Eating Well with Type 2 Diabetes

Balancing your diet when you have Type 2 diabetes can be challenging but it is important. Making sensible food choices and adapting your eating habits will help you manage your diabetes and help protect your long-term health.

The good news is that you should still be able to enjoy a wide variety of food. It is better to make small changes that you feel you can stick to rather than completely altering your diet and not sticking to it.

About carbohydrate

What is carbohydrate?

Carbohydrate can be classified in a number of different ways but essentially there are two main types, starchy carbohydrates and sugars.

Starchy carbohydrates include foods like bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals.

Sugars include table sugar (caster, granulated, etc), and can also be found in fruit (fructose), and some dairy foods (lactose). They can often be identified on food labels as those ingredients ending with –ose.

Why is carbohydrate important?

All carbohydrate is converted into glucose and will have an impact on blood glucose levels. Since this is the case, some people with diabetes wonder if it would be better not to have any carbohydrate in their diet to keep their glucose levels under control. This is not recommended, as:

• glucose from carbohydrate is essential to the body, especially the brain
• high fibre carbohydrates, such as wholegrains and fruit, also play an important role in the health of the gut
• some carbohydrates may help you to feel fuller for longer after eating.

How much do I need?

The actual amount of carbohydrate that the body needs varies depending on your age, weight and activity levels, but it should make up about half of what you eat and drink.

For good health most of this should be from starchy carbohydrate, fruits and some dairy foods, with no more than one fifth of your total carbohydrate to come from added sugar or table sugar.

Ten steps to eating well

1. Eat three meals a day

Avoid skipping meals and space out your breakfast, lunch and evening meal over the day. This will not only help control your appetite but will also help control your blood glucose levels.

2. At each meal include starchy carbohydrate foods

Examples include bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals. The amount of carbohydrate you eat is important to control your blood glucose levels. Especially try to include those that are more slowly absorbed (have a lower glycaemic index) as these won’t affect your blood glucose levels as much. Better choices include: pasta, basmati or easy cook rice, grainy breads such as granary, pumpernickel and rye, new potatoes, sweet potato and yam, porridge oats, All-Bran and natural muesli. The high fibre varieties of starchy foods will also help to maintain the health of your digestive system and prevent problems such as constipation.

3. Cut down on the fat you eat, particularly saturated fats

A low fat diet benefits health. Choose unsaturated fats or oils, especially monounsaturated fat (eg olive oil and rapeseed oil) as these types of fats are better for your heart. As fat is the greatest source of calories, eating less fat will help you to lose weight if you need to. To cut down on the fat you eat, here are some tips:

• Use less saturated fat by having less butter, margarine and cheese.
• Choose lean meat and fish as low fat alternatives to fatty meats.
• Choose lower fat dairy foods such as skimmed or semiskimmed milk, low fat or diet yogurts, reduced fat cheese and lower fat spreads.
• Grill steam or oven bake instead of frying or cooking with oil or other fats.
• Watch out for creamy sauces and dressings and swap for tomato-based sauces instead.

4. Eat more fruit and vegetables

Aim for at least five portions a day to provide you with vitamins, minerals and fibre to help you to balance your overall diet. One portion is, for example, a banana or apple, a handful of grapes, a tablespoon of dried fruit, a small glass of fruit juice or fruit smoothie, three heaped tablespoons of vegetables or a cereal bowl of salad.

5. Include more beans and lentils

Examples include kidney beans, butter beans, chickpeas or red and green lentils. These have less of an effect on your blood glucose levels and may help to control your blood fats. Try adding them to stews, casseroles and soups, or to a salad.

6. Aim for at least two portions of oily fish a week

Examples include mackerel, sardines, salmon and pilchards. Oily fish contains a type of polyunsaturated fat called omega 3 which helps protect against heart disease.

7. Limit sugar and sugary foods

This does not mean you need to eat a sugar-free diet. Sugar can be used in foods and in baking as part of a healthy diet. Using sugar-free, no added sugar or diet fizzy drinks/squashes, instead of sugary versions can be an easy way to reduce the sugar in your diet.

8. Reduce salt in your diet to 6g or less a day

More than this can raise your blood pressure, which can lead to stroke and heart disease. Limit the amount of processed foods you eat (as these are usually high in salt) and try flavouring foods with herbs and spices instead of salt.

9. Drink alcohol in moderation only

That’s a maximum of 2 units of alcohol per day for a woman and 3 units per day for a man. For example, a single pub measure (25ml) of spirit is about 1 unit or half a pint of lager, ale, bitter or cider has 1-1 1/2 units. Over the years the alcohol content of most drinks has gone up. A drink can now contain more units than you think – a small glass of wine (175ml) could contain as much as 2 units. Remember, alcohol contains empty calories so think about cutting back further if you are trying to lose weight. Never drink on an empty stomach, as alcohol can make hypoglycaemia (low blood glucose levels) more likely to occur when taking certain diabetes medication.

10. Don’t use diabetic foods or drinks

They offer no benefit to people with diabetes. They will still affect your blood glucose levels, contain just as much fat and calories as the ordinary versions, can have a laxative effect and are expensive. 

Your questions answered

Can I still have some sugar in my diet?

Yes. Eating sugar doesn’t cause diabetes and people with diabetes do not need to have a sugar-free diet. It’s okay to have foods like chocolate and cakes occasionally alongside a healthy diet. Remember sugary foods provide empty calories.

I’d like to use a sweetener instead of sugar in my tea but I’ve heard that they aren’t safe. Is this true?

