Diabetes & The Diabetic Diet: Ultimate Guide

    
Kiah Connolly, MD

If you’re not personally suffering from diabetes, you almost certainly know someone who is. Almost half of the United States (43%) suffers from either diabetes (9.4%) or pre-diabetes (33.9%) (1). The outcomes of this disease are not pleasant, and include things like amputations, stroke, heart disease and even death. This is a short list of a few of the complications, but there are many more discussed below.

Luckily, this condition can almost always be treated with everyday choices you can control including basic changes to what you eat, starting with some general principles commonly know as the diabetic diet. This diet is designed to help people with diabetes change their eating habits to control their diabetes, so they suffer fewer consequences of the disease and hopefully are not dependent on medications for the rest of their lives.

This guide will take you step by step through what this disease is, dangerous complications that can occur, and how to prevent and treat your diabetes for good. 

This article starts with action. Let's dive into everything you need to know about how to both treat and prevent diabetes. 

Diabetes Treatment 

Goals of diabetic treatment include:

These can all be reached by eating the right diabetic diet, weight loss, exercise, not smoking, and taking medications as your doctor prescribes. 

Treating diabetes starts with getting on the right diet. Here's the foundation of nutrition knowledge you need to achieve these goals.


3 Steps to Diabetic Diet Success

Dietary modifications are arguably the most important element in treating type 2 diabetes and are also critical in the management of type 1 diabetes. There are some basic principles that all diabetics should follow.

Step 1: Learn Basic Diabetic Diet Principles

Start your journey by answering the three questions below. Once you know the answers to these questions, you can better guide yourself through a plan to control your diabetes. Or if you're pre-diabetic, you can prevent yourself from developing diabetes.

1. How Many Calories Should I Eat?

You need to know how many calories you should eat each day to loose and maintain a healthy weight. The cornerstone of weight loss is calories in, calories out, so you need to get on a path towards a daily calorie deficit. Step 1 is calculating your calories using our calorie calculator.

Get My Calories

Tip: Using a phone app like the Trifecta app, or keeping a diabetic log on paper can ensure you will accurately keep track of your calories and carbohydrates. Always read nutrition labels on everything you eat!

2. How Many Carbohydrates Should I Eat? 

Every diabetic needs a daily carbohydrate goal that is based off your weight, age, activity levels, and personal metabolism. This is because carbohydrates most dramatically raise blood sugar. Controlled carbohydrates leads to controlled blood sugars. 

Carb Calculator

Calculate how many grams of carbohydrate you need each day using this simple carb calculator. 

Tip: Carbohydrate counting, glycemic index and glycemic load are tools that can help to keep track of your carbohydrates throughout the day. 

This guide is a useful place to start, but these can vary based on factors specific to you, including your metabolism and what medications you're taking. So for formal recommendations, you should also discuss how many carbs you should be eating with a board certified medical doctor or dietitian.

3. What Food Should I Eat? 

Often times people think they have to give up tasty food in order to treat their diabetes or pre-diabetes. This isn't always the case, but you should mentally prepare yourself for some changes. Your main goal now when eating is to properly fuel your body to treat a chronic disease, not always just to maximize flavor. That said, there are so many diabetic food options that chances are, you'll like the taste of many of the foods you should be eating.

Learning what to look for in foods you're choosing to include and avoid in your diet is critical to your diet success.

Tip: Tools like the popular diabetes 'exchange diet' can help you learn flexible dieting that works for you.

