Expert Q&A: A Healthy Diet for Type 2 Diabetes

Expert Q&A: A Healthy Diet for Type 2 Diabetes
An interview with Hope Warshaw, MMSc, RD.
By R. Morgan Griffin

FeatureReviewed by Louise Chang, MDHere's some good news: Healthy eating can have a dramatic impact on the symptoms and progression of type 2 diabetes and its frequent precursor, prediabetes. But the problem is that there's a lot of conflicting information out there. Just what does healthy eating with type 2 diabetes really mean? No sweets? Scheduled snacks? Low-fat, low-carb -- or neither?

To help guide you, Let's turned to Hope Warshaw, MMSc, RD, CDE. She's been a dietitian and diabetes educator for almost 30 years, and is the author of numerous books on the subject, including Diabetes Meal Planning Made Easy, published by the American Diabetes Association.

How does a healthy eating plan for someone with type 2 diabetes differ from what everyone else should be eating?
It doesn't. The nutrition recommendations from the American Diabetes Association echo the healthy eating guidelines for the general public. Everyone should be eating more whole grains, fruits, and vegetables and less saturated and trans fat. Remember that the type of fat matters to your heart and blood vessels. We've moved away from recommending a strict low-fat diet and shifted toward an eating plan that allows for a moderate amount of fat, provided you choose healthier fats, like monounsaturated and polyunsaturated fats.

If you have diabetes and are trying to lose weight, don't take the drastic diet approach, like a low-carb diet. It might help you lose weight in the short-term, but there's not good evidence that it will help you keep it off. Here's my point: You're going to have diabetes for the rest of your life. You need to be thinking about minor doable changes in your eating habits that you can really maintain. Even small steps towards healthier eating result in big rewards, like lower blood glucose and improved blood pressure and lipids.

You also don't need a special diet to tell you how to eat healthy. Most people -- especially people reading WebMD -- already know. The big challenge is actually doing it day after day, year after year.

What is the connection between diabetes and heart and blood vessel diseases?
The connection is huge. It is said that diabetes is a cardiovascular disease. But lots of people haven't realized it yet. They worry more about diabetes affecting their eyesight and kidneys. Yes, that can happen. But the fact is that people with diabetes suffer and die much more from heart and blood vessel disease. That's the real issue.

This is the key reason there's been a big change in the focus of diabetes management. It's no longer just about glucose control. It's at least -- if not more -- important for people to focus on controlling blood pressure and blood lipids, particularly LDL cholesterol. By the time someone gets diagnosed with diabetes, he or she may have already been living with serious risk factors for heart and blood vessel disease for years.
What is prediabetes and what should people do if they're diagnosed with it?
Prediabetes is an in-between stage -- blood glucose is higher than normal but not high enough to fit the diagnosis of diabetes. The diagnosis of prediabetes should be a clear message that you're currently on the road to type 2 diabetes. If you don't take action now, you have a greater than 70% chance of developing type 2.

But this doesn't need to happen. Results from several studies, including the Diabetes Prevention Program, suggest that a small amount of weight loss -- 5% to 7% of your body weight combined with 150 minutes a week of physical activity -- can help slow down the progression. If you catch it early and do something, you can really have an impact on either preventing or delaying the onset of type 2.

What is the relationship between being overweight and type 2 diabetes?
It's a pretty direct relationship. About 80% of people with type 2 diabetes are overweight. Excess weight leads to insulin resistance, and insulin resistance leads to elevated blood pressure, abnormal blood lipids and diabetes.

Do people with type 2 diabetes need to eat snacks throughout the day to control their glucose?
No, but there's a lot of confusion about this. Experts used to tell people to eat snacks because the only medications we had to treat high blood glucose levels could cause the side effect of hypoglycemia, or low blood glucose. Regular meals and scheduled snacks were a way of limiting the problem. But now there are several newer medicines that lower blood glucose without that side effect. Plus, people have blood glucose meters and can check their glucose at any time.

If snacking is your natural way of eating, there's nothing wrong with one or two snacks a day. For instance, if a healthy snack in the afternoon -- like an apple and some reduced-fat cheese -- prevents you from being so famished at dinner that you gorge yourself, go ahead.

