Nutrition for Adults with Diabetes
Making healthy food choices and exercising regularly can help control and may even help prevent diabetes. Recommendations for healthy eating are similar for type 1 (formerly called juvenile diabetes) and type 2 diabetes.
Without proper health care, diabetes can damage the eyes, kidneys, nerves, and blood vessels, and can increase the risk for high cholesterol, high blood pressure, and heart disease. Controlling diabetes is very important.
Before type 2 diabetes develops, a stage called pre-diabetes (i.e., when blood sugar levels are higher than normal) usually occurs. Research has shown that, in many cases, people with pre-diabetes symptoms can prevent the onset of type 2 diabetes with healthy food choices and exercise.
One of the first things to do after receiving a diagnosis of diabetes or pre-diabetes is to talk with a qualified health care provider and establish a diabetes care plan. In many cases, patients are referred to a nurse educator or registered dietician to create a healthy eating plan, including information about what, when, and how much is to be eaten, and when to take diabetes medication, if necessary.
General guidelines for managing diabetes include the following:
- Eat three balanced meals each day at regular intervals. Do not skip meals.
- If necessary, have a healthy snack between meals.
- Drink water rather than soft drinks or sweetened juice.
- Choose whole-grain foods with higher fiber contents.
- Limit sweets, regular soft drinks, desserts, candy, jam, and honey.
- Limit saturated fats and dietary cholesterol.
- Avoid trans fats (found in foods with hydrogenated or partially-hydrogenated oils).
- Engage in daily physical activity.
- Establish and maintain a healthy weight through diet and exercise.
- Regulate blood glucose levels with diet, exercise, and medication if necessary.
For more information about eating a healthy diet, please see Nutrition.
Eating Balanced Meals
Although there are special guides designed for patients with diabetes, people who have the condition have the same basic nutritional needs as people without diabetes. Healthy eating means eating plenty of fresh fruits, vegetables, and whole grains. It also includes choosing protein sources such as lean meats, poultry, fish, legumes, soy-based meat substitutes, and low- or non-fat dairy products.
Guidelines include the following:
- Eat plenty of non-starchy vegetables of various colors (e.g., spinach, broccoli, cauliflower, carrots, peppers, onions, eggplant, kale).
- Use whole grains such as brown rice or whole-wheat spaghetti.
- Substitute beans or lentils for meat a few times per week.
- Eat fish 2-3 times per week.
- Choose lean meats and remove skin from poultry.
- Switch to non-fat dairy products such as skim (or non-fat) milk, non-fat yogurt, and non-fat cheeses.
- Use vegetable-based oils such as canola, olive, or corn oil.
Due to potentially high levels of mercury, women who are pregnant or who may become pregnant should limit fish consumption to 2 servings per week; should limit white or albacore tuna intake to no more than 6 ounces per week; and should avoid shark, swordfish, king mackerel, and tilefish Talk with a qualified health care provider or registered dietician about the safety of fish in the diet.
Choosing Healthy Snacks
A healthy snack is high in vitamins, minerals, and fiber and low in fat and added sugar or sweeteners. A licensed dietician can provide ideas for healthy snacks. Examples of healthy snacks include fresh fruit with low-fat cheddar cheese, raw vegetables with low- or non-fat dressing or yogurt dip, and whole grain crackers with low-fat cheddar cheese.
Whole Grains and Other High Fiber Foods
Generally, foods made with whole grains are healthier choices than those made with refined flour. For example, 100% whole-wheat bread, brown rice, and oatmeal are healthier than white bread, white rice, and sugary, low-fiber breakfast cereals. Foods made with refined grains (e.g., white flour, white rice) can make blood sugar rise faster than whole-grain foods. Talk to a qualified health care provider or licensed dietician about managing carbohydrates.
Recommendations for adding fiber to the diet include the following:
- Eat plenty of fresh fruits and vegetables.
- Use brown rice instead of white.
- Eat 100% whole-grain bread.
- Substitute whole-grain pasta for traditional pasta.
- Choose breakfast cereals made with whole grains (containing at least 2.5 grams of fiber per serving).
- Check for whole grains in the ingredients lists of all grain-based products.
- Snack on raw vegetables instead of chips, crackers, or candy.
- Substitute lentils or beans for meat 2-3 times per week.
- Have a green salad with dinner or lunch.
- Try Indian, Latin, or Middle Eastern foods that have beans, lentils, or chickpeas.
