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Nutrition for control sugar levels, diet and physical activity if you have diabetes

Nutrition and physical activity are important parts of a healthy lifestyle for people with diabetes. In addition to other benefits, following a healthy eating plan and being physically active can help you keep your blood glucose level within your target range. To manage your blood glucose level, you need to balance what you eat and drink with physical activity and diabetes medicines, if you use them. What, how much, and when to eat is important to keep your blood glucose level within the limits recommended by your healthcare team.

Increasing your physical activity and making changes in what you eat and drink may seem difficult at first. It may be easier for you if you start with small changes and get help from your family, friends, and your healthcare team.

Eating well and being physically active almost every day of the week can help you:

• keep your blood glucose, blood pressure, and cholesterol levels within target range
• lose weight or maintain a healthy weight
• prevent or delay diabetes problems
• feel good and have more energy

What can I eat if I have diabetes?
You may think that having diabetes means that you will not be able to eat the foods you like. The good news is that you can eat your favorite foods, but you may need to eat in smaller portions or less often. Your healthcare team will help you create a diabetes meal plan that meets your needs and tastes.

The key in diabetes is consuming a variety of healthy foods from all groups, in the amounts set out in your eating plan.

The food groups are:

• vegetables
• non-starchy (non-starchy): include broccoli, carrots, green leafy vegetables, bell peppers, and tomatoes
• starchy (rich in starch): includes potatoes, corn, and peas
• fruits - includes oranges, melons, strawberries, apples, bananas, and grapes
• grain - at least half of the day's grains should be whole
• includes wheat, rice, oats, corn, barley, and quinoa
• examples: bread, pasta, cereals and tortillas
• protein
• lean meat (low fat)
• chicken or turkey without the skin
• fish
• eggs
• walnuts and peanuts
• dried beans and other legumes like chickpeas and split peas
• meat substitutes, such as tofu
• skim or low-fat dairy
• milk or lactose-free milk if you are lactose intolerant
• yoghurt
• cheese

Learn more about the food groups from the United States Department of Agriculture (USDA) ChooseMyPlate.gov External link (with information in Spanish).

Eat foods that have heart-healthy fats, mainly from these sources:

• Nuts and seeds
• For cooking use oil instead of butter, heavy cream, lard, or solid margarine.
• Avocado (or avocado), salmon, nuts, seeds and olive oil.
• Choose healthy fats, like nuts, seeds, and olive oil.
• What foods and drinks should I limit if I have diabetes?

Foods and drinks to limit include:

• fried foods and other foods rich in saturated fat and trans fat
• foods high in salt, also called sodium
• sweets, such as baked goods, candy, and ice cream
• drinks with added sugars, such as juices, sodas, and regular sports or energy drinks
• Drink water instead of sugary drinks. Consider using a sugar substitute in your coffee or tea.

If you drink alcohol, do so in moderation. This means no more than one drink a day for a woman or two drinks a day for a man. If you use insulin or diabetes medicines that increase the amount of insulin your body makes, alcohol can make your blood glucose level drop too low. This is especially true if you haven't eaten in a while. It is better to eat something when you drink alcohol.

When should I eat if I have diabetes?
Some people with diabetes have to eat at almost the same times every day. Others may be more flexible with the timing of their meals. Depending on your diabetes medicines or the type of insulin you use, you may need to eat the same amount of carbohydrate at the same time each day. If you take insulin "at mealtime," your meal times can be more flexible.

If you use insulin or certain diabetes medicines and skip or delay a meal, your blood glucose level may drop too low. Ask your healthcare team when and if you should eat before and after physical activity.

How much can I eat if I have diabetes?
Eating the right amount of food will also help you manage your blood glucose and weight. Your healthcare team can help you figure out how much food and how many calories to eat each day.

Weight loss planning
If you are overweight or obese, work with your health care team to establish a weight loss plan.

The Weight Loss Planner can help you tailor your physical activity plans and calorie plans to reach and maintain your desired weight.

To lose weight you need to eat fewer calories and replace less healthy foods with foods low in calories, fat and sugar.

If you are diabetic, overweight, or obese and are thinking about having a baby, you should try to lose the excess weight before you get pregnant. Learn more about pregnancy and diabetes .

Methods for planning meals
Two methods that are often used to help plan how much to eat if you have diabetes are the plate method and counting carbohydrates (also called carbohydrates). Talk to your healthcare team about the method that is best for you.

Plate method
The plate method helps you control your portion sizes. You don't have to count calories. The method shows you how much of each food group to eat and works best for lunch and dinner.

