Diabetic Diet

Definition

The diabetic diet is a diet designed to control the level of glucose (sugar) in the blood of people who have diabetes or prediabetes.

Origins

Diabetes mellitus is a disease that is characterized by abnormally high levels of glucose in the blood. Carbohydrates (sugars and starches) are broken down during digestion into glucose, a monosaccharide (simple sugar) that circulates in the blood. Normally, the hormone insulin regulates blood glucose levels by controlling how much glucose enters cells. Once in cells, glucose either is used to meet the immediate energy needs of the cell or stored for later release into the blood when blood glucose levels are low. In people with diabetes, this regulatory mechanism does not function correctly and glucose builds up in the blood, a condition called hyperglycemia.

There are two main types of diabetes. In type 1 diabetes, the pancreas, a digestive system organ, does not make any insulin or does not make enough insulin to properly regulate blood glucose. People with type 1 diabetes must control their blood glucose levels through diet, exercise, and most importantly, through the regular injection of synthetic or animal insulin. In type 2 diabetes, the pancreas produces enough insulin, but cells become unresponsive to its effects. As a result, adequate amounts of glucose cannot enter these cells, and glucose builds up in the blood. Many people with type 2 diabetes can control their blood glucose level through diet and exercise alone. Others must take supplemental insulin either by mouth (orally) or by injection.

Prediabetes is an increasingly common condition in which glucose levels are high but have not yet reached the level needed for a diagnosis of diabetes. If not treated, prediabetes generally progresses to type 2 diabetes within five years.

In 2017, the U.S. Centers for Disease Control and Prevention (CDC) issued a report on national diabetes statistics. According to CDC researchers, as of 2015, 30.3 million Americans had diabetes; nearly one in four of these individuals did not know they had the disease. Another 84.1 million (more than a third of the U.S. population) had prediabetes; only about one in ten of these individuals knew they had it. The report noted that diabetes was the seventh leading cause of death in the United States in 2015.

According to the World Health Organization (WHO), an estimated 422 million adults had diabetes as of 2014, double the number who had the disease in 1980. Countries with the highest percentage of individuals with diabetes are India, China, the United States, Indonesia, and Japan. In 2015 30.3 million Americans (9.4% of the population) had diabetes.

The goal of a diabetic diet is to help keep blood glucose within a healthy range. For people with type 2 diabetes, weight loss and regular exercise are the main focus. Achieving a healthy weight and engaging in physical activity can reduce or eliminate the need for medication.

Description

Carbohydrates

Regulating sugars and starches in foods can help manage blood sugar levels. One method approved by the American Diabetes Association (ADA) is carbohydrate (carb) counting. The ADA suggests that people start by eating 45–60 grams of carbohydrates at each meal, a range that can be adjusted with a dietitian. To help measure portion sizes, the ADA advises limiting carbs to one-fourth of the plate. Another fourth should be devoted to protein, such as meat, fish, eggs, or pulses, and the remaining half should be comprised of nonstarchy vegetables such as broccoli, spinach, and cabbage (starchy vegetables such as potatoes, sweet potatoes and yams fall into the carbohydrates category). This is similar to the recommendations of the U.S. Department of Agriculture's (USDA) MyPlate, which advises filling half the plate with fruits and vegetables and the remaining quarters with carbohydrates and protein.

Other diet strategies involve exchange lists. A dietitian will help establish a daily target calorie intake based on the individual's size, age, and level of physical activity. Categories of foods in this method are starches (carbohydrates), vegetables, fruits, milks, meats and other protein foods, and fats. The amount of food permitted in each category is divided into what is called an exchange. Exchanges within each category of food are equal to one serving size and are approximately equivalent in calories. Within the limits of any category, the individual has free choice of which foods to eat, up to the permitted number of exchanges for the day.

An example of a diabetic diet for an individual who should eat 1,600 to 2,000 calories daily might look like this:

Dozens of possible food choices are available within each exchange group. One starch exchange, for example, could consist of either one slice of bread, one small potato, one 6-inch tortilla, or one small ear of corn. One vegetable exchange could consist of either one-half cup of green beans, one-half cup of carrots, or one cup of salad. One fruit exchange could equal one-half cup of fruit juice or one small apple. Portion size is controlled by the size of the exchange, and food must be weighed or measured.

Fiber

People on a diabetic diet are encouraged to choose whole-grain foods instead of refined-grain foods (e.g., brown rice instead of white rice) and whole fruits over fruit juices. These foods provide more dietary fiber and have a lower glycemic index. The glycemic index is a measure of how high carbohydrate-containing foods raise the blood glucose level within two hours of being eaten. The more complex the carbohydrates in the food, the more slowly they are broken down during digestion. This causes them to raise blood glucose levels at a slower and more steady rate, rather than causing a quick, short-term spike in glucose level, therefore requiring less insulin to return glucose levels to normal.

