Diabetes Dietary Recommendations: What Is a Good Diabetic Diet?

Diet plays a vital role in the patient with type 1 and type 2 diabetes and control and prevent micro and macrovascular complications. For many years scientists have prescribed dietary recommendations to help control diabetes. (1)
Previous nutritional guidelines for people with diabetes just focused on carbohydrate-based meal planning. But nowadays, emphasis on the role of dietitians to create a good diabetic diet plan and education of patients to choose the right foods, dietary choices based on culture, more flexibility for choosing carbohydrates, limitations on intake of polyunsaturated fats, and greater recognition of physical activity. (2)
This article is about dietary recommendations for diabetes patients.

For overweight or obese people with diabetes, reducing energy intake remains the most significant dietary aim. Weight is a critical problem for many people. But when you have diabetes, there are huge benefits to losing weight if you're carrying extra weight. Losing weight can help you to control blood sugar and diabetes. Losing weight in type 2 diabetes could even go into diabetes remission.
If you are struggling with your weight and keeping it in a healthy range, be aware you are not alone, and millions of people have this problem. An excellent first step is to ask your dietitian for help with advice and a weight loss diet. (3)
Although type 1 diabetes has nothing to do directly with weight, losing any extra weight will help you inject less insulin.

When it comes to managing diabetes, the carbs you eat have a significant effect. Carbohydrates should make up about 50-55% of the dietary calorie intake. (4) All kinds of carbohydrates you eat and drink are broken into glucose. Your body uses that glucose as a primary fuel throughout the day. This is what you probably know of as your blood glucose or blood sugar. (5)
You can make a difference to your blood glucose levels and diabetes management by the type and amount of carbs you eat.
There are three main types of carbs in foods: starches, sugar, and fiber. The goal of a diabetic diet is to choose carbohydrates that are rich in fiber, vitamins, and minerals. You should avoid unhealthy carbs in a diabetic diet, which are high in added sugar, sodium, and unhealthy fats.

• Eat more whole, unprocessed, and non-starchy vegetables like lettuce, cucumbers, kale, cauliflower, artichoke, broccoli, tomatoes, green beans, etc., which have a lot of fiber, vitamins, minerals, and very little carbohydrate. Most of your plate should include these foods.
• Eat some whole and minimally processed carbohydrate foods. Include fruits, whole grains, starchy vegetables, and legumes. 25% of your meal should consist of these foods.
• Eat less or don't eat refined, highly processed, and added sugar carbohydrates. Have sugary drinks like soda, sweets, juice, snack foods like cake, cookies, candy, refined grains like white bread, white rice, sugary cereal, chips, etc.

Another important nutrient to consider as part of a diabetic diet is fat. Consumption of a high-fat diet and high intakes of saturated fat are associated with an increased risk of type 2 diabetes. Reduction of fat intake to 30–35% of daily calorie intake help to control blood sugar. Polyunsaturated, monounsaturated, saturated, and trans fat are the main fats in a diabetic diet. The American Diabetes Association (ADA) recommends eating more monounsaturated and polyunsaturated fats than saturated or trans fats in a diabetic diet.

• Monounsaturated fats include avocado, olive and olive oil, canola oil, nuts and seeds, nuts butter, and seeds oil. To have more monounsaturated fats in your diet, replace olive, canola oil, or sunflower oil with butter, margarine, or hydrogenated vegetable oil.
• Polyunsaturated fats are among the best fats on our planet and are one of the most important parts of a healthy diet. Omega-3 and Omega-6 fatty acids are two essential fatty acids that our body is unable to produce. These fatty acids should be a part of a healthy diet plan. Oily fish (salmon, sardines, herring, mackerel, tuna), walnuts, flaxseeds, flaxseed oil, canola oil, and chia seeds are Omega-3 sources. And tofu, eggs, sunflower seeds, and peanut butter are Omega-6 sources.
• Saturated fats are fats that you should limit in a diabetic diet. Saturated fats mostly come from animals and are solid at room temperature. Also, some plant-based fats are high in saturated fats. We aim to get less than 10% of one's daily calorie intake from saturated fat. Saturated fats include butter, high-fat meat, poultry skin, cream, high-fat dairies, palm oil, and hydrogenated vegetable oil.
• Trans fats are more harmful than saturated fat, and you should eat as little trans fat as possible by avoiding foods that contain it. Trans fats are found in processed foods like snacks (biscuits, cakes, crackers, chips, muffins, etc.) with hydrogenated oil or partially hydrogenated oil, margarine, some fast foods, french fries, and fried food. You should get a maximum of 1% of your daily calorie intake from trans fats.