Use a 9 inch (15 cm) diameter plate. Fill half of the plate with the non-starchy vegetables, in a quarter of the plate place a meat or other protein and in the last quarter of the plate put the grains or another type of starch source. Sources of starch include starchy vegetables like corn and peas. You can also have a small cup of fruit or a piece of fruit and have a small glass of milk if it is included in your meal plan.

• Dish in which half of the plate contains cucumber and spinach, a quarter of the plate contains brown rice, and the last quarter contains baked chicken.
• The plate method shows how much of each food group you should eat.
• You can find many different food combinations and more details on the plate method in the resource Create your plate External link from the American Diabetes Association.

Your daily meal plan can also include small snacks between meals.

Serving sizes
You can use everyday objects or your hand to calculate the size of a serving.

• 1 serving of meat or chicken equals the palm of your hand or a deck of cards
• 1 3-ounce (100g) serving of fish is the size of a checkbook
• 1 serving of cheese equals six dice
• ½ cup of cooked pasta or rice is equal to a handful or the size of a tennis ball
• 1 serving of pancake or waffle is the size of a DVD
• 2 tablespoons of peanut butter is the size of a ping-pong ball.

Carbohydrate counting
The carbohydrate counting involves keeping track of the amount of carbohydrates you consume each day. Since carbohydrates are turned into glucose in the body, they affect your blood glucose level more than other foods. Counting carbohydrates can help you control your blood glucose. If you use insulin, counting carbohydrates can help you determine the proper dose.

The correct amount of carbohydrates varies according to how you manage your diabetes, and includes how much physical activity you do and what medications you take, if applicable. Your healthcare team can help you create a personal carbohydrate-counting meal plan.

The amount of carbohydrates in food is measured in grams. To count the grams of carbohydrates in your food, you will need:

• know which foods contain carbohydrates
• read the nutrition label , or learn how to calculate the number of grams of carbohydrate in the foods you eat
• add the grams of carbohydrates in each food to get the total carbohydrates for each meal and for the day
• Most carbohydrates come from starches, fruits, milk, and sweets. Try to limit carbohydrates that have added sugars or refined grains, such as white bread and white rice. Instead, eat carbohydrates from fruits, vegetables, whole grains, legumes, and skim or low-fat milk.

A grocery bag containing fruits, vegetables, milk, and bread.

• Choose healthy carbohydrates, such as fruits, vegetables, whole grains, legumes, and low-fat milk, as part of your meal plan.
• In addition to using the plate method and carbohydrate counting, you can consult with a registered dietitian or nutritionist who will discuss medical nutrition therapy options with you.

What is medical nutrition therapy?
Medical nutrition therapy is a service provided by registered dietitians or nutritionists to create personalized meal plans based on your needs and tastes. Medical nutrition therapy has been shown to improve diabetes management. Medicare pays for medical nutrition therapy for people with diabetes External link . If you have insurance other than Medicare, ask if medical nutrition therapy for diabetes is covered.

Do supplements and vitamins help me with diabetes?
There is no clear evidence that taking NIH external link dietary supplements such as vitamins, minerals, herbs, or spices can help with diabetes management. 6 You may need supplements if you cannot get enough vitamins and minerals from food. Talk to your doctor before taking any supplements, as some can cause side effects or alter the effect of medicines. 7

Why should I be physically active if I have diabetes?
Physical activity is important for controlling blood glucose levels and staying healthy. Physical activity has many health benefits.

Physical activity:

• lowers blood glucose levels
• lowers blood pressure
• It helps with blood circulation
• burns extra calories so you can keep your weight in check if needed
• improves your mood
• can prevent falls and improve memory in older adults
• can help you sleep better

If you are overweight, combining physical activity with a reduced calorie meal plan can have even more benefits. In the Look AHEAD: Action for Health in Diabetes 6 study , obese adults with type 2 diabetes who ate less and moved more had greater long-term health benefits than those who did not make these changes. These benefits include better cholesterol levels, less sleep apnea, and greater freedom of movement.

Even small amounts of physical activity can help. Experts suggest that you set a goal of at least 30 minutes of moderate or vigorous physical activity 5 days a week. 8 Moderate activity is a bit difficult and vigorous activity is intense and difficult. If you want to lose weight or not regain the lost weight, you may need to do 60 minutes or more of physical activity 5 days a week. 8

Have patience. It may take a few weeks of being physically active before you notice any changes in your health.

How can I stay physically active without problems if I have diabetes?
Be sure to drink water before, during, and after exercising to stay hydrated. Here are some other tips for safe physical activities for people with diabetes.


