Diabetes and Carbohydrates
Best Diet For Diabetics
The general consensus among diabetes experts and dietitians is that a healthy diabetic diet should conform to the following guidelines regarding carb intake and calories:
- Its calorie content should promote a healthy weight
- Its carbohydrate content may amount to 45-55 percent of total calories
- The best type of carbohydrates for diabetics are low-GI carbs - that is, those with a lower GI value on the Glycemic Index
- The diet should include 25-30 grams of daily dietary fiber (the indigestible type of carbohydrate) - both soluble and insoluble
- Carb sugars need not be avoided, but sugar-intake should be regulated by energy needs
Healthy Eating Habits For Diabetics
Dietitians recommend the following guidelines for diabetic patients:
- Eat little but often, ideally at regular times each day
- Monitor carb intake and regulate medication/insulin according to carbohydrate consumption
- Take regular postprandial exercise
- Ensure a healthy intake of vitamins and minerals, if necessary by taking daily nutritional supplements
- As colds and flu can adversely affect the management of blood glucose levels, it is important to follow a healthy, low-stress lifestyle in order to maintain optimum physical health.
Diet Studies Into Diabetes and Carbohydrate
Research into healthy diets for diabetes is ongoing. Here are some general findings concerning carbs and diabetes.
Total Amount of Carbohydrate in Your Diet
Many factors influence how our blood glucose level responds to the food we eat (glycemic response), including the amount of carbohydrate consumed, type of sugar (glucose, fructose, sucrose, lactose), type of starch, cooking and food processing, as well as other food ingredients that slow digestion in the stomach, such as food acids, fiber and so on. That said, according to studies, in patients with type 1 or type 2 diabetes, consumption of a variety of starches or sucrose produced no significant differences in glycemic response "if the total amount of carbohydrate was similar". This indicates that the total amount of carbohydrate in meals and snacks is more relevant than the source or the type.
Insulin Adjusted For Carb Content (Type 1 Diabetes)
Research studies in patients with type 1 diabetes show a strong relationship between the premeal insulin dose and the after-meal response of blood glucose levels to the total carbohydrate content of the meal. This indicates that the pre-meal insulin dose should be adjusted for the carbohydrate content of the meal. For individuals receiving fixed doses of insulin, day-to-day consistency in the amount of carbohydrate is essential.
Substituting Fat For Carbs (Type 2 Diabetes)
In patients with type 2 diabetes, on weight control diets, replacing carbohydrate with monounsaturated fat reduces postprandial glycemia and triglyceridemia. However, there is concern that increased fat intake in ad libitum diets may promote weight gain. Therefore, the contributions of carbohydrate and monounsaturated fat to energy intake should be individualized based on nutrition assessment, metabolic profiles, and treatment goals.
Diabetic Diets Based on Glycemic Index (GI)
The Glycemic Index (GI) remains the basic guide for effective management of blood glucose levels. That said, while low-GI diets may indeed reduce postprandial glycemia, the ability of individuals to maintain these diets in the long-term is not yet fully established. Some studies of persons with type 1 diabetes or type 2 diabetes in which low glycemic index diets were compared with high glycemic index diets do not report consistent improvements in HbA1c, fructosamine, or insulin levels.
Diabetics Should Eat Enough Dietary Fiber
The presence of fiber in the gut does retard the metabolism of carbohydrate and short-term studies using large amounts of fiber in small numbers of subjects with type 1 diabetes indicate a positive effect on glycemia. That said, some studies have reported mixed effects on glycemia and lipids. In subjects with type 2 diabetes, it appears that ingestion of very large amounts of fiber are necessary to confer metabolic benefits on glycemic control, hyperinsulinemia, and plasma lipids. It is not clear whether the palatability and the gastro-intestinal side effects of fiber in this amount would be acceptable to most people.
Glycemia Not Increased By Sucrose
Evidence from clinical studies shows that dietary sucrose does not increase glycemia more than isocaloric amounts of starch. Thus, intake of sucrose and sucrose-containing foods by people with diabetes does not need to be restricted because of concern about aggravating hyperglycemia.
Added Fructose Not Recommended
In diabetics, fructose produces a lower postprandial response when it replaces sucrose or starch in the diet; however, this benefit is tempered by concern that fructose may adversely effect plasma lipids (blood-fats). Therefore, the use of added fructose as a sweetening agent is not recommended; however, there is no reason to recommend that people with diabetes avoid naturally occurring fructose in fruits, vegetables, and other foods.
Non-Nutritive Sweeteners For Diabetics
The Food and Drug Administration has approved four non-nutritive sweeteners for use in the U.S.—saccharin, aspartame, acesulfame potassium, and sucralose. Before being allowed on the market, all underwent rigorous scrutiny and were shown to be safe when consumed by the public, including people with diabetes and during pregnancy. In short, non-nutritive sweeteners are safe when consumed within the acceptable daily intake levels established by the Food and Drug Administration.
Alcohol and Diabetes
Some alcohol may improve health. Studies indicate that light-to-moderate alcohol ingestion in non-diabetics is associated with increased insulin sensitivity and decreased risk of type 2 diabetes, coronary heart disease, and stroke. In patients with diabetes, chronic intake of light-to-moderate amounts (5–15 g/day) was associated with decreased risk for coronary heart disease, presumably due to the concomitant increase in plasma HDL cholesterol.
However, anecdotal as well as clinical evidence suggests that heavy drinking episodes play havoc with blood glucose management among people with type 1 or type 2 diabetes. As a result, alcohol intake for diabetic patients should be carefully regulated. If a diabetic chooses to drink alcohol, his/her daily intake should be limited to one drink for adult women and two drinks for adult men. One drink is defined as 12 oz of beer, 5 oz of wine, or 1.5 oz of distilled spirits. Furthermore, to reduce the risk of hypoglycemia, alcohol should be consumed with food.
