Diabetes drugs can and often do stop working. Many factors can affect how well your medicine is working like weight gain, changes in your diet or activity level, or a recent illness. Making a few changes to your diet or exercising more each day might be enough to get your blood sugar under control again.
It’s also possible that your diabetes has progressed. The beta cells in your pancreas that produce insulin can become less efficient over time. This can leave you with less insulin and poorer blood sugar control. And medication change might be required.
Nutritional Recommendations for Individuals with Diabetes
Please Note that nutrition plans should be individualized and flexible to meet the specific needs of the individual. A team approach with the doctor and nutritionist and should not simply be delivered by giving a person a one-size-fits all diet sheet.
Goals
1.To promote and support healthful eating patterns, emphasizing a variety of nutrient dense foods in appropriate portion sizes and meal timings in order to improve overall health and:
- Achieve and maintain body weight goals
- Attain individualized glycemic, blood pressure, and lipid goals
- Delay or prevent complications of diabetes
- To address individual nutrition needs based on personal and cultural preferences, access to healthful food choices, willingness and ability to make behavioral changes, as well as barriers to change, to maintain the pleasure of eating by providing nonjudgmental messages about food choices
- Choose an insulin regimen that is compatible with the patient’s normal pattern of meals, sleep and physical activity. Patient should measure blood glucose levels prior to meals and snacks and at bedtime and adjust the insulin doses as needed based on intake.
- Monitoring A1C, weight, lipids, blood pressure, and other clinical parameters, modifying the initial meal plan as necessary to meet goals and Achieve and maintain the best possible glycemic control.
- For children with type 1or 2 Provide individualized nutrition therapy with guidance on appropriate energy and nutrient intake to ensure optimal growth and development.
- Promote regular exercise
- Specifically FOR TYPE 1 DIABETES AND THOSE ON INSULIN: People taking insulin should be consulted regularly on the importance of balancing food and beverage intake with timing and dosing of insulin.
Putting Goals into Practice
The added value individualized consultation with a Nutritionist, along with regular follow-up, has on long-term outcomes and is highly recommended to aid in lifestyle compliance. Medical nutrition therapy (MNT) is associated with A1C reductions and prevention of other diabetic complications.
Target Guidelines for Macro and Micro Nurtients
The best mix of carbohydrate, protein, and fat depends on the individual metabolic goals and preferences of the person with diabetes. It’s most important to ensure that total calories are kept in mind for weight loss or maintenance. (1)
Carbohydrates
The total amount of carbohydrate (CHO) consumed has the strongest influence on glycemic response (1).
Practical Tips on Carbohydrate Intake
Use whole grain breakfast like steel-cut oats, whole grain breads and Rotis for lunch. Try brown rice or less well-known grains like millet, or quinoa.
Include beans/legumes which are an excellent source of slowly digested carbohydrate as well as a great source of lean protein. Substitute for meat as a protein and fiber source.
Include a variety of fresh fruits and vegetables in meals every day.
Fiber
Include a good source of fiber containing food with every meal or snack.
Patients should consume 20 to 35 g of fiber from raw vegetables and unprocessed grains (or about 14 g of fiber per 1,000 kcal ingested) per day (the same as the general population) (1).
A fiber rich meal is processed more slowly, which promotes satiety, may be less caloric, and lower in added sugars, which can help combat obesity and also may prevent complications of diabetes.
Fat
An eating plan emphasizing elements of a Mediterranean-style diet rich in monounsaturated and polyunsaturated fats like vegetable oils such as olive, peanut, avocado, may be considered to improve glucose metabolism and lower CVD risk.
Practical Tips on Fat Intake
Try to eliminate Tran’s fats from partially hydrogenated oils. Check food labels for Trans fats; limit fried fast foods.
Limit intake of saturated fats by cutting back on processed and fast foods, and full-fat dairy foods. Try replacing with beans, nuts, skinless poultry, and fish whenever possible, and switching from whole milk and other full-fat dairy foods to lower fat versions.
Eat one or more good sources of omega-3 fats every day—fatty fish, walnuts, soybean oil, ground flax seeds or flaxseed oil.
Protein
Protein intake goals should be individualized based on current eating patterns. Aim to maintain dietary protein at the recommended daily allowance of no more than 0.8g/kg desirable body weight/day.
Practical Tips for Protein Intake
Include a source of lean animal protein, such as skinless poultry, fish or egg, and reduced fat dairy products skim milk/yogurt, cheese, paneer.
Plant protein sources such as tofu, tempeh,and legumes.
Nuts or seeds: almonds, cashews, macadamia nuts, peanuts, Nut butters
Protein should be a supplement to vegetables, fruits and whole grains in a meal, not the entire meal.
Vitamins and Minerals
People with diabetes should be aware of the necessity for meeting vitamin and mineral needs from natural food sources through intake of a balanced diet.
Only deficiency vitamins and minerals should be supplemented.
Glycemic Index (GI) and Load (GL)
Substituting low–glycemic load foods for higher–glycemic load foods may modestly improve glycemic control and improves insulin sensitivity.
Eg. Refined grain products and potatoes have a higher GI, legumes and whole grains have a moderate GI, and non-starchy fruits and vegetables have a low GI.
Exercise
Exercise for individuals with diabetes has many benefits; for most, benefits outweigh risks. Exercise and resistance training may improve glycemic control (2). Patient should be encouraged to exercise to improve cardiovascular and overall fitness, weight control, and for improved psychological well-being and quality of life.
There are several factors that can affect the blood glucose response to exercise:
Individual response to exercise varies
Type, amount, and intensity of exercise
Timing and type of the previous meal
Timing and type of the insulin injection or other diabetes agent
Pre-exercise blood glucose level
To better help with weight management, and avoid hypoglycemia, exercise should be scheduled post-meals when blood glucose levels are higher. If this is not possible, it may be necessary to decrease medication dose to facilitate exercise without increasing caloric intake.
Hypoglycemia
Hypoglycemia is defined as a low blood glucose level ≤70 mg/dL.
1.Don't skip or delay meals or snacks. If taking insulin or oral diabetes medication, be consistent about the amount eaten and the timing of meals and snacks.
2.Monitor blood sugar regularly.
3.Measure medication carefully, and take it on time. Take medication as recommended by the physician coordinating diabetes care.
- Drinking alcohol on an empty stomach can contribute to hypoglycemia.
- Keep a snack or drink handy if travelling
References
- American Diabetes Association. Diabetes Care. 2019 Jan;42 Supplement 1:S46–S60.
About The Author
Nutan Khimasiya certified Fitness and Nutrition expert. Nutan Khimasiya is internationally certified Fitness and Nutrition expert from ACSM-Clinical Nutrition, K11-Sports Nutrit..
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