T2DM AND EATING

                                                  

Type 2 Diabetes affects how your body uses and stores glucose. Glucose comes from digestion of sugars and starches in the foods we eat. Our body produces a hormone called insulin that it uses to remove glucose from our blood. In Type 2 diabetes our body may not be making enough insulin or our body is not properly responding to the insulin it is making. Glucose levels in our blood rise and can cause both short term and long-term effects on our body.

• Symptoms include: unusual thirst, frequent need to urinate, weight change, lack of energy, blurred vision, frequent infections, cuts and bruises that are slow to heal, tingling in the hands and feet.

• Risk factors include: being overweight, a parent or sibling with diabetes, having diabetes while pregnant (gestational diabetes), impaired glucose tolerance or impaired fasting glucose, high blood pressure, high cholesterol, polycystic ovary syndrome, being of Aboriginal, Hispanic, Asian, South Asian or African descent.

Blood Glucose Target Ranges

Fasting: 4.0 -7.0 (empty stomach or no food for at least 3 hours) Postprandial: 5.0-10.0 (2 hours after a meal)

       

EATING PLAN FOR TYPE 2 DIABETES

This eating plan is low in re ned grains and sugar, low in saturated and trans fat and high in bre. It focuses on eating regularly timed meals and selecting low glycemic index foods.

Did You Know?

More than 3 million Canadians have diabetes and more than 90% of these have Type 2 Diabetes.

Tips to Help Keep Your Blood Sugar levels in a Healthy Range

1. Eat three balanced meals per day, no more than six hours apart. Limit added sugars and sweets.

2. Eat a combined total of at least 7 servings of vegetables and fruit each day.

3. Eat your fruit rather than drinking it as juice.

4. Include small portions of whole-grain starchy foods at each meal.

5. Eat lower glycemic index foods. See ‘Go Low GI’.

6. Drink water instead of regular pop and fruit drinks. Tea, coffee and low
calorie juices and beverages are great too.

7. Include lean protein choices at each of your meals.

8. Make lower fat choices, avoid frying your foods and limit add on fats
such as butter, margarine and oil.

9. Move your body for at least 30 minutes every day – walking is great!

10. If you are overweight, try to lose 5 to 10% of your present weight.

Type 2 Diabetes FACTS – Focus on Carboyhdrate, Fibre and Glycemic Index

• Over time, high blood sugar causes damage to your blood vessels and can result in blindness, heart disease, kidney problems, circulation problems, nerve damage and erectile dysfunction.

• By choosing appropriate portions of carboydrate containing foods and selecting ones that have more bre and a lower glycemic index, you help improve you blood glucose control.
Go Low GI – Foods and Their Glycemic Index
Glycemic index is a scale (0-100) ranking how quickly a carbohydrate containing food will digest into glucose in our blood. High GI foods break down quickly whereas low GI foods break down slowly. With low GI foods you feel full longer and you body’s insulin has more time to perform its job and remove glucose from the blood.
Hint: Hint low GI foods are generally ‘close to the farm.’

LOW GI FOODS (55 OR LESS) MEDIUM GI FOODS (56-69) HIGH GI FOODS (70+)

CHOOSE MOST OFTEN CHOOSE LESS OFTEN

Whole grain bread Couscous White bread

Pumpernickle bread Rye bread Instant mashed potatoes

Oatmeal Instant Oatmeal Corn Flakes, Rice Krispies

All-Bran cereal Shredded Wheat Re ned, sweetened cereals

Converted rice Cream of Wheat Instant rice

Brown & Basmati rice Whole grain crackers Bagels

Bulgur, Barley, Quinoa Pita bread Waf es/pancakes – made with white our

Firm cooked pasta Long grain white rice Soda crackers

Beans, peas, lentils Apricot, banana French fries

Apples, peaches, pears Cantaloupe Dried dates/ gs

Grapefruit, oranges Pineapple, raisins Sweetened fruit juice

Berries, cherries, grapes Canned fruit in juice Parsnips, pumpkin

Kiwi, Mango, Plum Cranberry juice Rutabaga, turnip

Avocado New potatoes Broad beans

Sweet Potato Beets Refried beans

Carrots, broccoli Cauli ower, corn Leafy vegetables

Low fat milk, soymilk, yogurt and cottage cheese

Sweetened condensed milk

*Adapted from “The GI Diet” Rick Gallop

Ice cream Soft drinks Glucose

   

 

Tips for using the Glycemic Index

• Think low and slow – choose from the low and medium GI foods most often.

