1. What can I eat?
The food we eat can have a significant impact on our healthy and is typically one of the first things health professionals talk about when someone has just been diagnosed with diabetes. However because there is so much information, people can often feel overwhelmed and are unsure about what they can actually eat.
The good news is that healthy food for most people with diabetes is the same as for the general public. There are no “special” diets or foods for people with diabetes. The whole family can eat the same healthy food. A new diagnosis of diabetes is a good time to have a close look at the food and drink you are having on a regular basis but it doesn’t mean you will have to change every aspect.
So what does a healthy diet look like?
Choose low sugar drinks. Water, plain milk, teas and coffee without sugar are the best options. If you typically drink sugary soft drinks, cordials or fruit juice, sugar-free soft drinks and cordials can help lower your sugar intake.
Eat three meals a day, every day. Don’t skip meals because you think it will help keep your blood sugar levels down. We need to eat regularly through the day so we don’t get too hungry later on and snack or eat larger meals.
Base your meals around the Diabetes NZ Healthy Plate model.
Fill half of your plate or sandwich with lots of non-starchy vegetables like carrots, capsicum, puha, cucumber, mushrooms, pumpkin, watercress and more.
Eat some carbohydrate food like bread, potato, kumara, rice, taro at each meal but not too much. Aim for quarter of your plate to be covered in these types of foods.
The last quarter of the plate is for protein foods like meat, chicken, fish, legumes and eggs.
Eat three to four pieces of fruit spread throughout the day. These can be used to add sweetness and flavour to breakfast cereals, as snacks between meals if needed or at the end of a meal.
Wherever possible eat fresh whole foods from each of the main food groups, fruit and vegetables, breads and cereals, meat and meat alternative and dairy products. These foods tend to be lower in sugar, saturated fat, salt and rich in nutrients and fibre.
Fats and oils are not listed as a food group but it is recommended to eat some heart-friendly fats as part of a regular diet. Examples include olive, canola and sunflower oil, avocadoes and natural, unsalted nuts.
If using manufactured foods, use the Diabetes NZ label reading guidelines in the link below to choose food lower in sugar, saturated fat, salt (sodium) and energy (calories/kilojoules).
2. What can I use instead of sugar?
Diabetes NZ recommends having whole foods and drinks in your daily food intake. These are foods like fruit and vegetables, meat, fish and dairy products that have little or no processing. If you are looking for alternatives to sugar-sweetened drinks when you are thirsty, choose water, milk, sugar-free teas or coffee. Use fruit to add sweetness to breakfast cereals or at the end of a meal. Cutting down on cakes, biscuits and chocolates, and other similar processed foods, can also lower your sugar consumption.
But there are occasions when people with diabetes may want something to add sweetness to a food or drink without the sugar content. They may also be looking for something to help wean themselves off sugary drinks. In these situations they may want to consider an intense sweetener.
Click on this link to find out more about intense sweeteners.
3. What is the best type of exercise I can do?
Regular physical activity is good for everyone and especially for those with diabetes for many health and wellbeing reasons. Aim for at least 30 minutes of physical activity most days of the week. If you are trying to lose weight, at least 60 minutes of physical activity most days of the week is recommended.
You gain the most health benefit from physical activity if you have regular moderate amounts every day rather than a longer session one or two days a week. Choose an activity you enjoy or find a friend to help motivate you.
Aerobic activity is the most beneficial type of activity. This type of activity uses oxygen and will make you breath harder than when you are resting. Examples of aerobic activity include:
Mowing the lawns
Doing the vacuum cleaning
Playing ball games
Aerobics or dance classes
Washing the car
You may need to see your health care team and have a medical check before starting a new type of physical activity or increasing your current level of physical activity.
4. Why do I need to eat breakfast?
Eating regular meals throughout the day helps the body maintain blood glucose levels within the desired range, helping prevent the situations of hypo or hyperglycaemia. Because there is often a huge time gap between the evening meal and the first meal the following day, blood sugar levels can be low. So, having breakfast shortly after getting up is important way of maintaining blood glucose levels within desired levels.
Studies have shown breakfast eaters have increased mental ability, while breakfast skippers report irritability, fatigue and restlessness. In addition, there are only so many occasions to get all the nutrients we need each day. By skipping breakfast you have a much harder time meeting your daily nutrient requirements.
Some people skip breakfast because they think it will help them lose weight. But, skipping breakfast can actually lead to weight gain. If the breakfast meal is missed, there is often more frequent snacking later in the day, serving sizes for other main meals may be larger and higher in fat and sugar content.
