WHAT IS TYPE 2 DIABETES?
Type 2 diabetes is a disease that causes blood glucose (sugar) levels to increase in your blood vessels. In individuals without diabetes, insulin produced from the pancreas in the abdomen, binds to glucose in the blood. The insulin binds an insulin receptor and the blood glucose goes through an open passage that is created into muscle, brain, fat, etc. These body tissues then use the glucose to create energy to allow us to function and live.
In Type 2 diabetes, blood glucose levels are high because the pancreas doesn't make enough insulin or the tissues in the body are resistant to the insulin (insulin resistance). The pancreas then tries to make more insulin to overcome the insulin resistance but at the point the pancreas can't overcome the insulin resistance this is when blood glucose levels rise and individuals develop symptoms of type 2 diabetes including increased urination, thirst, hunger, blurred vision and/or fatigue.
DIABETES PREVENTION
You can make a difference. A combination of 150 minutes of week of moderate-vigorous physical activity (brisk walking) and reduced calorie diet leading to modest weight loss of 5 - 7% has been proven to lower risk of diabetes.
Diabetes Prevention Program
The Diabetes Prevention Program (DPP) was a major multi-center clinical research study aimed at discovering whether modest weight loss through dietary changes and increased physical activity or treatment with the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in study participants. At the beginning of the DPP, participants were all overweight and had blood glucose, also called blood sugar, levels higher than normal but not high enough for a diagnosis of diabetes—a condition called prediabetes.
The DPP found that participants who lost a modest amount of weight through dietary changes and increased physical activity sharply reduced their chances of developing diabetes. Taking metformin also reduced risk, although less dramatically. The DPP resolved its research questions earlier than projected and, following the recommendation of an external monitoring board, the study was halted a year early.
ACCELERATE Diabetes Prevention Research
Our Research and others has shown that in addition to Physical activity and dietary modifications improving the following modifiable risk factors may also lower your risk for diabetes:
Improving Sleep Quality and Length (7-9 hours)
Long Term Smoking Cessation
Normal Blood Pressure
Normal Cholesterol
Maintaining Normal Body-mass index
DIABETES NUTRITION
The Role of Nutrition in Diabetes Prevention and Treatment
One of the most challenging aspects to prediabetes and type 2 diabetes is knowing what to eat. There is no special diet for individuals with diabetes but there are components that are important. I prefer to use the term healthy meal planning. The key is to make changes in food choices and proportions that are healthy and sustainable. If one of your risk factors for diabetes is an elevated weight than it may also be helpful to lower the calories in your meals with a goal of weight loss.
I have included many resources below to help you with preparing healthy proportion controlled meals, but I will give you a few tips that I've learned over the years from experts including Dr. Reza Yavari.
Summary
INCREASE:
Fruits,
Vegetables
Fish
Lean Meats
Nuts
Water
DECREASE:
Fast Food
Fried Processed Foods
Fatty Processed Foods
Specifics
Choose lean meats – preferably organic and free-range, as opposed to fatty meats.
Reduce the consumption of hi-fat pre-mixed foods such as ground beef, pate and sausages.
When possible choose real cheese from a farm and not processed cheese made in a factory.
Cold water fish such as salmon, herring, haddock and white tuna are rich in good fats such as omega-3 fatty acids.
Do not buy junk food, soda; artificially flavored and colored products.
Buy fresh and seasonal foods rich in anti-oxidants, vitamins and trace elements.
The more colorful your fruits and vegetables, the more they contain healthy flavinoids, lycopenes and other anti-oxidants.
Use herbs in your diet.
They have no calories and contain minerals and other trace elements. They are good for you.
Try different spices, condiments, vegetarian spreads.
They are usually low-calorie and add excitement to simple dishes such as meats.
Buy and eat real and seasonal fruits, as opposed to canned fruit, fruit juice or fruit flavored product such as yogurt and drinks.
Canned fruits are often come with syrup which contains additional sugar. Fruit juices often contain added sugar and spike blood sugar to a greater degree than raw fruits because they lack fiber.
Buy shelled almonds, walnuts, peanuts and macadamia nuts (not cashews).
Cracking the shells takes time and you will not over-eat them as easily. Nuts are healthy snacks but they are calorie-dense. If you cannot stop eating them pre portion them in small bags or buy them pre portioned and only eat one bag – put the rest away.
Do not use too much vegetable oil such as safflower, sunflower or canola oil.
These are rich in polyunsaturated fatty acids that may trigger inflammation and coagulation in the arteries. Olive oil is better because it has more monounsaturated fatty acids that are healthful.
Learn to enjoy drinking water throughout the day as opposed to sweetened drinks, soda or even coffee and tea (if you use cream and sugar).
Some people believe that if you drink a lot of water before and during a meal, you will feel full and not eat as much. Others suggest that drinking fluids with meals accelerates gastric emptying and reduces the satiety effect. Let your body be the judge.
