Diabetes Diet for Type 2

Introduction

Diet is one of the most important behavioral treatments for diabetes type 2 and cannot be overemphasized. Many patients have difficulty adhering to a specific diet. We have some suggested recipes. The role of nutrition for type 2 diabetes is discussed here. With diet changes the goals are to control the blood sugars, blood pressures, and the blood cholesterol. "Medical nutrition therapy" (MNT) is the description of creating a diet prescription for patients with diabetes based on the following aspects.

Caloric intake

There are several formulas to estimate baseline caloric intake for weight maintenance. These formulas make many assumptions taking into account patient age, sex, weight and height and physical activity. These calculators are available online. Many patients are surprised to know that to maintain the same weight every year, their average daily caloric intake must decrease every year.

Weight management

Major emphasis should be placed on on lowering caloric intake to induce weight loss for patients that are overweight (BMI more than 25) or obese (BMI more than 30). Improved blood sugar control will occur with sustained weight loss. Weight loss goals are a 10% weight loss initially and at least 30 minutes of moderate physical activity most days of the week. A weight loss of 3-5 pounds per month would be considered a successful diet. Generally the dietary changes need to be long term changes and we recommend a diet that a patient can do for at least 3 years consistently. Strategies to lose weight include counting calories, meal replacement, medications, and surgery. Patients that are on diabetes medications that can cause hypoglycemia should be aware that their medications need to be adjusted to avoid worsening low blood sugars.

Carbohydrate consistency

Patient with diabetes type 2 who are on medications such as insulins or sulfonylureas pills (glipizide, glyburide, glimepride, etc) need to take extra care with their carbohydrate intake as it can cause severe blood sugar variability. Too many carbohydrates cause high blood sugars and too few will cause low post meal sugars. Generally these patients should count carbohydrates to for a goal of about 30 - 45 grams of carbohydrates with each meal and 15 - 20 grams for snacks.

Nutritional content

The American Diabetes Association recommends no specific "diabetic diet" but diets that would apply to the general population. There is no perfect diet but here are general recommendations.

• includes carbohydrates from fruits, vegetables, while grains, legumes, and low fat dairy

• a variety of eating patterns (low fat, low carbohydrates, Mediterranean, vegetarian)

• Fat quality more important that fat quantity. Replace saturated fats with monounsaturated and polyunsaturated fats (fish oils, olive oils, nuts)

• daily intake of protein should be 10-25% of total caloric intake

• fiber intake should be significant, at least 14 grams per 1000 calories per day. higher natural fiber intake is associated with lower blood sugars

• patients with high blood pressure should reduce salt intake to less than 2 grams per day

• generally less than half of the carbohydrates eaten should be from sugar or alcohol. Artificial sweeteners can be substituted for regular sugars BUT caution is warranted when using artificial sweeteners (saccharine, aspartame, etc) , as they are associated with adverse brain effects and weight gain.

Generally it is best to discuss your diet changes with your endocrinologist or physician.