Mastering Diabetes Nutrition: Your Ultimate Guide to Thriving!

A diabetes or prediabetes diagnosis can feel overwhelming. Worsening A1Cs or out of control blood sugars can feel defeating. Because food and nutrition can play an important role in managing blood sugars, dietitians can be a helpful member of your treatment team. We’ve also developed a series of blogs about diabetes management to hopefully help it feel less overwhelming.

What is diabetes?

Diabetes is a chronic (long term) health condition involving how the body breaks down food and uses/stores it.

Type 1 vs Type 2

Type 1 diabetes is believed to be an autoimmune reaction that prevents the body from being able to produce insulin. Type 1 requires insulin injections. 

Type 2 diabetes is a condition where the body’s ability to use insulin is affected. Type 2 can be managed with diet and lifestyle, as well as medications. (1)

What is insulin?

Insulin is a hormone produced when we eat carbohydrate foods and is needed to move glucose from the bloodstream into the cells so it can be used for energy. The typical response is the insulin will act as a key to “open” the cell and let the glucose in. With insulin resistance, the process of opening the cell is slowed, and the pancreas must produce more insulin to force the uptake of glucose. Eventually the pancreas cannot keep up with insulin production, and tThis causes glucose to stay in the bloodstream longer.

The cause of insulin resistance is not fully understood, however family history, body composition, and inactivity can increase the risk (2). It is clear, however, that you cannot predict insulin resistance by looking at someone, as people of all body sizes can have insulin resistance and diabetes. 

What Happens if Your Blood Sugar Stays Elevated Long Term? 

Diabetes side effects have changed drastically over the years as treatment options have improved. However, long term uncontrolled blood sugars can have a significant impact on your health. Nerve damage, eye damage, kidney damage, and heart disease are some of the top concerns (3). 

How does nutrition impact diabetes?

Because diabetes involves an issue with insulin (whether it be insulin resistance or the inability to produce insulin), that means what you eat matters. All carbohydrate foods, such as bread, pasta, and potatoes, are broken down into glucose for fuel. In order to utilize that fuel, the body needs insulin to get the glucose out of the bloodstream. If your body doesn’t have enough insulin or isn’t able to use it as effectively, the glucose will stay in your bloodstream, leading to higher blood sugar. 

For those with type 2, we can make changes to how much carbohydrate is eaten, the type of carbohydrate, and what it is eaten with to improve blood sugars (along with other treatments like medication, exercise, sleep, stress management, etc).

For type 1, the primary goal is understanding how much insulin is needed to “cover” the amount of carbohydrates eaten. Because your body does not make insulin on its own, you need to provide your body with the necessary insulin dosage to help bring the glucose into the cells. Balance, variety, and type of carbohydrate is important with both types, however, insulin management is crucial for type 1. 

What should I eat with diabetes?

Disclaimer, while we are dietitians, we are not necessarily your dietitian. Please consult with your medical team before making significant changes to your diet and treatment plan. 

Carbohydrates

When it comes to blood sugar management, carbohydrate foods are the first on the chopping block for most people. Because they are broken down into glucose, they do directly impact blood glucose the most. However, we don’t have to remove carbohydrate foods completely from the diet.

We need carbohydrates for energy. It is our main source of energy for the brain. We also need carbohydrates to get enough fiber in our diet which supports heart and gut health. Meals with carbohydrates can also be more satisfying. Feeling unsatisfied after meals can lead to overeating or binge eating behaviors. 

Carbohydrates include: 

• Starches like bread, noodles, rice, and crackers
• Fruit 
• Starchy vegetables like corn and peas
• Dairy like milk and yogurt 

While we don’t want to eliminate carbohydrates, it is important to consider how much carbohydrate is being eaten at one time. You can work with your medical team to determine how much is right for you. A goal of 30-60 grams of carbohydrate per meal is a typical starting point. It is also helpful to consider the type of carbohydrate you are eating. Higher fiber carbohydrates are digested slower and therefore blood sugar rises slower. 

Fiber

Since fiber helps slow the rise of blood sugar, we want to incorporate it into most meals. Fiber can be found in whole grains, starchy vegetables, legumes, and fruit. However, it can also be added into the meal in other ways. Adding foods like non-starchy vegetables, nuts, seeds, and avocado can help stabilize blood sugar. 

