Diabetes and Nutrition

Get the Nutrition 4-1-1

You’ve probably heard it before: eat your fruits and veggies, drink plenty of water, avoid junk foods. But did you know nutrition involves so much more than just getting in 3 square meals per day? Following a healthy diet gives you energy to do all of your favorite activities. Plus it can play a role in helping your body heal difficult wounds. A well-rounded, balanced diet can be challenging to follow when you have diabetes, but careful planning and a bit of knowledge can help you make nutritious choices for a healthy lifestyle that can manage your diabetes.

The Basics Behind Diabetes

Insulin, blood sugar, glycemia: oh my! Diabetes is a disorder of the metabolism, which affects how the pancreas makes insulin to regulate the amount of sugar, or glucose, in your blood. As the body digests carbohydrates and releases nutrients into the bloodstream after eating, insulin helps move glucose into the body’s cells for energy. With diabetes, however, the body either does not use or make enough insulin, affecting how you function on a day-to-day basis.

There are 3 types of diabetes:

• Type 1, in which the immune system attacks and destroys the pancreas’s cells that make insulin. This type must be treated with an additional insulin prescription. You may have heard of this referred to as “juvenile diabetes.”
• Type 2, in which the body creates an insulin resistance and cannot make enough insulin to keep a normal blood sugar level. It can be treated effectively with healthy behavior changes, including diet, exercise, and medication. Type 2 is the most common form of diabetes.
• Gestational, which only develops during pregnancy. Most women return to more normal blood glucose levels after giving birth, but they should be monitored afterwards because they are at higher risk of developing type 2 diabetes later in life.

The American Diabetes Association (ADA) estimates that over 30 million Americans live with diabetes and an additional 84 million have prediabetes, a condition in which blood sugar levels are high but not high enough for a complete diabetes diagnosis. The ADA also found that the total cost of diabetes in the United States was $327 billion in 2017, with $90 billion in costs for reduced productivity. If not monitored and treated properly, diabetes can have serious complications, including:

• Neuropathy
• Stroke
• Kidney disease
• Skin infections
• High blood pressure
• Glaucoma 

Keys to Living With Diabetes

• Consult with a registered dietician (RD).  The RD will help you put together a personalized “diabetes diet” based on your tastes and health goals. Your doctor may be able to assist you in finding the right RD for you.
• Monitor your blood sugar levels closely.  Check your glucose twice a day and keep it under control as directed by your doctor. Typical goals for blood sugar levels include 80-130mg/dL before eating and less than 180mg/dL two hours after eating.
• Eat at a regular time each day. Following a schedule can help keep your blood sugar at a more stable level from day to day to avoid serious complications. Be sure not to skip any meals either!
• Be aware of the portion sizes of what you eat. Read more on the other side of this handout about eating a balanced diet.
• Keep an eye on your feet, from your toes to your heel.  Proper fitting footwear can help prevent cuts, cracks, and sores in your feet that can turn into ulcers. Keep your foot moisturized and dry.
• Throw exercise into your everyday routine. Increased physical activity can lower blood pressure and cholesterol; burn calories for weight management; strengthen the heart, muscles, and bones; and improve mood, sleep, and energy level.

The ‘Dreaded’ Carbohydrate 

People with diabetes should pay close attention to the amount of carbohydrates (carbs) they consume daily. Carbohydrates are a macronutrient and include fiber, starches, and sugars, which are broken down during digestion and used for energy stores. Counting how many carbs you consume per day, from fruits and grains but also juice and alcohol, can help manage your blood sugar levels. 

Everyone has a different amount of carbs they can eat; a RD can help you determine how many carbohydrate servings are a good daily goal for you. Generally, 1 serving of carbohydrates is 15 grams, which is equivalent to:

• A small piece of fruit
• 1 slice of bread
• 1/3 cup of cooked pasta or rice
• 1/4 of a large baked potato
• 2/3 cup of nonfat yogurt

A Well-Balanced Plate 

When you were younger, you may have seen a food wheel or pyramid graphic with serving size suggestions for each food group. In 2011, the United States Department of Agriculture updated its dietary guidelines with MyPlate, a more individualized approach to a well-rounded, healthy diet. The concept is simple:

• Divide your plate into 2 halves. Split one of those halves again, so that there are 2 quarters on one side and 1 half on the other.
• Fill the largest section (the half) with non-starchy vegetables like a salad, cauliflower, spinach, or peppers.
• Add a grain or starchy vegetable to 1 quarter. Starchy vegetables include potatoes, green peas and corn, and grains include pasta, rice and tortillas.
• In the other quarter, place some protein: fish, poultry, eggs, beans, and nuts are all great options.
• Finally, add a serving of fruit (e.g., berries or apple) or dairy (e.g., cheese or yogurt) as a side.

It’s easy to take the “MyPlate” concept and use it for grocery shopping as well. Half of your grocery list should be filled with non-starchy vegetables, while the other half is lean proteins, whole grains, fruit, dairy, and starchy vegetables. Typically, grocery stores put the healthiest options (fruits, veggies, meat/fish, and dairy) on the outside aisles. Stick to these aisles as you fill your cart or basket.

Diabetes & Nutrition Affect How You Heal 

You likely know already that diabetes can slow wound healing if it is not carefully kept in check. Diabetic neuropathy, or damage to your nerves, can cause you to feel fewer pain sensations, so you may miss signs of an injury to the bottom of your foot. Further, high levels of glucose in the blood can cause the arteries to be stiff and narrow, preventing proper blood flow and delivery of key nutrients and oxygen to an injured area. In addition, the white blood cells cannot fight off bacteria as well, increasing the possibility of infection. Uncontrolled diabetes also can cause inflammation, prolonging the amount of time a wound needs to heal to the point where the wound is considered chronic. 

Following a balanced diet as recommended by your doctor or RD can help combat these effects on wound healing. Nutrients thought to help with wound healing include protein, vitamin C, vitamin A, and zinc. 

1. Centers for Disease Control and Prevention. Living with Diabetes: Eat Well! https://www.cdc.gov/diabetes/managing/eat-well.html. Reviewed March 20, 2019. Accessed June 30, 2019.

2. Mayo Clinic Staff. Diabetes diet: Create your healthy-eating plan. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295. Updated February 19, 2019. Accessed July 1, 2019.

3. American Diabetes Association. How Your Body Uses Glucose and Insulin. http://www.diabetes.org/are-you-at-risk/lower-your-risk/highbg.html. Last edited August 30, 2018. Accessed July 1, 2019.

4. American Diabetes Association. Statistics About Diabetes. http://www.diabetes.org/diabetes-basics/statistics/. Last edited March 22, 2018. Accessed July 1, 2019.

5. Centers for Disease Control and Prevention. Diabetes and Carbohydrates. https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbohydrates.html. Last reviewed January 22, 2019. Accessed July 1, 2019. 

6. WoundSource Editors. How Diabetes Impacts Wound Healing. https://www.woundsource.com/blog/how-diabetes-impacts-wound-healing. Published December 4, 2017. Accessed June 30, 2019.

7. Cleveland Clinic. Nutrition Guidelines to Improve Wound Healing. https://my.clevelandclinic.org/health/articles/11111-nutrition-guidelines-to-improve-wound-healing. Last reviewed September 23, 2014. Accessed June 30, 2019.