Whether you have type 1 or type 2 diabetes -- what, when, and how much you eat affect your blood glucose. Blood glucose is the main sugar found in the blood and the body's main source of energy.
If you have diabetes (or pre-diabetes), eating too much can make your blood glucose too high. If your blood glucose goes too high, you can get sick. Your blood glucose can also go too high or drop too low if you don't take the right amount of diabetes medicine. If your blood glucose stays high too much of the time, you can develop:
- Heart disease
- Eye problems
- Foot problems
- Kidney disease
- Other problems.
You can also have problems if your blood glucose gets too low (this condition is called hypoglycemia).
Because of all these reasons, keeping your blood glucose at a healthy level will prevent or slow down diabetes problems. One way of controlling your blood glucose level is by maintaining a diabetic diet. This diabetic diet begins by understanding the Diabetes Food Pyramid.
The Diabetes Food Pyramid
The Diabetes Food Pyramid is a general guide of what and how much to eat each day as part of your diabetic diet. It is similar to the Food Pyramid you see on many food packages. The Diabetes Food Pyramid is divided into six groups. You should eat more foods from the largest group at the base of the pyramid and less from the smaller groups at the top of the pyramid.
The number of servings needed every day is not the same for everyone, so for a diabetic diet, a range of servings is given to ensure you get the foods you need for good health.
The food groups and suggested servings per day as part of this diabetic diet include:
- Grains, beans, and starchy vegetables: These are good source of B vitamins and fiber -- 6 or more servings per day.
- Fruits: These contain vitamins C and A, potassium, folate, and fiber -- 3 to 4 servings per day.
- Vegetables: These provide vitamins A and C, folate, and fiber -- 3 to 5 servings per day.
- Milk: This is a source of calcium, protein, and vitamins A and D -- 2 to 3 servings per day.
- Meats and meat substitutes: These are a source of iron, zinc, B vitamins, and protein -- 2 to 3 servings per day.
- Fats, sweets, and alcohol: The foods at the tip of the pyramid should be eaten in small amounts. Fats and oils should be limited because they are high in calories. Sweets are high in sugar and should only be eaten once in a while.
(Click Diabetes Food Pyramid for more information.)
As stated, in a diabetic diet, the number of servings needed every day is not the same for everyone. The following presents some diabetic diet guidelines with regards to calories and number of servings based on your gender, body type, and fitness goals.
Have about 1,200 to 1,600 calories a day if you are:
- A small woman who exercises
- A small or medium woman who wants to lose weight
- A medium woman who does not exercise much.
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Choose this many servings from these food groups to have 1,200 to 1,600 calories a day:
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6 starches
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2 servings of milk or yogurt
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3 vegetables
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2 meat or meat substitutes
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2 fruits
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Up to 3 fats
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Have about 1,600 to 2,000 calories a day if you are:
- A large woman who wants to lose weight
- A small man at a healthy weight
- A medium man who does not exercise much
- A medium to large man who wants to lose weight.
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Choose this many servings from these food groups to have 1,600 to 2,000 calories a day:
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8 starches
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2 servings of milk or yogurt
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4 vegetables
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2 meat or meat substitutes
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3 fruits
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Up to 4 fats
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Have about 2,000 to 2,400 calories a day if you are:
- A medium to large man who does a lot of exercise or has a physically active job
- A large man at a healthy weight
- A large woman who exercises a lot or has a physically active job.
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Choose this many servings from these food groups to have 2,000 to 2,400 calories a day:
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11 starches
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2 servings of milk or yogurt
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4 vegetables
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2 meat or meat substitutes
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3 fruits
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Up to 5 fats
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For whatever category you fit into, ask your healthcare provider or dietician to create a diabetic diet meal plan that fits:
- The way you usually eat
- Your daily routine
- Your diabetes medicines.
Starches are:
- Bread
- Grains
- Cereal
- Pasta
- Starchy vegetables like corn and potatoes.
They give your body energy, vitamins, minerals, and fiber. Whole-grain starches are healthier because they have more vitamins, minerals, and fiber.
