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Regular physical activity, which can contribute to both weight loss and prevention of weight regain, and behavioral strategies are also important components of lifestyle therapy for weight management 26 , 74 , 83 , — Structured weight loss programs with regular visits and use of meal replacements have been shown to enhance weight loss in people with diabetes — The combined data do not point to a threshold of weight loss for maximal clinical benefits in people with diabetes; rather, the greater the weight loss, the greater the benefits.
A meta-analysis conducted by Franz et al. Other meta-analyses focusing on nonmedicine or medicine-assisted weight loss interventions in type 2 diabetes support this finding — The intensive lifestyle intervention resulted in 8. A systematic review of the effectiveness of MNT revealed mixed weight loss outcomes in participants with type 1 and 2 diabetes 9. Similarly, while DSMES is a fundamental component of diabetes care 1 , it does not consistently produce sufficient weight loss to achieve optimal therapeutic benefits in people with diabetes , , The addition of metabolic surgery , weight loss medications , and glucose-lowering agents that promote weight loss can also be used as an adjunct to lifestyle interventions, resulting in greater weight loss that is maintained for a longer period of time.
The data also support the position that weight loss therapy is effective at all phases of type 2 diabetes, both in individuals with recent-onset disease 1 , and in people with longer durations of diabetes treated with multiple diabetes medications , Regular physical activity by itself , or as part of a comprehensive lifestyle plan 26 , 74 , 83 , can prevent progression to type 2 diabetes in high-risk individuals.
Studies have demonstrated beneficial effects of both aerobic and resistance exercise and additive benefits when both forms of exercise are combined — What is the best weight loss plan for individuals with diabetes? For purposes of weight loss, the ability to sustain and maintain an eating plan that results in an energy deficit, irrespective of macronutrient composition or eating pattern, is critical for success — Studies investigating specific weight loss eating plans using a broad range of macronutrient composition in people with diabetes have shown mixed results regarding effects on weight, A1C, serum lipids, and blood pressure , , , — As a result, the evidence does not identify one eating plan that is clearly superior to others and that can be generally recommended for weight loss for people with diabetes Individualized eating plans should support calorie reduction e.
Weight loss interventions can be implemented in usual care settings and alternately in telehealth programs , In general, the intervention intensity and degree of individual participation in the program are important factors for successful weight loss — , What is the role of weight loss on potential for type 2 diabetes remission?
The Look AHEAD trial and the Diabetes Remission Clinical Trial DiRECT highlight the potential for type 2 diabetes remission—defined as the maintenance of euglycemia complete remission or prediabetes level of glycemia partial remission with no diabetes medication for at least 1 year , —in people undergoing weight loss treatment. In the Look AHEAD trial, when compared with the control group, the intensive lifestyle arm resulted in at least partial diabetes remission in Diet composition may also play a role; in an RCT by Esposito et al.
What is the role of eating plans that result in energy deficits and weight loss in type 1 diabetes? Obesity prevalence among people with type 1 diabetes has been significantly increasing — A recent study suggested obesity may promote progression to overt type 1 diabetes in at-risk individuals , but further confirmatory studies are needed.
In addition, in people with established type 1 diabetes, presence of obesity can worsen insulin resistance, glycemic variability, microvascular disease complications, and cardiovascular risk factors — Therefore, weight management has been recommended as an essential component of care for people with type 1 diabetes who have overweight or obesity — There is a scarcity of evidence from RCTs evaluating weight loss interventions in type 1 diabetes.
A retrospective nested-control study indicated that lifestyle-induced weight loss improved glycemia with a reduction in insulin doses compared with controls Individuals with type 1 diabetes and obesity may benefit from eating plans that result in an energy deficit and that are lower in total carbohydrate and GI and higher in fiber and lean protein Currently, adjunctive pharmacotherapy is not indicated for individuals with type 1 diabetes.
However, there is preliminary evidence that in select individuals with type 1 diabetes and excess adiposity, newer pharmacotherapy i. In addition, metabolic surgery in appropriate candidates can decrease body weight and improve glycemia , How does disordered eating factor into weight management? When counseling individuals with diabetes and prediabetes about weight management, special attention also must be given to prevent, diagnose, and treat disordered eating. Disordered eating can make following an eating plan challenging Health care professionals should consider screening for disordered eating, refer to a mental health professional, and individualize nutrition therapy accordingly When sugar substitutes are used to reduce overall calorie and carbohydrate intake, people should be counseled to avoid compensating with intake of additional calories from other food sources.
