in the Dietary Management of Diabetes
By Roslyn Smith
Accredited Practicing Dietitian, 18 years
Senior Diabetes Dietitian, 15 years
What is the right diet for diabetes? Opinions abound!
Sugar-free, paleo, low GI, low carb…
Week by week the media churns out the latest dietary fads, leaving the average person with diabetes very confused.
In the quest for a quick-fix answer, one ingredient is often left behind. Common sense!
In truth, there is no one-size-fits-all diet for diabetes. How can there be? So many factors affect a person’s dietary needs. For example:
Type of diabetes and other health conditions
- Medications
- Food preferences
- Social and emotional needs
- Culture, work, physical activity and lifestyle
Type 1 verses Type 2 Diabetes
Take for example, Type 1 verses Type 2 diabetes.
In Type 1 diabetes, the pancreas cannot make insulin, the key hormone that controls blood sugar (glucose). Insulin is given via injections or pump device.
For good glucose control, insulin doses must be carefully matched to the amount
of carbohydrate eaten. Knowing how much carbohydrate is in foods is critical. Healthy
eating alone will not control blood glucose. Neither will exercising or losing weight.
Type 2 diabetes is different. Here, the body does not respond well to insulin.
This places the pancreas under stress, so it cannot make enough insulin in certain situations. The result is high blood glucose. Weight loss, exercise and healthy eating improve the body’s insulin response, so can lead to better glucose control for many people.
Two Carbohydrate Myths
Myth 1: People with diabetes should avoid all sweet foods
It is true that most people with diabetes need to limit foods with heavy sugar content, such as rich desserts & biscuits, cakes, soft-drinks and chocolates. (On occasions these are OK, but not on a regular basis).
Even so, not all sweet foods lead to problems…and some non-sweet foods can!
If someone carefully avoids putting 1 teaspoon of sugar in a cup of tea, but then eats 2 cups of rice for lunch, they are misguided.
Two cups of cooked rice will release the same as 20 (twenty!) teaspoons of sugar
into the blood…and it doesn’t taste sweet.
In Type 2 diabetes, a better amount of rice for a meal will be one cup, not two.
Similarly, some people avoid sweetened yoghurts, milks and fruits, yet eat large amounts of bread.
However most fruits and milk products are low glycaemic index. This means glucose is released slowly into the blood.
In contrast, white, wholemeal and many other breads are high glycaemic index: fast
glucose release.
This means fruits and milk products (including sweetened types) are less likely to lead to high glucose than the same amount of carbohydrate as wholemeal bread.
In Type 2 diabetes, a sensible amount of bread is often two slices at a meal (look for a low GI brand), followed 2-3 hours later by a tub of yoghurt or piece of fruit.
Myth 2: People with diabetes should follow a low carbohydrate diet
Low carbohydrate diets may improve weight and blood glucose in the short-term. However, the long term picture is unclear. Very little research has been done beyond 6-12 months.
For starters, most people cannot follow a low carb diet for longer than a few weeks. They get too bored…and often, constipated!
Imagine having no breads, cereals, pasta, potato, corn, rice, fruit or milk. In fact, most foods made from flours and grains are off limits in a low carb diet. This leaves mainly meats, eggs, cheese, oils, fats and certain vegetables.
As you can imagine, low carb diets are often inadequate in nutrients and fibre, yet high in protein and animal fats.
Animal fats can increase long-term risk of heart disease, kidney disease and insulin resistance. This means that even if glucose levels improve short-term, down the track they may worsen.
For Type 2 diabetes, a better approach is often ‘carbohydrate spreading’.
Instead of eating one or two big meals per day, carbohydrate is divided into small regular amounts. This puts less strain on the pancreas, and improves glucose levels.
Low glycaemic index (low GI) carbohydrates can also help, by releasing glucose
slowly into the blood.
Low GI foods include:
- certain wholegrain breads, grains and cereals;
- most fruits
- most dairy products
- most nuts and legumes (lentils and beans)
For more details, visit www.glycemicindex.com.
Getting personalised help
With so many factors in play, people with diabetes need personalised diet assessment and advice. This is best provided by an Accredited Practicing Dietitian (APD).
APD’s are university-trained in the science of nutrition, so are able to judge fact from fiction.
To find an APD, contact your local hospital or visit www.daa.asn.au.
Interested in becoming a Credentialled Diabetes Educator? Read more about our Graduate Certificate in Diabetes Education and Management
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