• Balance your choices with lean protein choices and healthy fats. Protein and fat also slow the digestion, keep you feeling
full and slow the release of glucose into your blood.

• More details can be found online at http://www.gidiet.com or http://www.diabetes.ca/ les/glycemicindex_08.pdf
Did you know?
The Glycemic Index diet was developed by David Jenkins, a professor of nutrition and reasearcher at the University of Toronto.

Balancing Carbohydrates (‘Carbs’)

Along with the glycemic index approach, it is important to understand and control the amount of carbohydrates you eat and drink to better manage your blood glucose.

Here are some tips:

1. Carbohydrate is the nutrition term used for starch, sugar and bre.

2. Spacing your carbohydrates over the day helps your body to keep a stable glucose level.

3. Starch choices that are higher in bre contribute less to raising your blood glucose. Use the Nutrition Facts panel to choose
cereal, bread, crackers, rice and other grain or starch choices that have at least 2 grams of bre per serving.

4. Breakfast should be 1/3 starch or grain, 1/3 fruit and 1/3 protein.

5. Lunch and supper should be 1/2 vegetables, 1/4 starch and 1/4 protein.

6. Snack choices can help prevent dips in blood glucose that can occur if your meals are more than 4 hours apart or if you are
very active.

7. Choose snacks with about 20 grams of carbohydrate. Fruit, vegetables, high bre granola bars, whole grain crackers with
cheese or peanut butter are just a few options.

Sugar and Re ned Starches

• Table sugar, brown sugar, honey, maple syrup and molasses
are all simple sugars and they all have 5 grams of carbohydrates or “carbs” in a teaspoon.

• Simple sugars such as these and ‘white’ or re ned starches break down quickly and cause blood glucose to rise quickly.

• A quick rise in blood glucose can often be followed by an equally quick drop.

• This can lead to cravings for more sugary foods and feelings of hunger and fatigue.

• Aim to choose packaged foods with less than 10 grams of sugar per serving

• Avoid adding sugar, reduce the amount or substitute a non-sugar sweetener for baking such as Splenda (sucralose)
The Canadian Diabetes Association has an excellent summary sheet on sugars and sweetners.
Find it on line at http://www.diabetes.ca/ les/en_sweeteners_ nal.pdf or call 1-800-BANTING to request a copy.
Did you know?
A standard can of regular pop contains the equivalent of 10 tsp of sugar and a 2L bottle of pop has 11⁄2 cups of sugar! Water is the best beverage for quenching your thirst.
Decoding Food Labels
The Nutrition Facts table found on the side of packaged food can help you make better food choices. Always check the serving size rst and consider this in relation to how much of the food you usually eat.

 

See it to Believe it!

1 tsp = 5 grams sugar

  

Look for choices with less fat, saturated fat, cholesterol and sodium. Look for choices that give you more bre.

Learn more about using food labels to make healthy choices on the web: Health Canada – http://www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.php Healthy Eating Is In Store for You – http://www.healthyeatingisinstore.ca

                                                                                                                                                                                                             

Did you know?

Fibre is a carbohydrate that does not raise blood sugar. Using the Nutrition Facts, you can subtract the grams of Fibre from the grams of Carbohydrate. Only count the remaining carbohydrate toward your meal plan.

 

Portions to Live By

• One serving of whole grains is 1/2 cup cooked, not the 3 or more cups served in most restaurants! Too much of a good thing is not a good thing.

• For more details on healthy portions see
Eating Well with Canada’s Food Guide
online at http://www.healthcanada.gc.ca/foodguide.

Breakfast

Lunch & Supper

  

Protein

Fruit

Starch

Protein

Starch

Vegetables

How Many carbs are right for me?

• Carbs are one of the energy nutrients. We all have diferent energy needs based on our activities, age, gender, goals to maintain or lose weight just to name a few.

• In general, most adults need 45 to 60 grams of carbohydrates per meal.

• Using food labels will help you to choose foods to provide about this amount of carbohydrate per meal.

• To plan your meal you should know that in each of the following foods there are about 15 grams of carbs:

–  1slice of bread (the size of a CD case)

–  1⁄2 cup of cereal

–  1 piece of fruit (the size of a tennis ball)

–  1 cup of low fat milk

• Vegetables are very low in carbs and are often considered ‘free’ – load up!
Exchange lists indicating the portions of food to provide 15 grams of carbohydrate are available. Ask a registered dietitian for more details.
If you are using insulin to control your blood sugars, you may want to learn more about balancing your carbohydrates with an approach called Carbohydrate Counting. Ask to speak with a registered dietitian.
Fibre

• When reading food labels look for foods higher in bre.

