Diabetes Management

A diabetic diet follows a specific set of dietary guidelines that have been developed by the American Diabetes Association and the American Dietetic Association to improve the management of diabetes. The goal of this diet is weight management through the reduction of calories, daily intake of dietary fat (specifically saturated fat) and individualization of carbohydrate intake based on the type of diabetes a person has and the level of control over blood sugar levels.

There are two primary types of diabetes.

Type 1
diabetes is known as insulin-dependent diabetes mellitus (IDDM) formerly called juvenile-onset diabetes. This type usually starts in children, whereby the pancreas does not produce insulin. Type 2 diabetes is known as noninsulin-dependent diabetes mellitus (NIDDM) formerly known as adult-onset diabetes.

Type 2
diabetes accounts for more than 90% of all diabetes cases. In this type, the pancreas will produce insulin, however, the body's tissues do not respond well to the insulin signal to metabolize glucose properly, a condition called insulin resistance.

The nutritional goals for type 1 and type 2 diabetes are different. Type 1 diabetes focuses mostly on matching food intake to insulin. With type 1 diabetes, studies show that total carbohydrates have the most effect on the amount of insulin needed to maintain blood sugar control. There is a delicate balance of carbohydrate intake, insulin, and physical activity that is necessary for optimal blood levels of a sugar. If these components are not in balance, there can be wide fluctuations in blood glucose levels. For those with type 1 diabetes, on a fixed dose of insulin, the carbohydrate content of meals and snacks should be consistent from day to day.

With type 2 diabetes, the main focus is on weight control, because 80-90% of people with this disease are overweight. A meal plan, with reduced calories, even distribution of carbohydrates, and the replacement of some carbohydrates with healthier monounsaturated fats helps improve blood glucose levels. Examples of foods high in monounsaturated fat include peanut or almond butter, almonds, walnuts, and other nuts. These can be substituted for carbohydrates, but portions should be small because these foods are high in calories.

Reduce the amount of dietary fat.
The current American Diabetes association guidelines advise that less than 7-10% of calories should come from saturated fat. These are the fats that raise LDL ("bad") cholesterol. Dietary cholesterol should be less than 200-300mg per day. Additionally, intake of trans-unsaturated fats should be minimized. These are better known as partially hydrogenated oils. Reducing fat intake may also help contribute to modest weight loss.

Keep protein intake in the range of 15-20% of total calories.
Choices low in fat are recommended such as nonfat dairy products, legumes, skinless poultry, fish and lean meats. To keep cholesterol content in range, approximately 6 ounces of protein per day is recommended. This is about the size of 2 decks of cards.

Increase intake of dietary fiber.
Carbohydrate choices should come from whole grain breads, cereals, pasta, brown rice, beans, fruits and vegetables. Increasing dietary fiber is a general guideline for the entire population rather than specifically for people with diabetes. Portions and type of carbohydrates affect calories and is reflected by weight and blood glucose control. Learning to read labels for total carbohydrates rather than sugar provides the best information for blood glucose control.

Limit sources of high calorie and low nutritional value foods.
This includes those with a high content of sugar. Other carbohydrate sources (such as potatoes) are recommended instead of high-sugar-containing foods with little nutritional value