DIABETES Health

The ABCs of Diabetes

The goals of nutrition for people with diabetes are to attain the ABC's of diabetes. The A stands for the A1C or hemoglobin A1C test, which measures average blood glucose (sugar) over the previous 3 months. B is for blood pressure, and C is for cholesterol. People with diabetes should attain as near as normal blood glucose control (HbA1c), blood pressure, and healthy cholesterol level.

Dietary Tips

• Eat a wide variety of foods. Having a colorful plate is the best way to ensure that you are eating plenty of fruits, vegetables, meats, and other forms of protein such as nuts, dairy products, and grains/cereals.
• Maintain a healthy weight.
• Choose foods high in fiber such as whole-rain breads, fruit, and cereals They contain important vitamins and minerals. You need 25 to 35 grams of fiber per day. Short-erm studies have shown that people with type 2 diabetes who eat a high-iber diet can improve their blood sugar and cholesterol levels. Similar results have been shown in some studies in people with type 1 diabetes.
• Watch your portions. Eat only the amount of food in your meal plan. Excess calories results in excess amounts of stored energy from food which results in excess fat and excess weight. In people with type 2 diabetes excess body fat means less sensitivity to insulin. The dietitian will help you determine what portion sizes you can eat. This will be determined based on many things such as whether you need to lose weight, maintain weight, have high sugars or suffer from low sugars.
• In women with gestational diabetes, eat multiple meals and snacks per day as recommended.
• Do not skip meals.
• Eat meals and snacks at regular times every day. If you are taking a diabetes medicine, eat your meals and take your medicine at the same times each day.

Note: If you are taking some of the newer diabetes medicines, some of these tips may not apply to you; ask your health care provider the tips you should follow.

Protein Intake

In people with diabetes, protein intake should not exceed 15%-20% of the total daily calories. Since the effects of high amounts of protein and low amounts carbohydrates on the development of kidney disease has not been established, experts do not recommend diets high in proteins and low in carbohydrates (for example, Atkins Diet) in people with diabetes as a way to loseweight and control blood glucose levels. This does not apply to those with overt kidney disease. In people with kidney disease, reducing protein intake may slow the progression of the disease.

Fat Intake

People with diabetes have higher than normal risk for heart disease, stroke and disease of the small vessels in the body. Controlling blood pressure and limiting the amounts of fats in the diet will help lower the risk of these complications.

Limiting the amounts of saturated fats, increasing the amount of regular exercise and receiving medical therapy can lower bad LDL cholesterol and increase good HDL cholesterol. This has been repeatedly shown in many studies to help people with diabetes reduce their risk of heart disease and reduce the risk of death if a heart attack does occurs in a diabetic person.

TLC Diet

People with diabetes who have abnormal cholesterol levels will likely be placed on a diet known as a "TLC" diet. This diet will help reduce the intake of cholesterol raising nutrients. As part of this diet you may be asked to lose weight and increase physical activity levels -- all of these are components that will help lower bad LDL cholesterol. Looking at food labels will help you become more knowledgeable about your intake of fats and cholesterol.

Specifically the diet calls for:

• Total fat consumption should be 25%-35% or less of total calories eaten per day.
• Saturated fats should be less than 7% of total calories eaten in a day.
• Polyunsaturated fats (from liquid vegetable oils and margarines low in transfats) should be up to 10% of the total calories per day consumed.
• Monounsaturated fats (derived from vegetable sources like plant oils and nuts) should be up to 20% of total calories per day eaten.
• Carbohydrates should be 50%-60% of total calories per day eaten
• We should eat 20-30 grams of fiber per day. These can be derived from oats, barley, psyllium and beans.
• The amounts of protein in the diet should equal about 15%-20% of total calories eaten per day.
• Cholesterol content of the diet should be less than 200mg/day.

Can I Eat Sugar?

You might have heard that, as a person with diabetes, you shouldn't have any table sugar. While some health care providers continue to promote this, many -- realizing that the average person lives in the real world and will probably indulge in a bit of sugar every now and then -- have adopted a more forgiving view. Most experts now say that small amounts of sugar are fine, as long as they are part of an overall healthy meal plan. Table sugars do not raise your blood sugar any more than similar amounts of calories from starches which is found in many foods that we consume. It is important to remember that sugar is just one type of carbohydrate.

When eating sugar, keep these tips in mind:

• Read food labels. Learn how to determine how much sugar or carbohydrates are in the foods that you eat.
• Substitute, don't add. When you eat a sugary food, such as cookies, cakes, or candies, substitute them for another carbohydrate or starch (for example, potatoes) that you would have eaten that day. Make sure that you account for this in your carbohydrate budget for the day. If it is added to your meal for the day, then remember to adjust your insulin dose for the added carbohydrates, this way you will continue to maintain glucose control as much as possible. In other words readjust your medications if you do add sugars to you meals.
• Sugary foods are fattening. Many foods that have a lot of table sugar are very high in calories and fat. If you are watching your weight (and many people with diabetes must), you need to eat these foods in moderation!
• Check your blood glucose after eating sugary foods and talk to your health care provider about how to adjust your insulin if needed when eating sugars.

Ultimately the total grams of carbohydrates -- rather than what the source of the sugar is -- is what needs to be accounted for in the nutritional management of the person with diabetes.

Should I Use Artificial Sweeteners?

Artificial sweeteners can be added to a variety of foods and beverages without adding more carbohydrates to your diet. Using non-caloric artificial sweeteners instead of sugar also greatly reduces calories in your favorite foods.

Keep in mind that foods with artificial sweeteners are not necessarily 'no' carbohydrates foods. Many have carbohydrates; therefore, you must read the food labels to determine the gram amounts per serving that these have in order to take into account the effect that these carbohydrates have on your glycemic control. Foods labeled with artificial sweeteners can affect your blood sugars.

As long as you are aware of the content of carbohydrates you can adjust your meal or medication to maintain blood glucose control. Sugar free means -- no sugar has been added but you must remember these foods still contain carbohydrates which does affect your blood sugars.

Examples of artificial sweeteners you can use include:

• Aspartame
• Acesulfame-k
• Saccharine
• Sucralose
• Other non-nutritive sweeteners

Pregnant or breastfeeding women should avoid saccharine, and people who suffer from phenylketonuria should not use aspartame. People with phenylketonuria are unable to metabolize phenylalanine, an amino acid that's a common part of many proteins.

Some artificial sweeteners -- such as xylitol, mannitol, and sorbitol -- have some calories and do slightly increase blood glucose level.

The American Diabetes Association cautions that eating too much of any artificial sweetener can cause gas and diarrhea.

For more dietary information, see Eating Right.

Get the facts about diabetes.
Find resources and support.
View the full table of contents for the Diabetes Guide.

 

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.