Healthy food choices are a critical component of diabetes care. Choosing the correct foods and avoiding others will help patients keep their blood sugar in check and reduce the side effects that occur with wide fluctuations in blood sugar. Diet is also important for keeping other factors such as weight, cholesterol, and blood pressure within healthy ranges.

General Diabetic Diet Recommendations

• Snack between meals (every 3-4 hours) to avoid overeating at meal time
• Increase fiber intake, which improves blood sugar control and helps lower cholesterol
• Use plate method
• 1/2 plate vegetables
• 1/4 plate bread, pasta, rice, potato
• 1/4 plate meat, poultry, fish

Foods to Eat with Diabetes

• Lean meats
• Fish
• Vegetables
• Beans
• Whole grains
• Non-fat dairy
• Fruits (in moderation due to high sugar content)
• Nuts (in moderation due to high-fat content)

Foods to Avoid with Diabetes

• High in sugar (high glycemic load)
• Simple carbohydrates (high glycemic index)
• High saturated fat foods
• Highly processed foods

Diabetes Diet Guide Overview

When thinking of diabetes in terms of diet, always think “wholesome.” Including foods that contain fiber, low-fat proteins, heart-healthy fats, slowly absorbed carbohydrates, and as little added sugar as possible. This guide will help you understand what constitutes a healthy meal for those following a diabetic diet.

Carbohydrates

Carbohydrate counting an often the first principle taught to those starting a diabetes diet. How much carbohydrates you need per meal and snack is based on aspects such as height, weight, current insulin dosage, and overall caloric needs. Carbohydrate counting is often the most effective way to ensure adequate carbohydrate that will not negatively impact blood sugars.

The average person would need around 60 grams of carbohydrate per meal (four servings) and 30 grams (two servings) at each snack.  One serving of carbohydrate contains around 15 carbohydrate grams. This information can be very helpful when grocery shopping. Reading labels and looking at carbohydrate content is the best way to know exactly how many carbs are in different types of foods. A doctor or Registered Dietitian can provide more specific information as to what is needed on an individual basis.

Carbohydrates encompass a wide variety of foods. They are found in starches and grains, dairy, legumes, fruit, some vegetables, caloric beverages, and desserts. When managing carbohydrate intake, it should not be to the exclusion of any of those food groups. It is more beneficial to learn how to have some of each food group to maintain adequate nutrient intake from a variety of foods.

Starches and grains include foods such as potatoes, bread, pasta, quinoa, rice, oatmeal, grits, cold cereals, and corn. This is not an inclusive list of all items but does include many types of starchy foods. For these items, around one half cup would be a serving. One serving of a starch would be 15 grams of carbohydrate.  The only exception to this rule would be rice where one third cup contains 15 grams of starch and would be considered one carbohydrate serving. A fist-sized potato would be one serving of carbohydrate (again, around 15 grams). One slice of bread about the size of your hand (fingers extended) would be one serving of carbohydrate.  In thinking of practical application of this information, having a 60 gram carbohydrate lunch (serve servings) could include a sandwich (two carbohydrate servings). Examples will continue to be given as to how to round out this meal and make it balanced throughout the remainder of instruction on managing diabetic diet.

Whole grains are superior to refined grains for the management of diabetes and keeping blood sugars at an appropriate level. There are three parts of a grain: bran, germ, and endosperm. A whole grain contains all three of these parts. A refined grain (meaning that some of the grain has been stripped away making lower in fiber) has only the endosperm. The endosperm is the starchy part of the grain. The parts that have been stripped away, the bran and germ, are the parts of the grain that contain the fiber. Having as many grains as possible in your diet be whole grains are important. When adding fiber in, blood sugar response to carbohydrate foods slows because your body has to work a bit harder to break down the fiber. Due to the slower digestion, blood sugars are kept lower becomes the sugar does not enter the blood as quickly.