What Diabetic Diets Should Include: 

diabeticdietfoods

1. Lean Protein

  • Helps repair tissue
  • Helps build and maintain bones and muscle
  • Helps create many hormones and enzymes
  • Helps weight loss (helps you to feel full) 

2. Healthy Fats (Aka Unsaturated Fats, Aka Monosaturated Fats) 

  • Increases your 'good cholesterol' (HDL)
  • Lowers your 'bad cholesterol' (LDL)
  • Lowers blood pressure (when they replace carbohydrates or unhealthy fats)

3. Vegetables

  • Nutrient dense: rich in vitamins, minerals, fiber and antioxidants
  • Low in calories
  • High in fiber 

4. Fruit

  • Nutrient dense: rich in vitamins, minerals, fiber and antioxidants 
  • Low in calories 
  • High in fiber
  • Excellent ‘sweet tooth’ substitute 

5. Whole Grains

  • Nutrient dense: rich in vitamins, minerals and fiber 
  • Reduce risk of chronic health conditions including heart disease, diabetes and some cancers. 
  • Reduce risk in overall mortality 

6. Fiber

  • Improves glycemic control
  • Improves bowel health 
  • Recommended at least 14 grams of fiber for every 1000 calories of food you eat 

What Diabetic Diets Should Avoid 

Everything is a balance. Eating one sweet treat isn't going to make or break your diet. But in general foods with added sugar, saturated fats, processed foods and salt should be avoided.

diabetic_diets_should_avoid

1. Added sugar

  • No nutritional value 
  • Cause high glucose spikes 
  • Cause weight gain 

If you or a loved one is diagnosed with diabetes, eliminating added sugar should be one of the first things you tackle. This is easy to do by looking at nutritional labels under ‘added sugar’ and avoiding these foods. 

2. Saturated Fats 

  • Cause a rise in ‘bad cholesterol’ (LDL) 
  • High calories 
  • Low nutritional value 

Saturated fats increase the risk of developing and/or accentuating high cholesterol (hypercholesterolemia) as well as damaged blood vessels (atherosclerosis). All of this increases the risk of heart disease and other vascular diseases including stroke. 

3. Processed Foods

  • Often high glycemic index 
  • Often low nutritional value 
  • Often high calories 
  • Often high sodium 

Not all processed foods are bad. However they do commonly possess these undesirable properties. To ensure you're keeping your diet on point, always read nutrition labels before eating any processed foods. 

4. Salt

A diet low in sodium (salt) (at least <2300mg/day) is recommended because it helps  decrease other risk factors including high blood pressure.

If you already have high blood pressure or heart disease, your salt intake should be even lower, less than 1500 mg/day. 

Step 2: Use Diabetic Diet Tools

While all of this may seem overwhelming at first, making the right choices will soon become second nature to you. There are also many tools you should utilize to help you along the way. 

Diabetic Diet Tools:

  1. Nutrition Labels 
  2. Carbohydrate Counting 
  3. Glycemic Index 
  4. Glycemic Load 
  5. Exchange System

How to Read Nutrition Labels 

 There's no way to control your diet, unless you look at what the food you're eating contains. Regularly reading nutrition labels is critical for diet success.

how_to_read_nutrition_labels


Pitfall: Don't forget to count the sauces you eat, including salad dressings. These can frequently be high in calories, fat, and/or carbohydrates with small serving sizes. 

Carbohydrate Counting

Not all carbohydrates are evil. In fact, studies show that carbs like whole grains, fruits and vegetables are beneficial to our health in many ways (2). The goal is to make sure you're getting the right type of carbohydrates and not eating too many carbohydrates. Counting carbohydrates is a way to ensure you're meeting your goal.

How to Count Carbohydrates

1 Carbohydrate Serving = 15 grams of Carbohydrates 

This means that if a food item has 30g of carbohydrates, it has 2 servings of carbs.

Carb counting involves adding the total number of carbohydrates you have eaten and dividing this number by 15 to get the total number of carbohydrate servings. 

How Many Carbohydrates Should You Eat? 

Everyone may have different carbohydrate goals as each individual has a unique metabolism, activity level, body composition and lifestyle.

If you are a diabetic or prediabetic, this guide is a great place to start, but it's important to work with a doctor or dietitian to determine the right amount of carbohydrates for you.

In general, healthy adults should consume about 135g of carbs (9 "carb servings") daily and diabetics should almost never exceed 200g of carbohydrates (13 "carb servings") daily (3). 

Types of Carbohydrates

The three types of carbohydrates are: 

  1. Sugars
  2. Starch 
  3. Fiber

Many foods have at least some carbohydrates in them. Green vegetables have very low carbs, while candy containing pure sugar is made mostly of carbs. Some food like meat don't contain any carbohydrates. 