Protein 

Protein can play an important role in stabilizing blood sugar. It acts similarly to fiber in the sense that it slows digestion and slows the rise of blood sugar. Protein also helps promote satiety so you feel more full and satisfied. Protein foods include: 

• Meat, poultry, and fish 
• Eggs and dairy products
• Nuts/seeds and nut butter
• Legumes like beans 
• Tofu and other soy products 

Fat 

Fat is important for slowing digestion and stabilizing blood sugar, making meals more satisfying, and for better nutrient absorption! Several micronutrients require fat to be absorbed, like vitamins A, E, D, and K.  Fats include:

• Butter and oils
• Avocado
• Nuts/seeds and nut butter
• Dips and sauces 

Interpreting the Nutrition Facts Label 

While the nutrition facts label includes a lot of information, when it comes to blood sugar, we are going to focus primarily on just a few points. While the grams of sugar in a food can be helpful, it’s not the only thing to look for on the label.

First, check for total carbohydrate. We mentioned that most people have a carb goal between 30-60 grams per meal so this number will help determine how much of this food you can have to stay close to your goal. Total carbohydrate includes sugar so I find that total carbohydrate is the more important number to consider. However, if a food has a large amount of sugar, it will raise blood sugar more quickly. For example, if a food has 20 grams of total carbohydrate and 19 grams of sugar, the carbohydrate is mostly coming from simple sugar. This food will break down to glucose quickly and therefore raise blood sugar quickly. 

Next, check for dietary fiber. The more fiber a food has, the slower blood sugar will rise. A good rule of thumb to determine if a food has adequate fiber is for it to have at least 3 grams of fiber per serving. 

You may find foods that have very high amounts of fiber, like 10 grams per serving. This is a tool often used to make starchy foods into “low carb” foods. For example, a “carb smart” tortilla may have a large amount of fiber added. While this may help keep blood sugar from spiking, a large amount of fiber can also cause bloating or digestive distress. Pay attention to how you feel with these types of foods to determine if it’s a good option for you. 

Grocery Shopping

What should you buy when grocery shopping for blood sugar management? 

One of the benefits of home prepared meals is that you have the opportunity to control the type of carbohydrate in the meal, as well as home much protein and fiber the meal has. When grocery shopping for diabetes, pay attention to the total carbohydrate on the nutrition facts label. 

Try to choose carbohydrate foods that have at least 3 grams of fiber as this slows the release of glucose and helps stabilize blood sugar. Typical carbohydrate foods include bread, noodles, rice, tortillas, oatmeal, cereal, chips, crackers, as well as yogurt, starchy vegetables, and fruit. You can choose high fiber versions and also add fiber through the addition of non-starchy vegetables, beans, lentils, nuts, and seeds. 

Be sure to stock up on good sources of protein too as pairing carbs with protein can also help stabilize blood sugar. Protein can be meats, poultry, fish, and eggs, but also includes dairy, bean and bean products, peas, soy products, protein bars, nuts, seeds, and nut butters. 

Purchasing foods from the store that are good sources of fiber, protein, healthy fat and also paying attention to the carbohydrate content can help you better manage your blood sugar. 

Cooking for Diabetes

Cooking can feel like a difficult task for anyone, but add the challenges of managing a condition like diabetes, and it can feel overwhelming. You can certainly choose diabetes friendly recipes, or recipes for insulin resistance, however, most meals can be made blood sugar friendly by being mindful of the type and amount of carbohydrate being eaten and what you pair it with. 

Typically the recommended amount of carbohydrate in a meal falls somewhere between 30 and 60 grams of carb. There are plenty of ways to eat what you want, and add what you need to balance your blood sugar at meals! For example: 

• If it’s pizza night, you can enjoy pizza with diabetes, by choosing a thinner crust or opting for 1-2 slices. Pair your pizza with a salad to make the meal even more filling by adding fiber.
•  If the family wants pasta, that’s ok! 1 cup of cooked pasta is about 45 grams of carbohydrate. You can choose whole wheat or bean based noodles if you’d like, or stick with your favorite noodle brand and add fiber in other ways. Pair it with protein and veggies for a balanced meal. 
• Maybe you make a crockpot meal that the family loves, but you try serving it over a cup of quinoa rice blend for more fiber.

Eating Out with Diabetes 

Fast food and restaurant meals are sometimes necessary. Whether you are traveling, running errands, didn’t have time to pack lunch, whatever the case may be, you still need to eat. Going too long without eating can be detrimental to your blood sugar levels. Eating fast food when you have diabetes can be a little challenging as most options are low in fiber and veggies, but that doesn’t mean you don’t have options! 

Chipotle has a variety of items that have plenty of protein, fresh veggies, and fiber. The total carbohydrate of the bowls can seem high but that can be because of the fiber content if you’re adding beans! Taco Bell also has blood sugar-friendly  options, like the Veggie Mexican Pizza or the Chicken Power Bowl!  