Does the consumption of SSBs impact risk of diabetes? SSB consumption in the general population contributes to a significantly increased risk of type 2 diabetes, weight gain, heart disease, kidney disease, nonalcoholic liver disease, and tooth decay What is the impact of sugar substitutes?
The U. Food and Drug Administration FDA has reviewed several types of sugar substitutes for safety and approved them for consumption by the general public, including people with diabetes In this report, the term sugar substitutes refers to high-intensity sweeteners, artificial sweeteners, nonnutritive sweeteners, and low-calorie sweeteners. These include saccharin, neotame, acesulfame-K, aspartame, sucralose, advantame, stevia, and luo han guo or monk fruit.
Replacing added sugars with sugar substitutes could decrease daily intake of carbohydrates and calories. These dietary changes could beneficially affect glycemic, weight, and cardiometabolic control. However, an American Heart Association science advisory on the consumption of beverages containing sugar substitutes that was supported by the ADA concluded there is not enough evidence to determine whether sugar substitute use definitively leads to long-term reduction in body weight or cardiometabolic risk factors, including glycemia Using sugar substitutes does not make an unhealthy choice healthy; rather, it makes such a choice less unhealthy.
If sugar substitutes are used to replace caloric sweeteners, without caloric compensation, they may be useful in reducing caloric and carbohydrate intake , although further research is needed to confirm these concepts Multiple mechanisms have been proposed for potential adverse effects of sugar substitutes, e. As people aim to reduce their intake of SSBs, the use of other alternatives, with a focus on water, is encouraged Sugar alcohols represent a separate category of sweeteners.
Like sugar substitutes, sugar alcohols have been approved by the FDA for consumption by the general public and people with diabetes. Whereas sugar alcohols have fewer calories per gram than sugars, they are not as sweet. Therefore, a higher amount is required to match the degree of sweetness of sugars, generally bringing the calorie content to a level similar to that of sugars Use of sugar alcohols needs to be balanced with their potential to cause gastrointestinal effects in sensitive individuals.
Currently, there is little research on the potential benefits of sugar alcohols for people with diabetes Educating people with diabetes about the signs, symptoms, and self-management of delayed hypoglycemia after drinking alcohol, especially when using insulin or insulin secretagogues, is recommended. The importance of glucose monitoring after drinking alcohol beverages to reduce hypoglycemia risk should be emphasized.
What are the effects of alcohol consumption on diabetes-related outcomes? It is important that health care providers counsel people with diabetes about alcohol consumption and encourage moderate and sensible use for people choosing to consume alcohol. One alcohol-containing beverage is defined as oz beer, 5-oz wine, or 1. Starting with one drink per day, risk for reduced adherence to self-care and healthy lifestyle behaviors has been reported with increasing alcohol consumption What are the effects of alcohol consumption on hypoglycemia risk in people with diabetes?
Despite the potential glycemic and cardiovascular benefits of moderate alcohol consumption, alcohol intake may place people with diabetes at increased risk for delayed hypoglycemia , — This is particularly relevant for those using insulin or insulin secretagogues who can experience delayed nocturnal or fasting hypoglycemia after evening alcohol consumption. Consuming alcohol with food can minimize the risk of nocturnal hypoglycemia , It is essential that people with diabetes receive education regarding the recognition and management of delayed hypoglycemia and the potential need for more frequent glucose monitoring after consuming alcohol , How does alcohol consumption impact risk of developing type 2 diabetes?
Comprehensive reviews and meta-analyses suggest a protective effect of moderate alcohol intake on the risk of developing type 2 diabetes, with a higher rate of diabetes in alcohol abstainers and heavy consumers , — Knott et al. A meta-analysis and systematic review that examined the effects of specific types of alcohol beverage consumption and the incidence of type 2 diabetes found that wine consumption was associated with significantly lower diabetes risk, as compared with a smaller reduction in risk with beer and spirits.
