Index - click to read a topic
What is diabetes?
Treatment of diabetes
Diabetes, diet, and Nutrition
Diet- then exchange system
Diabetes without a weight problem
Nutritional recommendations from the ADA
Meal planning method
Diabetes Diet Analyzer
Diabetes and Hypoglycemia
Diabetes and Exercise
The importance of exercise
Types of Exercise
Review of scientific journals
The American Heritage Dictionary definition of diabetes
is "a chronic disease of pancreatic origin, marked by insulin deficiency,
excess sugar in the blood and urine, weakness, and emaciation." When
you have diabetes, your body cannot use the food that you eat in the proper
way. In a person without diabetes, when he or she eats, the food
is broken down into blood glucose or blood sugar. After the food is in
the form of glucose, the glucose is carried to all the cells of the body
for energy. In order for the cells to receive the glucose, a hormone made
in the islet or B-cells of the pancreas called insulin acts a receptor
on the cell membrane to let the glucose enter inside the cells. In contrast,
in people with diabetes, the body does not make enough of the hormone insulin,
or does not use the insulin properly. As a result, the food that is digested
and becomes glucose is not able to enter the cells and it builds up inside
the blood. Therefore, the cells are not getting any fuel and cannot survive
without energy for an extended length of time. A diagnosis of diabetes
is confirmed when an over-night fasting blood glucose level has been noted
to be 140 mg/dl or greater on more than one occasion.
Treatment of diabetes involves three things: food, exercise,
and medication. Food increases the blood sugar levels while
exercise and medication lower the blood sugar. Medication
may involve insulin or oral medications which help make use of any insulin
that is not working properly. The diet recommended for people with diabetes
is used to help control and regulate blood sugar levels and body weight.
This diet is based on the Food Guide Pyramid , and follows the same dietary
needs as those without diabetes.
The name of the diet given to the people with diabetes is called the
Exchange System. In this diet, an exchange equals one serving of
food. Like in the Pyramid, there are six different categories under which
these exchanges are grouped. Under each of the six categories, there is
a list which contains different foods that have almost the same nutritional
value. Using the exchange lists gives the diabetic a variety of food choices
and will help one monitor the amount of food one is consuming each day.
This balance of food along with exercise and medication, if it is necessary,
are what promotes a normal blood sugar level in a person who has diabetes.
See MEAL PLAN and STARCH/BREAD, FRUIT, VEGETABLE, MILK, MEAT, FAT, and
FREE FOODS LISTS from FHP Health & Wellness Library: Managing
Diabetes Through Diet (http://www.fhp.com/text/diabetes.htm).
The most important goal in the successful treatment of every person with diabetes is Nutritional therapy. The primary importance of Nutritional therapy in diabetics is to encourage blood sugar control and regulation. Nutritional therapy has five specific goals:
1. To maintain glucose levels in the blood as close to normal as possible by creating a balance between food intake and activity levels along with other treatments such as insulin or oral glucose lowering medications;
2. To accomplish optimal lipid levels in the blood;
3. To give enough calories for achieving or maintaining a normal weight for adults, normal development and growth patterns in children, and for allowing an increase in metabolism during recovery from a sickness or in times of pregnancy;
4. To prevent and control the symptoms and problems of diabetes;
5. To achieve optimal nutrition and overall health by following
the guidelines for all healthy American people.
It is very important that these five main goals are regulated by dietitians
or other trained professionals who have much knowledge of diabetes. These
professionals can help one change or manage their food and calorie intake
according to medication, exercise, illness and other stresses, such as
surrounding environments, school, work, family dynamics, and cultural patterns.
To achieve consistent management or modification of food intake is the
most complex and most difficult requirement of diabetic care. Since the
intake of food is the most challenging task, it is absolutely necessary
that every person with diabetes visit a Registered Dietitian, R.D. This
R.D. should be knowledgeable in diabetes and should help the diabetic obtain
a nutritional plan suited for his or her individual needs and provide ongoing
education of the disease and support.
Diet remains the cornerstone of treatment for all forms of diabetes.
This weight distinction must be determined and clear, for the types
of diet needed for the stable and unstable types of diabetes are different.
Usually, the unstable diabetic does not have a weight problem. Therefore,
the ideal diet for someone in this situation is like the diet the patient
consumed before their battle with diabetes: about 50% carbohydrate, 30%
fat, and 20% protein coming from well-balanced meals throughout the entire
A majority of the people who have stable diabetes are obese or overweight.