• Bread choices should have at least 2 grams per slice. Cereal choices should be 4 grams or more per serving.

• Grandually increase your bre intake and aim for 30 grams each day.

• Fibre is a carb that does not digest. When reading the Nutrition Facts table, subtract the bre grams from the total
grams of carbs to determine the carbs that contribute to your meal.
To Reduce Weight
If you are overweight a gradual reduction of 5-10% of your initial weight can inprove blood glucose control. Suggestions include:

• Eat smaller portions of foods and remember the balance of foods on your plate: 1/4 protein, 1/4 starch (including
potatoes), 1/2 vegetables for lunch and supper

• Eat 3 meals per day, no more than 6 hours apart. Don’t skip meals. Snack with fruit between meals.

• Choose foods lower in fat and sugar. Eating strategies including low glycemic index choices can be helpful. Learn
more from a registered dietitian.

• Aim for a maximum weight loss of 1- 2 lbs (0.5 -1 kg) per week.
“Waist loss” is as important as weight loss. For tips on how to trim your waist see our ‘Waisting Away – Healthy Weight Management’ nutrition fact sheet.
Staying Healthy with Diabetes
Being overweight or obese makes your body more insulin resistant. This makes controlling blood sugars more challenging. Excess weight and diabetes are both risks factors for heart disease.
For more details on Weight Management, Cholesterol or Hypertension see: Eating Plan for Hypertension, Eating Plan for High Cholesterol and Waisting Away – Healthy Weight Management. All are available from the Ottawa Cardiovascular Centre website. Go to http://www.ottawacvcentre.com.

Type 2 Diabetes Eating Plan

Choose Low Glycemic Index Foods Whenever Possible!

FOODS TO CHOOSE

Whole Grains

• Whole and multi grain breads, whole wheat pasta, brown rice

• Low-fat and multigrain crackers

• Low-sugar, whole-grain cereals

• Oatmeal, bran, bulgur, buckwheat

• Low-fat, whole grain baked goods with added bran
or oat bran
Vegetables and Fruit – with lots of colour

• Dark green leafy vegetables

• Eat an abundance fresh/frozen vegetables

• Unsweetened, fresh, frozen or canned fruits
Milk and Alternatives

• Dairy products with less than 1% fat

• Cheese should be 10-20% MF
Meat and Alternatives

• Fish (canned in water, fresh, frozen), seafood

• Skinless chicken and turkey

• Lean meats with fat trimmed, wild game

• Lean cold cuts (but watch the salt content)

• Legumes, tofu

• Eggs (up to eight per week)
Meat and Alternatives

• Olive, canola, soybean, sesame, sun ower oils (3 tsp

• or less per day)

• Non-hydrogenated soft margarinesLow-calorie
dressings and mayonnaise

• Light peanut butter, nuts (watch salt and calories)

• Unsalted seeds: ax, pumpkin, sun ower

• Defatted gravy and low-sugar condiments

• Cocoa powder or a small piece of dark chocolate
Sweets (in very small amounts)

• Sugar substitutes and arti cial sweeteners, low sugar jams/jellies/syrups

• Sugar-free candies, gelatins, gum

• Low-sugar and high ber baked goods

• Low-fat and low-sugar frozen dessert
Snack Foods

• Popcorn without salt, butter, or hydrogenated oils

• Choose low fat, low sugar snack foods

FOODS TO LIMIT OR AVOID

• White breads, croissants, sweet rolls, high-fat white crackers, waf es

• Short-grain and minute rice – white rice
• Sweetened re ned cereals
• Commercial muf ns, cakes, doughnuts, Danish

pastries, high-fat cookies
• Avoid “white” foods (white our, white sugar)

• Parsnip, pumpkin, white potatoes (high GI) • Dried fruits and fruits in heavy syrup
• Sweetened fruit juices

• Milk products higher than 1% fat
• Cheese higher than 21% MF and creams

• Fish with butter or breading
• Fried chicken, poultry with skin, wings
• Fatty marbled meats, ribs, regular ground meats,

organ meats
• High fat processed and canned meats: bacon,

sausages, patés, bologna, salami, wieners

• Hydrogenated oils, coconut and palm oils
• Shortening, butter, lard, hard margarines
• Peanut butter with palm or hydrogenated fat
• No more than 1/4 cup nuts per day (high calories)
• Heavy gravy, cream sauces, high-sugar condiments • Chocolate and carob

