A diabetes diet is a healthy eating plan that helps control blood sugar. It simply means eating the healthiest foods in moderate amounts and sticking to regular mealtimes. It's a healthy-eating plan that's naturally rich in nutrients and low in fat and calories, with key elements being fruits, vegetables, and whole grains.
Introduction: The Evolving Landscape of Diabetic Diets
Dietary advice for those with diabetes has evolved and become more flexible and patient-centered over time. The modern diet for those with diabetes is based on concepts from clinical research, portion control, and individualized lifestyle change.
General Goals: Setting the Foundation for Healthy Eating
Nutrition goals from the American Diabetes Association (ADA) 2024 include the following:
- To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health and:
- Achieve and maintain body weight goals.
- Attain individualized glycemic, blood pressure, and lipid goals.
- Delay or prevent the complications of diabetes.
- To address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and existing barriers to change.
- To maintain the pleasure of eating by providing nonjudgmental messages about food choices while limiting food choices only when indicated by scientific evidence.
- To provide an individual with diabetes the practical tools for developing healthy eating patterns rather than focusing on individual macronutrients, micronutrients, or single foods.
The American Association of Clinical Endocrinologists (AACE) guidelines have similar nutrition goals for people with type 2 diabetes.
Putting Goals Into Practice
The Diabetes Control and Complications Trial (DCCT) and other studies demonstrated the added value individualized consultation with a registered dietitian familiar with diabetes treatments, along with regular follow-up, has on long-term outcomes and is highly recommended to aid in lifestyle compliance (4). Medical nutrition therapy (MNT) implemented by a registered dietitian is associated with A1C reductions of 1.0-1.9% for people with type 1 diabetes and 0.3-2.0% for people with type 2 diabetes (1).
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Understanding Macronutrients: The Building Blocks of Your Diet
Many studies have been completed to attempt to determine the optimal combination of macronutrients. Based on available data, the best mix of carbohydrate, protein, and fat depends on the individual metabolic goals and preferences of the person with diabetes. It’s most important to ensure that total energy intake is kept in mind for weight loss or maintenance (1).
Carbohydrates: Fueling Your Body Wisely
The primary goal in the management of diabetes is to achieve as near normal regulation of blood glucose as possible. Both the type and total amount of carbohydrate (CHO) consumed influences glycemia. Carbohydrate intake should emphasize nutrient-dense carbohydrate sources that are high in fiber (at least 14 g fiber per 1,000 kcal) and minimally processed (1). Dietary carbohydrate includes sugars, starch, and dietary fiber.
Dietary Fiber
Current recommendations from the American Diabetes Association are that adults with diabetes should consume high fiber foods (at least 14g fiber per 1,000 kcal) (1). Current recommendations from the European Association for the Study of Diabetes are that adults with diabetes should consume at least 35g dietary fiber per day (or 16.7g per 1,000 kcal) (10). These two values are aligned, and higher than current World Health Organization recommendations for the general population of at least 25g dietary fiber per day, (7) although all three recommendations recognize a minimum intake level, with greater benefits observed with higher intakes. These values are appreciably higher than current dietary fiber intakes in the United States, which is approximately 16g per day.
Starch
Starch comprises most of the carbohydrates consumed globally, and is the storage carbohydrate found in refined cereals, potatoes, legumes, and bananas (16). Starch comprises two polymers: amylose (DP ~ 103) and amylopectin (DP ~ 104-105). Most cereal starches comprise 15-30% amylose and 70-85% amylopectin. In their raw form, most starches are resistant to digestion by pancreatic amylase, but gelatinize in heat and water, permitting rapid digestion (16).
Resistant Starches
Resistant starches are starch enclosed within intact cell walls. These include some legumes, starch granules in raw potato, retrograde amylose from plants modified to increase amylose content, or high-amylose containing foods, such as specially formulated cornstarch, which are not digested and absorbed as glucose. Resistant starches avoid digestion in the small intestine so do not contribute to postprandial glycemia and diabetes risk, and are instead fermented in the colon by the microbiota.
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Sugars (Nutritive Sweeteners)
Sucrose, also known as “table sugar,” is a disaccharide composed of one glucose and one fructose molecule and provides 4 kcals per gram (16). Available evidence from clinical studies does not indicate that the overall amount of dietary sucrose is related to type 2 diabetes incidence, however it is related to body weight gain and increased dental caries (5). Given the association between excess body weight and type 2 diabetes occurrence, (18) there is rationale to promote a reduction of sugar intake related to diabetes occurrence, and replace sugar-sweetened beverages (including fruit juices) with water or no/low calorie beverages as much as possible (1).
