Healthy eating and meal planning

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Diet and nutrition: an introduction

What kinds of foods you eat and how much you eat play a key role in diabetes management. Food has a direct effect on blood glucose and also contributes to weight gain (which increases risk for diabetes). It is a factor that can contribute to risk for high blood pressure and abnormal blood lipids. Along with regular physical activity, healthy eating can be a powerful tool in managing the “ABCDEs” (A1C, blood pressure, cholesterol, drugs to protect heart, exercise, and smoking cessation) of diabetes control

Healthy eating, along physical activity and dosing of medication, is one of the important factors that determine control of blood glucose. Even small changes in what you eat can affect blood glucose levels. That’s why for a person with type 2 diabetes it is important to eat a consistent amount of the right foods on a daily basis. Along with taking medications as prescribed and getting regular exercise, healthy eating can help you control blood glucose and decrease your risk for several serious complications associated with diabetes, including cardiovascular disease (heart attack, stroke), kidney disease, and neuropathy (diseases affecting the nerves).1

Despite the importance of healthy eating in controlling type 2 diabetes, it can be very difficult to make and stick with changes to the way we eat. Studies have found that as many as 6 in 10 people with diabetes have difficulty sticking with a healthy eating plan.2 However, because what we eat is so central to managing diabetes, it is important for you to work with your healthcare provider, a certified diabetes educator, and a registered dietitian (you may be able to find a diabetes educator who is also a dietitian) to come up with a healthy eating plan that will work for you and a strategy for changing your behaviors around eating.

Take advantage of Diabetes Self-Management Education and Support (DSMES)!

Ask your healthcare provider (doctor, nurse practitioner [NP], or physician assistant [PA]) to refer you to work with a certified diabetes educator who can help you with a healthy eating plan. Medicare and most private health insurance plans will cover DSMES services if you have type 2 diabetes. These service cover diabetes education and support provided by a American Association of Diabetes Educators (AADE)-certified diabetes educator. A diabetes educator is a healthcare professional who specializes in helping people with and at risk for diabetes and related complications to make behavioral changes designed to help them better manage their condition and lead a healthier life. DSMES services focus on seven important self-care behaviors that are keys to living a healthy life with type 2 diabetes:

  • Healthy eating
  • Being active
  • Monitoring blood glucose
  • Taking medication
  • Problem solving
  • Healthy coping
  • Reducing risks for health complications

If your provider is not familiar with DSMES services or the referral process, you can direct them to the AADE website or download and print DSMES information and a referral form and give it to your provider yourself.

Keep in mind that your diet plan doesn’t mean that you have to give up enjoying eating. If you don’t believe us, maybe you will believe the 114 chefs from around the world who contributed tasty and healthy recipes to The Joslin Diabetes Great Chefs Cook Healthy Cookbook (see the list below for more information about this book and others like it).
If you have diabetes, you can enjoy a gourmet menu of wonderful foods. In fact, no particular food is restricted if you have diabetes.

Check out some Diabetes Friendly Recipes

The goals of your diabetes diet plan

Learn the ABCs of diabetes1

A

A1C Target Below 7%*

B

Blood pressure target At or below 130/80 mmHg*

C

Blood fat (cholesterol) targets
LDL (“bad”) cholesterol Under 100 mg/dL
HDL (“good”) cholesterol Above 40 mg/dL (men)
Above 50 mg/dL (women)
Triglycerides Under 150 mg/dL

D

Drugs to protect your heart ACE inhibitors
ARBs
Asprin

E

Exercise Regular moderate physical activity for fitness and weight loss

S

Smoking cessation Quit smoking to improve diabetes control and reduce risk for CVD

*Unless your doctor sets a different goal.

Changing your eating behaviors

After you’ve been diagnosed with type 2 diabetes, you should work with a diabetes educator and registered dietitian to make changes to the way you eat. The challenge of eating healthy is not adopting a plan of what to eat and how much, but working to change eating behaviors that you have developed over a lifetime. This is where your diabetes educator/dietitian comes in and can offer you the instruction and support you will need for success. Your diabetes educator will explore with you the behaviors that contribute to weight gain (if you are overweight or obese) and high blood sugar. The overall goal of changing your eating behaviors and adopting a healthy eating plan will be to3

  • Change your beliefs and behaviors related to eating
  • Help you achieve and maintain a healthy weight
  • Keep your blood glucose within target levels
  • Satisfying your nutritional needs based on personal and cultural preferences
  • Reduce your risk for common diabetes complications

Provide appropriate calories to achieve a healthy body weight

You will learn to keep track of how many calories you consume and where you get those calories. Your diabetes educator and/or dietitian will give you tools that will help you plan daily meals that meet your nutritional needs, while preserving the pleasure of eating.