But people with diabetes should ditch the idea that they need to eat snacks. It can be counterproductive. Some people find all the snacks really inconvenient. Other people sit down for a snack and overeat, or they make unhealthy choices because they don't have anything better around.

Can people with type 2 diabetes eat sweets?
Yes, people with diabetes can enjoy sweets. There's an old idea that sweets are verboten for those with diabetes, but that's no longer correct.

It's true that the carbohydrates in sweets can raise your glucose levels, but an equal amount of starch would have similar effect. I don't think people with diabetes need to run around looking for sugar-free candies or insist that their families bake them sugar-free deserts.

However, you have to be smart about sugary foods and sweets. Sweets pack in a lot of calories and they tend to be high in fat, particularly in unhealthy saturated fat. So anyone with diabetes needs to be careful about how many they eat.
Can people with diabetes drink alcohol?
Yes. Generally, the recommendations for people with diabetes are the same as they are for everyone else. For women it's one drink a day, for men it's two. However, the amount of alcohol you drink -- and whether you drink alcohol at all -- should be affected by how you manage your condition, what medications you're on, and your overall health.

One precaution: some diabetes medications can increase the risk of hypoglycemia when you're drinking alcohol. So if you're at higher risk of hypoglycemia, practice caution.

What impact does physical activity have on type 2 and prediabetes? How much and what types of exercise are recommended?
Physical activity is crucial for people with type 2 diabetes and prediabetes. It helps lower blood pressure and boost levels of good HDL cholesterol, which reduce your risk of heart and blood vessel disease. It lowers blood glucose and decreases insulin resistance. Studies show that while exercise doesn't help much with weight loss, it's critically important for maintaining weight loss.

As for what and how much, start with small steps -- literally! Walking is easy. Find time to walk a few times a week for 20 minutes. Work your way up to 30 minutes five times a week. You need to find physical activities that you enjoy, since you need to incorporate them into your life permanently. Using weights and resistance training can be a good idea too. The higher the percentage of muscle and the lower the percentage of fat in your body, the better your insulin sensitivity.

Do you have any other tips on successful weight loss and control for people with prediabetes and type 2 diabetes?
If you're thinking about losing weight, the first thing you need to do is assess whether you're really ready to make some big, permanent changes. If you are, start by looking at what you're doing now. What are you eating and how much physical activity do you get? Do some self-monitoring. Then once you have a sense, target specific things you want to change. Don't try to fix your whole life at once. You've got to focus on small changes to what you're doing now.

You also need some support. As a dietitian (and person who works hard to manage my weight) I know how hard it is to follow a healthy eating plan and be physically active day after day. So, it's my belief that if people are going to be successful in maintaining weight loss, they need to be connected and supported. For people who are comfortable online, I think the most cost-effective and efficient approach is joining an online program that fits your needs. Today there are a variety of them, from Weight Watchers to Vtrim to the Cardiometabolic Support Network.

In today's environment, I think we all can find it challenging to live a healthy lifestyle. How do you do it?
I'm 4-foot-10 inches and not getting any younger, but I really do put the healthy eating guidelines into practice. Portion control is my 'numero uno' strategy. In fact, my nickname at home with my food-loving husband and daughter is the Portion Control Queen. I enjoy sweets a couple of times a week, but it's either eating a half cup of really good ice cream or splitting a superb dessert from a restaurant or bakery. I don't have the calories to spare on mediocre. When it comes to burning calories, I'm out to exercise nearly every morning Monday through Friday, either for a 2-mile walk or a longer stint at the gym. What really motivates me is both feeling good today and my desire for a healthy future

SOURCE:

Hope Warshaw, MMSc, RD, CDE, dietitian; diabetes educator; author, Diabetes Meal Planning Made Easy, 3rd ed., published by the American Diabetes Association.

7 Principles for Controlling Diabetes for Life

7 Principles for Controlling Diabetes for Life

This article describes the 7 principles of good diabetes care. These principles, or steps, will help you manage your diabetes and live a long and active life. Every person who has diabetes has different needs. Talk to your health care team about a treatment plan that is best for you. Diabetes affects almost every part of the body and good diabetes care requires a team of health care providers. They include doctors, diabetes educators, nurses, dietitians, pharmacists, mental health workers, eye specialists, foot specialists, dentists, and social workers.

