DIABETES

OVERVIEW, DIET AND

FOOD MODIFICATIONS
• Diabetes is mostly concerned with blood sugar management. In diabetes,
the response to blood sugar in the bloodstream by the hormone insulin is
either slow or ineffective. As a result, sugar cannot move inside the cells
effectively to provide energy, and it lingers in the bloodstream for a long
period of time. This is why this disease is referred to as hyperglycemia
(high blood sugar). One of the devastating effects of diabetes is vascular
(vessel) damage due to this abnormal condition.
• The human body goes through some adaptations to accommodate high
blood sugar in the bloodstream. For one, the kidneys transfer some of the
glucose into the urine for excretion. This may cause increased urination,
thirst and problems with concentration, speech and vision, since there may
be less available glucose for brain functions. Urine test strips are used to
test for this condition.
• Diabetics may feel hungry if they do not eat regularly scheduled and
balanced meals. Diabetics should have some protein, carbohydrates and
healthy fats at each scheduled meal or snack. Both protein and
carbohydrates help to regulate blood sugar, and healthy fats provide
satiety, so a combination of all three nutrients is ideal.
• Normal blood glucose levels after fasting should be between 70 to
100mg/dL; prediabetic blood glucose levels are between 100 and
125mg/dL, and diabetes is characterized by a blood sugar level after fasting
at 126mg/dL or above after two consecutive blood tests.
 TYPE I AND TYPE II DIABETES
• The two main types of diabetes are Type I (previously known as juvenile
diabetes) and Type II (previously known as adult-onset diabetes).
• Type I diabetes:
a. Generally strikes children under 12 years of age.
b. It is the result of very little or no insulin production by the pancreas.
c. Requires injected insulin to properly manage blood sugar.
d. There is speculation but not consensus about the cause(s) of Type I
diabetes. It may be the result of an allergic reaction or virus that affects the
insulin-producing cells in the pancreas. It also has a strong genetic
component.
e. Type I diabetes can emerge suddenly. Clinical signs include insatiable
thirst, rapid weight loss and frequent urination. Immediate medical care is
required, including insulin administration. If insulin is not immediately
provided, glucose will not be available for the brain and other vital organs.
This condition may cause hypoglycemia, or low blood sugar. Undetected
and untreated hypoglycemia may lead to confusion, dizziness, fatigue,
headache, irritability, nervousness, sweating, unconsciousness, weakness
or even death.
• Type II diabetes:
a. Usually affects adults over the age of 45 years old, although more children are now faced with this
disease.
b. The risk factors of Type II diabetes include genetic predisposition, family history and central-
type obesity (too much fat around the abdomen and visceral organs).
c. People with Type II diabetes may not be able to produce enough insulin, or there may be insulin
resistance at the cellular level. Overweight or obesity may interfere with proper insulin function. An
increase in diabetes may parallel the epidemic of global obesity.
d. Type II diabetes drives body fatness because more fat is stored than burned for energy. The liver
removes excess sugar in the bloodstream that is converted into fat and sent to the cells for
metabolism into energy or storage.
e. In Type II diabetes, this fat has a difficult time entering the cells to be metabolized into energy, so
more fat ends up in storage fat cells. The cells requiring energy send messages to the
hypothalamus (the hunger control center of the brain) that they need to “be fed.” If a person
responds by overeating, then the cycle continues and more fat is stored than metabolized into
energy. The storage fat cells may become larger and more resistant unless this cycle is broken.
Losing weight on a calorie, fat and carbohydrate-controlled diet is a sensible strategy. Exercise is
an equally important approach. Type II diabetes now affects an increasing number of children and
teenagers due to childhood and adolescent obesity. While Type II diabetes is controllable, Type I
diabetes is a lifelong disability.
 KETOSIS
• Ketosis is the condition when glucose is not available for energy, the human body
may turn to an intermediary state for its energy needs, in which the body
produces ketones, which are by-products that form when the body burns stored
fat for energy. Some high-protein/low-carbohydrate diets rely on ketosis for
weight and fat loss.
• People with diabetics it may cause too much weight loss and make the blood too
acidic. This condition is called acidosis, which may result in coma or death.
• The treatments for Type I diabetes is mainly treated by injected insulin, a healthy
and well-balanced diet, exercise, and weight loss (if required). Type II diabetes is
mainly treated by weight loss (if required), a healthy and well-balanced diet, and
exercise. Oral medications to help control blood glucose and boost insulin
effectiveness, and occasionally injected insulin are used if blood sugar is poorly
managed. Since the treatments for both Types I and II diabetes require a healthy
and well-balanced diet coupled with weight loss, this is where nutrition and
culinary specialists can be effective.
 DIETARY STRATEGIES TO IMPROVE BLOOD
SUGAR MANAGEMENT
A major goal in diabetes prevention and control is blood sugar management. Normal blood pressure
and cholesterol are also essential. Many of these strategies will improve all three risk factors of
diabetes:
1. Eat enough calories for optimal weight. Here are some guidelines:
a) Choose foods that are naturally lower in calories, such as some fruits, lean meats, legumes,
low-fat dairy products, vegetables and whole grains, and control the portion sizes of these
foods.
b) Replace higher-calorie side dishes, such as french fries, with lower-calorie vegetables, such as
side salads. As recommended by the USDA MyPlate Guidelines, fill half the plate with
vegetables and fruits. The extra fiber is not only filling, but it also helps to stabilize to blood
sugar.
c) Increase water consumption because soluble fiber depends on it, and water assists in fat
metabolism. But decrease other sweetened liquid calories, including fruit drinks, soft drinks,
and coffee and tea beverages. Even pure fruit juice should be consumed in moderation.
2. Eat regularly spaced meals. The exact number of meals and the precise timing of these
meals are not as critical as once thought. Consistency, meal size and composition are
essential in blood sugar management. Here are some guidelines:
a. Try to consume meals and snacks no more than three to four hours apart. Three well-
balanced healthful meals, plus one or two proportional snacks may help to normalize
and maintain blood sugar.
b. Ideally, each meal and snack should contain some lean protein, whole-grain
carbohydrates and healthy fats as described in the “Food choices to improve blood
sugar management” section that follows.

