Healthy eating with diabetes

What is diabetes?

Diabetes means that the body can no longer control the level of glucose (sugar) in the blood. Our bodies make insulin (a hormone), which allows glucose in the blood to be used by the body for energy.

At diagnosis, the level of glucose in your blood was too high because your body either did not produce enough insulin or, more commonly, was not using it efficiently.

Aims of this booklet

People with diabetes who keep their blood glucose, blood pressure and blood fats near to normal generally suffer fewer long-term health problems than those whose levels are too high.

The information in this booklet is designed to help you:

  • Keep your blood glucose levels near normal.
  • Keep your blood pressure near normal.
  • Keep your blood fats (such as cholesterol) near normal.

Does it matter what I eat?

Yes. What you eat affects the levels of glucose and fat in your blood, your blood pressure and your weight.

By eating healthily and increasing activity, some people will avoid or delay the need to take medication for diabetes.

If you are overweight, losing weight may help you avoid or delay the need to take medication.

You may need to make some changes to what you eat and when you eat. However, others can eat the same foods as you because you will not need to buy special foods.

Key points for healthy eating with diabetes

  • If you are overweight, try to lose some weight via long term, sustainable changes.
  • Eat at regular intervals during the day i.e. breakfast, midday and evening meals. Don’t miss meals.
  • Include starchy food (carbohydrate) at each meal (approximately one quarter to one third of the plate). Aim to have about the same amount at the same time each day.
  • Have a minimum of two to three portions of vegetables each day.
  • Have a maximum of 3 portions of fruit per day. Spread these portions throughout the day.
  • Limit foods with a high fat content.
  • Cut down on sugar, sugary foods and sugary drinks (this includes smoothies and fruit juice).
  • Drink alcohol in moderation.
  • Cut down on salt.
  • Special diabetic foods are not necessary.

Physical Activity

Try to do some activity each day. It is recommended to:

  • Aim for at least 150 minutes of moderate exercise which gets you out of breath every week, AND, strength exercises on two or more days a week that work all major muscles (legs, hips, back, abdomen, chest, shoulders, arms).

OR

  • Aim for at least 75 minutes of vigorous activity each week AND, strength exercises on two or more days a week that work all major muscles (legs, hips, back, abdomen, chest, shoulders, arms). Vigorous activity makes you breathe hard and fast. When exercising at this level, you won’t be able to say more than a few words without pausing for breath.

OR

  • A mix of moderate and vigorous aerobic activity every week. One minute of vigorous activity provides the same health benefits as two minutes of moderate activity.

It is also not helpful to sit for long periods of time. Tips to reduce sitting time include:

  • Stand or walk around while on the phone.
  • Walk to a co-worker’s desk instead of emailing or calling.
  • Stand on the train or bus.
  • Take the stairs and walk up escalators.
  • Swap some TV time for more active tasks or hobbies.

Activity can help to keep your blood glucose at nearer normal levels.

Effect of physical activity on blood glucose levels

  • Being physically active helps to use up sugar from your blood.
  • If you take insulin or some tablets to treat diabetes, exercise can cause your blood sugar levels to fall too low. You may need to make some changes to what you eat or to your medication before the exercise. Ask your dietitian or nurse for more guidance.

Planning your meals

This diagram shows the ideal amounts from different foods in your meal for those who want to maintain their weight.

One third of your meal should be vegetables or salad. One third should be starchy/carbohydrate foods, and one third should be meat, fish, cheese, eggs or pulses

Starchy foods

Eat some starchy/carbohydrate foods with each meal. Your body breaks these starchy foods down into glucose, which you need for energy. If you eat roughly the same amounts of starchy foods at meals, it helps keep your blood glucose levels more stable.

Examples:

  • Breakfast cereals: Porridge, no added sugar muesli, Special K, All Bran, Shredded Wheat, Weetabix, Fruit and Fibre, Branflakes.
  • Rice: Boiled easy-cook or Basmati rice. Pasta: All kinds.
  • Potatoes: Boiled or jacket rather than chips.
  • Bread: Ideally multigrain, granary or pitta bread, oat or rye crispbread or crackers.
  • Other grains: Bulgur wheat, barley, couscous or quinoa.

