Nutrition & Diet
No realm of living today generates more argument and causes more angst than food and eating. But good food should be one of life’s great pleasures, and the options to pursue a diet that’s both satisfying and healthy are endless. The guidelines for healthy eating are similar for people with diabetes as for anyone. It’s just that the consequences for diabetics are more serious when fuel and insulin get out of balance.
When you have diabetes in any form, you need to know a lot about food. How various foods affect your blood sugar, body weight, and heart health. Which foods contains carbohydrate, protein, and fat—and how to balance those nutrients. There’s no single perfect formula: it depends on your calorie goals, body weight, lipid profile, and personal tastes. Working with a dietitian can help in designing meals that work for you.
Whether or not a person has diabetes, the proportion of daily calories from each major nutrient in a balanced diet is about:
|Carbohydrate||45 to 65%|
||10 to 35%|
||25 to 35%|
(This breakdown comes from the Diabetes Education Online site of the University of California, San Francisco. However, these recommendations are in flux, many now believing that a figure closer to 40% carbohydrate is preferable because easier to match with insulin.)
In any case, carbohydrates are the key component in diabetes because they have the greatest effect on blood sugar. During digestion, both forms of carbohydrate (sugars and starch) break down into glucose. Glucose, of course, is the body’s preferred source of energy or fuel. So you don’t need to avoid carbohydrates—just be able to identify them in your food, and then plan how much carbohydrate you will eat, and when.
If you have type 1, you must match your carbohydrate intake to your insulin dose and/or your level of activity. To get the best blood sugar result, you need to accurately count carbohydrates. Grams is the unit of measurement, and even a few grams more or less can affect your blood sugar reading.
What about sugar? In the past, people with diabetes were told to avoid sugar, and that advice is still out there in some places. But research has shown that people with diabetes can enjoy sugar and sugar-containing foods within a balanced diet.
What about alcohol? Drinking alcohol when taking insulin can lead to serious low blood sugar reactions. Alcohol can also affect other medical conditions you may have, like diabetic nerve damage, diabetic eye disease, and high blood triglycerides. You should get guidelines for alcohol use from your medical provider.
What about low-carb diets? Such diets can be effective in controlling weight but will have a large effect on insulin dosing, so must be undertaken with advice and caution.
Heart health is key in managing diabetes. A heart healthy approach means making lifestyle changes that help keep your blood cholesterol and triglycerides levels and blood pressure under control. High blood pressure damages blood vessels—already stressed by diabetes—and makes your heart work harder.
On the whole subject of food and diet, you’ll find lots of excellent advice and recipes online.
Exercise is an important piece of the puzzle in managing diabetes. Among its many benefits, exercise:
- Usually lowers your blood sugar
- Improves insulin sensitivity, which means your body’s insulin works better
- Reduces body fat
- Helps build and tone muscles
- Lowers your risk for heart disease
- Improves circulation
- Preserves bone mass
- Reduces stress and improves quality of life
The first two benefits are also caveats for type 1 diabetics engaging in exercise. The risk here is that blood sugar may drop too low. You may need to adjust your diabetes medication or insulin dose to help prevent the blood sugar from going too low.
Minimizing the Risk of Complications
We’ve already discussed some of the acute—that is, short term—complications of type 1: those that occur when blood sugar levels get out of control. Both high blood sugars (hyperglycemia) and low blood sugars (hypoglycemia) arise when available insulin and need get out of sync. In short, you either have taken too much diabetes medication or too little. Another, ketoacidosis, is usually a byproduct of hyperglycemia.
These complications can be life-threatening and require immediate medical attention. Knowing how to respond to blood-sugar fluctuations and recognize dangerous symptoms are vital to self-education when you have type 1. You need to know what to do, and how, and when to get help.
Chronic complications, on the other hand, tend to develop over years or decades. Damage often occurs before symptoms manifest, but routine screening can catch problems before they occur or worsen. Common complications are:
- Vision loss or blindness
- Kidney damage or failure
- Nerve pain and damage
- Heart and blood vessel disease
- High blood pressure
- Dental problems
- Hand and foot problems
For both acute and chronic complications, tight control of blood sugar is the best treatment. Other interventions that help minimize complications include controlling blood pressure, blood cholesterol and triglyceride levels; controlling your weight; exercising; not smoking; and regular screening.
Life Skills for Type 1
Life complications as well as medical ones are a constant with type 1. Situations that other people can take for granted—living alone, going on a vacation, driving, the occasional sick day—call for way more planning and organizing.
Here’s a quick summary of considerations that require special attention in living safely with type 1, and basic advice:
- Wear some kind of medical alert so that your diabetes status can be quickly discovered.
- Always carry emergency contact information and a list of your medications.
- Always carry testing equipment, sugar or dextrose tablets, and insulin or medications with you at all times, so you can check blood sugar when needed, and correct a high or low.
- Know when to test for ketones and how to recognize when you need medical attention.
- Travel safely: Plan ahead for changes in time zone, climate, and diet; be sure to bring along everything you need plus back up supplies.
- Drive safely: Learn about target range blood sugar levels for driving, any regulations that may apply to where you live (or travel), and carry what you need, as always. Check blood sugar before driving and as needed on the road (not while driving!).
- Develop good drug-management habits such as labeling medications, ensuring that your equipment matches the drugs, discarding out-of-date supplies.
Hope Is a Management Tool: Emotional Health
Emotional and physical well-being are closely linked in managing diabetes. Dealing with type 1 disease 24/7 can be demanding, discouraging, frustrating, intrusive, and frightening. It can interfere with personal relationships and work. Meanwhile, the stress and negative emotions can take their toll on blood glucose control.
So look after your psychological and emotional health as well as your diabetes. When you feel good about yourself, you’re also more motivated to take better care of yourself. Some of the guidelines are well-worn but nonetheless helpful and true. Such as:
- Keep learning about the best ways to manage your diabetes. There’s plenty of information out there about current treatment and future prospects. There are classes and camps and workshops.
- Share the burden with loved ones, by letting them help with transportation, appointments, medication. Keep lines of communication open.
- Set limits for yourself, and avoid overcommitting.
- Practice life management skills, so you can cope better with stress, time pressure, and the emotional roller coaster diabetes imposes on the already complex challenge of life in the 21st century.
- Share support with other type 1’s. It’s relaxing and comforting to interact with people who that understand firsthand what you’re dealing with. Giving back to others helps you too.
- Get involved with diabetes advocacy. Whether it’s spreading the word about better treatments, or pushing organizations and government to use funding more effectively, you can help make things better for everyone with type 1, and even join in moving us closer toward a cure.
- A healthy diet is especially important for people with diabetes, who must “count carbs” to maintain the right balance with insulin.
- Exercise and activity contribute greatly to overall health for anyone with diabetes; they also affect how nutrients are metabolized so must be calibrated in relation to insulin and diet.
- All the components of a healthy lifestyle help reduce the risk of future complications from type 1. Psychological and emotional health are part of the big picture too.