Diet
The eating habits of people with diabetes play a major role in controlling their condition. The principles of the dietary recommendations for the treatment of diabetes mellitus are as follows.
- When giving dietary advice to patients, assessment of willingness to change should be considered.
- A suitable energy intake is required to meet energy demands and to achieve a reasonable weight for height and age.
- All adults with diabetes should aim to optimise body weight. Ideal body mass index (BMI) is 20-25kg/m2.
- Carbohydrate should make up 45-60% of dietary energy intake, the majority of this coming from complex sources, preferably foods naturally high in dietary fibre, e.g. wholegrain bread, wholegrain breakfast cereals, brown rice, whole-wheat pasta, jacket potato, pulses, vegetables and fruit. Carbohydrates like sugar, sweets, chocolate, jam, honey, syrup, sugary drinks, sweet puddings, biscuits, cakes and pastries should be minimised in the overweight and advice given about when this can be consumed.
- The fat intake should be reduced to less than 35% of energy intake with no more than 10% from saturated fat and trans fatty acids (mainly from animal sources e.g. dairy produce, fatty meats and meat products and bakery goods) and the rest from mono and polyunsaturated fatty acids (mainly from plant sources e.g. olive, soya, corn and sunflower oils and also from oily fish such as sardines and mackerel).
- People should be encouraged to eat at least 5 portions of vegetables or fruit per day to ensure a plentiful intake of vitamins and anti-oxidants.
- Protein intake should be no greater than 1g/kg ideal body weight and will provide the remaining 10-15% of energy. Ideally from fish, lean meats, beans, pulses & poultry.
- It is recommended that salt should be limited to 6g per day.
- Up to 10% energy from added sugar over the course of a day is acceptable, provided it is eaten in the context of a healthy diet i.e. part of a low fat and high fibre diet.
Major dietary messages for all types of diabetes mellitus
- Aim for a healthy diet that everyone (including people without diabetes) should be eating
- Eat regular meals
- Include starchy carbohydrate foods at each meal e.g. cereals, bread, potato, pasta, rice.
- Encourage carbohydrate foods which are naturally high in fibre.
- Include at least five portions of fruit or vegetables per day. Spread fruit intake out throughout the day.
- Encourage intake of oily fish, aim for 1-2 portions per week. Fish oil supplements are not recommended.
- Keep sugar to a minimum especially in the overweight.
- Dietary fat should be limited. Where used, monounsaturated fat should be encouraged.
- Try to achieve ideal body weight (i.e. BMI 20-25), or a realistic and achievable intermediate goal.
- Limit added salt to meals and food in preparation, keep highly processed foods to a minimum.
- Special diabetic foods are unnecessary and are not recommended.
- Alcohol is acceptable in moderation. Avoid drinking on an empty stomach. Alcohol should be limited to 3-4 units per day for males and 2-3 units per day for females with 1-2 alcohol free days per week. The weeks allocation should not be consumed at once.
- Patients on sulphonylurea or insulin should be advised that >3 units in one session can have a significant effect on blood glucose especially if combined with exercise.
Recommended dietetic literature
Diabetes UK
- Eating well with Diabetes - for initial stop gap dietary advice
Literature is available from dietetic departments locally and 1st line dietary advice can be downloaded from the *ECCI Clinical Guidance Intranet NHS Grampian WebPage.
Role of the dietitian
Diabetes UK recommends that all people with diabetes should see a dietitian within four weeks of diagnosis to enable the individual to adopt an appropriate eating plan. This may be done on a one to one basis or a group education session.
There should also be access to up-to-date dietary advice on at least an annual basis.