What is Diabetes? Diabetes can be controlled by:

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2 What is Diabetes? In people with diabetes, the body does not produce enough insulin, or the insulin it produces does not work properly. Insulin normally keeps the level of glucose in the blood under control. Diabetes can be controlled by: Following a balanced diet Taking tablets and following a balanced diet Taking insulin and following a balanced diet Taking insulin and tablets and following a balanced diet Controlling your diabetes is about getting a balance between activity, food and medication. FOOD ACTIVITY MEDICATION 1

3 Food and diabetes You may find that you get confusing advice about nutrition from the media, friends and family. This booklet has been produced by the dietitians to help give clear and up to date advice on appropriate diet for diabetes. If you need any further advice please contact your dietitian. Dietitian Hospital/Clinic Telephone Diabetes UK 10 Parkway, London NW1 7AA Diabetes UK Careline: (operates a translation service) Monday - Friday between 9am and 5pm Recorded information on diabetes-related topics is available on this number 24 hours a day. 2

4 How do I eat healthily for diabetes? Eat regular meals containing starchy carbohydrate foods - you should not need to snack in-between meals. Reduce your intake of sugar and sugary foods. Aim to have at least five portions of fruit and vegetables each day. Aim to have oily fish twice a week. Limit your fat intake. Aim to keep a healthy weight. Reduce your salt intake. Stay within the healthy limit for alcohol. Increase your physical activity. 3

5 What about carbohydrates? There are two types of carbohydrates: 1 SUGARS This group of carbohydrates is digested very quickly and can cause a rapid rise in your blood glucose (sugar) levels. It is important to cut out the main sources of sugar in your diet. (See overleaf for suitable alternatives). However, small amounts of sugar may be taken as part of a high fibre meal. 2 STARCHES Starchy foods take longer to digest, releasing glucose more slowly into the blood, therefore helping to control your blood glucose levels. It is important to eat starchy foods at each meal. For Example Unsweetened breakfast cereals: (Shredded Wheat, Weetabix, porridge, Rice Krispies, Cornflakes). All types of bread and flour based products: granary bread, mixed grain, white, crispbread crackers, chapattis, naan/pitta breads and crumpets. Pasta, noodles Rice, couscous Potatoes You should aim to eat a similar amount of carbohydrate each day: i.e. every day your breakfast, lunch and evening meal should contain a similar amount of carbohydrate. The following foods contain approximately the same amount of carbohydrate: 1 slice of bread 1 /2 bread roll 2 crackers or plain biscuits 1 Weetabix or Shredded Wheat 1 cupful of breakfast cereal 1 /2 cupful boiled rice/pasta or noodles 1 small potato 4

6 High Sugar Foods Sugar, glucose, fructose Reduced sugar sweeteners Squashes Fizzy drinks (lemonade, cola, tonic, some flavoured waters) Tinned fruit in syrup Yoghurts, fromage frais Jam, marmalade, honey, syrup Sweet puddings, desserts Ice-cream Sweet, cream-filled/ chocolate biscuits Cakes Hot chocolate drinks, Horlicks and Ovaltine Low Sugar or Sugar Free Foods to Eat Instead Artificial sweetener e.g. Canderel, Splenda, Hermesetas or Sweetex. Sugar free/no added sugar cordials Diet/slimline/low calorie drinks: soda water, diet cola/lemonade, sugar free tonic. sugar free flavoured water. Fresh fruit, dried fruit (in moderation), tinned fruit in natural juice, stewed fruit with sweetener. Natural low fat yoghurt, diet yoghurts: Shape, Ski Light, Muller Light, diet fromage frais. Reduced sugar jams/marmalade, pure fruit spreads. No added sugar / reduced sugar Instant desserts: Angel Delight, Instant whip, sugar free jelly, low sugar rice pudding - tinned or made with sweetener, low sugar custard. Plain ice-cream 1-2 plain biscuits: Marie, Rich tea, Morning coffee, Hob nobs Garibaldi oatcakes. Currant loaf, tea cakes, scones, malt loaf, low sugar cakes. Low calorie chocolate drinks: Options, Highlights, Duo s, cocoa made with sweetener There is no need to buy special diabetic foods, they are expensive and may not help with your diabetes. If you are trying to lose weight, low sugar foods should be limited 5

