Introduction

Type 2 diabetes is a prevalent illness leading to elevated blood glucose levels. Individuals with this disease will experience symptoms, such as excessive thirst, frequent urination, and fatigue, but some may be asymptomatic. This condition heightens the risk of severe complications affecting the eyes, feet, heart, and nerves. Characterised as a persistent ailment, it can significantly impact daily life. Nutrition therapy plays a vital role in the prevention and management of diabetes.  In the past, people believed that avoiding carbohydrates was the best approach, but now experts recommend a more holistic approach to diabetes management. Recent evidence highlights the importance of a balanced diet for individuals with this condition.

In this article, we explore the latest findings in the field of medical nutrition for people with type 2 diabetes. Instead of a "special diabetic diet," a healthy diet that helps maintain an optimal weight is now recognised as more beneficial. The focus is on promoting overall health in individuals with diabetes.

To learn more about the changing landscape of dietary recommendations for diabetes care, keep reading.

Understanding diet in diabetes

The diet of an individual with diabetes should be balanced and not so different from that recommended for a non-diabetic. A balanced diet attains more importance because of the consequence of deviation in individuals with diabetes.

The goals for Medical Nutrition Therapy (MNT) for individuals with diabetes can be found in the article on nutrition recommendations for diabetes by the American  Diabetes Association.¹

If you are contemplating the incorporation of evidence-based objectives into your dietary routine, it will be beneficial to seek guidance from a nutrition specialist, such as a registered dietitian. Engaging with a dietitian will facilitate the personalised customisation of dietary plans, ensuring alignment with the recommended health and wellness goals. This professional approach enhances the effectiveness of your dietary choices and assists in achieving specific health objectives through tailored nutritional strategies.

Healthy food groups

A balanced diet contains all classes of food in their right proportions. This is required for the maintenance of healthy living in both individuals with diabetes and non-diabetic people. Let's look closely at the various food groups and their implications for diabetes.

Macronutrients

The three principal ones include; carbohydrates, protein and fats. All three are involved in calorie generation. They are vital in preventing hypoglycemia and ensuring sustained energy levels in individuals with diabetes. However, they are also involved in weight gain when energy intake is not matched with energy usage. 

Carbohydrates

Contrary to past practices of carbohydrate avoidance as a form of nutritional therapy in diabetes, recent evidence suggests that there is no merit in excluding a specific calorie source. Instead, emphasis is placed on considering the entirety of calorie intake, regardless of the source.¹

Being overweight has been linked to insulin resistance. Thus a diet that encourages weight loss in obese individuals will be a good way to manage diabetes. A low-carb diet is just one way this can be achieved. Physical exercise is another.¹

This means that having smaller portions of food (to derive fewer calories) is more important than abstaining from a particular macronutrient. It has been said that “Variety is the spice of life”. Being diabetic should not prevent anyone from enjoying the variety offered by the different macronutrients. Instead, the key is moderation. 

Protein

Protein aids in stabilising blood sugars by slowing down the absorption of carbohydrates and sugars. Since protein breaks down into glucose at a slower rate than carbohydrates, its impact on blood glucose levels typically occurs gradually over a few hours.

Fats

In terms of blood glucose levels, fats exhibit a limited direct impact, rendering them a viable energy source for those with diabetes. Integrating wholesome fats into a well-rounded diet is crucial, with a focus on the benefits of monounsaturated fats. Examples of foods with good fat include olive oil, avocados, and fish oil.

Other macronutrients including fibre and water should be taken as recommended. Fiber is particularly important in helping maintain a healthy weight which is necessary for diabetic prevention, remission or management. 

Micronutrients

These are equally as important in diabetics as they are for non-diabetics. They consist of vitamins and minerals that support healthy bodily function such as vitamin D, zinc, vitamin C, iron, magnesium, calcium and more.

This shift in perspective acknowledges the importance of a holistic approach to dietary choices for individuals managing diabetes, fostering a more comprehensive understanding of nutritional needs and overall well-being.

Meal planning

A good way to achieve the goals of medical nutrition for individuals living with diabetes is to introduce meal planning. One can do this with the help of a dietician. You can also extrapolate what food item fulfils the different goals of MNT according to the ADA and implement it in your meal plan. This helps incorporate healthy combinations and enables you to effortlessly keep a healthy habit. Some available resources you can explore for your meal plans; are meal plan ideas and snacking ideas.

Evidence-based guidance for diabetes 

The evidence available stipulates this guidance for the different groups of food available.

