We all need a healthy diet, whether or not we have diabetes, and this page
describes a standard healthy diet.
Many of us need to lose weight, and this page
describes a plan.If we are trying to lose weight, we often need small
portions. If we are trying to eat healthy and need recipes and links
to wonderful websites, these are here.
Everyone with diabetes should see a dietician once a year, and certainly
at the time of diagnosis, shortly after that, and at regular intervals. This
page should supplement the individual advice that a dietician can provide.
Unless you have an excellent understanding what you need, and practice it,
make sure you see a dietician. A dietician is available to every NHS patient..if
not, insist your Primary Care Trust ensures you have an appointment. A careful diet is very helpful, BMJ
2010. A low calorie and salt diet reduces retinopathy progression (Archives 2010)
Healthy food, fibre, fruit and vegetables
New Zealand healthy food pyramid
People who overweight tend to eat less fibre....foods high in fibre are
not very fattening but they help to fill you up more easily. For instance a brown bread salad sandwich is just as filling (but less fattening
as it has fewer calories) than a white bread plain cheese sandwich.
National Cancer Institute now recommends 9 portions a day of fruit
and vegetable...and eating this much fibre will mean you will not be as
hungry and therefore eat less bread, meat etc.
A portion: a fruit portion may be a handful of grapes, medium size banana, not all at once..shoud be spaced out during the day. The amount of carbohydrate needed depends on the amount of exercise taken.
A meal plate
Canadas adopted plate
A meal should be proportioned as opposite. 50% vegetables (eg salad) and fruit; grains (such as brown rice) , and protein (such as fish or beans or lentils).
The meal could be a curry, chinese, rissoto, stew etc, but these are the ideal proportions of the ingredients of the meal.
Vegetarians and other issues
Other dietary issues are important:
a diet that includes plant sterols, soy protein, viscous fibers, and nuts lowers cholesterol significantly JAMA 2011.
1 g of plant sterols per 1000 kcal of diet in a plant sterol ester–enriched margarine;
10 g of viscous fibers per 1000 kcal of diet from oats, barley, and psyllium;
22.5 g of soy protein per 1000 kcal as soy milk, tofu, and soy meat analogues;
22.5 g of nuts (including tree nuts and peanuts) per 1000 kcal of diet.
3's are helpful preventing renal disease. Fish
and sea food has long chain omega 3s and is of proven benefit. Pulses
(lentils, beans, chick peas etc) have short chain omega 3s, although
some experts say these are not quite as beneficial.
Health benefits are not unique, but there are ecological benifits (less
CO2 used), BMJ 09
Some studies suggest restricting carbohydrate
improves cardiovascular outcomes (Foster
2010). The opposite was found here Yancy 2004! Review
whole grains not refined grains..no white (?brown) bread or rice etc BMJ 2018
the actual cholesterol level is not so important with a healthy Mediterranean diet
Blueberries help to protect against the risk of diabetes, cantaloupe melon increases the risk (fruit juice, not illustrated, increases the risk significantly more) see www.bmj.com
Glycaemic index (GI)
Food with a high glycaemic index GI (red) cause
a dramatic rise in blood glucose. Lower
glycaemic foods are healthier (green)
Generally foods with a low glycaemic index (GI) are healthy, because insulin (injected or natural) has enough
time to redistribute the glucose to the body's tissues. These have a glucose
profile shown in green. These make people feel 'full' after a meal and help
keeping weight down. See
Generally foods with a high glycaemic index are unhealthy, as the glucose
rises too quickly to be redistributes and will do some damage (shown in red).
They may even may you more hungry as their effect wears off, as in eating
hamburgers....you may still fell hungry even if you have had far more calories
than you need.
The only exception is fruit. Fruit has a high glycaemic index, but is still
considered healthy, as above. 1-2 portions of fruit eaten over 10 minutes
are unlikely to be harmful (100gm/portion, the same size as a medium size
apple.) Fruit is therefore ideal as a desert or a snack.
Even fruit is fattening in very large amounts, but 5-9 portions of vegetables
or fruit should be part of everyone's diet.
There are many leaflets which indicate the glycaemic index of foods. Here
are some recipessee and here.
A low glycaemic index (high protein) diet maintains weight loss NEJM
Many people with diabetes have found giving up bread is helpful, although a small amont of bread is not harmful.
Medium amounts of carbohydrate is best...too much or too little is unsafe, so a low carbohydrate diet increases mortality Lancet 18.
Cut down on fat
Too much fat, even healthy fats, are harmful.
Cut down on fried and fatty foods such as butter, margarine, cheese and
Choose reduced-fat spreads and cheeses instead. Try skimmed or semi-skimmed
A little fat is helpful, such as polyunsaturated fat (sunflower oil). The
fats in nuts are healthy, but nuts are 'fattening' as they have a lot of
calories, so they are best in small amounts, perhaps replacing the saturated
fat of red meat and full-fat dairy food. A new paper reviews 'healthy fats' here .
Healthy oils & margarines
when used cold
olive oil (mono-unsaturated, healthy
at low temperature; saturated at high temp's)
most of these seem to have unhealthy fats such
as transfats, and too much salt. Of these Flora seems the healthiest.
The Olive Oil margarines are not as healthy as olive oil itself. Why
not replace these with a dressing made with
has saturated foot and is best avoided in large
NICE have recommended that everyone using insulin should have training to
allow them to achieve good control of their diabetes. One course is the DAFNE
course, for users of multiple dose insulin regime who want their diabetes
well controlled. But very few people have had DAFNE
training, and very few diabetes nurses and doctors.
The DAFNE (and other courses) course teaches you how to measure how much
carbohydrate you eat, so you can match this as accurately as possible with
your insulin. In this way, if you use a rapid acting insulin, if you eat
2 portions of pizza instead of one, you have extra insulin as you eat the
second portion. If you have an apple, you have a tiny extra dose on insulin.
This method helps you achieve better diabetic control without more hypos. NICE recommend
a programme of structured diabetes education in the months after diagnosis,
and recommend patient education should be available when needed annually;
most of this should be educational and interactive, but it also needs to
include a formal review of self monitoring/insulin adjustment.
To achieve good control, insulin users need to be able to determine the
carbohydrate content of a meal, and adjust the insulin dose accordingly.
This is discussed here (University
of Leicester, permission to use applied for) clearly explains how to count
carbohydrate. (Page 8 onwards).
Essentially you have to start to weigh the carbohydrate for each meal for
a while, until you learn the portion sizes. You work out how much insulin
you need for 50g of pasta, or 50 g rice, and so on. You then inject different
amounts of insulin of adjust your insulin pump according to the type of carbohydrate,
the amount, and so on.
Even fatty foods will need some extra insulin, and you can learn how much. This
you to count your carbohydrates, so you can work out your insulin dose
(you need to register and log in).