Because fiber is so good for us, some people refer to net carbohydrates, or "net carbs", when carb counting to allow plentiful fiber in the diet.

Net Carbohydrates = Total Carbohydrates - Fiber - Sugar Alcohols

What is the Glycemic Index? 

A central goal in the treatment of diabetes is minimizing the fluctuation of blood glucose. When carbohydrates are eaten they cause a spike in blood glucose. But not all carbohydrates are created equally or cause the same rise in blood glucose. 

The American Diabetes Association recommends diabetics use the Glycemic Index (GI) to help diet planning for blood glucose control. 

The Glycemic Index is a ranking system that compares carbohydrates to show what their impact on your blood sugar will be. Each carbohydrate is assigned a GI from 0 to 100 based on how much they will raise blood glucose after eaten.

Some carbohydrates (ie: white bread) that have a high likelihood of raising blood glucose will have a very high glycemic index, while other carbohydrates (ie: rolled oats) that have a lower likelihood of raising blood glucose are assigned a lower glycemic index. 

Foods without any carbohydrates (ie: meats and fat) aren't assigned a glycemic index because they don't cause large spikes in blood glucose. 

Studies show that diets with an overall low GI help to prevent diabetes from developing and help to control glucose in people who already have diabetes, thus preventing many complications of diabetes. Additional research suggests that low GI diets offer other benefits including improved cholesterol and lowered risk of heart disease (4).
Glycemic Index Chart: Examples of Low, Medium & High GI Foods

 

Low Glycemic Index Foods

(GI < 55)

Medium Glycemic Index Foods

(GI 56-69)

High Glycemic Index Foods

(GI > 70)

Oatmeal Corn Pasta White Bread 
Barley Potato (boiled) Long Grain White Rice
Many Fruit & Vegetables Sweet Corn Yam (peeled & boiled)
Legumes Pineapple Cornflakes Cereal

Factors Influencing Glycemic Index

  1. Carbohydrate Type

    The composition of each carbohydrate can influence the GI. Compounds called amylose and amylopectin are both in carbs. In general, carbs with higher amylose content have a higher GI while carbs with higher amylopectin have a lower GI.
  2. Sugar Type

    The type of sweetener in foods affects the glycemic index. Fructose has the lowest GI (19) while maltose has one of the highest GI (105). 
  3. Food Ripeness

    Fruit and vegetables that are not as ripe have a lower GI than those that are more ripe.
  4. Cooking Time

    In general longer cooking times leads to a higher GI.

  5. Refining 

    Highly processed foods usually have higher GI.

Foods with Lower Glycemic Index Tend to Include At Least One of the Following: 

  • High Fiber 
  • High Fat
  • Limited or No Processing
  • Less Cooked

Just because a food has a high glycemic index, doesn't mean it's bad for you. In fact some high GI foods have more nutrients than low GI foods. Small portions of nutrient rich foods with a high GI can be balanced with other lower GI foods to keep your blood sugar under control.

Glycemic Index Limitations 

While glycemic index is a ranking system that helps to determine which carbohydrates have the greatest influence on blood sugar, it doesn't address how much of the carbohydrate has been eaten - aka the portion size. It also doesn't take into consideration the nutritional value of the food item. For full meals containing multiple carbohydrates, the GI can also be difficult to calculate. 

Bottom Line: Knowing the GI of a food equips you with additional information you need to help minimize large spikes in blood glucose. However, glycemic index alone doesn't provide the whole story to your nutritional needs as it does not include portion sizes or nutritional value. 

Glycemic Load 

Glycemic load (GL) was developed to include portion size into the equation. It takes into account both the glycemic index of a carbohydrate and how much you eat in grams (g). 