Learn more about ways to get to a healthy weight.

Keeping your blood glucose at your target level

Your healthy eating plan will help you balance your food intake with physical activity and medication or insulin dosing. This will involve determining the right amount of daily carbohydrate intake for you. Monitoring carbohydrate intake (using estimation based on experience or actually counting carbohydrates) is important because it will allow you to estimate your blood glucose level after a meal and this will determine your medication dose or how much insulin you take. You should aim to get your carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk, rather than other carbohydrate sources, such as those containing fats, sugars, and sodium.4

Learn more about meal planning and how to control carbohydrate intake

Satisfy your individual nutritional needs

Your healthy eating plan should provide the nutrients (vitamins, minerals) that your body needs to stay healthy, while satisfying your personal and cultural preferences for meals.

Learn more about the basics of nutrition to make you’re eating a healthy diet.

Manage risk factors to prevent complications of diabetes

Your healthy eating plan should be designed to prevent complications of diabetes. This includes helping you control your blood pressure and lipids (cholesterol, triglycerides). Your plan will be a heart-healthy diet, low in cholesterol and sodium. Your daily sodium intake should be kept under 2,300 mg (a quarter [1/4] teaspoon salt = 600 mg of sodium and most people normally take in about 3,400 mg of sodium). A diet low in salt and high in fruits, vegetables, and low fat dairy products has been shown to be useful in maintaining healthy blood pressure.

Your total cholesterol target should be under 300 mg daily. However, when it comes to a heart healthy eating, the quality of fat is more important than the quantity. Although no single eating plan is appropriate for every individual, in general, your plan should decrease consumption of foods with saturated fats (found in red meats, butter, cheese, margarine, and shortening) and trans fats (found in many processed and fried foods, including cookies, crackers, pizza, chips, frozen dinners, microwave popcorn) which contribute to heart disease. Your plan will increase consumption of foods with monounsaturated and polyunsaturated fats (found in fish, olive oil, nuts), which are considered protective when it comes to heart disease.

Learn more eating a diet that will lower the risk for complications, including high blood pressure and high cholesterol.

Weight management

If you have type 2 diabetes or prediabetes, one of your major goals should be to lose excess weight and achieve and maintain a healthy body weight. Results from the the Look AHEAD Study, a 4-year randomized, controlled trial conducted in 4,503 adults with type 2 diabetes who had a body mass index (BMI) of 25 or higher, found that an intensive program of lifestyle modification, including a weight-loss program aimed at decreasing weight by 10% resulted in a range of health benefits, including an increased likelihood of remission of type 2 diabetes to prediabetes, improved blood glucose control, improvements in blood pressure, improvements in quality of life, improved mobility and reduced muscle and joint problems, and decreased risk for a range of diabetes-related complications (e.g., kidney disease, retinopathy).5

Lowering your caloric intake (along with getting regular exercise) can help you achieve and maintain weight loss. Weight loss early in the course of type 2 diabetes, has been shown to improve sensitivity to insulin so that you can make better use of the insulin that you still produce.3

To gain the benefits of weight loss, you don’t have to reach an ideal body weight, especially if you get regular exercise. Even if you lose 5% to 10% of your body weight and maintain that weight loss from the time of being diagnosed with diabetes, this will help you achieve your goals in terms of blood glucose, blood pressure, and lipids.3

Strategies for weight loss. . Losing weight and keeping it off is difficult. That is why you should give yourself every advantage you can get to achieve your weight management goals. Your first step after being diagnosed with type 2 diabetes is to get a referral from your healthcare provider to work with a certified diabetes educator and registered dietitian. These health professionals can recommend proven strategies for losing weight and keeping it off. Typically these involve changing eating behaviors and reducing calorie intake, as well as getting regular physical activity (usually at least 30 minutes of moderate exercise on most days). Results from the Look AHEAD Study have shown that an intensive program of lifestyle modification, including calorie-appropriate healthy eating and physical activity, coupled with long-term support, can result in losing weight and maintaining weight loss.3,5

The first step in losing weight is to determine your target. Your healthcare provider or registered dietitian will work with you to determine your target weight and the daily calorie intake you will need to get to this weight. A person’s optimal body weight is a body mass index (BMI) of between 18.5 and 24.9. BMI is the ratio of how tall you are to how much you weigh and is the accepted way of defining whether a person is overweight.3

There are some simple ways of reducing calories, including meal planning strategies such as counting calories and grams of fat, using pre-packaged meal replacements, and an approach developed by the American Dietetic Association and the American Diabetes Association (ADA) called the exchange system. There are also a variety of low fat, low calorie and other types of diets. Before starting any diet, make sure you speak with your doctor or your dietitian or nutritionist to determine whether the diet is appropriate for you. In addition to dietary strategies for losing weight, there are also other approaches, including diet medications, behavioral modification, and surgical interventions.3

Learn more on weight management.

