LWD - Chapter C
Food & Diabetes
C1: What can I eat?
Food choices are an important part of managing diabetes but there is no special diet for children or young adults with diabetes. The food you eat should be based on healthy choices that can be enjoyed by all your family and friends. The following information will explain why food is important in managing your diabetes. Eating fatty, sugary or processed foods can make diabetes much harder to manage.
Why is food important?
Food is important to give us energy, for thinking, walking, running, playing, and to grow properly. Food contains many vitamins and minerals that keep us healthy. It is important to eat the right amount of food for age, size and level of activity. When people are first diagnosed with diabetes, they often feel very tired, weak and may have lost some weight; starting insulin will improve energy levels and help recovery.
How do bodies use energy?
Some of the food that we eat is broken down into glucose by the body. The glucose goes into the blood stream and travels around waiting to be let into our cells where it can be used as energy. Insulin is a hormone, produced by tiny cells in your pancreas, which acts as a key that opens the cells and lets the glucose in so that it can be used as energy. Insulin also allows us to store energy in our muscles and liver.
In diabetes the tiny cells in the pancreas stop producing insulin, so the glucose in the blood cannot be used. This causes high blood glucose levels (hyperglycaemia) which can make you feel tired, thirsty and unwell. This is why insulin is needed.
Blood glucose
There are three main macronutrients or food groups:
- Carbohydrate.
- Protein.
- Fat.
Carbohydrates & Blood Glucose
Carbohydrate foods are important as they provide energy and allow us to grow. Carbohydrate foods are broken down by the body into glucose. Glucose is our brain and body’s favourite source of fuel. Glucose helps us to learn, play and be active. Carbohydrate foods will have the biggest effect on blood glucose of all the food groups.
There are two types of carbohydrate:
- Complex or starchy carbohydrate.
- Simple carbohydrate.
Complex/Starchy Carbohydrate
This type of carbohydrate is found in the following examples of food: Bread, potatoes, rice, pasta, couscous, quinoa, grains, chapatti, naan bread, plantain, maize, porridge and flour.
These types of carbohydrates cause a steady rise in blood glucose over a long period of time. The glucose in these foods is joined together in long chains, which are what causes them to be ‘complex’.
High fibre versions of complex/starchy carbohydrates are better for health and for diabetes management. Choose them where possible. Starchy carbohydrate foods are low in fat and help to fill you up. They should be included as part of every meal and snack (if you need them) and spread evenly throughout the day.
Sugary Carbohydrate
This type of carbohydrates are found in the following examples of food:
Sugar, honey, jam, fizzy drinks and cordial, energy drinks, milkshakes, fruit juice, smoothies, sweets, chocolate, sugar-coated cereals, cakes, biscuits and puddings.
The glucose in sugary carbohydrates is not linked together in chains. These foods are broken down more easily which causes blood glucose to rise quickly. They should be eaten only in small amounts and not every day.
Normal fizzy drinks, sugar, honey, jam and fruit juice should be avoided as they have a big effect on blood glucose and it is difficult for insulin to match their rapid effect. There are sugar free alternatives that can be chosen e.g. sugar-free cordial, diet/zero fizzy drinks; but as they still damage your teeth, they should always be consumed as part of a balanced diet.
Natural sugars: these are found in milk and yoghurt (lactose) and fruits (fructose). Natural sugars will affect your blood glucose and will need to be matched with insulin but the foods they are found in are healthy and should be included, as they contain other good nutrients.
Protein, fat and blood glucose:
In small amounts, protein and fat have less effect on glucose values. If eaten in large amounts, such as in takeaways, glucose levels will rise.
How does food and insulin fit together?
Blood glucose will always increase after food 30 minutes to 2 hours after eating, due to digestion and absorption. The amount of carbohydrate and fibre in foods will affect how quickly the food is broken down and therefore will affect the rise in blood glucose. It is better for you to have a small rise in blood glucose after meals, rather than a big spike.
Insulin
Insulin is needed when food is eaten. It should always be taken before food, fifteen minutes before eating. The amount needed depends on how much carbohydrate eaten and your insulin to carbohydrate ratio (I:C ratio) e.g. 1 unit per 10g carbs.
On injections, meals and most snacks will need a rapid insulin injection (bolus).
Background insulin (basal) is unrelated to food. On a pump, all meals and snacks will need a bolus of insulin.
Sometimes rapid acting insulin can be taken to correct a high blood glucose value, even without eating.
The Eatwell Guide
This is a useful guide to help you manage your diabetes and food. There is no special diet for people with diabetes. The model is based on healthy eating principles and therefore can be used for the whole family. You need a variety of foods from each of these groups to stay healthy, and give you the right balance of nutrients, vitamins, minerals and fibre that you need.