Carbohydrates

Monitoring carbohydrates, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control.¹ Opting for low-carbohydrate diets may appear to be a rational strategy for reducing postprandial glucose levels (after eating). 

Nevertheless, it's crucial to recognise that carbohydrate-rich foods also serve as vital sources of energy, fibre, vitamins, and minerals. As such, these foods are essential components in the diets of individuals managing diabetes. The intricate balance between managing glucose levels and ensuring a well-rounded nutritional intake underscores the recommendation for a balanced diet including carbohydrates.¹ 

However, not all carbohydrates are equal, Brand-Miller et al. 2003 in their meta-analysis study found that opting for low-glycemic index (GI) foods, instead of conventional or high-GI options, yields a small yet clinically valuable impact on medium-term glycemic control in individuals with diabetes. This additional benefit closely mirrors the effects achieved by pharmacological agents designed to address postprandial hyperglycemia.² It is thus worthwhile to choose your carbohydrates wisely and avoid high GI options, especially added sugars. 

Protein 

Incorporating protein into the diet is unlikely to increase glycemia​ and may, in fact, have beneficial effects on blood glucose regulation. There is however no evidence suggesting a higher protein diet for diabetes. Moreover, the long-term effects of a high-protein diet on kidney function for individuals with diabetes are unknown. It is thus recommended that the usual protein requirement be maintained for individuals with diabetes. The dietary intake of protein for individuals with diabetes is similar to that of the general public and usually does not exceed 20% of energy intake.¹

Fats and cholesterol

The key objective regarding dietary fat for individuals with diabetes is to restrict the intake of saturated fatty acids, trans fatty acids, and cholesterol, aiming to minimise the risk of cardiovascular disease. It is generally advised to keep consumption of these fats to a minimum.³

Fiber 

Research indicates that a high-fiber diet lowers glycemia levels. Moreover, there is also evidence suggesting that individuals with type 2 diabetes may experience reduced hyperinsulinemia and lipemia when incorporating a high-fibre diet into their nutritional regimen.⁴ Thus encouraging higher fibre intake seems beneficial for individuals with diabetes, the primary focus could be to motivate them to meet the general population's fibre intake target of 14 g/1,000 kcal.⁵

Micronutrients

This again mirrors the requirement of the general public. There is no clear evidence to suggest increasing this with supplements except in specific cases where indicated. Salt is however advised to be kept to a minimum consumption.³

One thing you immediately notice is that the dietary recommendations are very similar to that applicable to everyone for healthy living, not just individuals living with diabetes 

Lifestyle and diabetes management

It should be noted that dietary modification, while one of the most important steps in managing or even preventing diabetes, is not the only method. Other lifestyle modifications are also recommended. One that stands out and has been shown to increase insulin sensitivity independent of diet is physical exercise.³ While the recommendations state that one can take the calories albeit moderately, the follow-up advice is to also engage in physical exercise to burn the amount consumed. 

Engaging in physical activity is essential to mitigate the potential loss of lean body mass associated with energy restriction. Exercise training plays a significant role in curtailing the decrease in maximal aerobic capacity linked to ageing, enhancing factors that reduce the risk of atherosclerosis, slowing the age-related decline in lean body mass, reducing central adiposity, and enhancing insulin sensitivity. These benefits are particularly advantageous for older adults with diabetes and in cardiovascular health which can also be a challenge in diabetics.^6,7It is however, recommended to seek advice from a healthcare professional, as exercise may present potential risks, including cardiac ischemia, musculoskeletal injuries, and hypoglycemia, particularly for individuals undergoing treatment with insulin or insulin secretagogues. Some recommendations by theNHS include; fast walking, climbing stairs, doing more strenuous housework or gardening.³

Summary

In conclusion, adopting a holistic approach, embracing a balanced diet, adhering to MNT goals, seeking personalised guidance, and incorporating lifestyle changes are integral components of effective type 2 diabetes management.

FAQs

• Is the same diet required for the prevention of diabetes and diabetic management? 

Although similar, there are slight differences in the diets recommended to prevent diabetes and manage diabetes.

• Can a diabetic eat carbohydrates? 

Yes, individuals with diabetes are encouraged to eat a balanced diet while limiting their sugar, fat, and salt intake.

• Can diabetes go into remission with diet therapy? 

Lifestyle modification (diet and physical exercise) in the early stage of diabetes can lead to remission of pre-diabetics.