We understand that managing Type 2 diabetes is a challenge. For pretty much every Type 2 diabetic (just as managing Type 1 diabetes is a challenge for every Type 1 diabetic!) That’s why we asked our friendly dietitian at Pick n Pay, Leanne Kiezer, to give us some tips.
Managing Type 2 diabetes
Diabetes is a condition where the amount of glucose (sugar) in your blood is too high because your body cannot use it properly. In Type 2 diabetes this happens because your pancreas doesn’t produce enough of the hormone insulin, and/or the insulin that is produced does not work correctly (called insulin resistance). Insulin is produced by the pancreas to help the glucose enter the body or muscle cells.
People with diabetes need to keep their blood sugar controlled. If it is frequently too high or too low it can lead to the development of serious long- term health problems, such as kidney damage, poor eyesight and an increased risk for heart disease. Losing weight, following a healthy eating plan and being more physically active are key to the optimal management of diabetes.
Weight loss for diabetics
If you are overweight, weight loss is the most important thing you can do to help control your blood glucose levels. Weight loss allows the insulin released by your body to work far more effectively, thereby helping to reduce insulin resistance. In addition, weight loss helps to reduce your cholesterol and blood pressure. It can be difficult to lose weight, but with a loss of just 5-10% of your current body weight, there are significant health benefits including lowered cholesterol and blood pressure and possibly even diabetes remission.
Ideal BMI for diabetics
Be aware of these important reference measurements:
- A healthy Body Mass Index (BMI) is between 18.5 and 24.9kg/m2.
- Measure your waist circumference: it should be no more than 88 cm for women and 102 cm for men.
- Calculate your waist-to-hip ratio: this should be no more than 0.85 for women and 0.90 for men.
Managing Type 2 diabetes
- Reduce your serving sizes to help you reduce and maintain a healthy weight. Recommended servings at your meals if you are not following a low carb diet:
- A slice of seed loaf, low GI bread or rye bread, or a small fist size serving of potato, pasta or other starchy carbohydrates
- A palm size serving of meat, fish or poultry
- Two handfuls of vegetables or salad, and
- A piece of fruit or a tub of low fat, plain yoghurt
- Eat regularly and try not to skip meals– eating breakfast may help you to manage your hunger and avoid overeating.
- Choose more unprocessed foods, such as whole fruits and vegetables, beans and pulses and wholegrains, and avoid more refined foods such as sweetened cereals, fruit juices, pastries, cakes, muffins, rusks and white bread.
- Cut back on your intake of animal fats (saturated fat). These are unhealthy fats known to increase your blood cholesterol, a fat which can contribute to the development of heart disease. As a person with diabetes, you have double the risk of developing heart disease than someone without diabetes.
Saturated fat intake for diabetics
Foods high in saturated fat include fatty cuts of meat, any fat on meat, chicken skin, sausage, salami, cream, butter, lard, ghee and cheese. In addition, some plant-based oils, such as palm oil, palm kernel oil and coconut oil, also contain saturated fats and also need to be restricted.
- Eat less red meat, especially fatty or marbled meat such as streaky bacon, pork belly, sausage, boerewors and processed meat such as polony and salami.
- Replace foods that are high in saturated fat with healthier fats to help lower your risk of heart disease. The healthier unsaturated fats are found in foods such as vegetable oils (olive, canola, avocado, peanut and sesame oil), soft margarines made from these oils, olives, avocados, nuts, nut butters and seeds.
- Avoid foods that are made with trans fats, as they are a known risk factor for developing heart disease. Trans fats can be found in many foods – including fried foods like doughnuts, French Fries and deep-fried chicken as well as baked goods including cakes, croissants, pastry, biscuits, frozen pizza, crackers, block margarines and other spreads.
- Eat fish at least twice a week. This includes all fish, but particularly fatty fish, such as pilchards, sardines, herring, salmon and mackerel which are high in the heart protecting omega 3 fatty acids. Each serving should be around 100g, or about ¾ cup of flaked fish.
Which drinks to choose if you have diabetes
- If you drink alcohol, do so only in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than 65, and up to two drinks a day for men age 65 and younger. Too much alcohol can lead to weight gain and higher blood pressure, so make sure there are 2-3 days in your week which are alcohol free.
- Drink 8–10 glasses of fluid per day. Water is best, but tea and coffee, herbal teas, no added sugar squash and diet fizzy drinks can all contribute.
- Take care with your salt intake. Recent guidelines recommend that daily sodium intakes for people with diabetes should be limited to 1500 to 2000mg. For most individuals this requires a substantial reduction in sodium intake.