• Sugar and regular jams, jellies, syrups, candies, gelatins, gum, honey

• Regular cakes, pies, cookies
• No “white” foods (white our, white sugar) • Regular frozen desserts

• Regular popcorn, chips, pretzels, cheesies, corn chips

      

Alcohol

• Limit alcohol to less than 2 drinks per day (1 drink = 12 oz beer or 1.5 oz liquor or 4 oz wine)

• Alcohol is not recommended if you:

–  have high triglycerides (type of blood fat)

–  have liver problems

–  are pregnant or breastfeeding

• If

–  To drink with your meal or snack (not on an empty stomach)

–  To drink slowly or dilute with water or diet soda

–  That liqueurs, sweet wines and dessert wines have more sugar

–  To wear your MedicAlert indicating that you have diabetes – alcohol can cause a low blood sugar reaction which,
if left untreated, may require medical attention
Supplements
Check with your Doctor, Dietitian or Pharmacist before starting a supplement.

• Heart Healthy Mixture = 1/3 ground ax, 1/3 oat bran and 1/3 psyllium. Use 2 Tablespoons per day added to foods
or beverages. The bre in this blend is good for both your heart and blood glucose control.

• For high triglycerides (a type of fat in the blood more commonly high with diabetes):
Omega 3 supplements – adding 2000 to 4000mg of EPA+DHA from sh oil. This should be done under the supervisionof your doctor.
Move your body, burn the glucose

• Aim to be active for 30 minutes at least 5 days per week (150 minutes/wk). Start with brisk walking for 10 minutes a few times per day and increase gradually from there. Be sure to have your doctors approval before engaging in an exercise program.

• Strength exercises can be included 2 -4 times per week to keep the bones strong and build lean muscle.

• A leaner body is better able to use the insulin it produces to manage blood glucose.

• Measure your blood sugar before and after exercise. Typically your readings after exercise will be lower.

• Be prepared incase your blood sugar drops too low during or after exercise. Treatments are listed below.

• If you take medications that have a risk of causing low blood sugar it is best to exercise with someone and take a cell phone
with you for emergencies. Let someone know where you will be and approximately when you will return. Take emergency glucose with you and wear your MedicAlert.
Recognize and be ready to treat low blood glucose
Usually we are concerned about blood glucose being too high but certain medications*, exercise, a missed meal or an illness can cause you to experience a low blood sugar.

• What is low? A blood glucose below 4.0

• Symptoms: shakiness, fatigue, excessive hunger, headache, blurred vision or dizziness, cold clammy or sweaty skin, pale
colour in face, weakness.

• Treatment:

–  Take 15 grams of fast acting carbohydrate such as glucose tabs, 3 packets of sugar dissolved in water, 3⁄4 c fruit juice or regular pop, 6 LifeSaver candies or 1 tablespoon of honey. Wait 15 minutes. If symptoms do not resolve treat again.

–  If symptoms resolve but the next meal is more than an hour away, have a snack with 15 to 20 grams of carbohydrate and some protein such as 1⁄2 a sandwich or cheese and crackers.
* Medications more likely to cause a low blood sugar include Amaryl, Diabeta, Diamicron, Gluconorm and Insulin.

you choose to drink alcohol, remember:

Keeping active can lower your blood sugar, lower your blood pressure, help you lose weight, help you feel better reduce the amount of medication you need, relieve tension or stress, improve your heart and lung function and improve your muscle tone! Look at all those bene ts!

Other Nutrition Fact Sheets Available:

Eating Plan for Hypertension
Eating Plan for High Cholesterol
Eating Plan for Heart Failure
Healthy Weight Management
Potassium Modi ed Eating Plan
Please visit http://www.cvtoolbox.com for more information

Ottawa Cardiovascular Centre

502-1355 Bank Street
Ottawa, ON K1H 8K7
Phone: (613) 738-1584
Email: admin@ottawacvcentre.com

 

Eating Plan for Type 2 Diabetes, December 2010

Danielle Aldous, BSc, RD (From Original 2006 Helene Charlebois, BsC, RD & Jasna Robinson, DI) © Continuing Medical Implementation ® Inc.

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