All sweeteners have to undergo rigorous safety tests before they can be sold in the UK. The government sets safe limits and surveys groups of individuals to see whether they are exceeding these limits. At the moment there is no evidence to suggest that the general public is exceeding these safe limits, but if you are at all concerned then you can minimise this risk by using a variety of sweeteners.

Is it true that I shouldn’t eat bananas or grapes?

No. All fruit is good for you. Eating more fruit can reduce the risk of heart disease, some cancers and some gut problems. Eat a variety of different fruit and vegetables for maximum benefit.

Does a smoothie count towards my fruit and veg target?

Yes, a smoothie can be an easy way to notch up a portion of fruit. The good news is that if, for example, you put two whole pieces of fruit into a homemade smoothie then it can count as two portions. Remember that some smoothies contain added sugar, honey, yogurt or milk that can bump up the calories, fat or sugar content so check the ingredients label.

Can people with diabetes follow a vegetarian diet?

Yes. Although, following a vegetarian diet does not necessarily mean a healthier diet. You still need to have a good balance of different foods. To make sure you are following a healthy balanced vegetarian diet contact the Vegetarian Society through their website.

Is it ok for me to take a vitamin supplement now that I have diabetes?

Diabetes UK does not recommend that people with diabetes take a supplement. If your diet is deficient in some nutrients then you may benefit from taking one, but this should be decided in conjunction with your doctor and/or dietitian. (Note: Women with diabetes should take a prescribable supplement of 5mg of folic acid when planning pregnancy and continue to take it until the end of the 12th week of pregnancy.)

I have several food allergies – how can I manage them now that I have diabetes?

Diabetes UK recommends that everyone with diabetes sees a registered dietitian. This is particularly important since you have additional nutritional considerations. Your doctor can refer you to one who can give you specific personalised advice.

Does having diabetes mean I have to miss out on eating out?

Eating out for special occasions are times to enjoy the foods that may be higher in fat or sugar than your usual choices. The odd one or two high glucose readings shouldn’t affect your long-term diabetes control or health – talk to your healthcare team about how to adjust your medication.

What is a structured education course and how do I get on one?

NHS guidelines recommend that people with diabetes are offered patient education programmes known as ‘structured education’. They usually contain lots of information on all aspects of diabetes – especially food. Ask your healthcare team about what’s available in your area. For guidance on choosing a course that meets recognised criteria, visit our Structured education section.

A healthy balance

Foods can be divided into five main groups:

• Fruit and vegetables
• Bread, rice, potatoes, pasta
• Milk and dairy foods
• Food and drinks high in fat and or sugar
• Meat, fish, eggs, beans. and other non-dairy sources of protein.

To enjoy a balanced diet we need to eat foods from these groups in the right proportions. Use the eatwell plate to help you get the balance right. It shows how much of what you eat should come from each food group.

© Crown copyright material is reproduced with the permission of the Controller of HMSO and Queen’s Printer for Scotland.

What's on your plate?

Watching what you eat when you have diabetes isn't about going on a diet. It's about making small, healthy changes to make your eating habits more balanced. The occasional one or two high-fat, sugary or salty foods won't undo all your good work.

Use the ideas on the following pages to plan your meals over the day.

Managing your weight

Weight is a significant factor in the development and management of Type 2 diabetes – 80 per cent of people with diabetes are overweight at diagnosis.

Benefits for your health

Losing weight can have a whole host of benefits for your health. And you probably don’t need to lose as much as you think – losing between 5 and 10 per cent of your weight (that’s 5–10kg if you are 100kg or about 3/4 stone – 1 1/2 stones if you are 15 stone) has health benefits such as lowering blood fats, blood pressure and blood glucose levels.

You don’t have to reach an ‘ideal’ weight either – be realistic and aim to lose weight slowly over time (0.5–1.0 kg [1–2 lbs] a week).

What’s the best diet to follow?

It may seem obvious but losing weight depends upon eating less and being more active. Many people have tried a variety of diets and it is quite normal for it to take a number of attempts before the weight comes off and more importantly stays off. Fad diets, which promise a quick fix or are over restrictive, offer no benefit in the long-term. Steer clear of diets that cut out food groups such as carbohydrate-free diets too. It’s better to set realistic, achievable targets that fit with a healthy balanced diet.

Where do I start?

1. Keep a food diary – noting what, how much and when you eat is the first step to being food aware.
2. Eat three regular meals a day.
3. Eat plenty of fruit.
4. Reduce your portions.
5. Cut down on snacks or replace them with healthier options like fruit.
6. Plan your meals so that you are less inclined to rely on old favourites that may be high in fat.
7. Be more active.
8. Become weight aware. Check your weight weekly for an insight into how things are going.
9. Think about joining a support group – ask your healthcare team about ones in your area.
10. Fill half of your plate at your main meal with vegetables.

How can I find out more?

Getting help with finding the right treatment option for you and your weight is important. Your GP, practice nurse or dietitian can work through this with you. You may also find it helpful to refer to Diabetes UK’s publication about weight management called ‘Weight creeping up on you?’ - available to order online or download for free.

What changes to my medication may I need to make?

Your diabetes medication should correspond with the food you eat and the activity you do. As you eat less, become more active and lose weight, you may need your diabetes medication dose reduced. Talk to your doctor or nurse for advice about how to adjust your medication.

Know your labels

Making sense of food labelling isn’t always easy.

Both ‘Traffic light’ labelling and Guideline Daily Amounts (GDAs), on food and drink labels, can be a starting point to help you to see how healthy or unhealthy your food or drink is.

They also allow you to compare differences between brands.