Therefore, their diets should be restrictive in caloric intake. This diet
will allow the diabetic to reach his or her ideal body weight while it
will also starve the patient a little at the beginning which will result
in a drop in circulating insulin.
There are a list of nutritional recommendations for all persons with
diabetes in the 1994 American Diabetes Association Nutritional Guidelines.
The guidelines give the recommended amount of nutrients needed in a diabetic
diet to achieve optimal nutrition and health. The ADA states that protein
should provide 10% to 20% of daily calories, saturated fat should
not exceed 10% of your calories, polyunsaturated fats should provide
less than 10% of calories, carbohydrates and mono-unsaturated
fats should divide the remaining calories of 50% to 60% depending
on the medical needs of the individual. Also, the ADA says caloric
sweeteners including sucrose or sugar are acceptable, but sugar
and foods containing sugar must be substituted for other carbohydrate food
in the meal. The substitutions should only be done when the diabetes is
under control, and it should be noted that the substitutions will lessen
the nutritional quality of the meal. The ADA strongly recommends a diabetic
person should intake 20 to 35 grams of fiber per day, sodium
or salt should not exceed 3000 mg per day, and cholesterol should
not exceed 300 mg a day. The ADA gives the same precautions about alcohol
to diabetics that apply to the general population, and they say that individuals
who use insulin to control their blood sugar should consume no more than
2 alcoholic beverages per day and always consume them with meals.
The best way to follow these ADA recommendations is to create and follow
a meal planning method which includes menu approaches,
food lists, and counting approaches. The menu approach
is a written description of what actually can be eaten. The food list
approach includes Healthy Food Choices, Exchange Lists, High Fiber/High
Carbohydrate lists and the Food Pyramid. And the counting approaches
have you count the number of calories, carbohydrates, and fats in your
daily consumption. See Exchange System above.
There are many different ways of regulating your diet for diabetic needs.
One example is the Diabetes Diet Analyzer which gives nutrient values
to your diet by knowing the amount of carbohydrates, calories, salt, and
more. See Diabetes Diet Analyzer(http://www.diabetesonline.com/dietanal.html).
Also, the Diabetes and Hypoglycemia forum on CompuServe
(CIS) has 23 topical sections for leaving messages, each with a related
library, allowing members to ask or answer questions, relate experiences,
and provide support from any place in the world, at any time of day.
The best diabetic meal plan is really a balanced nutritional meal plan,
and the USDA Pyramid is a good starting point for any diet.
This pyramid recommends using fats and sugary foods sparingly, have 2-3
servings of milk products, 2-3 servings of protein, 3-5 servings of vegetables,
2-4 servings of fruit, and 6-11 servings of carbohydrates or starches.
If you are confused about diabetic meal planning then call the American
Dietetic Association hotline at 1-800-366-1655 where you can consult
to a Registered Dietitian or find an R.D. in your area.
Exercise or by a regular exercise program is another way other
than dieting to promote the decrease in calories. It is very important
that one consult a physician before one starts an exercise program, for
the doctor can help you plan out exercises and schedules that meet your
medical and environmental needs. Also, the doctor can help create a lifestyle
for you that you will stick with and enjoy, allowing for 3 to 5 days per
week of 20 to 30 minutes of aerobic exercise.
Regular exercise improves the level of physical fitness and reduces
the risk of heart disease. Exercise also helps the efficiency of blood
circulation and allows for the loss and maintenance of body weight.
For diabetics, exercise is extremely important, for it provides additional
benefits. In the short term, exercise lowers blood sugar levels, and in
the long term, it may reduce the amount of medication a diabetic must take.
Regular exercise makes the body respond better and more rapidly to insulin,
preventing rapid changes in the sugar in the blood.
Aerobic exercise is the most beneficial form of exercise for it strengthens
the heart and lungs, lowers blood pressure, uses energy or burns calories,
lowers blood glucose levels, and increases responses to the hormone insulin.
Some examples of aerobic exercise are brisk walking, running, tennis,
bicycling, dancing, and swimming. The simplest form of exercise is walking,
which requires a good pair of tennis shoes, and it can be done either indoors
or outdoors depending on the weather.
It is very important that the diabetic patient consult with a doctor
to develop an exercise program that will meet his or her individual needs.