Glycemic Load Chart: Examples of Low, Medium & High GL Foods

Low Glycemic Load Foods

GL < 10

Medium Glycemic Load Foods

GL 11-19

High Glycemic Load Foods

GL > 20 

Legumes (33g) Oatmeal (250g) Corn Pasta (180g)
Apple (120g) Honey (25g) Long Grain White Rice (150g)
Barley (150g) Potato (150g) Yam Peeled & Boiled (150g)
Carrots (80g) White Bread (30g) Conflakes Cereal (30g)

 

Both the type of carbohydrate and the portion size of that carbohydrate matter. 

A daily glycemic load less than 100 is considered a low glycemic index diet. 

You can use this database to look up the GI and GL of any food. 

Glycemic_Load

Exchange System for Diabetic Diets 

The exchange system is a tool recommended by the American Diabetes Association that provides people with guidance on how to customize effective diets to their personal preferences and cravings.  

The principle of the exchange system is to group together foods with similar qualities that may be easily exchanged for one another.

The concept of an exchange system allows you to have flexibility in your diet while maintaining consistent high-quality balanced nutrition.  

Each day you want to get a certain amount of protein, fat and carbohydrates.

the Exchange System Categories are: 
  1. Very Lean Protein
  2. Lean Protein
  3. Medium-Fat Protein
  4.  Fat Free & Very Low Fat Milk
  5. Fruits
  6. Vegetables
  7. Starches 
  8. Fats 
    Exchange System Dieting Chart (11)
Category Calories Carbohydrates  Example Food Options
Very Lean Protein 35   

1 oz Fat Free Cheese 

1 oz Turkey Breast 

1 oz Canned Tuna 

Lean Protein 55  

1 oz Salmon 

1 oz Lean Beef or Pork 

1 oz Low Fat Cheese

Medium-Fat Protein 75  

4 oz Tofu 

1 Whole Egg 

1 oz Beef (prime cut)

Low Fat/Fat-Free Milk Products

90  

1 Cup Milk 

3/4 Cup Yogurt

Fruits 60 15g

1 Small Apple or Banana

1 Cup Fresh Berries 

1 Medium Peach

Vegetables 25 5g

1/2 Cup Cooked Vegetables 

1 Cup Raw Vegetables 

1/2 Cup Vegetable Juice

Starches 80 15g

1/2 Cup Pasta 

1/3 Cup Rice (cooked)

3 Ounces Baked Potatoe

Fats 45  

1 tsp Oil 

1 tsp Butter 

10 Large Stuffed Olives

Step 3: Personalize Your Own Diabetic Diet

The best diabetic diets are tailored to meet your needs and focus on controlling calories and minimizing major fluctuations in blood glucose while providing a rich source of nutrients. 

Personalized Diabetic Diet Created for You

Once you've learned these key dietary principles, you can use them to create a diet that works best for you. 

    1. Food Content: Focus on including nutrient-dense food that offers high nutritional value for relatively few calories. 
      Tips: 
        1. Read All Nutrition Labels 
          Caution Eating at Restaurants and Any Fast Food - Choose Orders with Fresh Lean Meat and Vegetables with Minimal or No Added Sauces and Avoid All Fried Food. 
          Minimize Oils and Butter
        2. Include diets rich in lean protein, fiber, unsaturated fats, whole grains, fresh fruits and vegetables 
        3. Minimize saturated fat, salt and added sugar 
    2. Weight Loss & Healthy Weight Maintenance: Determine your daily calorie goals. Control your calorie and portion intake to meet them.
       Tips
        1.  Weigh or Measure Food For Accurate Calorie and Carbohydrate Counting 
          Use a Phone App or Personal Log to Keep Track of Calories 
        2. Pre-measure Food Portions 
          Include Sauces, Alcohol, Butter, and Oil in Your Calculations
        3. Counting calories is key. In order to lose weight, you must eat fewer calories than you burn.
          Higher Calorie Foods Require Strict Portion Control 
          Low-calorie Foods can be eaten in larger portions
    3. Blood Glucose Control: Determine your carbohydrate goals. Use the below tools to learn how to incorporate the right amount and type of carbohydrates in your diet. 
      Tips
      1. Utilize tools like: Glycemic Index, Glycemic Load and Carbohydrate Counting
      2. Work with a dietitian or doctor to determine your carbohydrate goals. 
      3. Check your blood sugar frequently to make sure you’re staying on track.

