Diabetes Diet

In broad terms, dietary advice for a person newly diagnosed with diabetes is likely to include the following.

• Eat three, well-spaced meals a day, preferably at the same, regular times and do not miss meals. This is especially important for people being treated with insulin or the category of oral antidiabetic drugs known as sulphonylureas. These people are also likely to need additional snacks, for example, just before bedtime, to reduce the risk of hypoglycaemia.
• Cut down on sugar and avoid obviously sugary foods. Modern advice is that there is no need to avoid sugar completely, as this is very difficult anyway, but to switch to low-sugar or sugar-free varieties of manufactured foods and drinks. Sweeteners should be used in coffee, tea or home-prepared foods such as stewed fruit, custard etc. Many home-baking recipes can be adapted to contain less sugar (and fat) so that favourite foods can still be enjoyed in moderation. Diabetes UK produces a helpful booklet containing useful tips and recipes. Small quantities of sweets or chocolate are usually permissible, as long as they are only eaten sparingly and after a high carbohydrate meal. People with Type 1 diabetes occasionally require some form of sugar (often a sweet drink, jam, honey or glucose sweets), to treat a itypoglycaemic attack or 'hypo'.
• Eat more foods containing starch and fibre. Starch is a complex carbohydrate which takes a longer time to be digested and absorbed into the bloodstream as glucose. This is particularly helpful in diabetes as it avoids the 'peaking' of blood glucose levels that tends to occur when simple carbohydrates such as sugar are eaten. Eating starch, especially when combined with fibre, slows digestion and provides a steady and sustained supply of energy which is particularly helpful in diabetes, especially for those receiving insulin. Good sources of starch include cereals, bread, pasta, potatoes, pulses etc., and it is recommended that these foods should provide 55 per cent of total calories for those with diabetes.

• Eat more fresh fruit, vegetables and salad. It is recommended that everyone should eat at least five portions of fresh fruit and vegetables each day (not including potatoes) and these foods are especially important in diabetes. They not only supply carbohydrate and soluble fibre but vitamins, minerals and antioxidants which are beneficial for health and may help to protect against heart and circulatory disease and some cancers. Fruit is an ideal snack for a person with diabetes and can be helpful in a weight-loss programme as it is low in fat and calories. Although it contains some sugar (in the form of fructose), fruit has a small effect overall on levels of blood glucose. For those with Type 1 diabetes, it can be eaten as a replacement for other forms of carbohydrate.
• Change to a low-fat (but not a no-fat) diet and in particular, cut down on consumption of saturated fats. Saturated fats are the type found in red meat, butter, full-fat milk, cheese and cream and some other dairy products and are 'hidden' in many manufactured foods such as meat pies, sausages, biscuits, cakes etc. Excess consumption of saturated fats in Western diets is held to be responsible for many cases of heart and circulatory disease. Also, it is heavily implicated in the development of obesity and its consequences, which may include the development of insulin resistance and Type 2 diabetes. Polyunsaturated or monounsaturated fats such as those found in vegetable oils (sunflower, olive, safflower, soya etc.) and margarines should be eaten sparingly as a substitute for saturated fats. For those with diabetes, it is recommended that no more than 35 per cent of total daily calories should be derived from fats, with a preferred level at about 30 per cent. Saturated fat consumption should be no greater than 10 per cent of the total with the remainder being poly- or monounsaturated fats. Oily fish, which are a source of polyunsaturated fats, contain omega-3 fish oils which have been shown to be protective against heart and circulatory disease and these should be eaten regularly. All these recommendations are equally applicable to people who are not affected by diabetes.
• In order to reduce overall fat intake and to choose the 'right' sort of fat, the following guidelines may be given.
• Change to semi-skimmed or skimmed milk.
• Use low-fat spreads sparingly instead of full-fat, hard margarine or butter.
• Do not fry or roast food - grill, bake, boil, steam or microwave it instead. Stir-frying, with just a smear of oil, is a good method too.
• Cut off all visible fat from meat before cooking and choose lean varieties. Eat smaller portions, less frequently and choose lean chicken or turkey (the white meat is lower in fat), fish, shellfish or pulses as an alternative to red meat.
• Cut right down on consumption of manufactured high-fat foods such as pies, sausages, biscuits, cakes and chocolate. Eat less pastry.
• There are many fat-reduced types of popular cheeses such as cheddar, now available. Change to these and eat them sparingly. Try low fat varieties such as cottage cheese or fat-reduced soft cheese for a change.
• Bulk out stews, casseroles etc. with vegetables and pulses and reduce the amount of meat used. Try soya or quorn mince as a substitute for beef mince in bolognese etc.
• For most people with diabetes, it is recommended that no more than 15 per cent of the total daily intake of calories should be derived from protein. Protein is found both in foods of animal origin (meat, fish, poultry, eggs, cheese etc.) and in vegetable-based ones (such as pulses, nuts, wholegrains, seeds). Small portions of protein-rich foods should be eaten regularly by people with diabetes, as part of a balanced diet. Fish, including oily fish, is a valuable source of animal protein as well as having other beneficial properties. However, some people, especially those with Type 1 syndrome, may be recommended to follow a protein-restricted diet, obtaining no more than 12 per cent of daily total calories from protein-rich foods. This particularly applies to those with early diabetic nephropathy for whom there is some evidence that restriction of protein intake may slow progression of the condition. For people with advanced nephropathy, more severe protein restriction may be needed, under medical supervision.
• Restrict alcohol consumption. Evidence suggests that for most people with diabetes (especially for those with Type 2 syndrome), moderate consumption of alcohol within recommended safe limits may be beneficial. Modest drinking is associated with a lowered risk of coronary heart disease and atherosclerosis, a lower level of circulating insulin, a higher level of helpful HDL cholesterol and a reduction in blood-clotting tendency. There may be a decreased risk of developing Type 2 diabetes among those who drink moderately. A safe and health-enhancing level of alcohol consumption has been set at:
• no more than 30 g or 3 units each day for men
• no more than 20 g or 2 units each day for women.