Dairy is also a food group that includes carbohydrate. While cheeses tend to be lower in carbohydrate and do not necessarily need to be included in carbohydrate counting for a single serving, milk and yogurt do contain amounts of carbohydrate that would need to be included. An eight-ounce serving of milk contains 12 grams of carbohydrate and would be included in a carbohydrate count.  Six ounces serving of yogurt also contains 12 grams of carbohydrate and would need to be counted as one serving of carbohydrate at a meal. In continuation of the example of having two slices of bread at a meal (two carbohydrate servings), a cup of skim milk would then be a third carbohydrate serving.

Fruit includes natural sugars and counts as a carbohydrate. While sugar has gotten a negative connotation in today’s society, fructose (the simple sugar in fruit) is not harmful in the context of a well-balanced diet. When eating a piece of whole fruit, fiber is also included. So, while simple sugars can make blood sugars rise, fiber reduces this response. Fruit also contains many vitamins and minerals that are needed for health. Fruit is not something to be feared in a diabetic diet but, rather, choosing whole fruits and counting them as one carbohydrate serving in a meal or snack is the most advantageous. Having fruit juice is not as good of a choice because it does not contain the fiber that slows the breakdown of the simple sugar in the fruit (thereby, increasing blood sugars more rapidly.) In the context of the meal that was started with two slices of bread (two carbohydrate servings), one cup of milk (one carbohydrate serving), adding an orange to this would give a fourth carbohydrate exchange. One medium sized piece of whole fruit will yield around one carbohydrate serving.

Many vegetables tend to be lower in carbohydrates. Things like green beans, asparagus, broccoli, cauliflower, Brussels sprouts are foods that do not have much carbohydrate and would not need to be counted in the context of a meal or snack. Starchy vegetables include peas, potatoes, pumpkin, all types of squashes, zucchini, sweet potatoes, and yams. For these, one fist-sized serving (which would yield around one half cup of cooked vegetables), would count as a carbohydrate serving because they would include around 15 grams of carbohydrate.

Eliminating added sugar is important in every diabetes diet. Products like sodas, juices, desserts, packaged, and canned foods often contain added sugars. Purchasing products that contain fewer sugars such as fresh foods is a very simple ways to decrease the overall amount of carbohydrate intake. These added sugar foods should be consumed only on “special occasions” for example allowing a normal sized piece of cake when attending a wedding. Added, simple sugars require very little for the body to digest and causes a rapid spike in blood sugar. This could lead to not feeling well, requiring more insulin for blood sugar management,  and an overall elevation of ones blood sugar levels.

When blood sugars are improperly managed over a long period of time, this can often lead to heart disease and many other complications. One way to think of this is to think of how sugar mixes with water. When sugar is added to water, the result is a thicker substance that tends to be sticky. When blood sugar levels remain high for extended periods of time, the blood becomes thicker and harder to pump. This causes distress on the heart and can lead to heart disease. When blood sugars remain high, there also tends to be more of a congregation of blood fats which can lead to thinks like heart attack and stroke.

Protein

Protein is a non-carbohydrate containing food that contains amino acids, which are needed for normal body functioning and muscle repair. Protein foods include seafood, chicken, turkey, lean red meat, pork, eggs, beans, and nuts. When thinking of portions sizes, it would be three to five ounces of meat. When eyeballing an appropriate portion size of meat, it would look similar to the size of a deck of cards or the length and width of your palm (excluding fingers).

When looking to find appropriate poultry, white meat would be preferable to dark meat due to the heart health benefits of eating a lighter meat. Lean red meat would include lamb, beef, or bison meat. If having these products in ground form, look for a 93/7 cut of meat or better. (93/7 means that 93% of the product is lean meat, seven percent is fat. The lower the fat content, the better.) Pork is also a suitable high protein meat that works well for a diabetic diet. Appropriate ways to prepare these types of meats would include baking, grilling, roasting, preparation in a slow cooker, or shallow frying in a pan with a heart healthy fat.