Fruit and vegetables

Aim to have 2 or 3 portions of fruit spread throughout the day and at least 2 or 3 portions of vegetables or salad each day.

A portion of fruit is:

  • 1 medium-sized fruit e.g. apple, small banana, pear, orange or nectarine.
  • 2 small fruits e.g. plums, apricots, prunes, satsumas, kiwi fruit.1 handful of berry fruits such as strawberries, raspberries.
  • 1 slice of melon or papaya, 1 large slice of pineapple or 2 slices of mango.
  • 2 tablespoons stewed/ tinned fruit without added sugar.
  • 1 small glass of unsweetened fruit juice (about 150ml).
  • 10 large grapes.
  • 1 tablespoon dried fruit e.g. sultanas, raisins.

A portion of vegetables is:

  • 2-3 heaped tablespoons of cooked, raw, frozen or canned vegetables or beans.
  • A small bowl of salad.

Fruit juices and smoothies should be limited even if labelled as unsweetened or no-added-sugar due to their high natural
sugar content. Try to limit intake to no more than 150ml (small glass) per day. A 150ml serving can count towards a maximum of one serving of fruit and vegetables. Due to the high sugar content, they can cause a significant increase in blood glucose levels.

Meat, fish, cheese, eggs, nuts and beans

Choose two small portions each day from the following list.

  • Lean meats - beef, lamb, pork, chicken, turkey or other alternatives.
  • Fresh, frozen or tinned fish - preferably not fried.
  • Eggs - cooked without butter or oils.
  • Cheese - low fat soft cheese or small amounts of hard cheese.
  • Beans - baked beans, kidney beans, butter beans, haricot beans, borlotti beans, lentils, chick peas and similar beans, tofu and other soya products.
  • Nuts, seeds and reduced fat peanut butter in very small amounts.

Note: Oily fish such as sardines, pilchards, mackerel, trout, kippers, herrings or salmon may protect against heart disease.

Aim to eat fish at least twice a week, with at least one portion of oily fish.

Fluid

Aim to have at least eight cups of fluid each day e.g. water, tea, coffee, low sugar or low calorie squash and diet drinks.

Aim for a healthy weight

If you are overweight, your body is less sensitive to the insulin it makes (or that you inject). Losing weight will help your body respond better to the insulin and may improve your blood glucose levels.

Half of your meal should be vegetables or salad. A quarter of your meal should be starchy/carbohydrate foods and the other quarter should be meat, fish, cheese, eggs or pulses.
  • A realistic weight loss is about one pound / half a kilogram a week.
  • To lose weight you need to reduce your calorie intake from food. Increasing the amount of physical activity you take can help with weight loss but to less of an extent than making dietary changes.
  • Many people lose weight just by cutting down on fatty and sugary foods.
  • Making changes to reduce portion sizes may also be helpful.
  • It is usually better to make small changes to your eating habits, which can then become permanent, rather than going on a ‘crash’ diet which you cannot keep to for long.
  • Be more active. Build up to 30 minutes walking each day.
  • Ask your dietitian if you need more information.


Sugary foods and drinks

Aim to keep your intake of sugary foods and drinks as low as possible. Sugar is a concentrated form of carbohydrate and
can raise your blood glucose levels quickly.

Foods to avoid

  • Sugar added to drinks and cereals
  • Sugar-containing drinks
  • Ordinary milky drinks such as drinking chocolate, malted milk drinks
  • Sugary puddings and desserts, such as sponges, pies and tarts
  • Ordinary milk puddings and instant desserts
  • Full fat yoghurts containing cream
  • Ordinary jelly
  • Fruit canned in syrup
  • Packets of dried fruit

Foods to try instead

  • Tablet or sprinkle sweeteners such as Canderel, Splenda, Hermesetas, Silver Spoon Sweetener, Truvia
  • Low calorie, sugar-free or diet squash, fizzy drinks and flavoured waters
  • Cocoa and a sweetener
  • Low calorie drinking chocolate
  • Low-calorie or sugar-free desserts and milk puddings
  • 1 scoop of ice-cream
  • Low fat natural or greek yoghurts
  • Sugar free jelly
  • Fresh fruit, fruit stewed without sugar or fruit canned in juice

Foods with a high fat and oil content

Having diabetes makes you more prone to heart disease. 