It is further recommended that there should be one or two alcohol-free days each week and that total weekly consumption should not exceed 21 units for men and 14 units for women. Drinking alcohol at a greater level than this not only wipes out all the potential benefits but also has proven detrimental effects upon health. People with diabetes, especially those who are at risk of hypoglycaemia, have to be particularly careful with alcohol. Most alcoholic drinks have a high sugar/calorie content and hence are not helpful for those trying to lose weight. It is sensible to avoid alcoholic drinks with a high sugar content such as sweet wines, sherries and liqueurs.
However, the main risk is that of hypoglycaemia, in those who are receiving treatment with sulphonylureas or insulin, which can occur many hours after the alcohol has been consumed and even the next day, in some cases. In susceptible people, hypoglycaemia can occur even when they have consumed a modest amount of alcohol, which would not normally be expected to cause problems or intoxication. A further risk for diabetic people is that symptoms of hypoglycaemia can all too easily be mistaken for drunkenness and appropriate help may not be forthcoming. The reason why alcohol poses particular problems lies with metabolic processes in the liver. Metabolism of alcohol inhibits gluconeogenesis which would normally produce glucose, and risks are particularly high after a fast. In order to lessen the chance of alcohol-related hypoglycaemia, people at risk are given the following advice.

• Limit alcohol consumption and only drink while eating a high-carbohydrate containing meal.
• Never drink alcohol on an empty stomach.
• Avoid low-calorie drinks which are often higher in alcohol.
• Be alert to the risk of nocturnal hypoglycaemia or hypoglycaemia which can occur the following day. A high fibre, carbohydrate snack should be eaten before going to bed and you may need to adjust the insulin dose. Ask your clinical diabetes team for advice.
• Alert family and friends to the risk and carry diabetes identification.

Some people with particular complications, such as elevated triglyceride levels in the blood (hypertriglyceridaemia), diabetic neuropathy and persistent hypertension are advised to avoid alcohol altogether.

• Cut down on salt. Most people eat far more salt than they need and this is potentially harmful to health and puts a strain on the kidneys. Excess salt intake may contribute to hypertension and heart and circulatory disorders, both of which pose a particular threat to people with diabetes. This is because many of those with Type 2 diabetes already have high blood pressure to some degree and cutting down on salt, along with losing weight if obese, are measures that can help. There are several fairly simple ways to reduce salt intake.
• Eat fewer manufactured foods, which often have a high salt content. Check labels carefully.
• In home cooking, try flavouring foods with herbs and spices and use little or no salt.
• Do not add salt at the table.
• Do not use potassium salt substitutes without first obtaining medical advice.