Having quick, easy food to prepare can help you put together a nutritious breakfast as you run out the door. Spending a few minutes preparing for breakfast the night before can also save you minutes in the morning, especially if you are not a morning person. Alternatively try waking up a little earlier.
Some people find it easier to eat breakfast once they get to work. This can also be a good option for some people. Ensure you have food on hand for this so you don’t end up buying something from a local café, where they tend to be higher in calories, fat and sugar while being less filling.
Have a suitable breakfast cereal stored at work or put a serve in a container at home the night before. Fresh fruit and a pottle of yoghurt to go with the cereal can be grabbed as you run out the day in the morning. Alternatively, take some wholegrain bread and have spreads stored at work.
Less traditional breakfast meals include:
A fruit smoothie prepared the night before. Add low fat milk and yoghurt, fruit of your choice, rolled oats and a sprinkle of nutmeg or cinnamon.
A fruit muffin with fresh berries and yoghurt on top.
A sandwich with lean meat, hummus or lower fat cheese along with fresh salad ingredients and a flavoursome relish.
5. How often should I eat and do I need to eat snacks?
As previously mentioned, regular meals throughout the day helps control blood glucose levels, preventing them from falling to low leading to a hypo or having fewer, but larger, meals resulting in huge spikes in blood glucose levels. Regular meals also help regulate appetite and weight loss or maintenance.
This is particularly important for someone with diabetes. If there is too large a gap between meals, you run the risk of having a hypo. Alternatively you may simply become too hungry and reach for a higher calorie food, which could raise blood sugar levels in the short term or, over a longer term may lead to weight gain. Aim to eat three similarly sized meals, as a breakfast, lunch and dinner, spread evenly throughout the day.
You don’t have to have a snack between meals just because you have diabetes. Whether you need a snack or not will depend on your insulin and medication regime, blood glucose levels, length of time between meals and physical activity levels. Regular check your blood sugar levels to learn about how your individual blood glucose levels change throughout the day. Talk to your healthcare professional about whether you need to eat between meals for good blood glucose control.
6. What can I eat on special occasions like a birthday, Easter, Christmas?
Food is a key focus for many special occasions like birthdays, Easter and Christmas. These situations can be stressful for people with diabetes but with a little pre-planning, and following basic healthy eating guidelines, these events can still be enjoyed by everyone.
Follow the Diabetes New Zealand Healthy Plate Model when serving your meal. Cover half your plate with non-starchy vegetables, quarter of your plate with meat or meat alternative and a final quarter with some form of carbohydrate food like bread, pasta, rice, kumara or taro. Using a small plate also helps control serving sizes.
Take your time eating the meal. Try putting down your knife and fork between each mouthful. Aim to be the last person at the table to clear their plate. This allows you time to feel full and less likely to go back for seconds.
If you are heading out for a meal as part of a celebration, it helps to review restaurant menus beforehand. This makes it easier to choose a restaurant with a range of healthier options available. Check if you are able to ask for modifications to dishes such as serving the salad with the dressing on the side.
Try sharing a starter or dessert with someone else. Consider whether you need both. It can help to have made a decision at the start of the order process. Enjoying a good quality coffee might be an alternative way to finish off a meal.
If you are attending a celebration at someone else’s house it may be possible to call beforehand to discuss the menu. Offer to bring a dish so you know there will be something suitable for you.
Have a healthy snack and drink of water before heading out so you are not ravenous when you get to the event. This makes it easier to make rational decisions and to avoid starters and pre-dinner nibbles.
If you are organising a celebration, keep in mind that starters and pre-dinner nibbles are not always necessary. But, if they are on the menu, limit the amount of time they are available.
Choose a seat away from the food or stand so the food is not in your line of sight.
Give people suggestions for non-food related gifts to avoid being given unwanted food. A collection of your favourite fruit, any sort of flower, a magazine or book from the second hand store are all similar in price to a box of chocolates.
Visit the Diabetes New Zealand website for healthy, tasty recipe ideas.
Use holidays like Easter and Christmas to be more active. Plan some form of activity with the family as part of the day’s celebrations.
Finally, remember a birthday, Christmas or Easter is only one day out of the year. By following healthy eating recommendations leading up to and following the event, you can be a little more relaxed on the actual day itself.
7. How does carbohydrate affect blood glucose?
When you eat carbohydrates your body breaks them down into glucose (sugar) which is absorbed into the blood stream, raising your blood glucose levels. In response to the increase in blood glucose, your pancreas releases a hormone called insulin. Insulin helps return blood glucose to normal levels by transporting the glucose to muscles and cells where it is stored or used as energy to fuel your body.