While epidemiologic evidence shows a correlation between alcohol consumption and risk of diabetes, the evidence does not suggest that providers should advise abstainers to start consuming alcohol. It is recommended that MNT for people taking metformin include an annual assessment of vitamin B12 status with guidance on supplementation options if deficiency is present.
The routine use of chromium or vitamin D micronutrient supplements or any herbal supplements, including cinnamon, curcumin, or aloe vera, for improving glycemia in people with diabetes is not supported by evidence and is therefore not recommended. What is the effectiveness of micronutrients on diabetes-related outcomes? Scientific evidence does not support the use of dietary supplements in the form of vitamins or minerals to meet glycemic targets or improve CVD risk factors in people with diabetes or prediabetes, in the absence of an underlying deficiency — People with diabetes not achieving glucose targets may have an increased risk of micronutrient deficiencies , so maintaining a balanced intake of food sources that provide at least the recommended daily allowance for nutrients and micronutrients is essential For special populations, including women planning pregnancy, people with celiac disease, older adults, vegetarians, and people following an eating plan that restricts overall calories or one or more macronutrients, a multivitamin supplement may be justified A systematic review on the effect of chromium supplementation on glucose and lipid metabolism concluded that evidence is limited by poor study quality and heterogeneity in methodology and results , Evidence from clinical studies that evaluated magnesium , and vitamin D — supplementation to improve glycemia in people with diabetes is likewise conflicting.
However, evidence is emerging that suggests that magnesium status may be related to diabetes risk in people with prediabetes What is the role of herbal supplementation in the management of diabetes? It is important to consider that nutritional supplements and herbal products are not standardized or regulated , Health care providers should ask about the use of supplements and herbal products, and providers and people with or at risk for diabetes should discuss the potential benefit of these products weighed against the cost and possible adverse effects and drug interactions.
The variability of herbal and micronutrient supplements makes research in this area challenging and makes it difficult to conclude effectiveness. To date, there is limited evidence supporting the addition of herbal supplements to manage glycemia. Because of public interest and the lack of conclusive data, the National Center for Complementary and Integrative Health at the National Institutes of Health aims to answer important public health and scientific questions by funding and conducting research on complementary medicine.
Does the use of metformin affect vitamin B12 status? Metformin is associated with vitamin B12 deficiency, with a recent systematic review recommending that annual blood testing of vitamin B12 levels be considered in metformin-treated people, especially in those with anemia or peripheral neuropathy This study found that even in the absence of anemia, B12 deficiency was prevalent. The exact cause of B12 deficiency in people taking metformin is not known, but some research points to malabsorption caused by metformin, with other studies suggesting improvements in B12 status with calcium supplementation — The standard of treatment has been B12 injections, but new research suggest that high-dose oral supplementation may be as effective , More research is needed in this area.
For individuals with type 1 diabetes, intensive insulin therapy using the carbohydrate counting approach can result in improved glycemia and is recommended. For adults using fixed daily insulin doses, consistent carbohydrate intake with respect to time and amount, while considering the insulin action time, can result in improved glycemia and reduce the risk for hypoglycemia.
A cautious approach to increasing mealtime insulin doses is suggested; continuous glucose monitoring CGM or self-monitoring of blood glucose SMBG should guide decision-making for administration of additional insulin. What is the role of the RDN in medication adjustment? RDNs providing MNT in diabetes care should assess and monitor medication changes in relation to the nutrition care plan. Along with other diabetes care providers, RDNs who possess advanced practice training and clinical expertise should take an active role in facilitating and maintaining organization-approved diabetes medication protocols.
How should nutrition therapy vary based on type and intensity of insulin plan? For people with type 1 diabetes using basal-bolus insulin therapy, a primary focus for MNT should include guidance on adjusting insulin based on anticipated dietary intake, particularly carbohydrate intake 9 , — ; recent or expected physical activity; and glucose data. Intensive insulin management education programs that include nutrition therapy have been shown to improve A1C 9 , , , — and quality of life 9 , For people using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be consistent with respect to time and amount per meal 9 , , Checking glucose 3 h after eating may help to determine if additional insulin adjustments i.