These basic principles have been evaluated in clinical trials and observational studies
Dietary Approaches to Stop Hypertension (DASH) Diet
The DASH dietary pattern is rich in vegetables, fruit, and low-fat dairy products and has been shown to lower blood pressure, improve blood sugar, insulin resistance and risk of diabetes. (References below)
The Mediterranean diet is rich in high fiber foods such as whole grains, fruits, vegetables, and legumes. An emphasis is placed on good monounsaturated fats which come from seafood, olive oil, and nuts. This dietary pattern has been associated with improved blood sugar and lower risk of developing diabetes. (References Below)
Diabetes Nutrition Related Resources
Academy of Nutrition & Dietetics
Today’s Dietitian Magazine: Today’s Dietitian Magazine - Diabetes
National Institutes of Health - Diabetes Eating and Recipes
Joslin Diabetes Center - Diet and Nutrition Information
OLDWAYS - Inspiring Good Health Through Cultural Food Traditions
Meal Plans for individuals with type 2 diabetes based on caloric needs:
To lose weight a meal plan has to be designed for you to eat less calories than your body burns. A successful weight loss regimen has to cut back at least 500 Calories a day to lose one pound per week and 1000 Calories per day to lose 2lbs per week for most adults. There are many online calculator you can use to calculate your basal metabolic rate (the amount of calories your body burns per day). The following meal plans are based on a specific calorie goal.
Nutrition 411 (1800 and 2400 calorie meal plan)
The Ohio State University (1800 calorie meal plan)
Type 2 Diabetes Medications
Comprehensive diabetes education is a cornerstone of initial management of Type 2 Diabetes Mellitus. Comprehensive diabetes education includes lifestyle counseling, which includes increasing physical activity to a goal of 150 min/week of moderate physical activity (a brisk walk), improving dietary intake and setting a weight loss goal of a minimum of 7% of body weight. If glucose is not controlled through lifestyle modification, then oral medications are the next step.
Oral Medications act through 1 of 2 ways:
Some therapies lower glucose levels by improving how insulin works. Insulin binds to glucose in the blood and acts like a "key" opening up "doors" also known as insulin receptors that allow glucose to leave the blood and enter the tissues of the body (muscle, fat, liver, etc.) where it is used to create energy. These medications thus improve insulin sensitivity.
Other therapies lower glucose levels by increasing insulin levels from the pancreas. Thus, there are more "keys" to open more "doors" allowing glucose to leave the blood and enter the tissues of the body.
ACKNOWLEDGEMENTS
A special thanks to Audrey Kessler, RD, a Registered Dietitian Nutritionist, for providing guidance on diabetes specific resources.
REFERENCES
Abiemo EE, Alonso A, Nettleton JA, Steffen LM, Bertoni AG, Jain A, et al. Relationships of the Mediterranean dietary pattern with insulin resistance and diabetes incidence in the Multi-Ethnic Study of Atherosclerosis (MESA). Br J Nutr. 2013 Apr;109(08):1490–7.
Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. N Engl J Med. 1997 Apr 17;336(16):1117–24.
Ard JD, Grambow SC, Liu D, Slentz CA, Kraus WE, Svetkey LP. The effect of the PREMIER interventions on insulin sensitivity. Diabetes Care. 2004;27(2):340–7.
Blumenthal JA, Babyak MA, Sherwood A, Craighead L, Lin PH, Johnson J, et al. Effects of the Dietary Approaches to Stop Hypertension Diet Alone and in Combination With Exercise and Caloric Restriction on Insulin Sensitivity and Lipids. Hypertension. 2010 Mar 8;55(5):1199–205.
de Koning L, Chiuve SE, Fung TT, Willett WC, Rimm EB, Hu FB. Diet-Quality Scores and the Risk of Type 2 Diabetes in Men. Diabetes Care. 2011 May 1;34(5):1150–6.
Hinderliter AL, Babyak MA, Sherwood A, Blumenthal JA. The DASH Diet and Insulin Sensitivity. Curr Hypertens Rep. 2011 Feb;13(1):67–73.
Liese AD, Nichols M, Sun X, D’Agostino RB, Haffner SM. Adherence to the DASH Diet Is Inversely Associated With Incidence of Type 2 Diabetes: The Insulin Resistance Atherosclerosis Study. Diabetes Care. 2009 Aug 1;32(8):1434–6.
Martinez-Gonzalez MA, Fuente-Arrillaga C d. l., Nunez-Cordoba JM, Basterra-Gortari FJ, Beunza JJ, Vazquez Z, et al. Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ. 2008 Jun 14;336(7657):1348–51.
Salas-Salvado J, Bullo M, Babio N, Martinez-Gonzalez MA, Ibarrola-Jurado N, Basora J, et al. Reduction in the Incidence of Type 2 Diabetes With the Mediterranean Diet: Results of the PREDIMED-Reus nutrition intervention randomized trial. Diabetes Care. 2011 Jan 1;34(1):14–9.
Schwingshackl L, Missbach B, König J, Hoffmann G. Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public Health Nutr. 2015 May;18(7):1292–9.
Svetkey LP. Effects of Dietary Patterns on Blood Pressure: Subgroup Analysis of the Dietary Approaches to Stop Hypertension (DASH) Randomized Clinical Trial. Arch Intern Med. 1999 Feb 8;159(3):285.