When someone has diabetes, their pancreas isn’t able to produce enough insulin or the cells are not able to absorb enough glucose to lower blood glucose to desirable levels.
Different carbohydrate foods have different effects on blood glucose levels depending on their glycaemic index (GI). The GI of food gives an idea of how quickly different foods containing the same amount of carbohydrate raise blood glucose levels. Food can be described as having a low, moderate or high GI.
People with diabetes are recommended to largely eat foods with a low GI as they only produce a gradual rather than a rapid rise in blood glucose and insulin levels. However the total amount of carbohydrate eaten at any one time is more important than GI for maintaining blood glucose levels within the ideal range. This is referred to as the glycaemic load (GL) of a meal. Even though you may be choosing low GI foods, it is still important to keep an eye on the serving size.
High GI Foods >70
Low GI Foods <55
Glycaemic Load (GL)
Carbohydrates break down quickly during digestion, releasing glucose rapidly into the bloodstream and raising blood glucose levels.
White and many wholemeal breads
Cornflakes and rice bubbles
Carbohydrates break down more slowly during digestion, releasing glucose gradually into the bloodstream allowing for more even blood glucose levels.
Chickpeas, kidney beans, lentils
Glycaemic load takes into account how much carbohydrate a typical serving of food contains as well as the GI of that particular food or meal.
If you would like to find out the GI of a particular food, visit www.glycemicindex.com
8. How much carbohydrate should I have?
Your carbohydrate requirements are individual and depend on your weight, activity levels, medication and blood glucose control. A dietitian is the best person to help you work out your individual carbohydrate requirements.
It is recommended to eat some carbohydrate food at each meal. Likewise it is recommended to eat a similar amount of carbohydrate at each meal. This helps the body maintain blood glucose levels within the desired range.
Carbohydrate foods include starchy vegetables, fruit, breads and cereals, milk and milk alternatives. These foods are also provide a range of vitamins, minerals, protein and/or fibre. Sugar is also a carbohydrate food but doesn’t provide any other nutrients and is often called “empty calories”.
Serves of carbohydrate foods are based on the amount of food that provides 15g of carbohydrates i.e. 1/3 cup of rice or pasta, a slice of wholegrain bread, one piece of fruit or 1 cup of trim milk. Most people need 3-4 serves of carbohydrate food at each of the three main meals. Very active people may need larger serves of carbohydrate foods or between meals snacks to maintain blood glucose levels.
It can be helpful to keep a food diary and work out the amount of carbohydrate you are eating at each meal. Click here for more information about the carbohydrate content of different foods. Diabetes and healthy food choices (pdf)
9. What foods contain carbohydrate?
Carbohydrate is a nutrient found in the starchy and sugary foods we eat.
Foods containing carbohydrates are:
Breads, cereals, chapatti, roti
Pasta, rice, couscous
Legumes e.g. chickpeas, lentils, baked beans
Starchy vegetables e.g. potato, kumara and taro
Fruit and fruit juice
Milk and milk products either as the natural sugar, lactose, or as added sugar to milk drinks, yoghurt etc
Sugar, sweet foods and beverages.
Carbohydrate foods are an important fuel source for our brain and the rest of our body. Most carbohydrate foods also provide us with other essential vitamins, minerals, protein and/or fibre. But, consuming too many carbohydrate foods or drinks can increase blood glucose levels above recommended levels.
Most people need 3-4 serves of carbohydrate containing food at each of the three main meals. Use the Diabetes New Zealand Healthy Plate model and information in the Diabetes NZ “Diabetes and Healthy Food Choices” booklet as a guide for the servings sizes of carbohydrate food at main meals.
10. Can I eat fruit or is all fruit bad for me?
Yes you can eat fruit. Fruit does contain sugar so eating a lot of fruit at any one time will increase blood sugar levels in people with diabetes. But it is also a rich source of fibre, vitamins and minerals so can be a nutritious way of adding sweetness to breakfasts, midday snacks or at the end of a meal.
Some fruits contain large amount of glucose and little fibre, such as watermelon, so eating substantial amounts of this fruit can cause substantial increases in blood glucose levels. Very ripe bananas may also have a substantial effect on blood glucose. The best way to find out how different fruits affect your blood glucose levels is by measuring blood glucose before and after eating them.
Whether you have type 1 or type 2 diabetes, aim to eat three to four serves of fruit spread throughout the day to get the goodness of fruit while reducing their impact on your blood sugar levels.
A serve of fruit is:
One medium sized fruit such as apple or orange
½ a banana
½ cup of canned fruit
2 small sized fruits such as mandarins or plums
Fruit juice, dried fruits, canned fruit in syrup or fruit stewed with sugar are particularly high in sugar content. Keep these sources of fruit to a minimum.