Places like Chick Fil A and McDonalds can be challenging because most meals consist of a sandwich with a side of french fries so between the bread and the fries, the total amount of carbs can be outside of your recommended range for meal times. Opting for nuggets or chicken strips with a side of fries or just a sandwich can help you stay within your carb goals. 

While Subway and Panera can feel challenging because of the focus on bread, that doesn’t mean it’s off-limits. Subway offers salads and bowls if you want to forgo the bread. Panera’s ‘you-pick-two’ option also features some delicious salads that can be paired with half a sandwich for a carb-friendly meal. 

Mornings can be quite the rush, and skipping breakfast is not ideal. A balanced breakfast can help keep blood sugars stable through the morning. There are plenty of blood sugar-friendly fast-food breakfast options! Try choosing a meal with a good source of protein, like an egg sandwich or breakfast bowl. If you need a coffee fix, try tweaking  your Starbucks order by choosing sugar free syrups, or reducinge the number of pumps of syrup in your drink.

Snacks

A good general rule of thumb for snacks for diabetes management is to pair 15-20 grams of carbohydrates with some protein or fat. Pair a serving of fruit, crackers, chips, popcorn, etc with some cheese, yogurt, hummus, nuts, peanut butter, guacamole, etc. You can opt for an easy protein bar or shake if you’re on-the-go. 

Desserts

When it comes to dessert, you can certainly experiment with low carb dessert recipes or buy something like a low carb ice cream. However, if you don’t enjoy those things, it’s ok. You can mitigate the carbohydrate from the regular dessert by having a lower carbohydrate meal beforehand. Enjoy a meal with protein and fiber, and then follow it up with your desired dessert. 

What else can I do to lower my blood sugars?

Test Your Blood Sugar

Be informed, test your blood sugar! If you have no idea what your blood sugars are doing throughout the day, it can be much more difficult to determine what nutrition changes are best for your body. You can test your blood sugar using a glucometer, or talk to your doctor about a continuous glucose monitor. While it can be important to note your fasting blood sugar, it can also be helpful to know what your blood sugar is doing after meals. Test your blood sugar 1-2 hours after the start of a meal to determine how your body is responding to those specific foods. The goal for after eating is to be under 180 mg/dL. 

Sugar Substitutes

Sugar substitutes and non-nutritive sweeteners can be helpful tools when trying to manage blood sugar. Whether artificial (like aspartame and sucralose) or naturally derived (like stevia and monk fruit), these sweeteners have little effect on blood sugar. Sugar sweetened beverages and foods high in sugar can cause a large rise in blood sugar. Utilizing some sugar substitutes in place of regularly sweetened foods can help people with diabetes to improve their overall blood sugars. 

Water’s Role in Blood Sugar Management

We can’t deny the need for drinking enough water. But can drinking water lower blood sugar? In the short term, if your blood sugar is high, drinking water may help bring it down. Also opting for water instead of sugar sweetened beverages can help blood sugar. However, it’s not as simple as just drinking water. There are many health promoting behaviors that can be utilized together to improve blood sugar. 

Exercise and Blood Sugar

When we move our muscles, the muscles take up glucose and use it for energy. So movement of any kind can help bring down blood sugar. Whether it’s a workout or a gentle walk, coordinating your movement after eating can improve blood sugar. Additionally, regardless of timing, exercise can improve how cells respond to insulin (thus improving insulin resistance). Choose whatever type of movement feels good to your body. 

Intuitive Eating with Diabetes

When we talk about an intuitive eating approach to nutrition, it is not just an “eat when you’re hungry, stop when you’re full” diet. Intuitive eating is a framework for improving your relationship with food. You can strive towards intuitive eating while also addressing your blood sugar concerns. If you’re looking for a way to manage your diabetes that doesn’t feel restrictive and entrenched in diet culture, that is why we created our gentle nutrition guide for diabetes. 

Mindful eating is different from intuitive eating, and is a tool that can be helpful in both your relationship with food and managing your blood sugars. The goal of mindful eating is to slow down, to pay attention to what you are eating, and to discover how you feel about that food. Mindful eating helps you recognize if what you are eating is satisfying. Mindful eating also helps you check in with satiety and fullness cues. 

A common example of mindful eating is to take a single peanut m&m and to place it in your mouth and let the chocolate coating dissolve, without taking a bite, and pay attention to the taste and texture of the chocolate. Then when just the peanut remains, to chew and experience the crunchy texture. When we slow down and experience food in such a slow and intentional way, we may not need as much of that food to honor the craving. When we are distracted and eating on auto pilot, not only is it harder to recognize satisfaction, but it can result in higher blood sugars. 

If you need personalized nutrition information and someone to help you figure out how to keep in your favorite foods while also improving your blood sugars, consider working one on one with a dietitian from our team!