Fiber helps food move through the body but is not digested. Because of this, if a food contains more than five grams of fiber per serving, half of the fiber can be subtracted from the total grams of carbohydrates (per serving), according to the American Diabetes Association.

Artificial sweeteners

Artificial sweeteners and diet drinks allow people with diabetes to enjoy sweet treats while still limiting sugar. The American Diabetes Association has deemed artificial sweeteners safe for people with diabetes. Using a calorie-free sweetener in coffee or swapping soda with a diet version can help cut calories and carbohydrate intake. It is important to enjoy these treats in moderation as part of a well-balanced diet. Emerging evidence suggests that artificial sweeteners may not actually be beneficial for those with diabetes. Recent studies have found that regular use of artificial sweeteners may be associated with high blood glucose and diabetes, as well as weight gain and obesity.

Omega-3 fatty acids Other factors

Another aspect of the diabetic diet is the number and timing of meals. In consultation with a dietitian, individuals will determine how many times they should eat daily. Some people need to eat three meals and three between-meal snacks to best control their diabetes. Eating small amounts frequently can help keep glucose levels steady. Blood glucose control is best if meals are eaten and any diabetes medication taken at approximately the same times each day.

Beverages, such as alcohol and soda, should be consumed in moderation. Empty calories—foods that contain calories but no nutrients—can hinder weight loss efforts, and they generally contain carbohydrates and added sugars. Alcohol may increase the risk of hypoglycemia, or low blood sugar.

Function

Following a healthy diet allows many individuals with type 2 diabetes and prediabetes to control their blood glucose levels without supplemental insulin. The diabetic diet strategies do not differ much from general nutrition guidelines provided by the USDA. In individuals who need supplemental insulin, following the diabetic diet helps to reduce the amount of insulin needed and will make it easier to keep blood glucose levels within a healthy range.

Benefits

The diabetic diet provides a framework in which people with diabetes mellitus can choose foods and time the amount and consumption of those foods in a way that helps them maintain a healthy blood glucose level. By keeping blood glucose within healthy limits, the individual decreases the risk of serious side effects and long-term complications of the disease, including heart and blood vessel (cardiovascular) disease, which can lead to heart attack and stroke; kidney failure; blindness (diabetic retinopathy); and nerve damage (neuropathy). In people with prediabetes, following a diabetic diet can stop or slow the progression to diabetes and can also help overweight and obese individuals lose weight. Regular physical activity is recommended in tandem with the diabetic diet. Even people without diabetes can benefit from this diet, as it falls in line with dietary recommendations from federal and medical organizations.

KEY TERMS
Dietary fiber—
Also known as roughage or bulk. Insoluble fiber moves through the digestive system almost undigested and gives bulk to stools. Soluble fiber dissolves in water and helps keep stools soft.
Glycemic index—
A ranking from 1–100 of how much carbohydrate-containing foods raise blood sugar levels within two hours after being eaten. Foods with a glycemic index of 50 or lower are considered good.
Hypoglycemia—
Abnormally low blood sugar levels.
Insulin—
A hormone made in the pancreas that is essential for the metabolism of carbohydrates, lipids, and proteins, and that regulates blood sugar levels.
Type 1 diabetes—
A chronic immune system disorder in which the pancreas does not produce sufficient amounts of insulin, a hormone that enables cells to use glucose for energy. Also called juvenile diabetes, it must be treated with insulin injections.
Type 2 diabetes—
Formerly called adult-onset diabetes. In this form of diabetes, the pancreas either does not make enough insulin or cells become insulin resistant and do not use insulin efficiently.

Precautions

No specific precautions are associated with this diet. The most important thing is for individuals to understand how the diet works and to follow it. Before beginning the diabetic diet, individuals must consult their doctor and set targets for their blood glucose levels both before meals and after eating. They must acquire and learn how to use equipment to take their own blood glucose readings up to several times daily. Consultation with a registered dietitian and attendance at diabetic education classes are strongly recommended, and regular checkups with a physician are mandatory. Family members also may benefit from a diabetic education classes to better understand the diet and medication regimen that their loved one should follow.

Risks

QUESTIONS TO ASK YOUR DOCTOR

Research and general acceptance

The diabetic diet is accepted by physicians, registered dietitians, and other healthcare professionals throughout the United States, as well as recommended by the American Diabetes Association. This healthy, noncontroversial diet is acceptable for everyone over the age of three (unless they have special dietary considerations). Parents of children younger than age three should consult with their pediatrician about modifications in the diet needed to accommodate the rapid growth of young children.