Consider being careful about the type and amount of fat you eat because a diet high in fat, especially saturated fat, will increase your risk of heart disease and stroke even more. In addition, if you are trying to lose weight, high fat foods are also high calorie foods.

Ways to have a lower fat intake

Food choices

  • Ready meals and fast foods may be high in fat.
  • Try to cook more from scratch so you know what goes into your food.
  • Compare nutritional labels to go for the lower fat varieties.
  • Eat fewer pies, pasties, crisps, nuts, corn or potato snacks and biscuits.
  • Limit roast potatoes or chips to once a week or less.
  • Limit cheese to 4 ounces a week. Try a low fat variety.
  • Use skimmed, 1% or semi-skimmed milk rather than full-cream milk.
  • Use tomato or vegetable-based sauces for pasta rather than cream or cheese based sauces.
  • Choose plain fish or fish in breadcrumbs rather than fish in batter.

Cooking and preparing food

  • Use all fats, spreads and oils sparingly.
  • Grill, casserole, microwave or bake food rather than frying it.
  • Use low fat yoghurt rather than cream in cooking or on desserts.
  • Remove skin and visible fat from meats before eating.

Types of fat

Saturated fats tend to raise your blood cholesterol level. Hydrogenated vegetable oils, which are used in some manufactured products, do the same.

Unsaturated fats, particularly monounsaturated fats and fish oils, offer more benefits to your health.

Ways to change the type of fat you eat

  • Cut back on saturated fats and hydrogenated vegetable oils.
  • Choose a margarine labelled ‘high in monounsaturates’.
  • Use olive oil or rapeseed oil (vegetable oil) for salad dressings and in cooking.

Fats to avoid

  • butter
  • hard margarines
  • suet
  • creamed coconut
  • hydrogenated vegetable oil
  • meat fats
  • sausages
  • pasties
  • dairy fats including whole milk, full fat cheese, cream and creme fraiche

Fats to choose instead

  • margarines labelled ‘high in monounsaturates’ e.g. olive, rapeseed or vegetable.
  • Rapeseed oil (vegetable oil), olive oil, sunflower oil, soya oil, oily fish

Note: Foods containing fats and oils are usually high calorie foods. Use sparingly if you are trying to lose weight.

Making sense of food labelling

There are two things you can look at on the food label: the ingredients list and the nutrition information panel.

Ingredients are listed in order of weight.

If the first or second ingredient is sugar, glucose, honey or syrup it is likely to be a very concentrated carbohydrate food.

If the first ingredients are oil, hydrogenated vegetable oil, cream or cheese then it is likely to be a high fat food.

You can also look at the nutrition information panel. Most food labels give figures for both 100g or a ‘serving’ of the food. Look at the figure for a serving and compare it with the chart below to give you an idea of whether you would be eating a lot or a little of each component.

Per 100g of food item

Sugars: A lot = more than 22.5g. A little = less than 5g.

Total fat: A lot = more than 17.5g. A little = less than 3g.

Saturates: A lot = more than 5g. A little = less than 1.5g.

Salt: A lot = more than 1.5g. A little = less than 0.3g.

More on food labelling

‘No added sugar’ means that no extra sugar has been added to the product but it may still contain a lot of natural sugars.

’Reduced Fat’ / ‘Light’ or ‘Lite’ means the product still contains some fat. Look at the nutrition information panel to see how much fat is in the portion you are going to eat.

In many fat-reduced products the fat is replaced by extra sugar. Check the label. Sugar also has other names, e.g. glucose syrup, maltose etc.

Sweeteners

The ideal is to get used to having less sweet foods. If you need to use a sweetener then most tablet and liquid sweeteners are suitable.

Powdered sweeteners containing aspartame, acesulfame potassium, saccharine or sucralose are also suitable e.g. Canderel, Silver Spoon, Truvia, Splenda.

Use the smallest amount of sweetener you can and try to use a variety of sweeteners. For example, if you have a fizzy drink containing aspartame (Nutrasweet), use a tablet sweetener based on saccharine or acesulfame potassium in your drinks.

Special diabetic products

There is nothing to be gained from buying special diabetic products. They are often high in calories and may be expensive.

