Diet

Diet is so important for diabetes management that we would be wrong to say too much here.Diabetes UK will give you all the information and tips you need. Your doctor, medical carers and ideally a dietitian should advise you. You must have the best information you can get about diet with diabetes. Check our Diabetes Self Help list.

As a quick digest of advice we look at the Diabetes UK website, which freely admits that balancing your diet when you are diagnosed with diabetes can be challenging. On the up-side it says that although the food choices you make and your eating habits are important in helping you manage your diabetes, you should be able to continue enjoying a wide variety of foods as part of healthy eating.

Eating a balanced diet, managing your weight, and following a healthy lifestyle, together with taking any prescribed medication and monitoring where appropriate will benefit your health enormously. Remember, in the long run it is better to make small changes that you feel you can stick to rather than completely altering your diet and not sticking to it.

The objective in balancing your diet is to help you control your:

• blood glucose levels
• blood fats – cholesterol and triglycerides
• blood pressure

It will also help regulate your weight. If you are overweight losing weight will help you control your diabetes and will also reduce your risk of heart disease, high blood pressure and stroke.

Diabetes UK recommends that everyone with diabetes should see a registered dietician at diagnosis, and then have regular reviews for specific advice on their eating habits. Contact Diabetes UK or talk to your doctor about getting this help. Diet is too important to get wrong, so the following information is quoted pretty directly from the Diabetes UK website. We have added emphasis to some points. In general they recommend:

1. Eat three regular meals a day. Avoid skipping meals and spread your breakfast, lunch and evening meal over the day. This will not only help control your appetite but also help in controlling your blood glucose levels.

2. At each meal include starchy carbohydrate foods such as bread, pasta, chapattis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. All varieties are fine but try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much. Better choices include:

• Pasta
• Basmati or easy cook rice
• Grainy breads such as granary, pumpernickel and rye
• New potatoes, sweet potato and yam
• Porridge oats, all bran and bran flakes

The high fibre varieties of starchy foods will also help to maintain the health of your digestive system and prevent problems such as constipation.

3. Cut down on the fat you eat, particularly saturated fats as this type of fat is linked to heart disease. Choose unsaturated fats or oils, especially mono unsaturated fat (eg olive oil and rapeseed oil) as these types of fats are better for your heart. All fats contain calories. Fat is the greatest source of calories so eating less fat and fatty foods will help you to lose weight. Here are some tips to cutting the fat:

• Use less saturated fat by having less butter, margarine, cheese and fatty meats.
• Choose lower fat dairy foods such as skimmed milk, low fat or diet yoghurt, lower fat cheese and lower fat spreads.
• Grill steam or oven bake instead of frying or cooking with oil or other fats.
• Watch out for creamy sauces and dressings and swap for tomato based or other light sauces instead

4. Eat more fruit and vegetables. Aim for at least five servings in total a day to provide you with vitamins and fibre as well as to help you balance your overall diet. A portion is for example:

• a whole banana or apple
• a slice of melon
• two plums
• a handful of grapes
• a cereal bowl of salad
• three heaped tablespoons of vegetables

5. Include more beans or lentils such as kidney beans, butter beans, chickpeas, red and green lentils, as these can help to control your blood glucose levels and blood fats. Try adding them to stews, casseroles and soups, or to a salad.

6. Aim for at least two portions of oily fish a week. Oily fish contains a type of polyunsaturated fat called omega 3 which helps protect against heart disease. Eat oily fish such as mackerel, sardines, salmon and pilchards.

7. Limit sugar and sugary foods. This does not mean you need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a healthy diet. However, use sugar-free, no added sugar or diet squashes and fizzy drinks, as sugary drinks cause blood glucose levels to rise quickly.

8. Reduce salt in your diet to 6g or less a day – more than this can raise your blood pressure, which can lead to stroke and heart disease. Limit the amount of processed foods you eat and try flavouring foods with herbs and spices instead of salt.

9. Drink alcohol in moderation only – that’s a maximum of two units of alcohol per day for a woman and three units per day for a man. For example, a pub measure (25ml) of spirit or half a pint of normal strength beer is about one unit. Over the years the alcohol content of most drinks has gone up. A drink can now contain more units that you think – a pint of premium lager can contain as much as 3 units, and a small glass of wine (175ml) around 2 units. Remember alcohol contains empty calories so think about cutting back further if you are trying to lose weight. Never drink on an empty stomach, as alcohol can make hypoglycaemia (low blood glucose levels) more likely to occur when taking certain diabetes medication.

The good news here, of course, is there is not necessarily any need to give up alcohol just because you have diabetes. Be aware, however, that: Alcohol makes hypoglycaemia (low blood glucose levels) more likely to occur. However, as long as your diabetes is well controlled, moderate amounts of alcohol in line with the above daily guidelines can be drunk before, during or soon after a meal without affecting short-term blood glucose control.

As above: never drink on an empty stomach. If you are drinking throughout the evening snack on something starchy like crisps. Do not substitute alcoholic drinks for your usual meal or snacks as this may lead to hypoglycaemia (hypo).

Serious hypoglycaemia can occur with larger quantities of alcohol, particularly if you are treated with insulin and especially if too little carbohydrate is eaten. If this could apply to you, always make sure you take some carbohydrate before going to bed after drinking. Useful snacks include toast, cereal and sandwiches, although chips or pizza on the way home may be an easier, albeit unhealthier, option.