It Is Important to Control Diabetes

Taking good care of diabetes will make you feel better and can lower your chances of getting

*

heart disease
*

stroke
*

eye disease that can lead to a loss of vision or even blindness
*

nerve damage that may cause a loss of feeling or pain in the hands, feet, legs, or other parts of the body and lead to problems such as lower limb amputation or erectile dysfunction
*

kidney failure
*

gum disease and loss of teeth

Principle 1: Learn as Much as You Can About Diabetes

The more you know about diabetes, the better you can work with your health care team to manage your disease and reduce your risk for problems. You should know what type of diabetes you have. If you do not know, ask your doctor whether you have type 1 or type 2 diabetes.

*

Type 1 diabetes. People who have type 1 diabetes need to take insulin every day. This type of diabetes is less common and used to be called juvenile diabetes.
*

Type 2 diabetes. Diet and daily physical activity help to control type 2 diabetes. Most people also need to take diabetes pills or insulin. Type 2 diabetes is very common and used to be called adult onset diabetes.

Diabetes is always a serious disease. Terms that suggest that diabetes is not serious, such as “a touch of diabetes,” “mild diabetes,” and “sugar’s a little high,” are not correct and should no longer be used.

Many People Who Have Diabetes
Do Not Know It

Finding and treating diabetes early can prevent health problems later on. Many people with type 2 diabetes have no symptoms and do not know they have diabetes. Some people are at higher risk for diabetes than others. People at high risk include those who

* are older than 45

* are overweight

* have a close family member such as a parent, a brother, or a sister who has or has had diabetes

* had diabetes during pregnancy

* had a baby that weighed more than 9 pounds

* are African American, Hispanic or Latino, Asian American or Pacific Islander, or American Indian

* have high blood pressure

* have high cholesterol or other abnormal blood fats

* are inactive



Ask your doctor if you have type 1 or type 2 diabetes.

If you know someone who has any of the risk factors for diabetes, suggest they talk to their doctor about getting tested
Principle 2: Get Regular Care for Your Diabetes

If you have diabetes, it is important to

*

see your health care team regularly
*

make sure your treatment plan is working. If it is not, ask your health care team to help you change it
*

ask your family, friends, and co-workers for help and support when you need it

Work with your health care team to get the best help to control your diabetes.

Ask your health care team how often you need to see them for check-ups.

Write down the date and time for your next visit.

Ask your doctor, clinic or office staff, or pharmacist to help you find resources if you have problems paying for food, medicines, and medical supplies. You should be able to get Medicare or other insurance to help you pay for diabetes supplies.

Make a list of questions and concerns you want to talk about at your next visit to your health care team.
Principle 3: Learn How to Control Your Diabetes

Diabetes affects many parts of the body. To stay healthy, it is important to know how to eat the right foods, how to be physically active, and how to look after yourself. Using the following checklist will help you learn how to control your diabetes.

How Active Are You in Controlling Your Diabetes?

Look at the list below. Check all the boxes that describe you.

I talk to my health care team about:

*

my special needs to help control my diabetes
*

ways to improve my ABC numbers: A1C,* Blood pressure, and Cholesterol
*

aspirin therapy to prevent heart problems
*

getting regular physical activity
*

quitting smoking, if needed

I learn from my doctor, diabetes educator, podiatrist, pharmacist, or dietitian how to

*

follow a meal plan to control my diabetes
*

check my feet every day
*

take my medicines as prescribed
*

check my blood glucose levels

*A1C (pronounced A-one-C) is a measure of your average blood glucose over the last three months. You should get this test at least twice a year.

I visit my

*

doctor at least twice a year
*

eye doctor each year and report any changes in vision
*

dentist twice a year
*

specialists as my doctor advises

Go over any items you did not check with your health care team. Learning how to control your diabetes can help you stay healthy.
Principle 4: Take Care of Your Diabetes ABCs

A major goal of treatment is to control the ABCs of diabetes: A1C (blood glucose average), Blood pressure, and Cholesterol. You can do this in many ways.