Eat some starches at each meal. People might tell you not to eat starches as part of a diabetic diet, but that is not correct. Eating starches is healthy for everyone, including people with diabetes.
Examples of starches that may be part of a diabetic diet include:
- Bread
- Pasta
- Corn
- Potatoes
- Rice
- Crackers
- Tortillas
- Beans
- Yams.
Starch Serving Size
If you have more than one serving at a meal, you can choose several different starches or have two or three servings of one starch.
Starch Suggestions
Here are some healthy ways to eat starches as part of your diabetic diet:
- Buy whole-grain breads and cereals.
- Eat fewer fried and high-fat starches, such as regular tortilla chips and potato chips, French fries, pastries, or biscuits. Try pretzels, fat-free popcorn, baked tortilla or potato chips, baked potatoes, or low-fat muffins.
- Use low-fat or fat-free yogurt or fat-free sour cream instead of regular sour cream on a baked potato.
- Use mustard instead of mayonnaise on a sandwich.
- Use the low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.
- Eat cereal with fat-free (skim) or low-fat (1 percent) milk.
The next level of the Diabetes Food Pyramid consists of vegetables. Vegetables give you vitamins, minerals, and fiber, with very few calories.
Some examples of vegetables that may be included in your diabetic diet are:
- Lettuce
- Broccoli
- Vegetable juice
- Peppers
- Carrots
- Green beans
- Salsa
- Chilies
- Greens.
Vegetable Serving Sizes
If you have more than one serving at a meal, you can choose a few different types of vegetables or have two or three servings of one vegetable.
Vegetable Suggestions
Here are some healthy ways to eat vegetables as part of your diabetic diet:
- Eat raw and cooked vegetables with little or no fat, sauces, or dressings.
- Try low-fat or fat-free salad dressing on raw vegetables or salads.
- Steam vegetables using a small amount of water or low-fat broth.
- Mix in some chopped onion or garlic.
- Use a little vinegar or some lemon or lime juice.
- Add a small piece of lean ham or smoked turkey instead of fat to vegetables when cooking.
- Sprinkle with herbs and spices. These flavorings add almost no fat or calories.
- If you do use a small amount of fat, use canola oil, olive oil, or soft margarines (liquid or tub types) instead of fat from meat, butter, or shortening.
Fruit is at the same level of vegetables on the Diabetes Food Pyramid. Fruit gives you energy, vitamins, minerals, and fiber.
Some examples of fruit that is good for a diabetic diet include:
- Apples
- Fruit juice
- Strawberries
- Bananas
- Raisins
- Oranges.
Fruit Serving Size
If you have more than one serving at a meal, you can choose different types of fruit or have two servings of one fruit.
Fruit Suggestions
Here are some healthy ways to eat fruit as part of your diabetic diet:
- Eat fruits raw or cooked, as juice with no sugar added, canned in their own juice, or dried.
- Buy smaller pieces of fruit.
- Eat pieces of fruit rather than drinking fruit juice. Pieces of fruit are more filling and contain fiber.
- Drink fruit juice in small amounts.
- Save high-sugar and high-fat fruit desserts, such as peach cobbler or cherry pie, for special occasions.
Including Milk and Yogurt in a Diabetic Diet
Milk and Yogurt Serving Size
If you are pregnant or breast-feeding, have 4 to 5 servings of milk and yogurt each day as part of your diabetic diet.
Milk and Yogurt Suggestions
Here are some healthy ways to eat or drink milk and yogurt as part of your diabetic diet:
- Drink fat-free (skim or nonfat) or low-fat (1 percent) milk.
- Eat low-fat or fat-free fruit yogurt sweetened with a low-calorie sweetener.
- Use low-fat plain yogurt as a substitute for sour cream.
Meat and Meat Substitutes
The second highest level in the Diabetes Food Pyramid includes meats and meat substitutes. The meat and meat substitutes group includes:
- Meat
- Poultry
- Eggs
- Cheese
- Fish
- Tofu.
