Dr. Z' Diet 

 Diet For Diabetic Patients   

Nothing is more confusing and frustrating for diabetic patients than their diet. 

There are several reasons for this complex problem. 

Most physicians don't get appropriate training in nutrition for diabetic patients. From their residency training days, they remember just one lesson: Diet for all diabetics is an 1800 calorie diet. Chances are that you will be placed on this famous 1800 calorie diet if you happen to be admitted in a hospital. This 1800 calorie diet is too high for most people over the age of 50. No wonder many diabetic patients start having high blood glucose values during their hospital stay. 

Many dietitians prescribe a diet consisting of three regular meals and three snacks, regardless of your type of diabetes or treatment of diabetes. 

Most dietitians teach you to consume X-many calories from carbohydrates, X-many from fat and X-many from protein. It’s just not very practical. Try going to a restaurant and figuring out the percentages of carbohydrate, fat and protein before you order your food. If you’re like most people, you’ll skip the hassle and end up eating “whatever” for that meal. 

Many diet programs for diabetics are very generic and do not tailor towards individual needs. 

 

Diet for a diabetic person should be individualized based upon the following principles: 

 

The diet for a Type 1 diabetic patient is different from a Type 2 diabetic patient.  

The diet for an obese person is different from that of a lean person. 

The diet for a 70 year old patient is different from that of a 30 year old patient. 

Daily caloric requirement reduces drastically as we age, especially after the age of 40. 

The diet for a sedentary person is different from that of an active person. 

Diet for a Type 2 diabetic patient on oral drugs is different from someone who is on insulin injections. 

Diet will also vary depending upon the type of oral drugs you're taking. Diet of a Type 2 diabetic on insulin injections is different from a Type 1 diabetic who is on insulin. 

Also diet will vary depending upon the insulin regimen. Diet for a diabetic on an insulin pump is different from the one who is on insulin injections. 

 

 Diet for a Type 2 Diabetic patient  

This diet is for a typical adult, overweight, sedentary, Type 2 diabetic patient, who is on oral anti-diabetic drugs. 

1. Reduce the size of your portion. Contrary to your parent's teaching, you do not have to finish all the food on your plate. In fact, learn to leave some food on your plate!  Use smaller plates. This psychological trick helps with satisfaction of the size of your portion. Serving size is especially huge in American restaurants. In general, when you're eating out, cut the serving in half before you start eating and ask for a doggy bag. This will serve as another meal. 

2. Eat three regular meals per day. Try to have a garden vegetable salad before lunch and dinner. This serves as good, low-caloric stomach filler. Dinner should be the lightest meal of the day and lunch the heaviest meal of the day. Eat dinner at least 3 hours before bedtime. Walk for at least 30 minutes before or after dinner. You can either just go for an evening walk or use a stationary bike. A recumbent stationary bike is particularly useful if you have neuropathy in your feet. 

3. No snacks. Avoid snacks especially when you’re watching TV or working on a computer. If you have a craving to put something in your mouth, drink black tea or regular coffee. Caffeine is a good appetite suppressant. If you have a huge appetite, drink caffeinated tea or coffee about half an hour before your meal to help control your hunger. If you absolutely must have a snack, then try something like popcorn (without butter), carrot sticks or other raw vegetables. 

4. Reduce  Carbohydrates. Reduce the amount of bread, rice and pasta in your diet. Bread includes white bread, whole wheat bread, sour dough bread, French or Italian bread, donuts, bagels, croissants, pastries, hamburger buns, rolls, pita, pies, Indian naans, tortillas, tacos, enchiladas and many more similar bakery products. Rice includes white, brown as well as wild rice. Certain foods cause a marked increase in blood glucose and should be avoided. These foods include pizza, french fries, donuts, waffles, pancakes, pastries, fruit juices and desserts.  

5. No sodas, no fruit juices. Fruit juices are loaded with natural as well as regular sugar. Water, tea and coffee should be your beverages. In a restaurant setting, order water for your drink. Many people order a soda or a dessert in a restaurant under peer pressure. Remember your metabolism has not changed because you are in a restaurant. Avoid beer and hard liquors as these contain a large amount of carbohydrates. On the other hand, wine in moderation, such as one drink a day, does not significantly increase blood glucose and may even help to increase HDL cholesterol (the good cholesterol). 

6. Limit your fruit intake. Contrary to common belief, fruits are not that great for diabetics. Most fruits, especially the sweet ones, are loaded with natural sugar and usually cause marked elevation in blood sugar in diabetics. Restrict the amount of fruit to one fresh fruit a day. Certain fruits are worse than the others. Avoid bananas, grapes, oranges, watermelons and mangoes. You may have a small apple, pear, pomegranate, plum, a few strawberries, blackberries, blueberries, raspberries.  Fruits are also a good source of vitamins. However, you should take a multi-vitamin on a daily basis. Dr.Zaidi has created a multivitamin, Glupride-Multi, which contains 21 different vitamins and minerals including high doses of alpha lipoic acid, chromium picolinate, selenium , zinc, coenzyme Q10  and cinnamon. We recommend you take Glupride-Multi on a daily basis. 