Protein: The Building Blocks of Life
Protein is an important part of a diabetes meal plan. There are plenty of protein-rich plant-based options, such as beans, hummus, lentils, and others. However, many legumes do have carbs which can have an impact on your diabetes management.
Fats: Choosing Wisely for Heart Health
Focus on adding healthy fats (like monounsaturated and polyunsaturated fats) to help lower your cholesterol and protect your heart. Healthy fats can be found in foods like olive oil, nuts, avocados, some types of fish, and a host of other tasty options.
Practical Strategies for Meal Planning
A meal plan is your guide for when, what, and how much to eat. Your plan will help make sure you get the nutrition you need while keeping your blood sugar levels on target.
The Diabetes Plate Method: A Visual Guide
Simplify healthy eating with the Diabetes Plate- a low-carb meal pattern jumpstart that helps you portion your plate and support your diabetes management. Start with a nine-inch plate and fill half with non-starchy veggies, one-quarter with lean proteins, and one-quarter with quality carbs like starchy vegetables, fruits, whole grains, or low-fat dairy.
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Non-Starchy Vegetables
Using the Diabetes Plate as your guide, fill half your plate with non-starchy vegetables for a healthy meal. Non-starchy vegetables include broccoli, carrots, cauliflower, and more!
Fruits: A Sweet Treat with Benefits
While fruit does count as a carbohydrate food, they are loaded with vitamins, minerals, and fiber just like vegetables. Fruit can also help you satisfy your sweet tooth without the added sugar.
Making Informed Food Choices
Informed food choices are essential to living well. Food fuels the body and is a key part of diabetes management. However, no matter what eating plan you follow, there are some basic guidelines that apply across the board. What all healthy eating plans have in common:
- Non-starchy vegetables as a foundation for the plate
- Lean proteins and plant-based sources of protein
- Quality carbohydrates like starchy vegetables, fruits, whole grains, and low-fat milk
- Less added sugar
- Healthy fats
- Less processed foods
- Water or zero-calorie beverages
Diabetes Superstar Foods
To help create healthy meals, choose foods that give you more bang for your nutrition buck. These are often called “nutrient-dense” foods, which means they have high nutritional value.
Additional Considerations for Diabetes Management
Blood Sugar Levels
Blood sugar levels are important indications of prediabetes, and it’s no secret that most Americans eat more sugar than they should. Though some sugar is necessary for your body to function, too much can worsen prediabetes.
Sweetened Beverages
We urge our patients to watch what they drink,” Seymour says, noting that sweetened beverages such as sodas, sports drinks, juices and gourmet coffee shop creations account for some of the biggest concentrated sources of added sugar.
Physical Activity
Physical activity can help prevent diabetes while boosting heart health. Seymour recommends that people with prediabetes try to get at least 150 minutes per week of moderate to vigorous exercise or aim for 10,000 daily steps.
Weight Management
To steer away from type 2 diabetes, Seymour says men and women should try to achieve and maintain a body mass index of 25 or lower. Even small amounts of weight loss can have a benefit.
Sleep
The relationship among sleep, diabetes and weight gain is important to understand. “Sleep deprivation has been shown to increase people’s cravings for sugary foods,” Seymour says.
Monitoring Your Health
Seymour says people with prediabetes should be vigilant about their laboratory test results. “Know your ABCs,” she advises. “That’s A1C, blood pressure and cholesterol."
Alcohol Consumption
Drink alcohol in moderation only if you can account for the calories in your daily meal plan. Moderate drinking is defined as one standard drink a day for women and up to two a day for men. You must be cautious, however. Alcohol can worsen low blood sugar reactions in people who take insulin or certain other diabetes medications.
The Importance of Professional Guidance
Because everyone is different and many people with prediabetes have other health issues, Seymour says it is important to tailor prediabetes food plans to the individual. Working with a doctor or dietitian can be helpful. “People diagnosed with prediabetes can ask their primary care practitioner for a referral to a local registered dietitian,” Seymour says. If you have diabetes or prediabetes, your health care provider will likely recommend that you see a dietitian to help you develop a healthy-eating plan. A registered dietitian can help you put together a diet based on your health goals, tastes and lifestyle. The dietitian also can talk with you about how to improve your eating habits.
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