Low Carb Diet for Diabetes

Low carbohydrate diets are often advocated for both diabetes and weight loss. Studies looking at this have suggested that low carbohydrate diets are more effective in treating type 2 diabetes than other diets, including calorie deficit diets alone (5, 6, 7, 8) .

While low carbohydrate diets may offer many benefits, diabetics on insulin can be at risk for hypoglycemia if they cut too many carbs without adjusting their medication . So to get all the benefits without the risk, it is important to work with your doctor when starting a low carbohydrate diet if you’re taking medications for your diabetes.

Keto Diet for Diabetics

The ketogenic diet is an ultra-low carbohydrate diet that when carefully followed over time transitions the body into utilizing a different source of fuel, called ketone bodies. For most people, this requires eating less than 20grams of net carbohydrates per day. Anyone that has attempted this would probably agree that’s really low!

While some people are strongly advocating that keto is superior, there aren’t enough well-done studies to determine if it is more effective than basic calorie controlled other low carb non-ketogenic diets alone.

Want to learn more about the low carb and keto diet for diabetics? Read this article

2) Weight Loss 

Weight loss and healthy weight maintenance is key to diabetic treatment. Many different diets can be effective for weight loss - as long as they consistently achieve a calorie deficit (9, 10).

As discussed above, one of the biggest risk factors for type 2 diabetes is obesity. Weight loss and healthy weight maintenance in of itself can treat the disease. This also helps to treat and prevent other comorbid conditions like hyperlipidemia and hypertension.

Bottom line: no matter what diet you choose, you need to eat fewer calories than you burn for weight loss success. 

While exercise and diet are the ideal actions for achieving weight loss goals, other options like bariatric surgery may be considered in some individuals. 

3) Exercise 

Exercise independently improves glucose control in people with diabetes, in addition to contributing to weight loss.  It also similarly helps comorbid conditions like hypertension and cardiovascular disease.

Exercise has been shown to have a powerfully positive effect on our mood and emotions. It helps symptoms of many mental health conditions including depression and anxiety. In this way it often leads people to make healthy lifestyle choices including improved abstinence from unhealthy substances like smoking and alcohol and better food choices. 

4) Don't Smoke

Quitting smoking also improves comorbid conditions like  cardiovascular disease and hypertension in addition to improving glycemic control. When you make the choice to quit smoking, you also reduce your risk of developing many other serious medical conditions including a myriad of cancers and lung disease.  

5) Type 2 Diabetes Medications 

While lifestyle modifications are paramount in treating diabetes, medications are often necessary - especially at first. It is obviously important to take the medications your doctor prescribes. These may be in the form of a pill or injections. People with type 1 diabetes will always need to incorporate insulin injections into their daily lives.

Now that you know all about the treatment, let's take a closer look at what diabetes is, why it happens and complications to watch out for.

Diabetes Definition

When you hear the word ‘diabetes’ it is almost always referring to diabetes mellitus. 

Diabetes mellitus is a condition that prevents the body from properly using glucose because of a problem with insulin. 
 

But let’s break that down a little more. Glucose is a sugar that is critical to our survival. It is the main source of energy that the cells in our body need to function. Insulin is the hormone in charge of bringing glucose into our cells, which allows them to use it. 

insulin_glucose_diabetes

People with diabetes actually often have plenty of glucose in their blood; it just can’t be used as well by cells because insulin isn’t doing its job (10). This leads to dangerously high blood sugar levels. 

Types of Diabetes

While there are two different diseases that are called ‘diabetes’ , the most common type by far is diabetes mellitus. 

Diabetes Mellitus

Diabetes mellitus is broken down into two different types - ‘type 1 diabetes’ and ‘type 2 diabetes’. They are similar in that both types involve a problem with insulin that prevents cells from effectively using glucose. And people with both types of diabetes experience many of the same problems and need similar treatments. 