The liver gets rid of alcohol at the rate of about 1 unit per hour but this can vary. If you drink more than a few units in the evening you will have an increased risk of hypos that may occur up to 16 hours after heavy drinking. It is vital you keep your blood glucose levels topped up with carbohydrate and always remember to take something at breakfast. Monitor your blood glucose levels closely.

Remember you may be less aware of your hypo symptoms when you are drinking so always wear some form of diabetes identification. A hypo can be confused with drunkenness when there is the smell of alcohol on your breath. Continuous heavy drinking can lead to raised blood pressure so again try to limit your intake.

If you have neuropathy (nerve damage), drinking alcohol can make it worse and increase the pain, tingling, numbness and other symptoms associated with nerve damage.

Drinking low carbohydrate beers and cider offer no benefit because of their higher alcohol content. Low alcohol drinks can be useful if you are driving, but few are alcohol free, so remember if you drink enough of them you may still be over the limit. Low alcohol wines are often higher in sugar than ordinary ones, so if you do choose these, just stick to a glass or two. Drinks with a high sugar content, eg sweet sherries, sweet wines and most liqueurs should be limited. Mixer drinks should be ‘diet’ or ‘sugar free’ such as diet tonic water and diet cola.

Moderate alcohol consumption in line with recommended daily guidelines can be beneficial for your heart. Wine, especially red wine, may offer greater benefit than spirits or beer. However there is currently insufficient evidence to suggest that you take up drinking if you are currently ‘teetotal’ and again, for those of us watching our weight: all types of alcoholic drinks contain calories. Sad but true.

10. Don’t be too tempted by diabetic foods or drinks. They:

• Are expensive
• Tend to contain just as much fat and calories as the ordinary versions
• Can have a laxative effect
• Will still affect your blood glucose levels.

Diabetes UK suggests that if you use artificial sweeteners or products sweetened with them, then you should make sure that you use a variety of brands so as to reduce the risk of exceeding the Acceptable Daily Intake (ADI) for each one.

There are five types of sweeteners that are permitted for use in the UK: aspartame (Nutrasweet), saccharin, acesulfame potassium (acesulfame K), cyclamates and sucralose.

People with the condition Phenylketonuria, a disorder caused by an enzyme deficiency, are unable to metabolise the amino acid phenylalanine that is found in aspartame. They should avoid aspartame for this reason. Check with Diabetes UK for any questions about artificial sweeteners.

Fish and Fish Oils – Diabetes UK Position Statement:

Fish is a good choice for the protein portion of a balanced diet and can offer positive health benefits. White fish such as cod, plaice and haddock are low in fat and therefore helps us to follow a low fat diet. Oily fish are higher in fat than white fish and contain a special type of polyunsaturated fat known as ‘omega 3’ fat. This type of fat has been shown to help protect against heart attacks. It also helps to lower a type of fat in your blood known as triglycerides which is also beneficial for the health of your heart. People with diabetes are all encouraged to try to eat oily fish twice a week (one portion is about 140g). Even though oily fish is higher in fat it is still a good choice if you are trying to lose weight.

Oily fish are generally rich in vitamin D too, which is important to maintain calcium balance in the body. Most of us make our own vitamin D when our skin is exposed to sunlight, but eating foods that contain vitamin D is essential for people who are housebound or rarely expose their skin to sunlight. Examples of oily fish (fresh, frozen or tinned – either in brine, oil or tomato sauce)

• Salmon
• Trout
• Mackerel
• Herring
• Sardines
• Pilchards
• Kipper
• Eel
• Whitebait
• Tuna (fresh only. When tuna is canned the omega-3 is reduced to similar levels found in white fish)
• Sprats

Fish Oil Supplements:

Diabetes UK can only make general recommendations for all people with diabetes and because everyone’s needs are so different we cannot give individualised advice. Diabetes UK does not generally recommend that people with diabetes take any kind of supplements as there is not enough evidence available to support their use in diabetes care. Prescribed doses of fish oil supplements of more than 3g per day also have the potential to worsen blood cholesterol levels especially the LDL cholesterol (the bad type of cholesterol) although the potential benefits of taking the supplement could outweigh this effect.

There is clinical evidence both for and against the use of fish oil supplements. People with diabetes should consult their doctor if they already take fish oils supplements or are thinking about taking them. People who are taking high doses of prescribed fish oil supplements (greater than 3g per day) should ask their doctor to monitor the effect on their cholesterol and triglycerides.

Netdoctor emphasises the importance of diet in controlling Body Weight. Excess weight is associated with:

• high blood pressure
• Type 2 diabetes
• increased risk of cardiovascular disease e.g. heart attack, stroke, angina

We’ve said this many times, but is a clear and recurring point to get and works with: Diabetes, particularly Type 2, is easier to control when your weight is normal. If you have Type 1 diabetes, controlling your weight through a healthy diet will help your blood pressure and reduce your risk of cardiovascular disease.

Netdoctor suggests that a good rule of thumb is to burn an extra 250 calories a day through exercise, and eat 250 calories less per day by reducing the amount of fat and sugary foods in your diet.

If you have diabetes, you should have access to a qualified dietician through your GP or diabetes clinic. Your dietician can help you work out your daily calorie needs, taking into account your age, lifestyle, work and activity levels. Your dietician will identify any problems with your diet and is there to help if you’re having difficulties.

Most of all, your dietician will help you understand the relationship between what you eat and what you need – once you understand this, the diet aspect of diabetes will fall into place.