Diet - diabetes

Alternative names 
Diabetes diet

Definition

Specific diabetic dietary guidelines have been developed by the American Diabetes Association and the American Dietetic Association to improve the management of diabetes.

Key principles are to:

     
  • Achieve weight control through reducing calories  
  • Reduce intake of dietary fat (specifically saturated fat)  
  • Individualize guidelines for carbohydrates based on the type of diabetes you have and the control of your blood sugar levels.

Function

There are two primary types of diabetes and the nutritional goals for each are different.

With type 1 diabetes, studies show that total carbohydrate has the most effect on the amount of insulin needed and maintaining blood sugar control. There is a delicate balance of carbohydrate intake, insulin, and physical activity that is necessary for optimal blood levels of a sugar called glucose. If these components are not in balance, there can be wide fluctuations, from too high to too low, in blood glucose levels. For those with type 1 diabetes, on a fixed dose of insulin, the carbohydrate content of meals and snacks should be consistent from day to day.

For children with type 1 diabetes, weight and growth patterns are a useful way to determine if the child’s intake is adequate. Try not to withhold food or give food when a child is not hungry. Insulin dosing and scheduling should be based on a child’s usual eating and exercise habits.

With type 2 diabetes, the main focus is on weight control, because 80% to 90% of people with this disease are overweight. A meal plan, with reduced calories, even distribution of carbohydrates, and replacement of some carbohydrate with healthier monounsaturated fats helps improve blood glucose levels. Examples of foods high in monounsaturated fat include peanut or almond butter, almonds, walnuts, and other nuts. These can be substituted for carbohydrates, but portions should be small because these foods are high in calories.

In many cases, moderate weight loss and increased physical activity can control type 2 diabetes. Some people will need to take oral medications or insulin in addition to lifestyle changes.

Children with type 2 diabetes present special challenges. Meal plans should be recalculated often to account for the child’s change in calorie requirements as he or she grows. Three smaller meals and 3 snacks are often required to meet calorie needs. Changes in eating habits and increased physical activity help reduce insulin resistance and improve blood sugar control. When at parties or during holidays, sugar-containing foods can still be eaten, but your child should have fewer carbohydrates on that day. For example, if birthday cake, Halloween candy, or other sweets are eaten, the usual daily amount of potatoes, pasta, or rice should be eliminated. This substitution helps keep calories and carbohydrates in better balance.

For children with either type of diabetes, special occasions (like birthdays or Halloween) require additional planning because of the sweets that abound.

Recommendations

Reduce the amount of dietary fat. The current American Diabetes association guidelines advise that less than 7-10% of calories should come from saturated fat. These are the fats that raise LDL (“bad”) cholesterol. Dietary cholesterol should be less than 200-300 mg per day. Additionally, intake of trans-unsaturated fats should be minimized. These are better known as partially hydrogenated oils. Reducing fat intake may help contribute to modest weight loss.

Keep protein intake in the range of 15-20% of total calories. Choices low in fat are recommended such as nonfat dairy products, legumes, skinless poultry, fish and lean meats. To keep the cholesterol content in range, approximately 6 ounces of protein per day is recommended. This is about the size of 2 decks of cards.

Carbohydrate choices should come from whole grains breads, cereals, pasta, brown rice, beans, fruits and vegetables. Increasing dietary fiber is a general guideline for the entire population rather than specifically for people with diabetes. Portions and type of carbohydrate affect calories and is reflected by weight and blood glucose control. Learning to read labels for total carbohydrate rather than sugar provides the best information for blood sugar control.

Limit sources of high calorie and low nutritional value foods, including those with a high content of sugars. Sugar-containing foods should be substituted for other carbohydrate sources (such as potatoes) instead of just adding them on to the meal.

A registered dietitian can help you best decide how to balance your diet with carbohydrates, protein and fat.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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