Adding three to four ounces of lean turkey to the two slices of bread for a sandwich would be an excellent addition of protein to the carbohydrate. Adding protein to carbohydrates also helps to slow the blood sugar response and maintain overall blood sugar. Protein also helps to promote satiety and fullness for longer after a meal.

Vegetarian sources of protein are also abundant and include foods such as eggs, cheese, dairy, beans, and grains. Having two eggs provides 12 grams of protein; the yolks from 2 eggs daily will not impact cholesterol, but if you have high cholesterol egg whites are a superior option. All of the protein in eggs is found in the egg whites. Having eggs with breakfast, breakfast for dinner, egg salad made with low fat mayonnaise, or cooked in a fried rice dish are all great ways to include eggs as a source of protein. Beans are also a versatile and high fiber option.  One half cup of beans has around 15 grams of carbohydrate so this would also need to be included in overall carbohydrate intake for the meal.

Fats

Fat is one of the three macronutrients in the diet (in addition to protein and carbohydrates). The body needs dietary fat in addition to protein and carbohydrate for optimal functioning. Views on dietary fat are beginning to change for the better as people realize that having healthy fats in the diet is beneficial rather than something to be avoided. The key is to choose fats that will optimize health benefits such as poly nad mono-unsaturated fats. Saturated fats, on the other hand, should be avoided due to their impact on heart disease. These include things like animal fats (like choosing the lower fat protein sources discussed earlier). Trans fats should be avoided as well. Trans fats are unsaturated fats that have been hydrogenated (or turned into a man-made saturated fat) for the purpose of shelf stability. It is widely known that even the smallest amounts trans fats can have a large negative impact on cardiovascular and heart health.

So, what fats should be selected? Poly-unsaturated fat omega-6. omega-9 and omega-3 have proven health benefits. Most people consume adequate omega-6, but looking for sources of omega-3 fats and monounsaturated fats (omega-9s) are going to be most beneficial. Monounsaturated fatty acids include things like avocado, canola oil, olives/olive oil. Omega-3 fats include walnuts, flax/flaxseed.

Having fat in the diet helps to promote satiety, helps to slow blood sugar response, and is critical for the absorption of vitamins A, D, E, and K. When having a cup of skim milk, the added fat from the avocado helps to absorb vitamin D. Vitamin D, in turn, helps to absorb calcium. Foods work together this way so the inclusion of all food groups is necessary for health.

Sample meal

Turkey sandwich on whole wheat bread with avocado, a cup of milk, and a side salad with a serving of salad dressing would be an example of a complete the meal. This meal would provide much-needed nutrients and give volume to have overall fullness.

When constructing a meal for a diabetic patient, half the plate should be vegetables, 1/4 should be carbohydrates, and 1/4 should be proteins. Looking at the overall carbohydrate intake and needs are the first thing to consider. Adding protein, fat, and non-starchy vegetables round out the meal.

Example Snack

Planning a snack for the day would be much like planning a meal but on a smaller scale. For someone that would need four carbohydrate sources at three meals throughout the day, have two snacks with two carbohydrate sources would make sense to keep blood sugars stable and fullness managed throughout the day. Planning a snack with two carbohydrate sources would need to be balanced out with a fat or protein. Fat and protein as a measure to slow blood sugar response to carbohydrate and maximize satiety has been discussed around meals and this remains the same for a snack. Appropriate examples of a snack would be: a peanut butter sandwich (two slices of bread for two carbohydrate sources with peanut butter for fat/protein), a large apple with peanut butter (carbohydrate with protein/fat), grapes with cheese (carbohydrate in the fruit, protein in the cheese). The key to knowing  what to have is basing the snack around carbohydrates and then filling in with protein or fat.

