A high-fat diet causes glucose intolerance and insulin resistance. Atherosclerosis is the most common complication of diabetes. There is strong evidence from primary prevention studies in non-diabetics that reduction in LDL (bad cholesterol) level and elevation in HDL (good cholesterol) level each reduces the risk of coronary artery disease. It is essential that physicians pay attention to the control of plasma lipid disorders in their diabetic patients.
Studies of diabetes using high-fiber, high-legume diets have indicated improvements in blood sugar control and blood lipid profile. Similar improvements have also been noted when foods were selected on the basis of their slow rates of digestion and flatter glycemic response despite relatively small changes in fiber content. Simple carbohydrates like monosaccharides and disaccharides (monosaccharides and disaccharides are sugars) should be restricted.
High-fiber intake seems to be important. Studies have suggested that an increase in the intake of soluble dietary fiber can lead to decreases in plasma glucose and glycosuria(sugar in the urine) and a reduction in insulin requirements.
Exercise can improve blood sugar balance in the person with NIDDM (non-insulin dependent diabetes meletus—or type 2 diabetes) and may lower insulin requirements in the individual with IDDM (insulin dedpendentdiabetes meletus—or type 1 diabetes). Exercise usually decreases plasma glucose levels when the diabetes is well controlled. In the poorly controlled diabetic with plasma glucose greater than 300 mg/dL, exercise may actually increase glucose levels.
Be aware of the fact that giving nutritional supplementation to a diabetic taking insulin or other hypoglycemic agent may undermine control. Sometimes the supplementation is actually effective in bringing down blood sugar and if the insulin dose doesn’t change, can create a hypoglycemic (low blood sugar) state. The low blood sugar triggers cortisol (an adrenal hormone) production, raising blood sugar. The result is a loss of control of blood sugar levels. To make sure the patient maintains control:
- Make gradual changes. Add one supplement at a time. Start with a low dose and gradually increase it.
- Make sure that you monitor blood sugar regularly.
Food allergy testing and avoidance of allergens may be of value in the diabetic patient.
Insulin-Dependent Diabetes Mellitus (IDDM), commonly called “juvenile diabetes” Priorities:
- The patient must consume adequate calories to maintain desirable weight.
- Meal times and the composition of the diet must be consistent from day to day, with the carbohydrate content fairly evenly divided from meal to meal.
- Simple carbohydrates must be limited to 10% to 15% of total calories.
- Depending upon the insulin regimen, a bedtime snack may help prevent nocturnal hypoglycemia; midmorning and midafternoonsnacks must be taken if needed, to match the food intake to the peak insulin action.
- Food must be taken to correct hypoglycemic episodes.
- Food and fluids must be taken for periods of increased physical activity and during illness.
- Suggest modifications in the diet for hypertension, hyperlipidemia, and/or renal insufficiency if present.
- If obese, the patient must follow a program to reduce weight (persons with IDDM are usually not obese).
Non–Insulin-Dependent Diabetes Mellitus (NIDDM): This is adult onset diabetes. Obesity and poor dietary habits can cause this. It is a situation where the individual produces insulin, but is becoming insensitive to their insulin. This type of diabetes can be controlled by diet, and it is not as important to be consistent with timing of meals and carbohydrate.
The American Diabetes Association recommends that 12% to 20% of all calories be protein, 20% to 30% of all calories be fat and 55% to 60% of calories be carbohydrate. The amount of protein in the diet meets or exceeds the recommended dietary allowance (RDA) of 0.8 g/kg of body weight. The percentage of calories from protein may be as much as 20% in diets of 1200 calories or less and may decrease to 12% at higher caloric levels. There is no advantage to a high protein diet,in fact diabetics are vulnerable to renal complications. For the person who has only a slight elevation of creatinine levels, it is prudent to keep the protein level at approximately the RDA. Reduction of fat intake is recommended because of the high incidence of atherosclerosis. Cholesterol consumption should be less than 300 mg/day.
General Advice for Hyperglycemia:
- Avoid refined sugar and refined carbohydrates.
- Avoid hydrogenated and partially hydrogenated oils.
- Finding and eliminating hidden food sensitivities is sometimes useful: Avoiding food that an individual may be sensitive to, like gluten grains and dairy, commonly makes blood sugar easier to control. Testing for and eliminating common allergens is controversial when dealing with diabetes, but is sometimes useful.
- Increase fiber from vegetables and legumes:Vegetables contain antioxidants and fiber helps improve blood sugar control.