Diet: The foundation of diabetes treatment

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%.

The Harvard Healthy Eating Pyramid represents the latest nutritional science. The widest part at the bottom is for things that are most important. The foods at the narrow top are those that should be eaten sparingly, if at all. This Healthy Eating Pyramid shows daily exercise and weight control in the widest, most important category. Fats from healthy sources, such as plants, are in the wider part of the pyramid. Refined carbohydrates, such as white bread and white rice, are in the narrow top. Red meat should also be eaten sparingly, while fish, poultry, and eggs are healthier choices. Adapted from Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter Willett, M.D. (Simon & Schuster, 2005)

Dietary goals for type 1

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.

If you have diabetes, what kind of diet plan works best for you? How have you managed to commit yourself to it? 

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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