7 Increasing your fruit and vegetable intake It is important to have a wide variety of fruit and vegetables in your diet. FRUIT AND VEGETABLES ARE: High in soluble fibre A good source of essential vitamins and minerals that can help protect against heart disease & cancer Low in fat and an ideal snack You should aim to have at least five portions of fruit and vegetables each day and spread the portions evenly throughout the day. What is a portion? 1 medium fruit. eg. apple or banana 2 small fruits.eg. satsumas, plums 1 small glass of unsweetened fruit juice 1 dessert spoon of dried fruit 2 tablespoons of fresh, frozen/tinned veg 2 tablespoons of tinned fruit (in juice, not syrup) 1 salad Increasing your fibre intake There are two types of fibre in food: 1 SOLUBLE FIBRE This is especially good for people with diabetes as it: slows down the rise in blood glucose after a meal Helps to lower levels of cholesterol in your blood Food high in soluble fibre include: Oats, pulses (peas, beans, lentils), fruit and vegetables. 2 INSOLUBLE FIBRE This can be found in wheat cereals, wholemeal flour, brown pasta and rice. This type of fibre helps to keep your bowels regular, preventing constipation. Try to include a variety of high fibre foods throughout the day. 6

8 Healthy eating FRUIT AND VEGETABLES Try to have at least 5 portions a day. Include a wide variety. Eat them raw or with their skins on or cooked quickly in boiling water. 7 PROTEIN FOODS Choose lean meat, poultry, fish and alternatives. 2-3 small portions a day SUGAR AND FATTY Keep these foods to a m

9 for diabetes STARCHY FOODS These are cereals, bread, pasta, rice and potatoes. Include at least one of these at each meal. What is Glycaemic index? The Glycaemic index (GI) is a ranking of foods based on their overall effect on blood glucose levels. Slowly absorbed carbohydrates have a lower GI rating, whilst foods that are more quickly absorbed will have a higher rating. This is important because choosing slowly absorbed carbohydrates can help balance blood glucose levels when you have diabetes. Ask your Dietition if you have any further questions about GI. DRINKS Drink plenty of fluids-water, sugar free fizzy drinks/squash, tea and coffee. FOODS inimum. DAIRY PRODUCTS Choose lower fat dairy Foods. 2-3 portions a day 8

10 What about fats? Food contains different types of fat. One of the most important things you can do to reduce the risk of complications in diabetes is to reduce the total amount of fat you eat. When you do eat fat, choose polyunsaturated and monounsaturated fats, rather than saturated fats. 1. Saturated Fatty Acids (SFA) SFAs have been found to raise the level of cholesterol in blood. Too much cholesterol in the blood increases the risk of heart disease. Sources of SFA include: Butter, lard, dripping, suet, hard margarine Full fat dairy products Fatty cuts of meat, meat products Hidden fats in cakes, pies, biscuits and croissants 2. Monounsaturated Fatty Acids (MUFA) MUFAs can help to lower the cholesterol in the blood when used as a replacement for SFAs in the diet. Sources include: Olive oil, rapeseed oil, nuts and avocado. MUFA spread: e.g. Olivio. A large intake is not recommended: 3. Polyunsaturated Fatty Acids (PUFA) PUFAs also help to lower the cholesterol in the blood, but not as much as MUFAs. Sources include: Oils and margarine from sunflower, corn and soya. A large intake is not recommended: 9 Oily Fish: One type of fat called omega-3 fatty acid is particularly beneficial for people with diabetes, as it helps to protect the heart. It can be found in the natural oil of certain fish such as: mackerel, salmon, fresh tuna, pilchards, sardine, trout and herring. You should aim to have oily fish twice a week. If these are tinned, they should be in brine or tomato sauce, not oil. Fish oil supplements are not recommended.