11. What foods don’t contain sugar?
Sugar is just one type of carbohydrate. All carbohydrate foods can affect your blood glucose levels. Non-starchy vegetables, meat and meat alternatives such as chicken, fish, eggs and nuts contain minimal amounts of carbohydrate or sugar. Cheese is also low in carbohydrate.
Non-starchy vegetables are also low in fat and calories. Fill up on these foods by covering half of your plate with non-starchy vegetables at main meals. They also make great between meal snacks.
Meat, chicken, fish and eggs contains protein, fat and calories so eat some but not too much of these foods. A serve of meat, chicken or fish is the amount that fits into the palm of your hand. Aim to have no more than quarter of your plate covered in a meat or meat alternative.
Hard cheese is also high in saturated fat. Use them sparingly if using them to add flavour to dishes. Milk and yoghurt are healthier sources of calcium.
12. How often can I have high sugar foods such as ice-cream, cakes, biscuits etc?
High sugar foods such as ice-cream, cakes and biscuits are also high in fat, saturated fat and calories. These foods can increase blood glucose above desirable levels and can also contribute to heart disease and weight gain if eaten frequently or in large amounts.
Limit your treat foods to no more than twice a week. If you know you can’t stop at only 1 or 2 sweets or chocolates don’t have them in the house to tempt you.
13. Why does weight loss improve blood glucose levels?
People with diabetes are regularly encouraging to lose weight as a means of improving blood glucose levels.
Excess body fat, particularly around your middle, can increase your body’s resistance to insulin. A high fat diet itself, and in particular one high in saturated fat, also increases your body’s resistance to insulin. When your body becomes resistant to insulin your blood glucose levels raise above desirable levels.
Research has shown for individuals with pre-diabetes, weight reduction of 5% or more, reduction of total fat intake and increased physical activity (≥4 hours / week) can decrease their risk of developing diabetes.
If you have diabetes, the lifestyle changes made to achieve weight loss including reducing total calorie intake and being more active, can have a significant impact on blood glucose levels. You may be able to stop taking medication or reduce the amount of insulin you need.
Physical activity is one of the best things you can do to manage your blood glucose levels and improve your overall health. In general, blood glucose levels drop after exercise and are lower for the next 24 to 48 hours. When you exercise, your muscles use more glucose and they become more sensitive to insulin, absorbing more glucose from the blood stream.
Reducing the total calorie, fat and saturated fat content of your diet and having moderate amounts of carbohydrate spread evenly throughout the day will help your body respond to insulin and improve blood glucose levels.
14. If I lose weight will I be cured of diabetes?
Unfortunately, once you have been diagnosed with type 2 diabetes you can’t be ‘cured’ from diabetes. You can however manage it with a healthy lifestyle and appropriate medication. If you can lose weight, this will often improve your blood glucose control.
If blood glucose levels are kept within the ideal range with treatment including improved diet, increased activity, weight loss and/or medication it means the treatment is working. This doesn’t mean you are cured from diabetes. You will have to maintain the treatment plan to continue to have blood glucose levels within the ideal range.
If you have been diagnosed with pre-diabetes, losing weight can help return blood glucose levels to normal and help prevent you developing diabetes. Even a 5-10% weight loss can make a huge difference. However, if you gain weight in the future, you may still go on to developing diabetes.
15. Can fad diets like the Paleo diet, Cohen diet, Blood type diet help control diabetes?
Some aspects of these diets may be consistent with recommendations for people with diabetes such as the Paleo diet’s recommendation to avoid processed foods high in saturated fat, sugar and salt. But, these diets also promote the removal of key food groups potentially leading to nutritional deficiencies. The blood type diet, for example, recommends avoiding dairy products for most blood types which limits calcium intake. On the Cohen Diet website it specifically states the diet is not suitable for those with diabetes on insulin or other forms of diabetes medication.
There is no magic formula for weight loss from these fad diets, weight loss occurs purely as result of eating less calories. In addition these diets are difficult to maintain in the long term making it more likely you will regain weight lost while following the diet. To achieve long term, sustainable weight loss try to make changes to eating patterns and activity levels that can become part of your everyday life.
16. Will I always need to be on medication?
Not necessarily. If you have type 2 diabetes and change your diet and/or increase your activity levels you may be able to reduce or stop your medication.
If you have type 2 diabetes and take insulin, making similar lifestyle changes may mean you will be able to reduce or stop insulin therapy. Under certain circumstances, you may only need insulin temporarily such as during pregnancy or if you are acutely unwell. Often you will be able to stop taking insulin when the event or stress is over.