Products containing sorbitol, mannitol, xylitol or isomalt may cause stomach upsets.

Use ordinary low sugar products instead.

Alcohol

Everyone is advised to drink in moderation only. This means drinking no more than 14 units a week on a regular basis for men and women. It is best to spread these units of alcohol across three or more days. You should also aim for several alcohol-free days each week.

Examples of alcohol content:

  • Small glass of wine (175ml) = 2 units
  • Large glass of wine (250ml) = 3 units
  • Pint of lower-strength (less than 4%) lager / beer / cider = 2 units
  • Pint of higher-strength (more than 5%) lager / beer /cider = 3 units
  • Alcopop bottle (275ml) = 1.5 units
  • Single small shot of spirits (25ml) = 1 unit

Tips

  • Choose dry or medium drinks rather than sweet varieties.
  • Use sugar-free mixers.
  • Never drink on an empty stomach. Alcohol can reduce blood sugar levels for several hours afterwards and may sometimes lead to blood sugar levels that are too low.
  • Avoid low sugar beers and lagers or strong beers and lagers as they have a higher alcohol content.
  • Be careful with low alcohol beers, lager and wine. Sometimes they have a high sugar content which may raise your blood sugar level.

Ask your dietitian for more information about the alcohol content of drinks.

Special occasions

The occasional celebration will not cause long term harm. It is your day-to-day eating which is more important.

If you do take sugary foods occasionally then it is best to take them as part of a meal or before being physically active.

Salt

Most people take far more salt in their food than their body needs.

If you have high blood pressure, you may be able to reduce it by taking less salt.

  • Use less salt in cooking.
  • Avoid adding salt to meals.
  • Cut back on salty foods such as cheese, processed meats and ready-made dishes.
  • Avoid salt substitutes like Lo-Salt.

Ask for more information about eating less salt.

Ideas for meals

Breakfast

  • Cereal or porridge with semi-skimmed milk.
  • Bread or toast with a little margarine spread and a small amount of jam, marmalade or savoury spread.
  • No-added sugar muesli and natural yoghurt.
  • 2 scrambled eggs, grilled tomato and mushrooms with a slice of granary bread.

Quick meals

  • Sandwiches with salad and tinned fish, lean meat or eggs.
  • Lentil or vegetable soup and a bread roll.
  • Jacket potato with filling such as baked beans, cottage cheese or tuna served with salad.
  • Toast topped with baked beans, egg, tinned fish, cheese, tomatoes or mushrooms.
  • Smoked mackerel on pitta bread with celery, cucumber and pepper sticks.

Main meals

  • Lean roast meat with boiled or dry-roasted potatoes and a selection of vegetables.
  • Pasta with a tomato-based sauce and a bowl of salad.
  • Fish or cottage pie served with peas or a green vegetable.
  • Vegetable or lean meat curry with rice and salad.
  • Spaghetti bolognaise made with very lean mince and served with a salad.
  • Stews and casseroles made with lean meat and vegetables.

Puddings

  • Small bowl of fresh fruit salad.
  • Low fat, low sugar yoghurt.
  • Stewed fruit and no-added sugar custard.
  • Fruit tinned in natural juice.
  • Sugar-free jelly.

Between meals

If you need to lose weight try to avoid snacking between meals or have a piece of fruit.

If you do not need to lose weight choose from:

  • bread
  • toast
  • crackers
  • bread muffins
  • plain scones
  • crumpets
  • teacakes
  • breakfast cereal
  • fresh fruit
  • low fat yoghurt
  • plain biscuits
  • chopped vegetables

Keep the portions small.

Beverages

  • Water.
  • Tea, coffee (without sugar).
  • Low calorie or no added sugar squash, fizzy drinks or flavoured water.

Note: be careful with fruit juice. It may be labelled ‘no added sugar’ but still contains a lot of natural sugars, which can have
a big effect on blood glucose levels.

If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice.

How to contact us:

North Bristol NHS Trust
Gate 10, Level 6
Brunel building
Bristol BS10 5NB

See your appointment letter for the number to phone with any queries you may have.

www.nbt.nhs.uk/diabetes

© North Bristol NHS Trust. This edition published April 2021. Review due April 2023. NBT002947

Healthy eating with diabetes