Because these insulin dosing algorithms require determination of anticipated nutrient intake to calculate the mealtime dose, health literacy and numeracy should be evaluated. The effectiveness of insulin dosing decisions should be confirmed with a structured approach to SMBG or CGM to evaluate individual responses and guide insulin dose adjustments. In type 2 diabetes, counseling people on eating patterns that replace foods high in carbohydrate with foods lower in carbohydrate and higher in fat may improve glycemia, triglycerides, and HDL-C; emphasizing foods higher in unsaturated fat instead of saturated fat may additionally improve LDL-C.
The recommendation for the general public to eat a serving of fish particularly fatty fish at least two times per week is also appropriate for people with diabetes. Does comprehensive diabetes nutrition therapy support cardiovascular risk factor reduction? Nutrition therapy that includes the development of an eating plan designed to optimize blood glucose trends, blood pressure, and lipid profiles is important in the management of diabetes and can lower the risk of CVD, CHD, and stroke 9.
Findings from clinical trials support the role of nutrition therapy for achieving glycemic targets and decreasing various markers of cardiovascular and hypertension risk 9 , 24 , — What are considerations for fat intake for people who are at risk for or have CVD and diabetes? Total Fat There has been increasing research examining the effects of high-fat, low-carbohydrate eating patterns on cardiometabolic risk factors, with two systematic reviews showing benefits of low-carbohydrate eating plans compared with low-fat eating plans on glycemic and CVD risk parameters in the treatment of type 2 diabetes see the section Low-Carbohydrate or Very Low-Carbohydrate Eating Patterns , The scientific rationale for decreasing saturated fat in the diet is based on the effect of saturated fat in raising LDL-C, a contributing factor in atherosclerosis In a Presidential Advisory on dietary fat and CVD, the American Heart Association concluded that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD Subgrouping of the studies suggested that benefit occurred by replacing saturated fat with polyunsaturated fat but not with carbohydrate or protein In a systematic review of observational studies, saturated fats were not associated with all-cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but limitations common to observational studies were noted The replacement of saturated fat with monounsaturated or polyunsaturated fat in food or replacement of trans fat with monounsaturated fat in food was inversely associated with CVD The retinopathy of prematurity model, caused by oxygen toxicity and relative hypoxia, can be set up in mice to study retinal vasculogenesis 9 , but the absence of hyperglycemia in such a model makes translation to PDR indirect and poorly reliable.
The reasons for this paradox have never been fully clarified. Understanding what drives such a tissue-specific angiogenic response may aid the discovery of novel therapeutic strategies to counter ischemic syndromes in the cardiovascular system. There is evidence that excess and abnormal angiogenesis occurs early in diabetic kidney disease DKD Both in humans within 2 years of disease onset 11 and in rats within 40 days from diabetes induction 12 , abnormal capillaries were observed to contribute to glomerular hypertrophy, forming anastomoses with peritubular capillaries.
Conversely, the later stages of DKD are marked by rarefaction of capillaries in the glomerulus, occupied by obliterating nodules, and in the peritubular areas undergoing progressive fibrosis. Whether early angiogenesis contributes to DKD progression or is simply one of its many histological manifestations is unclear.
A few studies found that blocking angiogenesis attenuated glomerular changes in diabetic animals 13 , 14 , but it is hard to dissect the specific effects conveyed by selected treatments on angiogenesis and those generally targeting the vasculature.
For example, production of vascular endothelial growth factor VEGF -A can exert both proangiogenic effects and simultaneously induce glomerular endothelial cell dysfunction. In fact, VEGF-A stimulates all phases of angiogenesis, with the first being attenuation of endothelial cell junctions to allow sprouting, an effect that can increase permeability of the ultrafiltration barrier and favor albuminuria 15 , However, VEGF-A produced by podocytes is a trophic factor for glomerular endothelial cells; its physiological importance is demonstrated by studies showing that VEGF-A neutralization can even cause proteinuria VEGF-A overexpression induced by hyperglycemia and shear stress in DKD may be viewed as a compensatory attempt to reduce intraglomerular pressure, as newly formed vessels were often found to bypass the glomerulus connecting to peritubular capillaries.
