Ideal diabetic diet?

brownbook · Jan 21, 2015

Not sure I understand your question? The best diet is one the patient, Dr., and RDA, have discussed. Hopefully they have taken into consideration the patient's food preferences, what grocery store they usually use, finances, etc.

A basic healthy diet with a balance of fats, carbohydrates, and proteins, with a lot of fruits and vegetables.

I have forgotten so much of nursing school, but my teachers words are cemented into my brain.....the healthiest diet anyone could try to follow is a diabetic diet.

Libby1987 · Jan 21, 2015

Not sure I understand your question? The best diet is one the patient, Dr., and RDA, have discussed. Hopefully they have taken into consideration the patient's food preferences, what grocery store they usually use, finances, etc.
A basic healthy diet with a balance of fats, carbohydrates, and proteins, with a lot of fruits and vegetables.
I have forgotten so much of nursing school, but my teachers words are cemented into my brain.....the healthiest diet anyone could try to follow is a diabetic diet.

I meant if you were to design a diet that would optimally provide/support glucose control and resources/preferences etc weren't an issue. No other diet restrictions/allergies etc.

Are you 100% behind the ADA recommendations?

Would you you reduce fat, increase fat, eliminate dairy..

Re your response, why lots of fruits? What do you consider a balance of macros?

morte, LPN, LVN · Jan 21, 2015

modest, consistent levels of carbs. protein per age group/activity level, fats to fill in the difference.

brownbook · Jan 21, 2015

Woah.....I have way to much respect for RDA's to even touch your questions. A basic healthy diet, fruits and veggies, is just my common sense approach. I don't think eating, eating healthy, is rocket science! Somehow we have been managing to eat what we need for the last 35,000 years. I don't think cro magnons thought about macros, somehow they survived?

NO, I am not endorsing the paleo diet!

llg, PhD, RN · Jan 21, 2015

Personally, as a nurse who has been borderline diabetic ... but who keeps things under control with diet and exercise ... I think the ADA recommendations are to lenient in relation to carbohydrates. They are too tolerant of people who don't want to exercise at all and/or who won't lower their carb intake. They are too quick to say, "Oh, just take meds so you don't have to make those lifestyle changes."

For someone who is highly motivated and reasonably intelligent (which I think I am) ... I would recommend what has worked for me -- lower carb (but not extremely low carb) and regular exercise. Someday, I might need medication, but it's been 7 years now and so far, so good.

I am a big believer in the phrase: Test, don't guess. I test my blood sugar regularly and identify the foods that drive my bs up a lot, etc. I minimize my intake of those foods and eat more of the foods that don't have that effect. For me, that means a lot of meat and non-starchy veggies -- and some whole grain breads and cereals occasionally. (Yes, in reality I "cheat" a lot -- but that's how I try to eat most of the time. I am far from perfect, but I try to stay close to being on track.)

As for fruit: It sounds healthy, but it contains lots of sugar. You have to watch those. Some fruits spike up your blood glucose real fast. I eat some fruit -- but I can't "load up" on it. I have to include the carbs in the fruit along with the carbs in the cake and cookies. I can only have a certain amount each day (about 150 grams for me) -- and it doesn't matter if it is fruit, bread, pasta, potatoes, or candy. It all effects my blood sugar and I have to be careful with it.

Libby1987 · Jan 22, 2015

Woah.....I have way to much respect for RDA's to even touch your questions. A basic healthy diet, fruits and veggies, is just my common sense approach. I don't think eating, eating healthy, is rocket science! Somehow we have been managing to eat what we need for the last 35,000 years. I don't think cro magnons thought about macros, somehow they survived?
NO, I am not endorsing the paleo diet!

The question wasn't define a healthy diet but what diet plan provided the best glucose control. How foods effect insulin secretion is relevant and what the RDA's/USDA currently recommend isn't necessarily it.

This is the diabetic forum, the question is regarding glucose control, I think a question of the best ratio of fat/pro/carb is reasonable.

SteveDE · Jan 22, 2015

I think what llg posted is reality. I personally believe the best meal plan is one that someone can live with long-term, be satisfied with, actually enjoy sometimes, but keep a balance. Fruits are important, but just like bread, potatoes, and pasta, there must be a balance. While this may not be food, I believe the best meal plan also includes a consistent exercise plan and consistent monitoring, those 2 areas must be fit into the plan. llg stated she works on about 150 grams per day, at the same time, many people know that 225 works for them due to their size, sex, weight control, monitoring, and exercise.