Always check with your doctor before making any adjustments to the dose of medication or insulin you are taking.
17. Why are my blood glucose readings higher in the mornings?
"Please help me to understand why my blood glucose readings are higher in the mornings than they were the previous night. Last night my reading at 10.30 pm was 5.6 and this morning it was 7.6. I was told it was residual sugar in my body. But surely if it was residual sugar it would be less than the original reading?"
It is important to realise food is just one factor affecting blood glucose levels. There is a relationship between food eaten and the resulting rise (while absorption of food is dominant) and then fall (while the rate of removal of glucose into cells as fuel or storage is dominant) of blood glucose levels. But once the blood glucose level falls to a normal level, it does not keep on falling unless it is driven by an excessive amount of insulin.
The liver has the role of maintaining the blood glucose level sufficiently high so that cells dependent on glucose as fuel, like those in the brain, can keep working properly. The liver can keep the blood glucose level from falling in the short term (a few hours) by releasing stored glucose (involving break-down of glycogen).
For a longer term need (such as overnight) the liver works by making new glucose from amino acids in the blood. The amino acids used up are replaced by breakdown of muscle proteins.
To understand more, we need to consider the actions of insulin. Everyone seems to know insulin is required to get glucose to enter cells for fuel or storage and so the link with food intake is easy to understand.
But much less widely understood, is the fact that insulin also controls the action of the liver in releasing stored glucose or making new glucose. Insulin is very important here.
If there is insufficient insulin, the liver will make an excess of glucose and this will, for example, lead to an abnormally high blood glucose level in the early morning. Whether it is just a little bit too high as in your reading, 7.6, or very high like 15, depends on how much reduced the action of insulin is.
18. Why is a low sodium diet so important?
"My doctor has urged me to eat a low-sodium diet, but everything tastes so bland! Why is a low sodium diet so important?"
Humans require only a small amount of sodium (salt) in our diet for good health. But many people crave salt. It can be found just about everywhere these days - especially in processed foods, where salt is used to preserve the product and enhance its flavour.
Unfortunately, research shows high sodium intake is linked with high blood pressure (hypertension). Also, some people are 'salt-sensitive', meaning that they are more likely than others to develop high blood pressure when eating salt.
Both high blood pressure and salt-sensitivity are common in people with type 2 diabetes and insulin resistance. People with type 1 diabetes who have kidney damage are also at high risk of high blood pressure. High blood pressure is a major risk factor for heart disease and stroke. That's true for all people, not just those with diabetes.
Nonetheless, you can help keep your body healthy with the right diet. Try adding herbs and spices for extra flavour rather than salt.
19. What is an acceptable level of salt in foods?
"I'm confused about how much salt I should eat. When reading a label what is an acceptable level of salt in foods?"
Common salt is sodium chloride, and it is the sodium that causes health problems. For healthy people, the recommended daily intake for sodium is <2300mg daily, equivalent to 1 teaspoon of salt.
The sodium content per 100g on the Nutritional Information Panel of a product gives us an i
ndication of how much sodium is in a product and therefore how salty it is.
As part of healthy eating, it is important to watch our sodium intake - we actually require as little as 500mg a day, which is equal to 1/4 teaspoon of salt. Many people eat far in excess of this, having 4000-6000mg daily.
Our intake of processed and prepared foods accounts for most of our sodium intake. It's therefore wise to read food labels to identify foods lower in sodium.
Unfortunately, it is difficult to give a general guideline that will apply to all foods. As a guide:
Food with low sodium content has less than 120mg per 100g
Food with high sodium content has more than 600mg per 100g
I usually encourage people to look for foods with less than 400mg per 100g. However, it is important to consider the quantity you will eat. The sodium content of a soup is more relevant than that of a relish or a sauce, which you might use in only very small quantities.
By checking the sodium content, you will become more aware of the amount of sodium hidden in foods. For example, Arnott's Vita-Weat 9 Grain Cracker has 450mg sodium per 100g but Huntley and Palmers Sesameal Classic 5 Grain & Seeds cracker has 930mgsodium per 100g, despite both having a similar amount of fibre.
Look for packaged foods that are salt reduced or have 'no added salt'.
Fresh foods tend to be lower in sodium. Enjoy fresh meat, poultry and fish, fruit and vegetables, dried beans, peas and lentils, eggs, milk and yoghurt. Experiment with herbs and spices to add flavour rather than relying on added salt.
Remember - fresh is best!
Follow this link to find out more about salt in your diet http://www.stroke.org.nz/stroke-salt-reduction-campaign