In addition to VEGF-A, an imbalance of angiopoietin-1 and angiopoietin-2 has been implicated in the abnormal regulation of angiogenesis in DKD, with possible therapeutic effects of their blockade The knowledge that a finely tuned balance in the production of angiogenic factors e. Alternatively, tackling hyperglycemia and hypertension, which are the cornerstones for the prevention of DKD onset and progression, has proven capable of restoring normal balances of angiogenic factors in the diabetic kidney Diabetic neuropathy The development of diabetic neuropathy occurs with pathological changes to the axonal and microvascular components of the nerves.
Whereas damage to the neuronal body and axon reduces action potentials, rarefaction of the vasa nervorum slows electric conductance velocity by facilitating demyelination and impairing oxygen and nutrient supply. Several studies in murine and human diabetes found a reduced microvascular density within the nerves 21 , Although acute hyperglycemia can provoke nerve dysfunction independently from vascular changes 23 , such observations encouraged the idea that diabetic neuropathy relies on an insufficient angiogenic response.
Indeed, a few studies showed that induction of angiogenesis restored at the same time vasa nervorum support or nerve blood flow and electrical conduction properties 24 , The exact mechanisms of vasa nervorum damage by diabetes have not been elucidated, and it is unclear whether such mechanisms are specific for neuropathy or recapitulate the general pathways of endothelial cell damage elicited by hyperglycemia It has been suggested that high glucose induces VEGF expression and production by Schwann cells, which in turn could lead to vasa nervorum endothelial cell dysfunction Neutralization or prevention of VEGF overexpression can indeed ameliorate features associated with diabetic neuropathy Conversely, attempts have also been made to restore the nerve microvasculature by vehiculating VEGF expression to stimulate angiogenesis 29 , 30 , again highlighting a double-edged role of VEGF in diabetic complications.
Impaired wound healing Healing of cutaneous wounds is significantly delayed by hyperglycemia. Several mechanisms have been proposed involving the epidermis, connective tissue, and the vasculature. No single molecular target has so far translated into an effective therapy, such that impaired wound healing is still one of the most disabling diabetic complications, leading to amputations, morbidity, and mortality Angiogenesis, neovascularization, and lymphangiogenesis in the granulation tissue, which are of paramount importance to reinstate tissue integrity, are defective in murine models of diabetes In the presence of hemodynamically significant stenosis of leg arteries due to arteriosclerosis obliterans, impaired blood flow to foot ulcers is a prominent cause of delayed healing.
However, even in the absence of substantial obstacles to blood flow through conductance arteries, as observed in primarily neuropathic ulcers, impaired neovascularization of the wound bed represents a prototypical condition where the adverse effects of hyperglycemia on the formation of new microvessels is manifest Similarly, in most murine models, hyperglycemia is itself sufficient to delay wound healing, which is exacerbated by the concomitant limitation of upstream blood flow e.
Central to all processes of angiogenesis is remodeling of the growing microvasculature, which includes endothelial cell proliferation, elongation, tubulization, and stabilization by pericytes Coronary and peripheral macrocirculation As compared with nondiabetic individuals, patients with diabetes have a higher risk of myocardial infarction, stroke, and clinically relevant arteriosclerosis obliterans Such an increased cardiovascular risk depends on manifold reasons that have been extensively reviewed elsewhere [e.
Ischemic syndromes in the coronary and peripheral circulation result from impaired perfusion that develops chronically or abruptly. There is abundant evidence that, in the coronary circulation, diabetes is associated with an impaired development of collaterals in various cohorts, such as patients with obstructive disease 41 , 42 or total occlusion 43 — 45 , aged individuals 46 , or patients with chronic kidney disease Ischemia-induced collateralization is thought to mediate, at least in part, the protection exerted by prior minor ischemic episodes against severity of subsequent acute myocardial infarction events 48 , Inability to appropriately regulate collateral development could therefore contribute to the poor outcome of patients with diabetes patients after acute myocardial infarction Similar to what has been observed in coronary circulation, in a case series of patients with peripheral arterial disease and claudication, diabetes was independently associated with poor collaterals as evidenced by angiography Despite the causal relationship between hyperglycemia and atherosclerotic cardiovascular disease still being under debate [and certainly weaker than for microvascular disease 52 ], murine models of diabetes consistently indicate that hyperglycemia impairs collateralization in the peripheral circulation After induction of acute hind limb ischemia in diabetic mice or rats, the resulting degree of ischemia and blood flow recovery are worse than in nondiabetic animals 4 , Mice are normally able to bypass vascular occlusions within a few weeks by an extremely efficient collateralization response.