7. Eat more proteins. Eat egg white, lean meat, non-fried chicken, turkey, fish and legumes. Enjoy steaks and ribs. Have a Spanish egg omelettes but use egg whites only. Avoid egg yolk as it is full of LDL cholesterol (the bad cholesterol). Use cheese in small amount as it can increase your LDL cholesterol. Use regular milk. Have some plain yogurt. 

8. Eat more good fats. Diabetics are often low in HDL cholesterol (the good cholesterol). Fat phobia in the US has further worsened this problem. We need good fats. These good fats are found in olive oil, corn oil, cod liver oil, avocado, salmon, other fat fish and nuts. Eat plenty of raw nuts such as almonds, walnuts, pecans, cashews, pine-nuts, pistachios and macadamias. Nuts are also excellent source of vitamins and minerals such as vitamin E and magnesium. 

9. Plenty of vegetables. Eat plenty of vegetables as these are good source of complex carbohydrates (the good carbs). However, reduce the amounts of potatoes, sweet potatoes, corn and beets as these can cause a significant rise in blood glucose. 

10. Get involved in your food. Read labels on foods while you are in the grocery store. You'll be surprised how many food items contain sugar, fructose syrup and corn syrup. Avoid these food items. Try to prepare your meal yourself, at least over the weekend. Avoid buffets! When you opt for a buffet meal, you want to get the most for your buck (after all, you're only human), and you generally end up overeating. Try to eat at home as much as possible. Keep a diary of food you eat and observe the result it has on your blood glucose by checking your blood glucose two hours after the meal. Soon you will learn which foods to eat and which ones to avoid. You will become the best dietitian for yourself. Don't watch TV while eating. Many people overeat because they get too involved in watching a TV show or reading a newspaper and don’t keep track of their food intake. Eat slowly and drink plenty of water with your meal. Enjoy your meal. Read these recommendations on a daily basis in order to discipline your mind. Discipline of the mind is the key to any diet. 

 

Practical suggestions for meals  

Breakfast:  

Egg white omelet using 2-3 egg whites only.

 OR 2-4 hard boiled eggs  (egg whites only). 

1/2 to 1 cup of yogurt. 

A cup of coffee or tea or milk.     

 

 Lunch / dinner

A cup of coffee or tea. 

A bowl of vegetable soup. 

A plate of grilled chicken and fresh garden salad (you may add salad dressing). 

A fresh fruit such as a small apple or pear or plum or a few strawberries.   

OR 

A cup of coffee or tea. 

A bowl of vegetable soup. 

A small chicken or turkey or tuna sandwich. Discard  the top slice of bread, and make it an open sandwich. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

Grilled vegetables such as bell pepper, zucchini or eggplant Chicken or turkey strips stir fried. 

A small glass of wine. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

Steamed vegetables such as broccoli or cauliflower. 

Grilled chicken or Steak. 

A small baked potato (without butter or cream). 

A small glass of wine. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

Shrimp on a small bed of pasta. 

A small glass of wine. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

A bowl of soup  

Fish, grilled or baked, especially Salmon. 

A small glass of wine. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

6 inch turkey or chicken Subway sandwich. Discard  the top slice of bread, and make it an open sandwich. 

A diet soft drink. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

 

   Ethnic foods 

Chinese: 

A cup of won ton soup. 

Beef or chicken or shrimp, cooked any Chinese style with a small portion of steamed rice such as ½ a cup. 

Hot tea. 

A fresh fruit such as a small apple or pear or plum or a few strawberries.   

OR 

Mongolian barbeque beef or chicken. 

Hot tea. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

 

Japanese: 

2-3 sushi, avoid rice rolls. 

Stir fried beef or chicken on a small bed of steam rice such as ½ cup. 

Hot tea. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

 

Mexican: 

One chicken or beef burrito with beans. 

Very small amount of rice (no chips or nachos or guacamole). 

A cup of coffee. 

   OR 

A cup of minestrone soup.

A plate of chicken or beef fajitas. 

A cup of beans. (Do not eat tortilla, chips or nachos). 

A cup of coffee. 

A fresh fruit such as a small apple, pear, or a few strawberries. 

 

Indian/ Pakistani 

 Two pieces of Tandoori chicken. 

 A small portion of rice (about ½ of a cup). 

 About a cup of dal. 

 Hot tea (chai without sugar). 

 A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

Two Seekh Kebobs. 

1/2 naan.

A plate of vegetable such as okra, spinach or cauliflower. 

A small glass of wine. 

A fresh fruit such as a small apple or pear or plum or a few strawberries.   

OR 

One samosa.

 1/2 naan. 

A small portion of chicken or beef or lamb curry. 

Hot tea. 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

 

Mid Eastern: 

A small portion of chicken or beef kebob. 