View the Eatwell Guide here.
Fruit and Vegetables
These foods are good sources of vitamins, minerals and fibre. ‘5 a day’ - It is recommended that you should aim for 5 portions of fruit and vegetables every day to give you all the vitamins and minerals your body needs. Vitamins and minerals are protective against the damage that higher blood glucose can do to blood vessels. Due to the sugar content of fruit, they should be limited to 2-3 portions per day. However, you can never have too many vegetables!
Children often prefer raw vegetables to cooked ones which are also great as a snack between meals (e.g. slices of cucumber, sliced carrot, celery sticks, sugar snap peas, chopped peppers, olives).
Meat, Fish and Alternatives
These foods give you protein, which is necessary to help the body grow and repair body tissues. Protein choices should include chicken, fish and some vegetable protein, rather than only meat
Protein foods include:
- All types of meat, poultry and fish - fresh and frozen.
- Soya, Quorn, Tofu.
- Pulses e.g. baked beans, red kidney beans, lentils, chickpeas, mung beans, butter beans, hummus.
- Eggs.
- Nuts and seeds.
Milk and alternative milk products
Milk, yoghurt, cheese, and alternative milk products are all good sources of calcium. Calcium is important for healthy bones and teeth.
Milk products such as yoghurts or milky puddings often contain sugar. Try to choose products that have no added sugar or contain a sweetener. Only soya and oat milk are recommended for children and young people as nutritionally similar to dairy milk. Choose calcium fortified varieties.
Choose reduced fat products for children over the age of two years e.g. yoghurts, semi-skimmed milk, reduced fat cheeses. Children under the age of two years should be given full fat milk as they need the energy in this to grow.
Sweets, treats and desserts
These are not essential for health although nice to have. They should be limited to a small portion and eaten after a meal, not every day. They should be seen as treats.
Vegetarian and Vegan diets
The reasons some people choose to follow a vegetarian or vegan diet are varied. When well planned, balanced and nutritionally complete, these diets can be very healthy.
Eating Out
Eating out can be enjoyed with family and friends - it is just a question of being prepared. Restaurants, particularly chains, will often have nutritional information on their websites or app. If the information is not available think about the usual size portion you would have at home and estimate it from that.
Takeaways
Take away foods generally contain a lot of fat combined with large quantities of carbohydrate. This combination may cause a spike in blood glucose for a sustained amount of time and may require an extra correction dose following the meal. Takeaway meals can be enjoyed as part of a balanced diet but should be eaten no more regularly than fortnightly.
Cultural or Religious Festivals
If you require any advice around cultural or religious holidays or festivals, your diabetes team is always there to support you and answer any questions you may have.
C2: Carbohydrate counting
Carbohydrate counting means calculating the amount of carbohydrate you are eating so that you can give the right insulin dose to help control glucose levels. The amount of insulin needed varies between different people and the diabetes team will advise how much you need.
Carbohydrate foods have the greatest effect on blood glucose. Protein foods, most vegetables and fats have less immediate effects on blood glucose and are not usually included in insulin calculations. Protein foods and vegetables are important for other nutrients and should be eaten regularly.
Carb Counting - Understanding the Basics
This films takes you through the basics of carbohydrate counting.
What foods need to be counted?
- Foods containing starchy/complex carbohydrate: Bread, potatoes, pasta, rice, chapattis, breakfast cereals, oats, noodles, bread products and things containing flour, couscous, quinoa, bulgur wheat, yams, cassava, plantain, maize, squashes, sweet potato, parsnips, pastry, crackers, pulse vegetables (baked beans, peas, chickpeas, lentils, dhal, mushy peas), *oat milk. (*sweetened versions of alternative milks will contain more carbohydrates than unsweetened versions).
- Foods containing natural sugars: (fructose and lactose): All fruits, fruit juice, fruit smoothies, dried fruit, Milk, yogurt, fromage frais, drinking yoghurt, milkshakes, custard, rice pudding
- Foods containing added sugars (sucrose): Biscuits, cakes, muffins, cookies, brownies, doughnuts, sweets, chocolate, chocolate biscuits, Ice cream, mousse, trifle, cheesecake, other desserts, sweet/chocolate cereals, all foods containing “added sugar”.
How to Count Carbohydrates
Food labels
Use the nutritional labels on a product, giving values per 100g and/or per portion. You need to use the ‘total carbohydrate’ figure NOT the ‘of which sugars’. The ‘traffic light’ labelling on the food packaging only gives the sugars value. If you are weighing food, you can use the ‘per 100g’ figure. The ‘per portion’ value is useful for quantities you can easily count e.g. per slice of bread, per biscuit, per fish finger etc.
