Diabetes - Healthy Eating for Types 1 and 2

Diet therapy is crucial to treating diabetes, but the approaches are quite different for type 1 and type 2. In type 1 diabetes, your diet must be coordinated with your insulin regimen. Because the goal is to match insulin delivery to insulin requirements, which are largely dictated by meal size and content, understanding the impact of specific foods on your blood sugar levels is key. On the other hand, type 2 diabetes is largely a consequence of overeating, so cutting calories is vital. In both forms of diabetes, it is important to consume the right mixture of carbohydrates, proteins, and fats every day to keep blood sugar levels as normal as possible throughout the day.

One dietary recommendation applies universally: Aim for a diet low in saturated fats and high in fiber, fruit, and vegetables. Why? Because both types of diabetes are associated with cardiovascular disease. American Diabetes Association (ADA) and the American Dietetic Association recommend that people with diabetes get most of their daily protein requirement from beans, grains, and vegetables, not meat. If you cut down on animal proteins, your diet will have less fat and cholesterol. And high-fiber foods may help lower both your cholesterol and blood sugar levels. A 2000 study in the New England Journal of Medicine found that a diet rich in fiber (about 50 grams per day) lowered blood sugar levels by 10%.

In the past, people with type 1 diabetes had to plan meals around a set schedule of insulin injections. Now, the emphasis is on tailoring insulin doses around your eating habits. This approach is more flexible but still requires effort.

Frequent monitoring of blood sugar levels (using a glucose meter) allows you to adjust your insulin dose to match glucose levels and make “mid-course” corrections, if necessary. To keep blood glucose levels from fluctuating too much, however, it’s important to maintain a consistent eating pattern. Erratic habits make tight control particularly difficult. You may also find that it’s important to have a snack just before bedtime to prevent hypoglycemia (low blood sugar) during the night.

Because most cases of type 2 are caused in part by obesity, it’s necessary to lose weight. In spite of the many diet fads that come and go, the sad truth is that for most people, there is only one way to lose weight: Cut calories. To lose weight, start by reducing your consumption of saturated and trans fats, while increasing physical activity. Even losing 5% to 10% of your weight, while adding 30 minutes of moderate physical activity, should help.

Adding the medication metformin at the time of diagnosis — as is currently recommended by the ADA — should also help because it doesn’t cause weight gain (as some other medications do) or hypoglycemia (which can trigger hunger pangs). In addition, many people with type 2 diabetes have high blood pressure and may need to reduce their salt intake.

While losing weight and keeping it off is a constant challenge, it can have enormous rewards.

No matter which type of diabetes you have, the foods emphasized in your eating plan are good for everyone in your family. A diet low in saturated fats, cholesterol, and sweets, but high in fiber, fruits, vegetables, and whole grains can help you sidestep many common ailments, such as heart disease and high blood pressure, and can go a long way in helping you live a longer, healthier life.

People with diabetes should try to get about 45% to 55% of their daily calories from carbohydrates, including both complex carbohydrates — those in vegetables and whole-grain breads and cereals — and simple sugars that exist naturally in fruit and low-fat milk.

Watching your carbohydrate intake is particularly important because most of the glucose flooding your bloodstream after you eat comes from the breakdown of carbohydrates. But not all carbohydrates are equal. The amount of glucose and the speed with which it’s released into your bloodstream vary, depending on the food’s manner of preparation, its fiber content, and other foods it’s combined with. For example, raw vegetables are digested more slowly than cooked ones; eating fats with carbohydrates retards digestion; and drinking a glass of apple juice raises blood sugar more rapidly than eating an apple.

No more than 20% to 35% of your total daily calories should come from fat, and less than 7% from saturated fat. Try to avoid trans fats altogether.

Saturated fat is notorious for raising unhealthy LDL (“bad”) cholesterol levels. And it speeds the artery-clogging process called atherosclerosis, raising your risk for heart disease. It’s found in meat, dairy products, and certain vegetable oils, such as palm oil and coconut oil, and it’s generally solid at room temperature. The best way to reduce the saturated fat in your diet is by limiting your consumption of red meat, fatty dairy foods, and poultry skin.

Trans fats are even worse for you. These partially saturated vegetable oils are produced through a chemical process called hydrogenation, and are commonly found in margarine, deep-fried foods, commercial baked goods, and many other products. Check food labels for ingredients described as “hydrogenated” or “partially hydrogenated.” Trans fats produce a double whammy: They not only raise the harmful blood lipids LDL cholesterol, triglycerides, and lipoprotein(a), all of which have been linked to heart disease, but they also depress levels of healthy HDL cholesterol.

When you do consume fat, opt for polyunsaturated or monounsaturated fats. Polyunsaturated fats (such as corn, safflower, and soybean oils) and monounsaturated fats (such as olive, peanut, and canola oils) don’t raise cholesterol levels. Indeed, research indicates that monounsaturated oils reduce LDL cholesterol and increase HDL cholesterol.

Before purchasing an item, always check the nutrition facts label, and choose foods low in saturated and trans fats. Choose skim or 1% milk, and buy light or low-fat cheeses and yogurt. To keep trans fats to a minimum, avoid margarine, shortening, and commercial baked goods. When eating dessert, stick with ice milk, low-fat or nonfat frozen yogurt, or fat-free ice cream.

Although sugar and so-called concentrated sweets that contain a lot of sugar were once considered dangerous for people with diabetes, small amounts won’t necessarily thwart your effort to control your blood glucose. Most people with type 1 and type 2 diabetes can consume some sugar as long as they count it as a carbohydrate and don’t add it to their diet indiscriminately. Of course, they must adjust their insulin dosage accordingly. Nevertheless, experts still advise limiting simple sugars because they raise blood glucose levels quickly. Artificial sweeteners — such as saccharin (Sweet’N Low), aspartame (NutraSweet, Equal), and sucralose (Splenda) — don’t raise blood glucose levels.

You can drink alcohol in moderation if you account for the calories in your daily meal plan. Research has shown that drinking moderate amounts of alcohol can lower heart disease risk. Moderate drinking is defined as one standard drink a day for women and up to two a day for men.

You must be cautious, however. Alcohol can cause low blood sugar or further exacerbate a low blood sugar reaction. And because some effects of alcohol (such as drowsiness or slurred speech) resemble those of hypoglycemia, it can be hard to recognize a true diabetic emergency.

Diabetes: A plan for living, a report from Harvard Medical School, will help you better understand and manage your diabetes. Among other things, you’ll learn the basics of how your body metabolizes sugar, the tools of diabetes control, and the fundamentals of nutrition and exercise. You’ll get up-to-date information about recent innovations in treatment. Perhaps most importantly, you’ll see that it’s not just possible to live with diabetes; it’s possible to live well.

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