11 It is recommended that we eat less total fat and replace some SFA with MUFA or PUFA Use Less Butter, hard margarine, lard, suet, dripping Full fat cheese: cheddar, stilton, cream cheese, brie Savoury snacks such as crisps, nuts and samosas Chips, wedges, roast potatoes Full cream milk, evaporated milk, condensed milk, full fat yoghurt, cream, cream substitutes Mayonnaise, salad cream, salad dressings Fatty meats: belly pork, breast of lamb, processed meats: (sausages, burgers, luncheon meat, corned beef and black pudding), Fried fish in batter Replace with Small amounts of low fat spread: e.g. Gold, Flora Light Low fat olive oil based spreads: e.g. Olivio, Bertoli and supermarket own brand olive spreads Sunflower spreads: e.g. Flora, Vitalite, sunflower margarine Cottage cheese, low fat cheese spread, reduced fat cheese Fruit and vegetables Low fat oven chips, roast potatoes, wedges made with as little oil as possible Skimmed, semi-skimmed milk. Low fat natural yoghurt or diet yoghurt/fromage frais Salad dressings - minimal amount of olive oil or sunflower oil, low fat salad dressing; low fat mayonnaise, Weight Watchers, Waistline Lean meat: chicken, turkey, beef, lamb, pork - take off excess fat/skins. Fish: all types - avoid tinned in oil 10

12 What about alcohol? Most people with diabetes can enjoy alcohol in moderation 2 units per day for women 3 units per day for men A unit of alcohol is: Half a pint of bitter or lager One pub measure of spirits, sherry/liqueur One small glass of wine You should try to have at least two or three alcohol free days each week Always choose sugar free/diet mixers: slimline tonic, diet lemonade/cola If you are on insulin or certain tablets for your diabetes Never drink on an empty stomach Eat a meal or snack with or after consuming alcohol If drinking during the evening, have starchy food before bed, eg: toast or cereal Drinking alcohol can make you more likely to have a hypo (low blood glucose) - ask your diabetes team for advice Try not to drink strong beers/lagers Remember, alcohol is high in calories 11

13 Exercise Activity is good for everyone. Being more active can help with blood sugar control and weight management. Gentle exercise, such as walking, should be part of your diabetes care plan. Strenuous activities may need more planning, so discuss this with your diabetes team Salt Too much salt may increase your blood pressure and increase your risk of devloping heart disease. Most of the salt we eat is from processed food so it is important to reduce your intake of processed foods and other high salt foods. Try to use less salt at meal times - this includes sea salt and salt substitutes. Taste your food first and either add salt at the table or in cooking, but not both. Herbs and spices create different flavours, which will help make your food tasty. 12

14 Weight and weight loss If you are overweight, losing weight will help you control your diabetes and will also reduce your risk of heart disease, high blood pressure and stroke. Tips for losing weight: Be realistic about your target weight Aim to lose weight gradually Make small changes you can stick to Try to be more active Changing behaviour: Try to eat slowly, sitting down Shop on a full stomach Write a shopping list and stick to it Keep healthy snacks easily to hand Choose non-food rewards Snacking: If picking is a problem, think about when you are more likely to snack and think of ways you can deal with this. For example, having a bath, talking to a friend on the phone, or going for a walk - all will make you feel better and distract you from snacking. Feelings: Be aware of how your feelings affect what you want to eat. For example, do you eat more when you re upset, lonely or bored? Noticing a pattern can help you plan how to cope. 13

15 What can I do? 14

16 Produced by Liverpool Dietitians Healthy Eating for Diabetes photograph reproduced with the kind permission of Diabetes UK and the Food Standards Agency. MAY 2005