Plan your physical activity
Talk to your healthcare team before starting a new exercise routine, especially if you have other health problems. Your healthcare team will tell you the target range for your blood glucose level and suggest how to exercise safely.

Your health care team can also help you decide the best time of day to exercise based on your schedule, your meal plan, and your diabetes medicines. If you use insulin, you will need to balance your activity with your insulin doses and meals to prevent your blood glucose from dropping too low.

Prevent hypoglycemia
Since physical activity lowers your blood glucose level, you must protect yourself against hypoglycemia . Hypoglycemia is more likely in people using insulin or other diabetes medicines, such as sulfonylureas. Hypoglycemia can also occur after a long, intense workout or if you miss a meal before exercising. Hypoglycemia can occur while doing physical activity or for up to 24 hours afterward.

Planning is key to preventing hypoglycemia. For example, if you use insulin, your doctor may suggest that you lower the dose or eat a small carbohydrate snack before, during, or after physical activity, especially if it is vigorous. 9

It may be necessary to measure your blood glucose level before, during, and immediately after physical activity.

Stay safe when your blood glucose is high
If you have type 1 diabetes, you should avoid vigorous physical activity if you have ketones in your blood or urine. Ketones are chemicals that your body makes when your blood glucose level is too high, that is, when you have hyperglycemia, and your insulin level is too low. If you are physically active when you have ketones in your blood or urine, your blood glucose can go even higher. Ask your healthcare team what ketones are dangerous for you and how to detect them. Ketones are not common in people with type 2 diabetes.

Take care of your feet
People with diabetes can have foot problems due to poor blood circulation and nerve damage, which can be the result of high blood glucose levels. To help prevent these problems, you should wear comfortable, supportive shoes and keep your feet and skin healthy before, during, and after physical activity.

What physical activities should I do if I have diabetes?
Almost all types of physical activity can help you manage your diabetes. Some can be dangerous for certain people, such as those with poor vision or nerve damage in the feet. Ask your health care team which physical activities are safe for you. Many people prefer to walk with their friends or relatives as a way to exercise.

Doing different types of physical activity each week will give you the most health benefits. Mixing them together also helps fight boredom and decrease your chance of injury. Try some of the physical activity options below.

Add extra activity to your daily routine
If you have had a period of inactivity or are starting a new activity, start slowly, doing only 5 to 10 minutes a day. Little by little increase the time each week. You can increase your daily activity by spending less time in front of the TV or another screen. Try these simple ways to add physical activity to your life every day:

• walk around the house while talking on the phone or during TV commercials
• do housework like gardening, raking leaves, cleaning the house, or washing the car
• leave your car as far away as possible in the shopping center parking lot and walk to the store
• Make your family outings include physical activity, such as a family bike ride or a walk in the park.

If you sit a long time working at your desk or watching television, do some light activity for 3 or more minutes every half hour. 10 Light activities include:

• lift or extend legs
• stretch your arms over your head
• turn in the desk chair
• do torso twists
• do lateral bends
• walk in place (without moving from the same place)

Do aerobic exercise
Aerobic exercise is an activity that makes your heart beat faster and makes it harder for you to breathe. The goal is to do aerobic exercise for 30 minutes a day, most days of the week. You don't have to do all the activity at the same time. You can divide these minutes into a few periods throughout the day.

To get the most out of your activity, exercise should be moderate to vigorous. Try:

• walking briskly or hiking
• climbing stairs
• swim or take a water aerobics class
• to dance
• ride a bike (can be stationary)
• take aerobics classes
• play basketball, tennis, or other sports

Talk to your health care team about how to warm up before and cool down after doing physical activity.

• Do strength training to increase muscle mass
• A woman who smiles and lifts some hand weights.
• You can do strength training with hand weights, elastic bands, or weight machines.
• Strength training is light to moderate physical activity that strengthens muscles and helps keep bones healthy. Strength training is important for both men and women. When you have more muscle and less body fat, you burn more calories and this can help you lose weight and keep it off.

You can strength train with hand weights, elastic bands, or weight machines. Try to do it two to three times a week. Start low and gradually increase the size of the weights as your muscles get stronger.

Do stretching exercises
Stretching exercises are mild to moderate physical activity. Stretches increase flexibility, decrease stress, and help prevent muscle pain.

You can choose from many types of stretching exercises. Yoga is a type of stretching that focuses on breathing and helps with relaxation. Even if you have trouble moving or balancing, certain types of yoga can be helpful. For example, chair yoga has stretches that can be done sitting in a chair or leaning on a chair while standing. Your healthcare team can tell you if yoga is right for you.