Protein is an essential nutrient found in every cell in our bodies and bloodstream. Our bodies use protein for growth, maintenance, energy, chemical reactions, building and maintaining bones, supporting the immune system, making hormones, etc.
There is some evidence that an increase in dietary protein intake above the current recommendation is a valid option for better diabetes control, weight reduction, improvement in blood pressure, lipid profile, and markers of inflammation.
On average, a diabetic patient with normal kidney function should eat about the same amount of protein as normal people, which is about 15-20% of their daily calories (1-1.5 g/ kg). Increasing the dietary protein intake to 1.5-2 g/kg (or 20-30% of total daily calorie intake) has been suggested for overweight and obese patients with type 2 diabetes and normal kidney function. (6)
In a hypocaloric diet, it's better to use grams per kilogram of bodyweight protein intake to prevent protein malnutrition.
The protein intake in diabetic patients' diet with chronic kidney disease should be 0.8-1 g/kg. Other diabetic patients should not reduce protein intake to less than 1 g/kg of body weight.
Foods high in protein, including fish, chicken, meats, soy products, cheese, milk, yogurt, etc., are all called protein foods. The proteins you eat in your diet plan are classified into two groups as complete and incomplete, based on whether they contain all nine essential amino acids or not.
Animals' proteins like eggs, meat, fish, cheese, milk, etc., are complete proteins and most plant-based proteins like nuts, seeds, beans, grains, etc., are incomplete. Soy is an exception and provides all nine essential amino acids.
It's better to take at least 50% of your diet proteins from complete or HBV (High Biological Value) protein foods.
And the last point about protein is the fat content and carbohydrates content; the most significant difference between foods in these two groups is how much fat they contain, and for the plant proteins, whether they have carbohydrates. So try to take low-fat animals protein and count plant protein carbohydrates.

There are some vitamins and minerals that people with diabetes need to pay special attention to. Most diabetic patients can get enough vitamins and minerals through diet; the American Diabetes Association (ADA) standards do not support the use of vitamin and mineral supplements for these patients because of the lack of sufficient evidence. But some patients do not receive enough nutrients from food and should be supplemented.
In the following, we discuss vitamins and minerals which needed for patients with diabetes:

• Vitamin E's effects on glucose control are related to the lipophilic antioxidant activity, and also it affects non-oxidative glucose metabolism, lipid oxidation, insulin sensitivity, and secretion.
• Vitamin C reduces glycosylation, and as an antioxidant, it is beneficial to people with diabetes.
• Vitamin B12 may help with some success in treating diabetic neuropathy. A vitamin B12 deficiency is characterized by numbness of the feet, pins and needles sensations, or a burning feeling, which are common symptoms of diabetic neuropathy.
• Biotin (vitamin B7) improves glucose metabolism and nerve function. Biotin enhances insulin sensitivity and increases the enzyme glucokinase (Glucokinase concentrations in diabetes patients are very low, and it is responsible for the first step in utilizing glucose by the liver).
• Vitamin B6 has significant protection against the development of diabetic neuropathy and prevents other diabetic complications because it inhibits the glycosylation of proteins.
• Vanadium has been used to control blood glucose since the discovery of insulin. Vanadium's mechanism of action in glycemic control is primarily insulin-mimetic with up-regulation of insulin receptors. It enhances glucose oxidation and glycogen synthesis, facilitates glucose uptake and metabolism, and enhances insulin sensitivity.
• Chromium is a trace element required to maintain normal glucose metabolism, and its deficiency is associated with impaired glucose tolerance. Good dietary sources of chromium are brewer's yeast, meat, and barley flour. Refined sugars, white flour products, and lack of activity reduce chromium levels.
• Magnesium deficiency is associated with complications of diabetes, particularly retinopathy; it also causes insulin resistance. A magnesium deficiency is significantly more common among people with diabetes than in the general population, especially those with glycosuria, ketoacidosis, and excess urinary magnesium losses. Magnesium increases insulin secretion, insulin sensitivity, and peripheral glucose uptake; it's also involved in glucose oxidation and transport across cell membranes.
• Calcium improves insulin sensitivity in diabetic patients. A daily intake of 1000-1500 mg of calcium, especially in older people with diabetes, is recommended.
• Manganese is an essential nutrient for human health. It is a cofactor of various enzymes that aid in cellular biochemical reactions and its deficiency causes impaired glucose tolerance and altered carbohydrate and lipid metabolism. So it's important to get enough manganese through your diet plan.
• Potassium yields improve insulin sensitivity, responsiveness, and secretion. Insulin administration induces a loss of potassium. So eat high potassium foods in your diet.
• Zinc is involved almost in all aspects of insulin metabolism, including synthesis, secretion, and utilization; it also protects the pancreas β-cell against destruction. People with diabetes typically excrete excessive amounts of zinc in the urine and need more zinc than ordinary people. Zinc improves insulin levels and helps enhance poor wound healing in diabetes patients.

We suggest getting these vitamins and minerals through your diet but consult your dietitian or doctor to take a supplement if you don't get enough nutrients from your diet.