Carbs and Cals
Use Carbs and Cals book, app or other recommended apps to estimate carbohydrate portion size. Use this book at home to weigh your portion size and compare with the same weighed portion in the book which provides the carb values in the green circle.
Carb Counting - Weighing & Measuring
This film takes you through the different ways to count the carbs in food.
Weighing foods
This is the most accurate way to count carbohydrate in foods without labels or when the portion size varies. Foods that are good to weigh include pasta, rice, potatoes (roast, mashed, chips, and jacket), couscous, noodles, quinoa, plantain, grains, breakfast cereals, porridge oats, home-made recipes and fruits.
A pair of digital scales and some maths will help you work out how many carbohydrates are in the food. Remember: the actual weight of a food measured on scales, is NOT the same as the amount of carbohydrate that food contains.
Calculate the Carbohydrate Content of Your Food using ‘per 100g’ values on labels:
The amount of carbohydrate in 100g food ÷ Your portion weighed on scales in grams = Grams of carbs in portion weighed out.
Example for Cornflakes:
(85g ÷ 100) x (My portion 45g) = 38g carbs.
Example for Rice:
(30g ÷ 100) x (My portion 230g) = 69g carbs.
C3: Snacks
A regular meal pattern of breakfast, lunch and an evening meal helps to manage glucose levels and provide enough energy and nutrition to grow well and be healthy. It is not always necessary to snack if you are eating meals regularly Healthy snacks can contribute to daily intakes of energy, protein, vitamins, minerals and fibre.
Avoid frequent snacking or “grazing” between meals as this can cause high glucose levels even when matched with insulin. Frequent snacking can also reduce appetite at mealtimes and contribute to tooth decay and becoming overweight.
How big is a snack and when?
Below is a guide to the recommended amount of carbohydrate for between meal snacks.
- Under 5 years = 5-7g carbs
- 5-11 years = 10-12g carbs
- 11+ years = 12-20g carbs
Most of the time insulin is needed with snacks. Carbohydrate containing food or drinks may be taken without insulin to manage glucose levels during activity. Taking into consideration the size of the snack, individual insulin requirements and level of activity will help to decide if insulin is needed.
Low or no carb snacks (2 to 3 g Carbohydrate or less per portion)
Low fat, low salt options:
- Carrot sticks
- Cucumber
- Celery
- Tomato, Cherry tomatoes
- Raw peppers
- Mangetout, Sugar snap peas
- Pickles - pickled onions, gherkins
- Sugar free jelly
- Ice pop
- Ice lollies made with sugar free squash
- Diet or Zero sugar drinks
- Boiled egg
- Sliced low-fat cooked meat - Turkey, chicken, beef
- Fish - Tuna, salmon, prawns
- Low fat cottage cheese
Foods which can be higher in fat and salt to eat in smaller amounts:
- Olives
- Avocado
- Guacamole
- Coleslaw
- Scrambled egg
- Omelette with cheese/ham /vegetables
- Ham, bacon
- Chicken wings, chicken drumsticks
- Continental meats: Salami, Chorizo, Parma ham
- Prepacked meat snacks – Fridge raider, Chicken Satay
- Handful of nuts or seeds - Almonds / cashew/ peanuts/ Pistachios/ walnuts/
- sunflower seeds/ pumpkin seeds
- Cheese - 30g is a good snack portion
- String cheese
- Cheese triangle
- BabyBel
- Mozzarella
- Tuna, chicken or egg mayonnaise sandwich fillers
Snacks 10g Carbohydrate or less per portion
Low fat, low salt options
- Kiwi, satsuma, plum = 5g
- Raspberries (100g) = 5g
- Blueberries (40g) = 5g
- Pomegranate (40g) = 5g
- 8 Strawberries (80g) = 5g
- Roasted chickpeas (20g) = 10g
- Edamame beans (100g) = 5g
- Reduced fat humous (1 tablespoon) = 6g
- Glass of semi skimmed milk (180ml) = 9g
- Greek style natural yogurt (100g) = 7g
- Tube Yogurt = 7g
- Small apple, pear, peach (80g) = 10g
- Melon (150g) = 10g
- Mango (70g) = 10g
- 10 Grapes (65g) = 10g
- Small box raisins (14g) = 10g
- 3 Dried Apricots (28g) = 10g
- Plain Popcorn (20g) = 10g