*

Follow a meal plan that was made for you.
*

Be active every day.
*

Take your medicine as prescribed.
*

Before taking any non-prescription medicines, vitamins, or herbal products, ask your pharmacist how they may affect your diabetes or prescription medicines.
*

Test your blood glucose on a routine basis.



Talk to your health care team about the best ways to control your A1C, blood pressure, and cholesterol and know your target numbers.

Get involved in setting goals and making a treatment plan for your diabetes.
Principle 5: Monitor Your Diabetes ABCs

To reduce your risk for diabetes problems such as blindness, kidney disease, losing a foot or leg, and early death from heart attack or stroke, you and your health care team need to monitor the diabetes ABCs: A1C, Blood pressure, and Cholesterol. Talk to your health care team about how to reach your target numbers.

Get the A1C Test

The A1C test is usually done by your doctor. It measures how well your blood glucose has been controlled over the last three months. This test is very important because it tells how well you are taking care of your diabetes over the long term. It should be done at least twice a year.

* The target A1C for most people with diabetes is less than 7.

Ask your health care team what your A1C is and keep a dated record of the results.

Discuss your A1C target with your health care team and write it down.

Discuss what you need to do to reach your target.



Check Your Own Blood Glucose

You may need to check your own blood glucose on a regular basis to help control your diabetes. It will tell you what your blood glucose is at the time you test. Keep a record of your results and show it to your health care team. Some meters and test strips report blood glucose results as plasma glucose values which are 10 to 15 percent higher than whole blood glucose values. Ask your doctor or pharmacist whether your meter and strips provide whole blood or plasma results.

*

The target glucose range for most people using whole blood is 80 to 120 before meals and 100 to 140 at bedtime.
*

The target glucose range for most people using plasma is 90 to 130 before meals and 110 to 150 at bedtime.

Talk to your health care team about the best ways to check your own blood glucose.

Ask your health care team what your blood glucose targets are before meals, after meals, and at bedtime and write them down.
Principle 5: Monitor Your Diabetes ABCs continued...

Ask what to do if your blood glucose is often higher or lower than it should be.

Ask how to get the supplies you need to do the tests. Most insurance companies, including Medicare, now pay for diabetes supplies.

Know Your Blood Pressure

High blood pressure makes your heart work too hard. This leads to strokes and other problems such as kidney disease. Your blood pressure should be checked at every visit. You may need to check it yourself.

* The target blood pressure for most people with diabetes is less than 130/80.

Ask your health care team what your blood pressure is and keep a dated record of the results.

Discuss your blood pressure target with your health care team and write it down.

Discuss what you need to do to reach your target.

Ask if you need to test your blood pressure yourself. If so, find out how, when, and what supplies you need.



Know Your Cholesterol

LDL is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year.

* The target LDL cholesterol for most people with diabetes is less than 100.

Discuss your LDL cholesterol target with your health care team and keep a record of the results.

Discuss what you need to do to reach your target.



Keep a Record of Your Results

Keeping a record of your results helps you reach your targets. It helps you know when you and your health care team need to take extra action.

Use a record card to keep track of your ABC numbers.


Principle 6: Prevent Long-Term Diabetes Problems

People with diabetes must control their blood glucose, blood pressure, and cholesterol to prevent the problems of diabetes: heart attack, stroke, eye and kidney problems, nerve damage, impotence, foot or leg amputation, gum disease, and loss of teeth. Here are the key self-care activities to help you manage your diabetes and live a long and healthy life.

Daily

*

Follow your diabetes meal plan with the correct portion sizes. Eat a variety of foods that are high in fiber and low in fat and salt.
*

Be active every day.
*

Take medicines as prescribed. If you have questions, talk to your pharmacist or doctor about your medicines.
*

Look at your feet and wash and dry them well each day. Tell your podiatrist or health care team about any changes with your feet.
*

Check your mouth daily for gum or tooth problems. Call your dentist right away if you have problems with your teeth or gums.

