blood levels glycosylated hemoglobin, also known as hemoglobin A1c (HbA1c). Measuring glycosylated hemoglobin is not currently used for an initial diagnosis, but it may be useful for determining the severity of diabetes. The test is not affected by food intake so it can be taken at any time. A home test has been developed that might make it easier to measure HbA1c. In general, measurements suggest the following:

• Normal HbA1c levels should be below 7%.
• Levels of 11% to 12% glycolated hemoglobin indicate poor control of carbohydrates. High levels are also markers for kidney trouble.

Other Tests. Other tests are needed periodically to determine potential complications of diabetes, such as high blood pressure, unhealthy cholesterol levels, and kidney problems. Such tests may also indicate whether current diet plans are helping the patient and whether changes should be made. Annual urine tests showing even microscopic traces of a protein known as albumin can also indicate a future risk for serious kidney disease.

Preventing Hypoglycemia (Insulin Shock)

For prevention of long-term complications of diabetes, experts are now recommending that both type 1 and type 2 patients should aim at keeping blood levels as close to normal as possible. Such intensive insulin treatment increases the risk of hypoglycemia, which occurs when blood sugar is extremely low (below 60 mg/dL). The following tips may help avoid hypoglycemia or prepare for attacks.

• Patients are at highest risk for hypoglycemia at night. Bedtime snacks may be helpful.
• Patients who intensively control their blood sugar should monitor blood levels as often as possible, four times or more per day. This is particularly important for patients with hypoglycemia unawareness.
• In adults, it is also particularly critical to monitor blood glucose levels before driving, when hypoglycemia can be very hazardous.
• Diabetic patients on therapies that put them at risk for hypoglycemia should always carry hard candy, juice, sugar packets, or commercially available glucose substitutes designed for diabetic individuals.

Other Factors Influencing Diet Maintenance

Food Labels. Every year thousands of new foods are introduced, many of them advertised as nutritionally beneficial. It is important for everyone, most especially people with diabetes, to be able to differentiate advertised claims from truth. The current food labels show the number of calories from fat, the amount of nutrients that are potentially dangerous (fat, cholesterol, sodium, sugars) as well as useful nutrients (fiber, carbohydrates, protein, vitamins).

Labels also show "daily values," the percentage of a daily diet that each of the important nutrients offers in a single serving. Unfortunately, the daily value is based on 2,000 calories, generally much higher than most diabetics should have, and the serving sizes may not be equivalent to those on the Exchange Lists. Most people will need to recalculate the grams and calories listed on food labels to fit their own serving sizes and calorie needs.

Weighing and Measuring. Weighing and measuring food is extremely important in order to get the correct number of daily calories.

• Along with measuring cups and spoons, choose a food scale that measures grams. (A gram is very small, about 1/28th of an ounce.)
• Food should be weighed and measured after cooking.
• After measuring all foods for a week or so, most people can make fairly accurate estimates by eye or by holding food without having to measure everything every time they eat.

Timing. Meals should not be skipped, particularly for those who are on insulin. Skipping meals can upset the balance between food intake and insulin and also can lead to weight gain if the patient eats extra food too often to offset low blood sugar levels.

The timing of meals is particularly important for people taking insulin:

• Patients should coordinate insulin administration with calorie intake. In general, they should eat three meals each day at regular intervals. Snacks are often required.
• They should try to take an insulin injection 30 minutes before they eat, although this timing could vary, depending on the form. Some experts recommend a fast acting insulin (insulin lispro) at each meal and a longer (basal) insulin at night.