- 2 cream crackers = 10g
- Bread sticks (2 large) = 8g
- 2 Oat cakes = 10g
- 1 Crisp bread = 8g
- Rice cake (1 large) = 6g
- Fromage frais = 7g
- Options/ Highlights low calorie hot chocolate = 4-7g
Foods which can be higher in fat and salt to eat in smaller amounts:
- 2 Rich tea, Morning coffee, Malted milk, Nice biscuits = 10g
- 1 Digestive, oat biscuit, short bread finger = 10g
- 1 Custard cream, Bourbon biscuit, Chocolate chip cookie, ginger biscuit = 8-10g
- Ice cream 1 scoop = 8g
- Mini milk style ice lollies = 5g
- 2 Cheese Straws = 6g
- Wotsits, Quavers, Skips, Pom Bear (Multi pack small bag) = 8-10g
- 5 Cocktail sausages = 5g
- Savoury egg (2 mini) = 7g
Snacks 10 to 20g per portion
Low fat, low salt options:
- Medium apple, pear, peach = 15g
- Small Banana (100g weight with skin on) = 15g
- Pineapple (120g) = 12g
- Melon (200g) = 15g
- 20 Grapes /frozen grapes (130g) = 20g
- Plain Popcorn (30g) = 15g
- 4 cream crackers = 20g
- Bread sticks (4 large) = 20g
- 4 Oat cakes = 20g
- 2 Crisp breads = 16g
- Rice cakes (2 large) = 12g
- Glass of semi-skimmed milk (280ml) = 13g
- Fruit Yogurt 125g pot = 10-15g
- Tinned fruit/ fruit in juice (200g) = 15-20g
- Raisins / dried fruit (30g) = 20g
- Dried fruit snack e.g. Winders/Yoyo bear/supermarket own versions = 13-15g
- Toast (1 medium slice) = 15g
- Mini pitta bread = 19g
- Mini wrap = 15g
- Crumpet = 19g
- Malt loaf 30g slice / lunch box loaf = 19g
- Protein fruit yogurt 200g pot = 13g
Foods which can be higher in fat and salt to eat in smaller amounts:
- Crisps/ flavoured rice cakes/ Pop chips (Multi pack bag) = 12-15g
- Mini cheese biscuits (25g bag) = 13g
- Bombay mix (30g) = 12g
- Pretzels (25g) = 20g
- 2 Digestives, oat biscuits, short bread fingers = 20g
- 2 custard creams, bourbon biscuits, chocolate chip cookies = 16g
- 1 scotch pancake = 12g
- Croissant = 15-20g
- Banana chips (30g) = 18g
- Dried fruit and nuts/trail mix 30g portion (nuts, dried fruit, seeds, dark chocolate chips) = 10-13g
- Cereal bars e.g Fibre one, Alpen Light, Kind Nut protein bar or supermarket own brand versions. = 11-20g
C4: The Glycaemic Index (GI)
Carbohydrate containing foods are all digested by the body and release glucose into the bloodstream at different rates. This is due to different things including the amount of carbohydrate in the food, how processed a food is and the fat, fibre and protein content. Carbohydrate foods that are digested rapidly and release glucose quickly into the blood are described as high GI foods. Foods that are broken down slowly are described as having a low GI and cause a slower rise in blood glucose.
Studies have shown that diets based on low GI foods can improve blood glucose control, preventing a rapid rise in glucose levels after meals. This is helpful for reducing glucose spikes. Naturally low GI foods are good for gut and heart health. It is therefore important to include as many low GI foods in your diet as possible.
How to include low Glycaemic Index foods
Cereals
Oat based breakfast cereals (e.g. overnight oats, porridge, Oat Bran Flakes, Oatibix, homemade granola, unsweetened muesli).
Bread
Granary, mixed grain or seeded breads in preference to white, brown or wholemeal bread.
Pulses
Beans, peas, lentils and pearl barley (e.g., kidney beans, baked beans, haricot beans, chick peas, dahl, channa dahl, soya beans, and hummus). Add pulses to casseroles, stews and soups, tinned or pre soaked Baked beans on toast is a good breakfast or lunchtime meal.
Pasta, grains, potato
Wholegrain or white pasta or noodles, cold or reheated pasta, Sweet potato and boiled new potatoes, Quinoa (pronounced ‘keenwah’) can be used as an alternative to rice or couscous.
Fruit
Whole fruits, especially those with skins (apples, pears, oranges, plums, berries)
Milk and Alternative Milk Products
Diet / Greek-style/ Icelandic / high protein yoghurts for dessert or with breakfast. Full fat milk at breakfast. Full fat natural yogurt as an alternative to milk on cereal.