Understanding which foods affect your blood sugar level
All carbohydrates are broken down to provide sugar (glucose). This sugar is what our bodies use to provide us with energy. The following foods contain carbohydrates:
- Vegetables: starchy vegetables like potatoes, sweet potatoes, mealies, sweetcorn and peas have higher amounts of carbohydrates, compared to vegetables such as cucumber, lettuce, peppers and onions, which have a negligible carbohydrate content.
- Fruit: all fruit, including fresh, frozen, canned, dried and fruit juice.
- Grains: such as rice, pasta, breads, crackers, porridge and cereals.
- Milk, yoghurt and soy beverages.
- Legumes, such as beans, lentils and dried peas.
- Sweets, chocolate, ice cream, biscuits, rusks, cakes and other more refined, high sugar foods are carbohydrate-rich foods, which should be limited or avoided in a healthy meal plan.
How to choose carbohydrates
All kinds of carbohydrate can increase your blood glucose level, but how much your blood sugar goes up will depend on:
- the amount of carbohydrate and fibre in your food and drink
- how active you are
- how much insulin your body still produces and how your body uses it
- your medication
Individuals with diabetes should choose most of their carbohydrates from the nutrient-rich whole foods such as vegetables and fruit, beans, whole grains and dairy products. Many people find it useful to spread their carbohydrate intake throughout the day to keep their blood glucose levels stable.
Low carb diets
Some people find it helpful to substantially reduce the quantity of carbohydrate in their diet to help control their weight as well as their blood sugar levels. Low carb diets can be safe and effective over the short term to help with weight loss, but the long-term side effects of these diets remain unknown. There is not enough evidence to recommend a low carb diet for the long-term management of Type 2 diabetes.
If you are considering following a low carb diet, it is strongly recommended that you talk to a healthcare professional first, preferably a dietitian, to assist you with developing a healthy meal plan. Remember your medication may also need to be adjusted when restricting your carb intake.
Restricting sugar intake
Your body uses natural and added sugars in the same way. However, compared to foods with added sugars, foods with natural sugars, such as fruit and milk, have more healthy nutrients like fibre, vitamins and minerals. Foods with added sugars are often low in nutrient content, but high in energy. To lower your intake of added sugar, consider the following:
- Choose minimally processed foods, as these foods will contain less added sugar.
- Read food labels to help you choose foods with less added sugars. Look under “Carbohydrates” and find the amount of sugar (in grams) in one serving of the food. This value includes both natural and added sugars. Compare products and choose the one with less sugar. Make sure the servings sizes of the foods you’re comparing are the same.
- Take care of ‘natural’ sweeteners such as honey, agave and maple syrup – they are not healthier than other types of added sugar and have a similar energy content.
You may consider sugar substitutes like aspartame, sucralose, or stevia as a way of eating less added sugars. Although sugar substitutes are one way to decrease added sugars, not all foods that are sweetened with sugar substitutes are healthy or low in calories.
The importance of fibre
Fibre is the roughage found in plant foods such as wholegrains, fruits, vegetables and legumes. In addition to keeping the digestive system healthy, fibre can delay digestion, improve blood glucose control, and it can assist with weight loss as it contributes to a greater sense of satiety after meals.
To increase your fibre intake, follow these guidelines:
- Include more whole fruits and vegetables, including dried fruit and frozen vegetables into your meal plan.
- Add baked beans, chickpeas, lentils and split peas to your meals.
- Use ‘heavy’ breads, such as seed loaf, dark rye bread and health bread– they have up to 4 times the amount of fibre per serving than in white and brown bread.
- Use wholegrains wherever possible, such as barley, brown or wild rice, crushed wheat, bulgur wheat and corn kernels.
- For breakfast, choose oats or whole-grain cereals such as bran or untoasted muesli.
- For a low-fat snack, replace potato crisps with home-made plain popcorn or have a few high fibre crackers with a light spread of peanut butter.
- Get creative with your recipes and substitute up to ¼ of the white flour with whole-wheat flour and oat bran.
Foods labelled ‘suitable for diabetics’ usually have no special benefit. They are often high in energy, may still increase your blood sugar and some may have a laxative effect.
Top tip: get active
Being active is an extremely important factor in managing your diabetes effectively. Current recommendations for people with diabetes is that they participate in 150 minutes of moderate to vigorous exercise every week, and this should ideally be spread over at least 3 days. Being more physically active has so many benefits, including:
- Improved blood sugar control by ensuring your insulin works more effectively.
- A marked reduction in heart and circulation related risks of diabetes, such as heart attacks and strokes.
- A significant improvement in weight loss.
Last thoughts on managing Type 2 diabetes
If you have diabetes, pay special attention to the type and amount of carbohydrate you eat. The right amount and type of carbohydrate for you depends on your size, medications and physical activity levels. Consider making an appointment with a registered dietitian, who can review your individual needs and circumstances and help you tailor a nutrition plan that’s right for you.
In the end, the best diet is the healthy one you’re able to follow.