In order to receive the full benefits of exercise it is necessary to follow the FIT Formula:
F-Frequency of at least 3 times per week
I-Intensity of exercise must be enough to work up a sweat and increase your heart rate
T-Time of each exercise period must be at least 20 to 30 minutes
Diabetics need a balance of diet and exercise in their lives, whether
they are Type I or Type II, allowing for the improvement of blood sugar
or blood glucose control and for their general health. Doctors do not strongly
push the diet and exercise regimen more as a way of controlling diabetes
because they know the statistics on how few people can stay on the exercise
and diet plan which in fact changes their lifestyle.
See The Diabetes Sports and Exercise Book which has the latest
scientific information about the importance of exercise for everyday vitality
and diabetes control (http://www.diabetesnet.com/diabex.html).
"Oat bran concentrate bread products improve long-term control
of diabetes: A pilot study". American Dietetic Association. Journal
of the American Dietetic Association; Chicago, Dec. 1996
In this study, the long-term effects of oat bran concentrate bread
products in the diet of free-living subjects with non-insulin-dependent
diabetes by dietary, clinical and biochemical methods. The results concluded
the well-accepted oat bran concentrate bread products improved glycemic,
insulinemic and lipidemic responses.
Eight men with non-insulin-dependent diabetes with the mean age of
45 in good health and had good metabolic control were selected. Subjects
in this 6-month study lived in the community. The crossover experimental
design consisted of two periods of 12 weeks each; each subject served as
his own control. Four subjects, randomly selected, consumed oat bran concentrate
bread first; the other four ate control white bread first. After 12 weeks
each subject switched diets and immediately continued for another 12 weeks.
At the beginning of the study, each subject's dietary intake was assessed
by one 48-hour recall to evaluate his dietary pattern. From this, diet
plans were created for each individual to provide about 55% carbohydrate,
30% fat. 15% protein, and no less than eight servings per day of yeast
bread and bread products as bread exchanges.
Patients were seen every 3 weeks to make anthropometric and dietary
assessments, to discuss maintenance on the diet and measuring of body weight,
and to give the subjects their bread supplies.
The bread and bread products were palatable, high-fiber oat bran
concentrate bread, buns, and muffins and were developed in the Department
of Agricultural Food and Nutritional Science, University of Alberta, and
baked commercially using oat bran concentrate. The mean intake of bread
was six bread exchanges per day for both the white bread and oat bran concentrate
As expected, mean total dietary fiber intake increased form 19 g/day
in the white bread period to 34 g/day in the oat bran concentrate period.
In the oat bran concentrate period, glycemic response after meals improved.
Glucose maximum values were lower in the oat bran period than in the white
bread period. Insulin response area in the oat bran concentrate period
was reduced. In the study, total insulin response and peak insulin values
were lower in the oat bran concentrate period than in the white bread period.
The reduced insulin response in the oat bran concentrate period may be
because of a decrease in the rate of glucose absorption by soluble fiber
in oat bran concentrate. Also, in the study, oat bran concentrate appeared
to enhance insulin sensitivity because the glucose was disposed of more
efficiently with less insulin secretion. There was also evidence of increased
pancreatic sensitivity in the oat bran concentrate period compared with
the white bread period; maximum insulin values were reached earlier in
the oat bran concentrate period than in the white bread period.
The improvement in metabolic control obtained in the oat bran concentrate
period suggests that oat bran concentrate bread products may be desirable
in the diet of persons with diabetes. The results of this pilot study indicate
improvement in the control of diabetes when oat bran concentrate bread
products were incorporated in daily diet of persons with non-insulin-dependent
Diabetes, Diet and Nutrition http://www.health-net.com/dandn.htm
Diabetes Diet Analyzer http://www.diabetesonline.com/dietanal.html
Diabetes: Diet & Exercise
Diet and Diabetes http://www.provo.lib.ut.us/~rpyne/diabetes.html
FHP Health & Wellness Library: Managing Diabetes Through Diet
The Diabetes Sports & Exercise Book http://www.diabetesnet.com/diabex.html
Diabetes and Exercise http://www.sgh.gov.sg/gmi/exercise.htm
Diabetes and Exercise http://www.sgh.gov.sg/gml/exercise.htm
Psychology DepartmentThe Health Psychology Home Page is produced and maintained by David Schlundt, PhD.
Vanderbilt Homepage | Introduction to Vanderbilt | Admissions | Colleges & Schools | Research Centers | News & Media Information | People at Vanderbilt | Libraries | Administrative Departments | Medical
|Return to the Health Psychology Home Page|
|Send E-mail comments or questions to Dr. Schlundt|