Consistency of carbohydrate intake and timing of meals

If you have type 2 diabetes, an important part of your healthy eating plan will be aimed at establishing consistency in your eating, specifically in:

  • Carbohydrate amount you get from each meal
  • Timing of meals

Since carbohydrates (sugars and starches) are changed into glucose through digestion, carbohydrates are the most important nutrient in terms of its direct effect on your blood glucose. Establishing consistency in how much carbohydrates you take in will allow you to prevent big sudden increases or decreases in your blood glucose. Consistency is particularly important if you are taking diabetes medication, such as sulfonylureas, or insulin to help you control your blood glucose. Since what you eat has a direct effect on your blood glucose, the dosing of these medications depend to a certain degree on being able to predict regular changes in blood glucose resulting from meals.3

Carbohydrate counting. Carbohydrate counting is an important strategy that your dietitian may have you use to establish consistency in terms of carbohydrate intake. If you use carbohydrate counting, you will consume a certain pre-determined amounts of carbohydrates throughout the day.

Timing of meals.Establishing consistent timing of meals is particularly important for people who are taking medications to control blood glucose, including sulfonylureas or meglitinides and different insulin regimens.

Learn more about meal planning, including carbohydrate counting and meal timing.

Nutrition

There is no single eating plan that is best for people with diabetes. Your dietitian will work with your to determine the optimal proportion of protein, fat, and carbohydrates that suit your metabolism and health status. There are, however, some general recommendations that work for many people with type 2 diabetes (they also work for most people in the general population!). The ADA recommends that:4

    • When selecting carbohydrate-containing foods, you choose nutrient-dense, high-fiber foods when possible, instead of processed foods with added sodium, fat and sugars
    • Select leaner sources of protein and meat alternatives

Learn about ADA general recommendations for diet and nutrition.

Type 1 diabetes and diet and nutrition

Many of the same principles about diet and nutrition that apply to people with type 2 diabetes also apply to those with type 1 diabetes. Eating a consistent diet at the same times every day is important, especially if you are taking a long-acting insulin. Skipping or delaying a meal may put you at risk for hypoglycemia. Eating too much or too often, without adjusting your insulin dosing, may result in poorly controlled blood glucose. You should work with your doctor and registered dietitian or nutritionist to put together a dietary plan that is part of your larger diabetes care plan. While every individual will have different dietary needs, depending on individual factors such as weight and level of activity, the ADA has a list of general recommendations to help people with type 1 diabetes live healthily and manage the “ABCs” of diabetes control.6

view references
1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998;352:837-53. -- 2. Hernandez-Ronquillo L, Tellez-Zenteno JF, Garduno-Espinosa J, Gonzalez-Acevez E. Factors associated with therapy noncompliance in type-2 diabetes patients. Salud Publica Mex 2003;45:191-7. -- 3. Delahanty LM, McCulloch DK. Nutritional considerations in type 2 diabetes mellitus. Nathan DM, Lipman TO, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013.-- 4. Evert AB, Boucher JL, Cypress M, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care 2013.-- 5. Delahanty LM. The Look AHEAD study: implications for clinical practice go beyond the headlines. J Acad Nutr Diet 2014;114:537-42. -- 6. Delahanty LM, McCulloch DK. Patient information: Type 1 diabetes mellitus and diet (Beyond the Basics). Nathan DM, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: www.uptodate.com. 2013. further reading
Giedt FT, Polin BS. The Joslin Diabetes Great Chefs Cook Healthy Cookbook. New York, NY: Simon and Schuster; 2002. -- Polin BS, Giedt FT. The Joslin Diabetes Healtlhy Carbohydrate Cookbook. New York, NY: Fireside; 2001. -- Polin BS, Giedt FT. The Joslin Diabetes quick and easy cookbook : 200 recipes for 1 to 4 people. New York, NY : Fireside; 1998. -- Polin BS, Giedt FT. Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook. New York : Broadway Books; 2007. -- Rubin AL. Diabetes for Dummies. 4th ed. Hoboken, NJ: Wiley Publishing, Inc; 2012. -- American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts. 5th ed. American Diabetes Association. Alexandria, VA: American Diabetes Association; 2011.
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