Drinks

That leaves the question of, what should someone drink for management of diabetes? Water is the number one beverage that should be consumed. A simple equation for knowing how much water is need daily is take current weight in pounds divided by two. The number yielded is the ounces of water needed throughout the day. An example of this would be to look at someone that weighs 200 pounds. 200 divided by two yields 100. That person would need 100 ounces of water daily for adequate hydration. Having enough water daily helps keep blood sugars low. Water helps to dilute the amount of sugar in the blood which keeps blood sugar lower. Adequate hydration is also a key component in feeling full throughout the day. Having enough water can help decrease inaccurate hunger cues that come from become dehydrated.

Other beverages that could be consumed throughout the day would be sugar free beverages (such as tea, flavored waters, diet beverages) although sugar free products like diet coke are often unhealthy. While there is still debate over the safety of sweeteners like splenda and aspartame, opting for the organic option of stevia is preferred. Coffee is an acceptable beverage, but watch the creamers for added suagrs. One other thing to keep in mind is that anytime a caffeine containing beverage is consumed, more water or hydrating beverages are needed. Caffeine acts as a diuretic and can further a person.

Exercise Competent

While diet may be 80% of the battle, exercise is the other 20% and is a critical aspect of diabetes management. People with diabetes may need to increase their exercise slowly and under medical supervision due to the effect exercise has on carbohydrate use by the body. In general, if you blood sugar is on the low side before working out it is important to have a snack prior and bring a snack to your workout in case you blood sugar starts to drop. For some their blood sugar will drop after working out, for others it will increase due to stress hormones being released during exercise. It will be very important to monitor your blood sugar levels whenever starting or changing your exercise program, especially if it is going to include a lot of cardio.

Benefits 

Many patients are able to lower their diabetes medication and insulin use when they follow and exercise program. Exercise helps manage blood sugar in two ways. One is that exercise helps the body to be able to utilize insulin more efficiently. Since insulin is the hormone that works to take sugar (in the form of glucose) from blood into the cells, this would automatically help to decrease blood sugar. The other way that exercise helps in blood sugar management is that it helps to use extra sugar (glucose) in the body for energy. When the body begins to burn energy through exercise, it uses the stored form of carbohydrate (glucose) first. If a person begins to walk, sugar in the blood (glucose) is primarily used to facilitate the movement. At that point, the body would begin to use glucose that has been stored in the liver and muscles for energy as sugars in the blood would already be lowered to a reasonable amount to facilitate the exercise.

Consistency  

The primary indicator that a person will stick with exercise is finding something that is enjoyable. For one person, that might be taking their dog on a 30-minute walk around the neighborhood. For someone else, it might be purchasing a pedometer and monitoring that a specific number of steps gets taken daily. Exercise can look like going to the gym and going to a fitness class, running outside, spending time on the elliptical machine, lifting weights, completing an exercise DVD at home, hiking, walking around a parking lot on a lunch break from work, doing yoga, training for and running a road race, competing in triathlons, or just getting up during commercial breaks and walking around the house or doing crunches and squats. Exercise can easily take on many forms. The best thing to do is find something that fits into the structure of the day, is enjoyed, and is sustainable. If someone that has not exercised in years decides to train for a marathon and begins over exercising without working up properly, injury and burnout is likely to result which would often lead in less movement than before.  Enjoyment, sustainability, and moderation are key.

Diet and Exercise Conclusion

In summation, a diabetic diet is going to be best balanced by eating wholesome foods and counting carbohydrates. This will be based on the amount of carbohydrate needed throughout the day and balancing it out at meals and snacks based on caloric needs, weight/size, and insulin taken.  Examples were given on how to put together meals and snacks that will be filling, manage blood sugars, and be satiating. Drinking water throughout the day is important in managing blood sugars to help with the dilution of actual sugar in the blood as well as help to manage hunger cues that could be driven by thirst. The final way to manage diabetes is through walking and exercise. Getting adequate steps throughout the day and finding ways to exercise that are both enjoyable and sustainable are the keys to success in maintaining an exercise regimen long term.