Diabetes Outreach Network
QUICK REFERENCE GUIDE TO DIABETES FOR HEALTH CARE PROVIDERS

Chapter 3
Nutrition and Diabetes

Meal plans for persons with diabetes can vary dramatically based on lipid levels, glucose control, weight loss goals, insulin use, activity habits and other health concerns. The majority of persons with diabetes are overweight, and it has been discovered that even a small amount of weight loss (10-20 pounds or 5-9 kg) can greatly assist with glycemic control, even if the person does not attain a desirable body weight. For most individuals, therapeutic lifestyle change (TLC) is the best strategy for weight loss. TLC involves a reduction in calorie intake combined with an increase in physical activity.

In General, Persons with Diabetes...

• Do not need any special diet foods (Some of the reduced calorie items can be useful).
• Benefit from eating on a regular basis (every 4-5 hours).
• Benefit from eating consistent amounts of carbohydrates (from fruit, milk, bread/starch, and sweets) at meals.
• Benefit from eating high fiber foods (dried beans, fruits, vegetables and whole grains) everyday.
• Can eat foods that are good for the whole family.
• Benefit from decreasing portion sizes, if weight is a concern.
• Benefit from limiting alcohol and if drinking, only drinking with meals.
• Benefit from eating a wide variety of foods.
• Need to limit the amount of saturated fat and hydrogenated or trans fat consumed - found in animal products such as cheese, hamburger, bacon, butter, as well as processed snack foods, shortening and other fats which are solid at room temperature.

Regular meetings with a registered dietitian are recommended to help persons with diabetes develop a meal plan that works for them.

Sugar and Diabetes
Most persons with diabetes can also include some sugar in their meal plan. Sugar containing foods must be substituted for some of the other carbohydrate (bread and starches, fruits, vegetables or milk) at a meal. Also, if the product is high in fat, less fat should be added to the rest of the meal.

Fat Intake and Diabetes
Because individuals with diabetes have an increased risk of heart disease, it is recommended they follow the guidelines from the National Cholesterol Education Program for fat intake. These guidelines recommend a total fat intake of 25-35% of calories, with < 7% from saturated fat. Fat intake from trans fat should be minimal. When substituted for saturated fats, monounsaturated fats can decrease LDL cholesterol and triglyceride levels without decreasing HDL levels. Monounsaturated fats are found in most nuts, olive oil, canola oil, peanut butter and avocados.

Sugar-free Products
Not all sugar-free products are reduced calorie items. If it contains aspartame, saccharin, acesulfame K, or sucralose, the calorie and carbohydrate content may be lower than the regular product, and it may be useful for the person with diabetes. If the item is sweetened with fruit juice, honey, fructose, sugar alcohol (e.g. sorbitol), molasses or any other sugar replacement product, it may not be a calorie or carbohydrate-reduced product! There is no real benefit to using these products in place of sugar-sweetened products.

Additional Help for the Overweight Client

• Determine if your client is truly ready to lose weight. Are they intending to make changes within the next six months to lose weight? If no, client may need to explore in more detail the benefits of weight loss.
• Set reasonable goals. A 10-15% weight loss is generally achievable.
• Do they have a problem with binge eating or bulimia? An eating disorder clinic or specially trained counselor may be needed.
• A good understanding of nutrition is necessary--a registered dietitian can help.
• Mild caloric restrictions are easier to adapt to (250-500 calorie deficit.)
• Surgical intervention or medication may be options for some obese persons.
• Regular physical activity is key in helping maintain weight loss.

Many nutrition handouts are available through the Diabetes Outreach Networks
go to www.diabetesinmichigan.org.

References: American Diabetes Association (2006). Clinical Practice Recommendations. Diabetes Care, Vol 29 (1).