Limiting Saturated Fat and Cholesterol
Being overweight makes it harder for the body to manage blood glucose level and increases the risk for heart disease. Limiting saturated fat and cholesterol in the diet can help control diabetes, maintain a healthy weight, and keep the heart healthy.
To reduce saturated fat and cholesterol in the diet:
- Limit meat and poultry servings to 6 ounces or 1/3 of a pound.
- Choose lean cuts of beef (cuts with "loin" in the name, or 90% lean ground beef).
- Remove the skin from poultry before eating.
- Eat fish such as salmon, trout, and herring 1-2 times per week.
- Limit or avoid shellfish.
- Substitute beans, lentils, or tofu for meat 2-3 times per week.
- Drink low-fat or non-fat milk instead of whole or 2% milk.
- Substitute plain low- or non-fat yogurt for sour cream.
- Limit butter, avoid stick margarines, or use a special margarine that is made with plant stanols and sterols and does not contain trans fat.
Avoid Trans Fats
Trans fats, from hydrogenated and partially-hydrogenated oils, are unhealthy because they raise LDL ("bad") cholesterol and lower HDL ("good") cholesterol. Eliminating trans fats from the diet can also help control weight and prevent heart disease.
Check the ingredients lists for foods and avoid foods that contain hydrogenated or partially-hydrogenated oils. Choose products made with healthier unsaturated fats such as canola, olive, soybean, safflower, and corn oils.
To eliminate trans fats (hydrogenated and partially-hydrogenated oils) from the diet avoid the following:
- Stick margarine
- Some peanut butters (check the ingredients list)
- Microwave popcorn
- Many pastries and other bakery items (also raise blood glucose levels)
- Many crackers, cookies, and chips (also raise blood glucose levels)
- Fast food French fries, fried chicken, breaded chicken and fish patties
Physical Activity & Diabetes
Talk with a qualified health care provider before beginning any exercise program. Start slowly—5-10 minutes of exercise each day. Aerobic exercise, which gets the heart beating faster and uses the large muscles, can help keep blood glucose in balance. It also can help lower cholesterol and blood pressure, and can improve feelings of well-being.
Simple ways to increase activity include the following:
- Use a cordless phone and walk around while talking on the phone.
- Walk the dog.
- Mow the lawn or rake leaves.
- Clean house.
- Shop for groceries.
- Take the stairs instead of an elevator.
- Do errands that involve walking.
- Park farther away from store entrances.
Ideas for daily exercise include the following:
- Walking, jogging, or in-line skating
- Ballroom, ballet, tap, jazz, or hip-hop dancing
- Bike riding
- Playing basketball, volleyball, or tennis
- Ice skating
- Taking an aerobics class
Blood Glucose Levels
Skipping meals, eating too much or too little, exercising too much or too little, illness, and emotional stress can cause blood sugar levels to become too high or too low. It is important to learn how to detect the signs of low blood glucose and high blood glucose and know what to do in each case. Talk with a qualified health care provider, dietician, or nurse educator about how to handle each of these situations.
Signs of low blood glucose levels (also called low blood sugar or hypoglycemia) include confusion, irritability, and tiredness. If the blood glucose level is below 70 mg/dL, try one of the following suggestions:
- Drink one cup of milk.
- Drink ½ cup of fruit juice or soft drink (not diet).
- Take 2-3 glucose tablets.
- Eat 1 or 2 tablespoons of sugar or honey.
Check glucose levels again after about 15 minutes. If levels are still below 70 mg/dL, repeat one of the suggestions above.
Signs of high blood glucose levels (also called high blood sugar or hyperglycemia) include the following:
- Blurred vision
- Excessive thirst
- Frequent urination
If the blood glucose level is less than 240 mg/dL, exercise may help bring it down. If the blood glucose is over 240 mg/dL, check the urine for ketones. If the urine has ketones, do not exercise. Be sure to talk to a health care provider in advance about how to handle this situation.
A good way to prevent blood glucose levels from going out of balance is to follow a diabetes care plan as closely as possible. Talk with a health care provider about preparing for special situations such as holiday parties, vacation travel, or illnesses.
With the approval of a qualified health care provider, people with diabetes may be able to drink alcohol in moderation. Moderation is defined as one drink per day for women and two drinks per day for men. One drink is equivalent to 5-ounces of wine, 12-ounces of beer, or 1½-ounces of 80 proof spirits. Changes in medication require checking for warnings against drinking alcohol.
In patients who have diabetes, maintaining a healthy weight through a good diet and regular exercise can help prevent or stop the advancement of other diseases. Talk to a qualified health care provider about how often to have blood pressure and cholesterol tested.