A small portion of rice (about ½ of a cup). 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

   OR 

A small portion of chicken shawarma. 

A small portion of rice (about ½ of a cup). 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

 

Greek: 

A small plate of Greek salad. 

A small portion of Gyro meat (no cream or fries or rice). 

A fresh fruit such as a small apple or pear or plum or a few strawberries. 

 

 

Diet for a Type 1 diabetic patient. 

Type 1 diabetic patients are usually thin and relatively younger patients. Generally, they are physically active and quite often, are involved in sport activities. 

As a rule, these patients are on insulin therapy. Either they take multiple insulin injections per day or are on an insulin pump. Various types of insulin are used when multiple daily insulin injections are used.  On the other hand, only one type of insulin (either Regular insulin or Humalog) is used in an insulin pump. 

 

Diet for a young, lean Type 1 diabetic person who is on three insulin injections per day.

(NPH and Humalog before breakfast, Humalog before lunch, Humalog and NPH before dinner.) 

Remember NPH starts working in 2-3 hours, reaches a peak level in about 6-8 hours and has a duration of action of about 12-16 hours. 

On the other hand, Humalog is a rapidly acting insulin. Humalog starts working within 15-30 minutes. Therefore, it should be taken just before your meal. Humalog peaks at about 1-2 hours and duration of action is only 3-4 hours. 

Eat a balanced diet three times per day near the same time every day. Learn to count carbohydrates in a meal. Learn to read food labels in the grocery store. 

Write down what you eat in a logbook and observe the impact it has on your blood glucose. Soon you will learn which foods to eat and which ones to avoid. 

The dose of Humalog insulin is adjusted by the patient according to the type of meal, the level of blood glucose before the meal and the level of activity after the meal. A detailed sliding scale should be provided by your physician to guide you to cover the pre-meal blood glucose value. Additional units of Humalog are required to cover the amount of carbohydrates in the meal. 

As a general rule, 1 unit of Humalog will cover 10-15 grams of carbohydrates. If an increased level of activity is planned after the meal, the dose of Humalog should be decreased. 

 

Diet for a young Type 1 diabetic person who is on NPH and Regular insulin before breakfast, Regular insulin before lunch and Regular and NPH before dinner (or Regular insulin at dinner and NPH at bedtime). 

Remember NPH starts working in 2-3 hours, reaches a peak level in about 6-8 hours and has a duration of action of about 12-16 hours. 

On the other hand, Regular insulin starts working in about 1-2 hours, reaches a peak in about 3-4 hours and has a duration of action of about 6-8 hours. 

Eat three regular meals and three snacks in between meals: a mid- morning snack, a mid- afternoon snack and a bedtime snack. 

Meals and snacks should be about the same time every day.  

Write down what you eat in a logbook and observe the impact it has on your blood glucose. Soon you will learn which foods to avoid. 

The dose of Regular insulin is adjusted by the patient according the type of meal, the level of blood glucose before the meal and the level of activity after the meal. A detailed sliding scale should be provided by your physician to guide you to cover the pre-meal blood glucose value. Additional units of Regular insulin are required to cover the amount of carbohydrates in the meal.  

As a general rule, 1 unit of Regular insulin will cover 10-15 grams of carbohydrates. If an increased level of activity is planned after the meal, the dose of Regular insulin should be decreased. 

 

Diet for a young, lean Type 1 diabetic person who is on Lantus once a day and Humalog before breakfast,  lunch  and dinner.

Lantus is a long acting insulin. One injection of Lantus lasts for about 24 hours and therefore, it is given once a day, usually at night. Unlike NPH insulin, Lantus does not have any peaks. Therefore, hypoglycemia is less frequent with Lantus. 

Eat a balanced diet three times per day near the same time every day. Learn to count carbohydrates in a meal and read food labels in the grocery store. 

Write down what you eat in a logbook and observe the impact it has on your blood glucose. Soon you will learn which foods to eat and which ones to avoid. 

 

Diet for a Type 1 diabetic patient who in on an insulin pump. 

The Insulin pump gives the patient full control regarding eating. They do not have to eat at a particular time of day. They eat whenever they want to eat. 

Before each meal, a bolus of insulin (Humalog or Regular) is given to cover the pre-meal blood glucose value, plus the amount of carbohydrates in the meal. 

It is important to have a detailed sliding scale from your physician to cover the pre-meal blood glucose value. Learn how to count the carbohydrates in a meal. 

Learn to read food labels in the grocery store. 

As a general rule, 1 unit of Humalog or Regular insulin will cover 10-15 grams of carbohydrates. If an increased level of activity is planned after the meal, the dose of Humalog or Regular insulin should be decreased. 

 

 

This article was written by Sarfraz Zaidi, MD, FACE. Dr. Zaidi specializes in Diabetes, photoEndocrinology and Metabolism.

Dr. Zaidi is a former assistant Clinical Professor of Medicine at UCLA and Director of the Jamila Diabetes and Endocrine Medical Center in Thousand Oaks, California.

 

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