Angiography studies have clearly determined that worsening of ischemia induced by hyperglycemia is associated with impaired collateral formation. One study in humans with significant coronary artery disease found no association between the presence of absence of the metabolic syndrome and coronary collaterals 54 , suggesting that hyperglycemia in overt diabetes is itself responsible for impairing collateralization. In the peripheral circulation more than in the coronary circulation, arteriogenesis needs to complement angiogenesis for the development of collaterals able to bypass long arterial obstructions.
Mechanisms reported to be responsible for the effects of hyperglycemia on collateral formation range from oxidative stress to alterations in vasomotor tone, impaired sensing of shear stress, inflammation, reduced availability of nitric oxide NO , imbalance growth factor regulation 55 , and accumulation of advanced glycation end-products AGEs 56 , as well as activation of the AGE receptor RAGE The role of glycation has been demonstrated also in a study showing an association between glycated albumin and impaired coronary collateral growth in patients with type 2 diabetes with stable angina and chronic total occlusion An interaction between diabetes and functional VEGF gene polymorphism in determining coronary collaterals has been shown 60 , providing clinical support to the notion that VEGF is central to the impaired angiogenic response in the diabetic coronary circulation.
At variance with what has been observed in the coronary and peripheral circulation, studies performed in patients with ischemic stroke or carotid occlusion showed no clear association between diabetes and the extent of brain collaterals 63 , This observation adds to the concept that ischemia occurring in the periphery, compared with that involving the central nervous system including the retina , triggers different pathologic and molecular processes. Atherosclerotic plaques Most of the time, acute vascular occlusions are the result of atherosclerotic plaque rupture or erosion.
Intraplaque hemorrhage is a major cause of rapid plaque growth, and it occurs because of the rupture of fragile intraplaque neovessels 67 , It is known that atherosclerotic plaques are invaded by a newly formed microcirculation sprouting from adventitial vasa vasorum. However, quantification of intraplaque vessels in human atherosclerosis is problematic, and most studies have evaluated plaque hemorrhage as a consequence of the degree of vascular plaque invasion Importantly, some evidence suggests that diabetes is associated with an excess development of intraplaque neovessels and hemorrhage 69 — This is a typical feature of plaque instability because vascularization allows homing of more inflammatory cells to the plaque and because newly formed intraplaque capillaries are immature, fragile, and prone to rupture, leading to hemorrhage and abrupt plaque growth.
Lack of pericyte coverage emerges as a common characteristic of plaque and retinal angiogenesis 72 , The striking similarities of immature and rupture-prone newly formed microvessels in the diabetic retina and in diabetic atherosclerotic plaques represent one possible way to reconcile tissue-specific angiogenic abnormalities in diabetes and explain the well-known epidemiological association between PDR and myocardial infarction
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A good meal plan will also: Include more nonstarchy vegetables, such as broccoli, spinach, and green beans. Include fewer added sugars and refined grains, such as white bread, rice, and pasta with less than 2 grams of fiber per serving. Focus on whole foods instead of highly processed foods as much as possible. Carbohydrates in the food you eat raise your blood sugar levels. How fast carbs raise your blood sugar depends on what the food is and what you eat with it.
For example, drinking fruit juice raises blood sugar faster than eating whole fruit. Eating carbs with foods that have protein, fat, or fiber slows down how quickly your blood sugar rises. For more information, see Carb Counting. Eating about the same amount of carbs at each meal can be helpful.
Counting carbs and using the plate method are two common tools that can make planning meals easier too. Counting Carbs Keeping track of how many carbs you eat and setting a limit for each meal can help keep your blood sugar levels in your target range. Work with your doctor or a registered dietitian to find out how many carbs you can eat each day and at each meal, and then refer to this list of common foods that contain carbs and serving sizes.