 TrifectaHealth_Keywords_Diabetes 2 (1)-1

What is the Difference Between Type 1 & Type 2 Diabetes Mellitus?

The main difference between type 1 and type 2 diabetes is where the problem with insulin originates. In type 1 diabetes insulin isn’t produced (at least as much as it needs to be). With type 2 diabetes, insulin is produced but it eventually stops working as well as it needs to.  You may hear this referred to as ‘insulin resistance’. 

Type 1 diabetes is often thought to occur in younger people (less than 30 years old), and because of this is sometimes referred to as juvenile diabetes. Type 2 diabetes more frequently occurs in older individuals.

Unfortunately, because of the growing obesity epidemic, it is becoming increasingly more common for younger individuals and even children to be diagnosed with type 2 diabetes (3).

What Causes Diabetes?

Type 1 diabetes is an autoimmune disease that develops when the immune system becomes misguided and begins attacking an important organ called the pancreas, which is in charge of producing insulin. The pancreas becomes damaged from these attacks, and can no longer make enough insulin to support the needs of the body.

Like so many illnesses, an exact cause for type 2 diabetes isn’t known.

It is well established that obesity, a sedentary lifestyle, smoking, high blood pressure and certain genetics all create a higher risk of developing type 2 diabetes (11). 

Some medications can also lead to higher sugars and the development of the disease. These medications include steroids, as well as some treatments for high blood pressure and mental health (12).

Pregnancy can  trigger gestational diabetes, which also increases the risk of type 2 diabetes after the baby is born (13).  

Cause of Type 1 Diabetes 
  • Immune System Problem 
Risks for Type 2 Diabetes 
  • Unhealthy Diet 
  • Obesity 
  • Low Levels of Physical Activity 
  • Medications 
  • Pregnancy 
  • Genetics 

Diabetes Insipidus 

Just to be extra confusing, there is another very separate form of ‘diabetes’, called diabetes insipidus - and it has nothing to do with sugar, glucose, or insulin. It’s a completely different disease process that involves a problem with another hormone, called vasopressin. 

This dysfunctional vasopressin results in a lot of peeing. Unfortunately, this leads to more than just frequent bathroom breaks. Excessive urination causes terrible dehydration and unquenchable thirst which leads to a myriad of other problems.

While diabetes mellitus can also cause frequent urination, it happens for different reasons. Luckily, diabetes insipidus is extremely rare (11).

As a general rule, it’s pretty safe to assume you can count on the word ‘diabetes’ referring to diabetes mellitus.

Diabetes Symptoms

People with both type 1 and type 2 diabetes experience similar problems.

  • Frequent Urination
  • Excessive Thirst 
  • Numbness 
  • Blurry Vision 
  • Hunger 
  • Weight Loss or Weight Gain
  • Generalized Weakness
  • Nausea & Abdominal Pain

These symptoms can occur much more quickly and can appear more dramatic in people with type 1 diabetes. People with type 2 diabetes may have more mild symptoms that develop gradually and may not be very noticeable for long periods of time (12).

Diabetes Complications  

There’s a reason you hear people making such a big fuss about living with diabetes - it can cause devastating complications. Many of these are life-threatening and include:  

 

Diabetes Diagnosis

The symptoms of diabetes can be so mild that some people may not even be aware of they are experiencing them.

Diabetic tests like hemoglobin A1c and fasting blood glucose levels are used to make the diagnosis of diabetes and help to determine how severe it is. These same tests can be used to track how the disease is progressing and determine how much medication should be taken on a daily basis.

Diabetic Cure

While people with type 1 diabetes can live very full and healthy lives there is unfortunately not yet a known cure for this disease. 

The amazing news about type 2 diabetes is that many cases can be reversed by implementing these lifestyle changes.

The best way of tackling the treatment of diabetes is to attack the disease at all ends. Integrating key lifestyle changes including diet and exercise to promote healthy weight management while taking medications as prescribed by your doctor will lead to the most success. 

Implementing these lifestyle changes can actually reverse the disease process - and all of the health problems  associated with it (13). 

 



 

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