Nutrition and Exercise for Diabetes

We obtain our nutrition through the foods we eat. Macronutrients provide energy for the human body to burn or to be stored. Essential calories and nutrients are consumed in the form of carbohydrate, protein, and fat. Carbohydrate and protein each provide 4 calories per gram. Fat provides 9 calories per gram. (Alcohol provides 7 calories per gram.)

a healthy woman sitting on chair with healthy food on the table

Carbohydrates are found in starches, grains, cereals, breads, fruits, milk, yogurt, vegetables and sugars. Monosaccharides are the smallest members of the carbohydrate family. Single unit sugars include glucose, fructose, and galactose. Disaccharides are two sugar units connected together. These double sugars are maltose, sucrose and lactose (the sugar in milk). The term simple carbohydrate refers to any of the one or two unit sugar mentioned above. Complex carbohydrate refers primarily to starch and fiber. Starch and fiber are both long chain lengths of simple sugars all connected together. With the exception of fiber which is indigestible, all forms of carbohydrate are digested to their smallest units: single sugars, and are then absorbed into the bloodstream. Circulating glucose is transported through the bloodstream to the awaiting cells, tissues and organs. Glucose is the body’s preferred fuel source.

In the past, individuals with diabetes were told to avoid sugar or simple carbohydrates. This approach did little to control diabetes. In fact, research has shown that people with diabetes can enjoy modest amounts of sugar, in the context of a healthy meal plan and with respect paid to the total amount of carbohydrate eaten. Patients should no longer be handed pre-printed diet sheets, or simply advised to quit eating sugar as a method to treat diabetes. The understanding of dietary management, also called Medical Nutrition Therapy (MNT), has evolved, so that individuals with diabetes now have options, such as carbohydrate counting, to help manage their blood sugar levels.

Carbohydrate is the macronutrient that has the most impact on the blood glucose. For people with type 1 diabetes, the insulin dose must be carefully balanced with carbohydrate intake. Preferably, the insulin dose should be adjusted to the amount of carbohydrate in the meal, with consideration to the current blood glucose level and to any planned exercise. For patients taking fixed doses of insulin (often called sliding scale insulin which is based on the blood glucose reading), carbohydrate consistency is necessary. Carbohydrate intake must be comparable from one day to the next in order to balance with the insulin regimen. Fixed doses of insulin and inflexible meal plans are not optimal in managing type 1 diabetes. For people with type 2 diabetes, appropriate amounts of carbohydrate should distributed rather evenly throughout the day. Portion control is important and it is prudent to eliminate juices and regular soft-drinks as liquid concentrated sources of carbohydrate can raise the blood sugar quickly.

Generally, carbohydrate should provide 45-65% of total calories. The minimum established Dietary Reference Intake (DRI) for carbohydrate is 130 grams per day. That amount however, is a bottom line minimum and most people require more to meet the recommended 45-65% of calories. For example a woman who is dieting and eating only 1300 calories per day would be encouraged to eat 146-211 grams of carbohydrate per day (45-65% of 1300 calories). For some individuals, eating at the higher range of the carbohydrate budget (> 55% of calories) may cause an increase in plasma triglycerides. Given that situation, the diet can be manipulated to eat at the lower range of the carbohydrate budget and increase the monounsaturated fats. (Such as the Mediterranean Diet which uses more olive oil, olives and nuts.)

Most patients with diabetes should learn how to count carbohydrates. There are alternative strategies for portion control for the low literacy patient. The plate method is one such approach and will be discussed later. Carbohydrate Counting Tools:

- Food labels list serving size and total grams of carbohydrate.

- ADA Exchange Lists group foods into lists with similar macronutrient composition.

- Reference text/carbohydrate counting books are available.

- Fast food brochures and some restaurant menus list nutrition information.

- Cookbooks are available that provide nutrient breakdowns.

-PDA software

-Apps for smart phones are available

-Web-based nutrient composition calculators (such as www.calorieking.com)

Safety note: Patients should be screened for cardiovascular problems, peripheral arterial disease, retinopathy, nephropathy, neuropathy (both peripheral and autonomic) and have a complete foot exam prior to beginning an exercise regimen. Sudden death and silent myocardial ischemia can occur in patients with cardiac autonomic neuropathy. The presence of complications may impose certain restrictions on the types of activities attempted. For example, individuals with peripheral neuropathy should not jog, jump rope or do stair master as diminished feeling in the feet can cause poor positioning and damage the feet. Individuals with retinopathy should avoid straining such as heavy weight lifting which can increase intraocular pressure.

Exercise is a foundation strategy in treating type 2 diabetes because it improves insulin sensitivity and therefore has a positive effect on blood glucose control. It also improves lipids, blood pressure, and it is an important part of weight management. Exercise helps maintain lean body mass in the elderly. For many individuals who are not currently exercising, it is important to begin with even a small amount of increased activity and gradually work towards a more structured exercise routine. Even a 5 minute walk to the corner is a reasonable place to start for some very inactive individuals. Then week by week the duration can increase by 5 more minutes until the person is walking at least 30 minutes a day, most days of the week. It is important to find activities that are enjoyed and physically and financially feasible for each person.