The plate method is a simple, visual way to make sure you get enough nonstarchy vegetables and lean protein while limiting the amount of higher-carb foods you eat that have the highest impact on your blood sugar. Start with a 9-inch dinner plate about the length of a business envelope : Fill half with nonstarchy vegetables, such as salad, green beans, broccoli, cauliflower, cabbage, and carrots.
Also limit coconut and palm kernel oils. Trans fats. Avoid trans fats found in processed snacks, baked goods, shortening and stick margarines. Cholesterol sources include high-fat dairy products and high-fat animal proteins, egg yolks, liver, and other organ meats. Aim for no more than milligrams mg of cholesterol a day. Aim for less than 2, mg of sodium a day. Your doctor may suggest you aim for even less if you have high blood pressure. Putting it all together: Creating a plan You may use a few different approaches to create a diabetes diet to help you keep your blood glucose level within a normal range.
With a dietitian's help, you may find that one or a combination of the following methods works for you: The plate method The American Diabetes Association offers a simple method of meal planning. In essence, it focuses on eating more vegetables. Follow these steps when preparing your plate: Fill half of your plate with nonstarchy vegetables, such as spinach, carrots and tomatoes.
Fill a quarter of your plate with a protein, such as tuna, lean pork or chicken. Fill the last quarter with a whole-grain item, such as brown rice, or a starchy vegetable, such as green peas. Include "good" fats such as nuts or avocados in small amounts. Add a serving of fruit or dairy and a drink of water or unsweetened tea or coffee.
Counting carbohydrates Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level. To help control your blood sugar, you may need to learn to calculate the amount of carbohydrates you are eating so that you can adjust the dose of insulin accordingly. It's important to keep track of the amount of carbohydrates in each meal or snack.
A dietitian can teach you how to measure food portions and become an educated reader of food labels. He or she can also teach you how to pay special attention to serving size and carbohydrate content. If you're taking insulin, a dietitian can teach you how to count the amount of carbohydrates in each meal or snack and adjust your insulin dose accordingly. Choose your foods A dietitian may recommend you choose specific foods to help you plan meals and snacks.
You can choose a number of foods from lists including categories such as carbohydrates, proteins and fats. One serving in a category is called a "choice. For example, the starch, fruits and milk list includes choices that are 12 to 15 grams of carbohydrates. Glycemic index Some people who have diabetes use the glycemic index to select foods, especially carbohydrates.
This method ranks carbohydrate-containing foods based on their effect on blood glucose levels. Talk with your dietitian about whether this method might work for you.
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Starchy vegetables Starchy vegetables are high in carbohydrates and can cause your blood sugar levels to rise. These vegetables include potatoes, peas, corn, and winter squash. Try to limit starchy vegetables in your diet or choose non-starchy vegetables instead.
Fried foods Fried foods are high in fat and calories, which can contribute to weight gain and can also cause a blood sugar spike. Fried foods include french fries, fried chicken, and doughnuts among others. High-carb foods Carbohydrates are healthy for people in general, but if you have diabetes, you need to be careful about how many carbs you eat.
High-carb foods include bread, pasta, rice, and cereal. Choosing low-carb alternatives is a great way to maintain a healthy diet and manage your blood sugar levels. Processed foods Processed foods are often high in sugar, salt, and fat, which can contribute to weight gain and other health problems. Processed foods include lunch meats, hot dogs, bacon, and sausage.
Unhealthy fats Unhealthy fats, such as saturated and trans fats, can contribute to weight gain and other health problems. Saturated fats are found in animal products, such as butter, cheese, and red meat. Trans fats are found in processed foods, such as margarine, shortening, and some types of cooking oil. The protein will help you feel full and the vegetables, such as cherry tomatoes, will provide high fiber content, vitamins, and minerals. Just be sure to avoid adding too much salad dressing or cheese to your salad, as these can add extra calories and fat.
Roasted turkey or chicken sandwich on whole-wheat bread Roasted turkey or chicken sandwiches are a healthier alternative to lunch meats. Look for whole wheat bread, which is higher in fiber than white bread, and add some greens and tomato to your sandwich for extra nutrients. Bowl of chili with beans and ground beef Chili is a hearty lunch option that can be made ahead of time.