3. Eat a consistent amount of healthy carbohydrates throughout the day. The

carbohydrates in processed fruit drinks and refined starches tend to raise blood sugar
quicker than those in whole fruits, vegetables
and grains. The glycemic index or GI addresses this difference in carbohydrates by ranking
them according to their effects on blood sugar levels. Here are some guidelines:
a. A good rule of thumb is to consume three to 5 servings (45 to 60 grams) of
carbohydrates at each meal and one or two servings (15 to 30 grams) of carbohydrates
at each snack.
b. Avoid consuming refined carbohydrates, such as soft drinks or alcoholic beverages, on
their own. Have some foods with a little protein or fat, such as cheese, nuts, or peanut
butter and crackers, to buffer rapid spikes in blood sugar that these refined beverages
may induce.
c. Follow a food pattern similar to the one that is shown in “Food choices to improve
blood sugar management.” It should be individually designed for specific needs as
determined by a diabetes specialist.
4. Eat just enough fat and the right kind of fat. A higher total fat intake–even healthy monounsaturated fatty acids—is
associated with insulin resistance. Here are some guidelines:
Another good rule of thumb is to limit “added fats” such as butter or salad dressing, to three or four servings daily. One serving is
equal to about 1 teaspoon of butter, margarine, oil or mayonnaise; 1 tablespoon of reduced-fat butter, margarine or mayonnaise;
1 tablespoon of regular salad dressing; or 2 tablespoons of reduced-fat salad dressing.
a. Substitute monounsaturated fats (avocado, canola oil, nuts and nut oils, olives and olive oil, and peanuts and peanut oil) for
saturated fats (butter, cheese and lard).
b. Replace higher-fat dairy products (butter, coffee cream and whipping cream) with lower-fat dairy products (light butter, half-
and-half and light cream).
c. Look for labels that read “no trans fat.” Since 2006, all packaged foods, including dietary supplements, must list the amount of
trans fat on the Nutrition Facts label. But unless there is at least 0.5 gram or more of trans fat in a food, the label can claim 0
grams. Like saturated fat, trans fat tends to increase
blood cholesterol levels.
d. Limit deep and shallow frying of meat, poultry, fish and vegetables to reduce excess oil. Even sautéing may add too much oil,
so limit the quantity.
e. Use herbs and spices to expand the flavor of butter, margarine or cream sauces so that less can be used. Cut back but not
necessarily eliminate these flavorsome additions.
5. Keep a food log. A food log helps to improve self-awareness and it encourages a person to modify his or her food intake to
improve blood glucose levels. Food logs can track portion sizes, the timing of meals and snacks, and their satisfaction.
6. Read food labels. Labels that read “low-fat” and “sugar-free” may still contain unwanted calories and other substances. For
example, a low-fat food might be higher in sugars and a sugar-free food might be higher in fats. Review favorite foods and
beverages to find the best-tasting products with the least fat, calories and other ingredients that fit diabetic diet requirements.
 DIABETES INDIVIDUALIZED MEAL AND
LIFESTYLE PLAN
• The American Diabetes Association (ADA) recommends an
individualized meal and lifestyle plan for managing diabetes and body
weight. The ADA also supports balancing food intake with daily
physical activity. For a more specialized meal plan, the ADA
recommends that individuals with diabetes consult a registered
dietitian (RD) or certified diabetes educator (CDE). Some of these
clinicians work with culinary specialists to design and create diets for