Eat small amounts of some of these foods each day.
Meat and meat substitutes help your body build tissue and muscles. They also give your body energy and vitamins and minerals.
Examples of meat and meat substitutes that can be used in a diabetic diet include:
- Chicken
- Fish
- Beef
- Eggs
- Peanut butter
- Tofu
- Cheese
- Ham
- Pork.
Meat and Meat Substitutes Serving Size
A serving of two to three ounces of meat (after cooking) is about the size of a deck of cards.
Meat and Meat Substitutes Suggestions
Here are some healthy ways to eat meat or meat substitutes as part of your diabetic diet:
- Buy cuts of beef, pork, and lamb that have only a little fat on them. Trim off extra fat.
- Eat chicken or turkey without the skin.
- Cook meat or meat substitutes in low-fat ways, such as broiling, grilling, stir-frying, roasting, steaming, or stewing.
- To add more flavor, use vinegars, lemon juice, soy or teriyaki sauce, salsa, ketchup, barbecue sauce, and herbs and spices.
- Cook eggs with a small amount of fat, or use cooking spray.
- Limit the amounts of nuts, peanut butter, and fried chicken that you eat. They are high in fat.
- Choose low-fat or fat-free cheese.
Fats, Sweets, and Alcohol in a Diabetic Diet
The tip of the Diabetes Food Pyramid includes fat, sweets, and alcohol. Limit the fats and sweets you eat. They have calories, but not much nutrition. Some contain saturated fats and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control.
Alcohol has calories but no nutrients. If you drink alcohol on an empty stomach, it can make your blood glucose level too low. Alcohol also can raise your blood fats. If you want to drink alcohol, talk with your doctor or diabetes teacher about how it fits into your meal plan.
Examples of fats that may be part of a diabetic diet include:
- Salad dressing
- Oil
- Butter
- Margarine
- Avocado
- Olives.
Examples of sweets include:
- Regular soda
- Ice cream
- Cake
- Cookies
- Pie
- Candy.
Diabetic Diet and the Sweet Tooth
It's okay to have sweets once in a while as part of your diabetic diet. Try having sugar-free Popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix.
Other tips:
- Share desserts in restaurants.
- Order small or child-size servings of ice cream or frozen yogurt.
- Divide homemade desserts into small servings and wrap each individually. Freeze extra servings.
- Don't keep dishes of candy in the house or at work.
Remember, fat-free and low-sugar foods still have calories. Talk with your doctor or dietician about how to fit sweets into your diabetic diet.
Blood Glucose Levels and the Diabetic Diet
For most people, target blood glucose levels should be:
- 90 to 130 before meals
- Less than 180 one to two hours after the start of a meal.
To keep your blood glucose at a healthy level:
- Eat about the same amount of food each day.
- Eat your meals and snacks at about the same times each day.
- Do not skip meals or snacks.
- Take your medicines at the same times each day.
- Exercise at about the same times each day.
Eating the same amount at the same time each day is important because your blood glucose goes up after you eat. If you eat a big lunch one day and a small lunch the next day, your blood glucose levels will change too much.
Also, keep your blood glucose at a healthy level by eating about the same amount of carbohydrate foods at about the same times each day. Carbohydrate foods, also called carbs, provide glucose for energy. Examples of carbohydrate foods include:
- Starches
- Fruits
- Milk
- Starchy vegetables (such as corn)
- Sweets.
To make sure your food servings are the right size for your diabetic diet, use:
- Measuring cups
- Measuring spoons
- A food scale.
Also, the Nutrition Facts label on food packages tells you how much of that food makes up one serving.
Weigh or measure foods to make sure you eat the right amounts.
These tips will help you choose the right serving sizes as part of your diabetic diet:
- Measure a serving size of dry cereal or hot cereal, pasta, or rice and pour it into a bowl or plate. The next time you eat that food, use the same bowl or plate and fill it to the same level.
- For one serving of milk, measure 1 cup and pour it into a glass. See how high it fills the glass. Always drink milk out of that size glass.
