By Carrie Snyder MPH, RDN, CDCES
Three things that directly affect blood sugar levels are portion sizes, food composition, and timing of eating or taking medicine. Making changes to food choices and portions can be one of the hardest parts of diabetes self-management, so I wanted to create a summary of recommendations to help determine what works best for you. The science of nutrition is always changing so I encourage you to never stop learning.
Meal plans are used to meet a weight goal, target cholesterol, meet A1c goals, and lower blood pressure. Blood sugar management is often a main reason for meal planning. The closer to normal blood glucose levels can be safely kept, the lower the risk for eyes, kidney, nerve, and blood vessel damage for people with diabetes. Meal planning is a basic component for all treatment plans for all forms of diabetes. Some individuals with type 2 diabetes can keep their blood sugar at target with meal planning alone.
Checking your blood sugar before you eat and 2 hours after a meal serves as your guide to determining if your eating plan is working for you, or if tweaks need to be made. Individuals using a continuous glucose monitor will see how much their blood glucose rises after a meal, and when it peaks. Continue reading to learn the basics of nutrients in food and several eating plans and tips that can be incorporated into your diabetes treatment.
Nutrients in food
Carbohydrates – Examples are sugar, starch, and fiber. Your body will break starches down to sugar to use as energy and will raise blood sugar. We cannot convert fiber into energy, and it does not raise our blood glucose levels. Fiber can help gastrointestinal issues, lower cholesterol, help lower blood sugar, and decrease your risk of colon cancer. The amount of total carbohydrates you need varies from person to person. Food sources of carbohydrates are grains, vegetables, fruits, beans, and dairy.
Protein – is made up of amino acids. We digest protein from our food and store it as amino acids, which are the building blocks for every cell in the body. Amino acids are crucial for repairing the body, including skin and muscle cells. The body needs insulin to use protein and does appear to increase insulin response among people with type 2 diabetes. Protein does not have a significant effect on blood glucose except when consumed in extremely high amounts in the absence of carbohydrates.
Fat – is an essential nutrient that supplies energy, maintains healthy skin, and carries the fat-soluble vitamins A, D, E, and K. (Example: if you take Vitamin D supplement be sure take it with a meal that contains fat to properly absorb it.) We need about 18% of our calories to come from fat to transport fat-soluble vitamins and maintain cells in the body. Fat takes longer to digest and absorb in your body than carbohydrates and protein. When combined with carbohydrates, fat helps to slow down how fast the glucose reaches the bloodstream. The type of fat appears to be more important than the total grams per day: Replace saturated fat with monounsaturated and polyunsaturated fat. Limit trans fats to as little as possible.
Common types of meal plans used for blood sugar treatment:
A personalized eating plan is prescribed by your registered dietitian nutritionist based upon other diagnoses, your dislikes, culture, family dynamics, as well as your medicines, financial, and health and other issues.
Carbohydrate counting – The amount of carbohydrates in your meals or snacks can make a significant difference to what your blood sugar does after the meal. Your dietitian will determine how many carbohydrates to consume at a meal. Carbohydrates from both foods and beverages add to the total amount of carbohydrates consumed. This method of meal planning is particularly important for individuals taking mealtime insulin. There are variations people can use such as using a carbohydrate exchange method or consuming the same amount of carbohydrates at each meal and snack.
Plate method – This plan does not involve any counting. It is a simple way to manage your portions and eat a balanced meal. Start with a 9-inch plate. Divide your plate in half where non-starchy vegetables will fill the first half. You will divide the second half into two quarters. Place protein rich food in the first quarter while including carbohydrate rich foods, such as starches or grains, in the last quarter. On the half side, include fruit or dairy rich food such as milk or yogurt. Finally, be sure to consume water or other zero-calorie beverages with the meal.
Mediterranean – this style of eating plan helps protect the heart and may help you manage weight and blood sugar levels. The focus of this meal is on eating mostly plant-based foods such as fruits, vegetables, whole grains, beans, nuts and seeds. The main source of fat is olive oil. You can also have a small portion of dairy, fish and poultry on this meal plan.
Low carbohydrate - a low carbohydrate meal plan will typically be less than 130 g per day. You may benefit from eating fewer high carbohydrates foods (grains, sweets, starchy vegetables) than typically consumed. People following this meal plan will focus on non-starchy vegetables, lean proteins and healthy sources of fat. It is recommended that certain types of diabetes and populations do not follow this eating plan.
DASH – Dietary Approaches to Stop Hypertension – This meal plan is used for individuals treating high blood pressure. It focuses on a high fiber diet while increasing fruits, vegetables, whole grains, nuts, seeds, and low-fat dairy products, poultry, and fish. Red meat, added sugar and salt are limited.
Vegetarian – a vegetarian meal plan may help you manage obesity and heart disease risk. You will focus on plant-based foods such as whole grains, vegetables, fruits, beans, nuts and seeds. Some forms will limit all animal products including dairy and eggs.
Additional tips
Timing of meals and snacks – The more you eat at one time, the more insulin your body needs to make. Eating a lot of carbohydrates at one time also increases your need for insulin. It takes more insulin to bring down high blood sugar. Insulin and most diabetes medications work better to manage your blood sugars when you take them about the same time every day.
Eat each meal and snack around the same time every day
Eat consistent amounts of carbohydrates at about the same time every day
Balance the times you take insulin with the times you eat and check your blood sugar level
Do not skip meals after taking mealtime insulin or medicines that increase your own production of insulin (insulin secretagogues).
People who take insulin and insulin secretagogues may find eating several small meals or snacks every 3-4 hours creates more stable blood sugar levels, reduced hunger and prevents overeating.
Portions – if your blood sugar is high after some meals or if your weight is increasing, eating smaller portions may help.
Glycemic index of foods – The glycemic index is a scale ranking different foods and beverages based upon how much it raises blood sugar after it is eaten or drank. Foods with a higher glycemic index raise blood sugar higher and faster than a food at a lower glycemic index. There are several things that can affect the glycemic index of a meal:
Preload your carbohydrates consumption by eating non-starchy vegetables and/or protein about 10 minutes prior to your carbohydrates. An easy way to remember this is just to eat your carbohydrates last.
Do not consume carbohydrate rich foods alone- always consume them with healthy fats, proteins and non-starchy vegetables.
Eat acid at the meal such as using a vinegar-based dressing.
Increase the consumption of whole foods over processed foods
Food storage and preparation can also affect the glycemic effect of food
Time restricted eating (intermittent fasting) – While this approach to eating has been around for a long time it has just begun to be researched in the past few years in individuals with prediabetes and type 2 diabetes. It shows promise for those with obesity, prediabetes and type 2 diabetes. Things to take into consideration prior to starting this lifestyle are:
You want to follow a plan that you can stick to long-term
Speak with your healthcare provider before starting to determine if you need adjustments to medications and/or insulin that can cause hypoglycemia
Monitor blood sugar levels more frequently, especially if you take medication or insulin that can cause hypoglycemia
Be sure you have support when following this lifestyle
Be prepared for side effects that may arise such as headaches, stomach cramps, diarrhea or constipation
Do not restrict fluids
Work with your dietitian to ensure you are still meeting your protein, vitamin, and mineral needs
Monitor your mood and energy levels. Especially those in high stress situations or being treated for anxiety or depression.
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