Is the “Diabetic Diet” a Thing of the Past?
If I had a dollar for every time I received a referral to provide education on the so-called “diabetic diet,” I’d be a very wealthy lady! While I understand the good intentions behind these referrals—helping patients develop sustainable eating patterns that support effective glycemic management—I can’t help but wonder what referring providers believe this magical “diabetic diet” really is.
The term “diabetic diet” often implies a one-size-fits-all approach, but the reality is far more nuanced. Join me as I explore some of the most common dietary patterns for managing glycemia.
Common Diabetes Eating Patterns
Before the discovery of insulin, people with diabetes often followed extremely restrictive diets, sometimes referred to as “starvation diets,” in an attempt to prolong life. These diets were low in carbohydrates and calories because consuming carbohydrates could cause dangerously high blood sugar levels.
It wasn’t until the discovery of insulin in 1921 that they finally gained more freedom in the types and quantities of carbohydrate-based foods they could eat.
Nowadays, people with diabetes have even greater flexibility. Modern dietary approaches focus on balanced eating patterns that promote stable blood sugar levels, overall health, and quality of life.
Carbohydrate Consistent or "Controlled" Diet
The Carbohydrate Consistent or “Controlled” Diet is likely the most common dietary approach for managing diabetes. The main goal of this diet is to help maintain stable blood sugar levels by controlling the amount and timing of carbohydrate intake throughout the day. Instead of drastically reducing or eliminating carbohydrates, this diet emphasizes distributing them evenly across meals and snacks.
The diet involves consuming a consistent amount of carbohydrates at each meal, which helps prevent large fluctuations in blood sugar levels. This consistency makes it easier to predict how much insulin or medication is needed. Managing this can be done through simple methods like using MyPlate guidelines or through more advanced carbohydrate counting by weighing or measuring food.
Low Carbohydrate or Ketogenic Diet
Low-carb and ketogenic (keto) diets focus on significantly reducing carbohydrate intake to lower blood sugar levels and reduce the frequency of postprandial spikes. By limiting carbs, the body is encouraged to use fat as its primary energy source, which can lead to improved insulin sensitivity and better glycemic control.
Additionally, low-carb and keto diets often result in weight loss, which is beneficial for many individuals with type 2 diabetes as it can further improve insulin sensitivity and reduce the need for diabetes medications.
Keep in mind that there is no consensus on what qualifies as “low carb,” but for keto eating, it generally means reducing carbohydrate intake enough to induce nutritional ketosis. Individuals on insulin or SGLT2 medications should be cautious with this eating pattern, as they may be at an increased risk for diabetic ketoacidosis, a dangerous condition requiring immediate medical attention.
Mediterranean Diet
The Mediterranean diet, known for its emphasis on whole foods like fruits, vegetables, whole grains, nuts, seeds, and healthy fats such as olive oil, is highly effective for diabetes management.
This diet is rich in fiber and healthy fats, which help regulate blood sugar levels and improve insulin sensitivity.
The inclusion of lean proteins like fish, along with a lower intake of red meat and processed foods, supports heart health. The Mediterranean diet’s balanced approach to nutrition makes it a sustainable and healthful option for managing diabetes while promoting overall well-being.
Plant-Based Eating Pattern
A plant-based diet emphasizes whole foods like vegetables, fruits, legumes, whole grains, nuts, and seeds, which are rich in fiber, vitamins, and minerals. The high fiber content helps regulate blood sugar levels by slowing down glucose absorption, thereby reducing blood sugar spikes.
Additionally, plant-based diets are generally lower in saturated fats, which can improve insulin sensitivity and support heart health. While adherence to a plant-based diet can be challenging, the Physicians Committee for Responsible Medicine has dedicated considerable time and resources to developing evidence-based materials on plant-based eating for diabetes management.
Key Takeaways
Patient’s needs, preferences, and lifestyle must be carefully considered to create a personalized eating plan that not only manages blood sugar levels but also promotes overall well-being. It’s not just about restricting certain foods; it’s about empowering patients with the knowledge and tools to make informed, balanced choices that they can maintain over the long term.
So, when I receive these referrals, I don’t just see an opportunity to teach about food choices—I see an opportunity to shift the narrative. It’s a chance to educate both patients and providers that there’s no single “diabetic diet” but rather a range of healthy eating strategies tailored to individual needs.
- The history of a wonderful thing we call insulin | american diabetes association. Accessed October 25, 2024. https://diabetes.org/blog/history-wonderful-thing-we-call-insulin
- What are the signs of dka? Cleveland Clinic. Accessed October 25, 2024. https://my.clevelandclinic.org/health/diseases/21945-diabetic-ketoacidosis-dka
- Goday A, Bellido D, Sajoux I, et al. Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus. Nutr Diabetes. 2016;6(9):e230. doi:10.1038/nutd.2016.36
- Carb counter and diabetes | ada. Accessed October 25, 2024. https://diabetes.org/food-nutrition/understanding-carbs/carb-counting-and-diabetes