As Needed

*

Test your blood glucose as prescribed by your doctor.
*

Check your blood pressure as prescribed by your doctor.
*

Reach and stay at a healthy weight.
*

Stop smoking.
*

Make sure your eyeglasses or contact lens prescription is up to date so you can see clearly. Report any changes in your vision to your health care team.

Work with your health care team to prevent diabetes problems.
Principle 7: Get Checked for Long-Term Problems and Treat Them

See your health care team regularly to check for problems that diabetes can cause. Regular check-ups help to prevent problems or find them early when they can be treated and managed well. Along with the checks of your A1C, blood pressure, and cholesterol (see Principle 5), here are some tests that you will need:

* Triglycerides (a type of blood fat)


Get yearly

* Dilated eye exam to check for eye problems


Get yearly

* Foot check


Get every visit

* Complete foot exam to check for circulation, loss of feeling, sores, or changes in shape


Get yearly

* Urine test to check for kidney problems


Get yearly

* Dental exams to prevent gum disease and loss of teeth


Get twice a year
Diabetes Care Record

A1C (blood glucose average) My target _______
Date Result

__________ __________

__________ __________

__________ __________

A1C target suggested for most people with diabetes is below 7

BLOOD PRESSURE My target _______
Date Result

__________ __________

__________ __________

__________ __________

BP target for most people with diabetes is below 130/80

CHOLESTEROL (LDL) My target _______
Date Result

__________ __________

__________ __________

__________ __________

LDL target for most people with diabetes is below 100

TRIGLYCERIDES My target _______
Date Result

__________ __________

__________ __________

__________ __________

Triglycerides target for most people with diabetes is below 150

WEIGHT My target _______
Date Result

__________ __________

__________ __________

__________ __________



SELF-MONITORED BLOOD GLUCOSE (SUGAR)
Whole blood Suggested target range My target Whole blood Suggested target range My target
Before meals: 80-120 _______ At bedtime: 100-140 _______

Plasma Suggested target range My target Plasma Suggested target range My target
Before meals: 90-130 _______ At bedtime: 110-150 ______


Talk to my health care team about my:
 ABCs - A1C, Blood pressure,
 Cholesterol (LDL)  Medications
 Meal plan  Glucose self-monitoring plan
 Physical activity plan  Foot care


Ask about:
 Aspirin therapy  Stopping smoking
 Pneumonia vaccine  Resources to help me
 Medicare or other insurance benefits


Make sure I get a: DATE DATE
 Dilated eye exam - once a year ______  Kidney function test - once a year
______
 Foot check - every visit ______  Dental exam - twice a year ______
 Complete foot exam - once a
year ______  Flu shot - once a year ______

Take good care of your diabetes for life and be sure to follow these 7 principles:

PRINCIPLE 1
Learn as Much as You Can About Diabetes

PRINCIPLE 2
Get Regular Care for Your Diabetes

PRINCIPLE 3
Learn How to Control Your Diabetes

PRINCIPLE 4
Take Care of Your Diabetes ABCs

PRINCIPLE 5
Monitor Your Diabetes ABCs

PRINCIPLE 6
Prevent Long-Term Diabetes Problems

PRINCIPLE 7
Get Checked for Long-Term Problems and Treat Them

  

People with diabetes who keep their blood glucose,
cholesterol, and blood pressure under control
can expect to live a long and active life.

Resources

For more information about how to control your diabetes, contact:

American Association of Diabetes Educators
800-TEAM-UP4 (800-832-6874)
Web site: www.aadenet.org

American Diabetes Association
800-DIABETES (800-342-2383)
Web site: www.diabetes.org

American Dietetic Association
800-366-1655
Web site: www.eatright.org

American Heart Association
800-AHA-USA1 (800-242-8721)
Web site: www.americanheart.org

Centers for Disease Control and Prevention
Division of Diabetes Translation
877-232-3422
Web site: www.cdc.gov/diabetes

Juvenile Diabetes Research Foundation International
800-533-CURE (800-533-2873)
Web site: www.jdrf.org

National Diabetes Education Program
800-438-5383
Web site: www.ndep.nih.gov

National Heart, Lung, and Blood Institute
(301) 592-8573
Web site: www.nhlbi.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
800-860-8747