See also American Diabetes Association ; Artificial sweeteners ; Bernstein diet ; Carbohydrates ; Diabetes mellitus ; Flaxseed ; Gestational diabetes ; Low-sugar diets ; Metabolic syndrome ; Omega-3 and omega-6 fatty acids .

Resources

BOOKS

Geil, Patti, and Tami A. Ross. What Do I Eat Now?: A Step-by-Step Guide to Eating Right with Type 2 Diabetes. 2nd ed. Alexandria, VA: American Diabetes Association, 2015.

Mayo Clinic. The Mayo Clinic Diabetes Diet. Boston: De Capo, 2013.

Powers, Margaret A. American Dietetic Association Guide to Eating Right When You Have Diabetes. New York: J. Wiley & Sons, 2008.

Wheeler, Madelyn, Anne Daly, Alison Evert, et al. Choose Your Foods: Food Lists for Diabetes. Chicago: Academy of Nutrition and Dietetics, 2015.

PERIODICALS

Fagherazz, G., A. Vilier, D. S. Sartorelli, et al. “Consumption of Artificially and Sugar-Sweetened Beverages and Incident Type 2 Diabetes in the Etude Epidemiologique aupres des femmes de la Mutuelle Generale de l'Education Nationale-European Prospective Investigation into Cancer and Nutrition Cohort.” American Journal of Clinical Nutrition. 97, no. 3 (2013):517–23.

Swithers, Susan E. “Artificial Sweeteners Are Not the Answer to Childhood Obesity.” Appetite. 93 (October 2015): 85–90.

Sylvetsky Meni, Allison C., Susan E. Swithers, and Kristina I. Rother. “Positive Association Between Artificially Sweetened Beverage Consumption and Incidence of Diabetes.” Diabetologica 58, no. 10 (October 2015): 2455–56.

WEBSITES

American Diabetes Association. “Carbohydrate Counting.” Diabetes.org . http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/carbohydrate-counting.html (accessed May 15, 2018).

American Diabetes Association. “Eating Patterns and Meal Planning.” Diabetes.org . http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-meal-plans-and-a-healthy-diet.html (accessed May 15, 2018).

American Diabetes Association. “Low Calorie Sweeteners.” Diabetes.org . http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/artificial-sweeteners (accessed May 15, 2018).

Mayo Clinic Staff. “Diabetes Diet: Create Your Healthy Eating Plan.” Mayo Clinic. http://www.mayoclinic.com/health/diabetes-diet/DA00077 (accessed May 15, 2018).

National Diabetes Information Clearinghouse (NDIC). “Diabetes Diet, Eating, & Physical Activity.” National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), U.S. National Institutes of Health. https://www.niddk.nih.gov/health-information/diabetes/overview/diet-eating-physical-activity (accessed May 15, 2018).

U.S. Centers for Disease Control and Prevention (CDC). “National Diabetes Statistics Report, 2017 Estimates of Diabetes and Its Burden in the United States.” U.S. Department of Health and Human Services. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf (accessed May 15, 2018).

World Health Organization (WHO). “Global Report on Diabetes: 2016.” WHO.int. http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=83B0C89B67E2CF08392AFB8F4F4540CE?sequence=1 (accessed May 15, 2018).

ORGANIZATIONS

Academy of Nutrition and Dietetics, 120 S. Riverside Plaza, Ste. 2190, Chicago, IL, 60606-6995, (312) 899-0040, (800) 877-1600, amacmunn@eatright.org, http://www.eatright.org .

American Diabetes Association, 2451 Crystal Drive, Suite 900, Arlington, VA, 22202, (800) 342-2383, AskADA@diabetes.org, http://www.diabetes.org .

Diabetes UK, Wells Lawrence House, 126 Back Church Ln., London, United Kingdom, E1 1FH, 44 0345 123 2399, Fax: 44 20 7424 1001, info@diabetes.org.uk, http://www.diabetes.org.uk .

Juvenile Diabetes Research Foundation International (JDRF), 26 Broadway, 14th Fl., New York, NY, 10004, (800) 533-2873, Fax: (212) 785-9595, info@jdrf.org, http://www.jdrf.org .

National Institute of Diabetes and Digestive and Kidney Diseases, 9000 Rockville Pk., Bethesda, MD, 20892, (800) 860-8747, TTY: (866) 569-1162, healthinfo@niddk.nih.gov, http://www.digestive.niddk.nih.gov .

Tish Davidson, AM
Revised by Jennifer E. Van Pelt, MA

  This information is not a tool for self-diagnosis or a substitute for professional care.