people with diabetes. A sample approach to blood sugar
management follows.
 FOOD CHOICES TO IMPROVE BLOOD SUGAR
MANAGEMENT
• It is important to space healthy carbohydrates throughout the day to help manage blood
sugar between meals
and snacks. This sample meal and snack pattern is designed for a person who consumes
about 2,200 calories
a day—the standard amount of calories that is used as a reference for the USDA Daily
Values (DV). A diabetes
specialist can adjust the number of calories and number of carbohydrate servings,
depending on individual needs.
Starches: 6 to 11 Servings Daily
2 servings at breakfast
1 serving at morning snack
3 servings at lunch
3 servings at dinner
Starches That Equal 1 Serving (15 grams of Carbohydrate)
1 slice whole-grain bread
½ bagel or English muffin
¾ cup unsweetened, ready-to-eat high fiber cereal
• 3 cups cooked pasta, rice,
½ cup cooked legumes, lentils or peas
Fruit: 2 to 4 Servings Daily
1 serving of fruit at breakfast
1 serving of fruit at morning snack
1 serving of fruit at afternoon snack
1 serving of fruit at evening snack
Fruits That Equal 1 Serving (15 grams of Carbohydrates)
1 fresh small-sized fruit
½ cup cooked fruit
½ cup fruit juice
⅓ to ½ cup fresh fruit juice (depends on sugar content)
¾ cup to 1¼ cups berries or melon (varies by size)
2 tablespoons dried fruit
Low-fat Dairy Products: 2 to 3 Servings Daily
1 serving of low-fat dairy products at breakfast
1 serving of low-fat dairy products at afternoon snack
1 serving of low-fat dairy products at dinner
Low-Fat Dairy Products That Equal 1 Serving (12 grams of Carbohydrates)
1 cup fat-free (skim) or low-fat (1%) dairy milk
1 cup fat-free or low-fat plain yogurt
1 cup reduced-fat kefir or buttermilk
Nonstarchy Vegetables: 3 to 5 Servings Daily
At least 1 serving at lunch
At least 2 servings at dinner
1 or more servings at afternoon snack
Nonstarchy Vegetables That Equal 1 Serving (5 grams of Carbohydrates)
½ cup cooked vegetables
1 cup raw vegetables
(Salad greens are considered “free foods” with <5 grams carbohydrates per serving.)
• Sweets, Desserts, Other Carbohydrates: 1 to 2
Servings Daily (Calories and
Blood Sugar Permitting)
1 serving of sweets with lunch
1 serving of sweets with dinner
Sweets, Desserts and Other Carbohydrates
That Contain 1 Serving (15 grams of
Carbohydrates)
3 gingersnaps
5 vanilla wafer cookies
1 tablespoon honey or 100 percent fruit spread
1 (100%) frozen fruit juice bar
½ cup sugar-free/fat-free pudding and some
frozen yogurt and ice cream*
*Read food labels on frozen yogurt and ice
cream to ensure grams of carbohydrates per
serving.
• Total Carbohydrate Per Meal or Snack
60 grams of carbohydrates at breakfast (2 starches, 1 fruit, 1 low-fat dairy)
30 grams of carbohydrates at midmorning snack (1 starch, 1 fruit)
65 grams of carbohydrates at lunch (3 starches, 1 nonstarchy vegetable, 1 sweet)
35 grams of carbohydrates at midafternoon snack (1 fruit, 1 low-fat diary, 1 nonstarchy
vegetable)
85 grams of carbohydrates at dinner (3 starches, 1 low-fat dairy, 2 nonstarchy vegetables,
1 sweet)
15 grams of carbohydrates at evening snack (1 fruit)

Total daily carbohydrates = 290 grams or 1,160 calories (290 grams × 4 calories per gram
= 1,160 calories)
On a 2,200-daily calorie diet, 1,160 calories from carbohydrates equal about 52 percent of
total calories. This
allows for about 30 percent or fewer calories from fat and 20 percent or more calories
from protein. The ratio
of 50:30:20 (50 percent carbohydrates, 30 percent fat and 20 percent protein) can be
applied to other calorie
levels for blood sugar management. This ration is also heart-healthy and sensible for
weight control.