Diabetes and Nutrition

Nutrition has always played a central role in the treatment of diabetes. Before the discovery of insulin, people with type 1 diabetes could be kept alive for a few months by severely restricting carbohydrate intake and eating mostly fats and pro­tein (a ketogenic diet). After the discovery of insulin in 1921, patients were able to eat more carbohydrates. However, the lack of home glucose monitoring and fast-acting insulins meant that there still were significant dietary restrictions. People with diabetes had to restrict carbohydrates and spread them throughout the day by eating three meals and three snacks. With the use of the new insulins analogs and blood glucose monitoring systems, the dietary restrictions are much less of a prob­lem, but there are still some limitations.

S ome general points about diet in diabetes:

• There is no such thing as a diabetic diet. In fact, the diet for most people with diabetes is the same as the diet for people without diabetes. If you have diabetes, you do not have to buy foods specifically marketed to people
with diabetes (for example, cookies, jams, and candy for people with diabetes, labeled as sugar-free)

• Obesity increases insulin resistance and insulin requirements, and so weight loss can significantly improve glucose control in people with type 2 diabetes. Weigh-loss strategies are generally the same as those for people without diabetes.

• Complications of diabetes such as gastroparesis , renal disease, and heart disease may require some additional dietary modifications.