So, my answer would be the best meal plan would include CONSISTENT carb. counting/portion size, exercise, weight control, and monitoring. While all of those don't deal with actual intake, I think a highly motivated person will take all of those to form the best meal plan for their needs.

Good question!

lorichka6 · Jan 23, 2015

Still have pancreatic function? Then exercise, exercise. In studies from the 70s researchers were able to totally reverse T2D with exercise. Strength training too - more muscle = more "sponge" to soak up glucose.

Diet wise - I'm a huge endorser of paleo. I don't believe carbs are bad I believe highly processed oils and carbs are bad. If you need a factory to make the product, don't eat it. If someone grew it or raised it - eat it. My father got his HbA1c from 9ish to a little over 6 in 30 days following very strict paleo (Whole 30). Considering A1c is ~ a 90 day average thats a pretty dramatic drop of circulating glucose in the last 30 days to affect the avg so much.

CampNurse1 · Jan 23, 2015

I usually stick to the camp nursing forum, but, when I saw the subject matter, I couldn't help but chime in.

I have been on insulin since 1967. I have been on a pump (Omnipod) for the last three years. Thankfully, no complications, except for a bit of numbness in my feet. I have spent my entire adult life in healthcare, with the last seven years as a nurse.

Before writing this, I took a cursory look at the dietary compliance data available online. As I suspected, compliance is low, between 17 - 28% in the studies I looked at. All of the studies used questionaires as the primary tools. Human nature being what it is, I doubt that any patient is compliant 100% of the time. Most of my 47 year life as a diabetic has been spent in complete dietary non-compliance. Life happens! When I was a scrub tech, some of the cases lasted 10-12 hours. Every now and then, I would break scrub for a few minutes and have a snack if it was necessary, but mostly I just soldiered on.

Keeping the compliance rate in mind, it is important to establish a relationship with our patients and to create a unique approach for each of them. This is where RDs do a great job. An interview is a good way to establish needs. What are the patient's likes and dislikes? Is our care culturally competent? What are the patient's education and socioeconomic levels? What are the patient's cooking abilities? Does the patient have an engaged family or other support system? Too much of our teaching is in one-size-fits-all written handouts. These do not serve well if the patient doesn't read well, or is depressed about the diabetes diagnosis.

Another big issue is time. When I was first diagnosed at the age of ten, I spent three weeks in Children's Memorial Hospital. My mother and I went to classes every day on diet and insulin therapy. The dietician (Mrs. Stubblefield, God bless her!) taught us how to weigh food on a gram scale and how to prepare low fat, low carb meals. No sugar! Ever! Period! No butter! Oleomargarine was thought to be better for you at the time. I remember two times a week I could have a very thin slice of angel food cake or a miniscule bit of ice cream.

No new diabetic is going to get three weeks in the hospital nowadays! More like three or four days, unless they are really sick. No one can learn much if they do not feel well. The RD and Diabetic Educator will not have much time at the bedside. I remember rolling a patient out to his car in his wheelchair one day when I worked med-surg. From his comments I got the feeling he had no idea what to do about his newly discovered NIDDM. I slowed way down! What could I come up with in the three minutes I had with him? I wrote down how to get in touch with our Diabetic Educator and get some outpatient teaching. "You've got to do this or you will get sick again!" I then spoke of the need to take his antidiabetic medication at the same time every day. I mentioned portion control and the nine inch plate diet. When we got to the car, his daughter said, "I thought it would take you forever to get down here!" I wished him good luck, with a sinking feeling.

The original poster asked what was the best diet in an ideal world. The old answer would have been an ADA diet matched to the patient's activity level. The ADA no longer endorses that diet. That is a surprise to some nurses, and some hospitals still serve up the famous "1800 ADA." The information on the ADA website is essentially to "eat healthy." Counting carbs, an essential, is best left for another post. I would say the best ideal world diet is one that fits the patient's likes, dislikes, culture, ability, and motivation. That would be ideal.

Libby1987 · Jan 24, 2015

My question was solely physiological and not related to compliance but I understand it's difficult to separate feasibility.

Alisonisayoshi, LVN · Jan 24, 2015

Personally, as a type 1 diabetic, I like Bernstein. He's a type 1 diabetic. I personally get the best control with it. I think physiologically speaking, every persons individual body is different. What works best for my diabetic body doesn't work best for the next persons. It's about the individual, not the overall.