are four key principles to remember about healthy eating with diabetes:
1. There’s no such thing as a “diabetic diet.” These so-called diabetic diets shouldn’t be used. The healthy eating guidelines for everyone apply to people with diabetes as well. People with diabetes do not need to buy or eat any special foods.
2. Change your behaviors slowly but surely. Healthy eating and staying active are well-known and effective ways to stay healthy. They are essential if you are at high risk of type 2 diabetes, or have pre-diabetes or type 2 diabetes because you are more likely to have or be at high risk for heart and blood vessel diseases. When you learn that you have type 2 diabetes, your eating habits and food choices may need changing.
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Try not to think of your eating plan as a “diet.” Think of it as a way to slowly change your family’s eating habits for the better.
3. Individualization is important. Find a registered dietitian (RD) who specializes in diabetes medical nutrition therapy (MNT). Medical nutrition therapy is the formal name for nutrition counseling. It is the term some health plans, including Medicare, use to describe coverage of nutrition counseling. Your RD should work with you to develop a personalized healthy eating plan and goals for behavior change. This health care provider should consider all of your health, diabetes, and nutrition goals, as well as your food preferences: including what foods you like to eat; what time you like to eat; your cultural and religious food habits and customs; whether you like or need snacks at certain times; your daily and weekend schedule; and, most important, what you are willing, able, and ready to change. For instance, the eating plan and goals for a vegetarian who works the evening shift would be very different from those of someone who lives alone and eats most meals in restaurants.
4. Be flexible and realistic with yourself. In today’s fast-paced world, life doesn’t always go according to plan, and the healthiest foods are not always at your disposal. Your eating plan and behavior change goals need to be flexible enough to fit your lifestyle. They need to help you be able to delay a meal or snack, eat at a restaurant, or opt for convenience foods. Your eating plan needs to fit the days when your activity level is way up—perhaps for a weekend hike or day of skiing—and the days when you feel ill and have no appetite.
Recommendations for Big and Small Nutrients
Most people at high risk for or with type 2 diabetes need to shed some weight. To lose those 10 to 20 pounds, you need to know the right number of calories for you to eat, along with the proper foods that will provide the right mix of carbohydrate, protein, and fat. Research shows there is no single combination of nutrients that’s best for diabetes care and/or weight control.
The goals below give a calorie range to shoot for when it comes to each of the big nutrients.
Carbohydrate
Carbohydrate is the main nutrient that raises blood glucose levels. Both the amount and the type of carbohydrate you eat will affect your blood glucose, but the amount has a greater effect on your blood glucose. Once you learn the impact of carbohydrate on blood glucose, it’s rational to think that a low carbohydrate intake may be an answer to blood glucose control. Research doesn’t support this notion. Many studies have shown that a lower carbohydrate intake can help lower blood glucose initially; however, over time, it doesn’t improve weight loss, blood glucose control, and most other health parameters of interest. Lower carbohydrate diets (less than 45% of calories from carbohydrate) also don’t allot sufficient grams of carbohydrate to get the nutrients, fiber, vitamins, and minerals you need.
The ADA suggests that people with diabetes consult the general nutrition guidelines, which recommend that you get somewhere between 45 and 65% of your daily calories from carbohydrate. For example, suppose you eat about 1,400 calories a day and you decide to get half of those calories from carbohydrates. Because each gram of carbohydrate contains 4 calories, you would need to eat about 175 grams of carbohydrate to consume half of your total calories from carbohydrate. (In other words, half of 1,400 calories is 700, and 700 calories divided by 4 calories per gram is 175 grams.)
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It’s important to eat similar amounts of carbohydrate at each meal and to keep snacks, if you need them, consistent.
If you are not able to keep your blood glucose levels on target by eating a healthy and balanced amount of carbohydrate throughout the day, you may need one or more blood glucose-lowering medications. Decreasing the amount of carbohydrate you eat to unhealthy levels will not bring your blood glucose down sufficiently. If you are not reaching your blood glucose goals, talk with your health care provider about the steps you should take to hit your blood glucose targets.
Sugars and Sweets
Sugars and sweets are no longer off-limits for people with diabetes. You can choose to fit sugars and sweets into your eating plan in small quantities; however, don’t forget that they are concentrated sources of carbohydrate and calories and can elevate your blood glucose levels. Plus, sweets such as cheesecake and regular ice cream maybe high in total fats, especially the unhealthy saturated fats. Finally, because sweets usually offer little in the way of nutrition, everyone who wants to eat healthier should limit the amount of sugars and sweets they eat. Consider your weight, blood glucose and blood fat levels, and diabetes goals when fitting sweets into your eating plan.
Dietary Fiber
In general, you should try to increase the amount of fiber you eat to 14 grams of fiber for every 1,000 calories you eat. The recommended daily fiber intake levels can help you figure out specifically how much fiber you should include in your diet.
These goals are roughly double the amount of fiber that most Americans eat (11-17 grams/day). Good sources of fiber are whole grains, beans and peas, fruits, and vegetables. You can get about 5 grams of dietary fiber from a serving of a whole-grain cereal, a third of a cantaloupe, or 1/2 cup of cooked lentils. Learn more about how to increase your fiber intake in section 2.
Glycemic Index and Glycemic Load
The use of the glycemic index (GI) and glycemic load (GL) in diabetes meal planning has been an area of debate for several decades. The ADA suggests that GI and GL may be valuable concepts for people with diabetes if these measures are used in addition to and after careful monitoring of total carbohydrate intake; however, using GI or GL to choose foods may or may not help you make healthier food choices. For example, you might decide to eat lentils or barley instead of white rice because lentils and barley have a lower glycemic index. Conversely, choosing a high-fat food like ice cream because it had a low GI instead of a serving of fruit with a higher GI, a banana or fresh pineapple, doesn’t make sense. Think of GI and GL as another factor, rather than the main factor, to consider when you choose which foods to eat.
The GI measures the increase in blood glucose levels during the two hours after eating a particular kind of food. Some foods that contain carbohydrate create a quick and more dramatic rise in blood glucose, while others cause a slower and less dramatic rise. Glucose is the standard for the glycemic index and is assigned an arbitrary number of 100. Other foods are assigned GI numbers relative to the glucose standard of 100—either higher or lower. Today, there are several different glycemic indexes in use.
Keep in mind that GI numbers are available only for several hundred commonly eaten, non-mixed foods. In other words, foods like carrots, watermelon,