- Meat weighs more before it is cooked. For example, 4 ounces of raw meat will weigh about 3 ounces after cooking. For meat with a bone, like a pork chop or chicken leg, cook 5 ounces raw to get 3 ounces cooked.
- One serving of meat or meat substitute is about the size and thickness of the palm of your hand or a deck of cards.
- A small fist is equal to about 1/2 cup of fruit, vegetables, or starches like rice.
- A small fist is equal to 1 small piece of fresh fruit.
- A thumb is equal to about 1 ounce of meat or cheese.
- The tip of a thumb is equal to about 1 teaspoon.
Maintaining a Diabetic Diet When You Are Sick
It's important to take care of your diabetes even when you're ill. Here are some tips on what to do as part of your diabetic diet if you are sick:
- Even if you can't keep food down, continue taking your diabetes medicine.
- Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you're awake.
- If you can't eat your usual food, try drinking juice or eating crackers, Popsicles, or soup.
- If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down, because you still need calories. If you don't have enough calories, you increase your risk of hypoglycemia (low blood sugar).
- Make sure that you check your blood glucose. Your blood glucose level may be high even if you're not eating.
- Call your doctor right away if you throw up more than once or have diarrhea for more than 6 hours.
Your Diet and Your Diabetes Medicines
What you eat and when affects how your diabetes medicines work. Talk with your doctor or diabetes teacher about the best times to take your diabetes medicines based on your diabetic diet.
What you eat and when also depend on how much you exercise. Exercise is an important part of staying healthy and controlling your blood glucose. Physical activity should be safe and enjoyable, so talk with your doctor about what types of exercise are right for you. Whatever exercise you do, here are some special things that people with diabetes need to remember:
- Take care of your feet. Make sure your shoes fit properly and your socks stay clean and dry.
- Check your feet for redness or sores after exercising. Call your doctor if you have sores that do not heal.
- Drink about 2 cups of water before you exercise, about every 20 minutes during exercise, and after you finish, even if you don't feel thirsty.
- Warm up and cool down for 5 to 10 minutes before and after exercising. For example, walk slowly at first, then walk faster. Finish up by walking slowly again.
- Test your blood glucose before and after exercising. Do not exercise if your fasting blood glucose level is above 300. Eat a small snack if your blood glucose is below 100.
- Know the signs of low blood glucose (hypoglycemia) and how to treat it.
Diabetic Diet and Hypoglycemia
You should know the signs of hypoglycemia (low blood sugar), such as:
- Feeling weak or dizzy
- Sweating for no apparent reason
- Sudden changes in your heartbeat
- Feeling hungry.
If you experience these symptoms, stop exercising and test your blood glucose. If it is 70 or less, eat one of the following right away:
- 2 or 3 glucose tablets
- 1/2 cup (4 ounces) of any fruit juice
- 1/2 cup (4 ounces) of a regular (not diet) soft drink
- 1 cup (8 ounces) of milk
- 5 or 6 pieces of hard candy
- 1 or 2 teaspoons of sugar or honey.
After 15 minutes, test your blood glucose again to find out whether it has returned to a healthier level. Once blood glucose is stable, if it will be at least an hour before your next meal, it's a good idea to eat a snack.
To be safe when you exercise, carry something to treat hypoglycemia, such as glucose tablets or hard candy. Another good idea is to wear a medical identification bracelet or necklace (in case of an emergency). Teach your exercise partners the signs of hypoglycemia and what to do about it.
The following points are important to keep in mind regarding a diabetic diet:
- What, when, and how much you eat affect your blood glucose level.
- You can keep your blood glucose at a healthy level if you eat about the same amount of food each day; eat at about the same times each day; take your medicines at the same times each day; and exercise at the same times each day.
- Every day, choose foods from these food groups: starches, vegetables, fruit, meat and meat substitutes, and milk and yogurt. How much of each depends on how many calories you need a day.
- Limit the amounts of fats and sweets you eat each day as part of your diabetic diet.
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