Be cognizant to choose lean ground beef and beans that are low in sugar. You can also add vegetables to your chili for extra fiber and nutrients. Fill your wrap with grilled chicken, avocado, greens, and whatever other vegetables you like. A whole wheat wrap is preferable. Avoid adding too much sauce or dressing. Black bean burger on a whole wheat bun Black bean burgers are a great vegetarian option for lunch.
Look for burgers that are made with whole wheat buns and have little to no added sugar for the healthiest option. You can add avocado, tomato, and onion to your burger for extra flavor and nutrients. Soup and a grilled cheese sandwich Soup, depending on the type, can be packed with nutrients.
Pair your soup with a grilled cheese sandwich made with whole wheat bread and low-fat cheese. Vegetable stir-fry over brown rice Stir-fries offer you many options for choosing your favorite vegetables. Brown rice, which is higher in fiber than white rice, is preferable.
You can also add protein to your stir-fry, such as chicken, shrimp, or tofu. Fruit and yogurt parfait A fruit and yogurt parfait is a great light lunch option. You can also add a handful of nuts or seeds to your parfait for extra protein and healthy fats. Choose a shake that has little to no added sugar to keep your glucose levels in the proper range. Adding a piece of fruit or vegetable to your shake for extra nutrients can also be beneficial and provide more flavor. Peanut butter and jelly sandwich on whole wheat bread A peanut butter and jelly sandwich is a classic lunch option that can also be healthy for diabetics.
Use whole wheat or whole grain bread and natural peanut butter to maximize its nutritional value. You can also add bananas, strawberries, or other fruits to your sandwich for extra sweetness. Cottage cheese and fruit Cottage cheese is a great source of protein. If you want more healthy fats, try adding nuts or seeds to your cottage cheese for extra healthy fats. Quinoa bowl with vegetables and grilled chicken Quinoa is high in fiber and protein which will help keep you full after lunch.
Cholesterol sources include high-fat dairy products and high-fat animal proteins, egg yolks, liver, and other organ meats. Aim for no more than milligrams mg of cholesterol a day. Aim for less than 2, mg of sodium a day. Your doctor may suggest you aim for even less if you have high blood pressure.
Putting it all together: Creating a plan You may use a few different approaches to create a diabetes diet to help you keep your blood glucose level within a normal range. With a dietitian's help, you may find that one or a combination of the following methods works for you: The plate method The American Diabetes Association offers a simple method of meal planning.
In essence, it focuses on eating more vegetables. Follow these steps when preparing your plate: Fill half of your plate with nonstarchy vegetables, such as spinach, carrots and tomatoes. Fill a quarter of your plate with a protein, such as tuna, lean pork or chicken. Fill the last quarter with a whole-grain item, such as brown rice, or a starchy vegetable, such as green peas.
Include "good" fats such as nuts or avocados in small amounts. Add a serving of fruit or dairy and a drink of water or unsweetened tea or coffee. Counting carbohydrates Because carbohydrates break down into glucose, they have the greatest impact on your blood glucose level.
To help control your blood sugar, you may need to learn to calculate the amount of carbohydrates you are eating so that you can adjust the dose of insulin accordingly. It's important to keep track of the amount of carbohydrates in each meal or snack. A dietitian can teach you how to measure food portions and become an educated reader of food labels. He or she can also teach you how to pay special attention to serving size and carbohydrate content.
If you're taking insulin, a dietitian can teach you how to count the amount of carbohydrates in each meal or snack and adjust your insulin dose accordingly. Choose your foods A dietitian may recommend you choose specific foods to help you plan meals and snacks. You can choose a number of foods from lists including categories such as carbohydrates, proteins and fats.
One serving in a category is called a "choice. For example, the starch, fruits and milk list includes choices that are 12 to 15 grams of carbohydrates. Glycemic index Some people who have diabetes use the glycemic index to select foods, especially carbohydrates. This method ranks carbohydrate-containing foods based on their effect on blood glucose levels.
Talk with your dietitian about whether this method might work for you. A sample menu When planning meals, take into account your size and activity level. The following menu is tailored for someone who needs 1, to 1, calories a day. Roast beef sandwich on wheat bread with lettuce, low-fat American cheese, tomato and mayonnaise, medium apple, water Dinner.
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