The Role of
Nutrition in

What is Diabetes?

Diabetes is when the body is unable to use and properly store glucose (a form of sugar), therefore, glucose builds up in the bloodstream causing one’s blood sugar to rise too high.

There are two major types of diabetes, Type 1 and Type 2. In Type 1, the body stops making insulin, a hormone produced by the pancreas that enables the body to use glucose found in foods for energy. People with Type 1 require insulin therapy for life. In Type 2, either the body does not produce enough insulin, or it is resistant to the normal action of insulin.

Uncontrolled blood sugar levels can increase your risk for heart attack and stroke, and lead to complications including kidney disease, nerve damage, hearing loss and even death.1

Uncontrolled Blood Glucose Levels Increase the Risk of Complications2,3

What is Pre-Diabetes?

Did you know an estimated 34% of U.S. adults ages 18 and older have pre-diabetes? Pre-diabetes (also referred to as impaired fasting glucose) is when blood sugar levels are higher than normal, but are not high enough to be characterized as diabetes.

To diagnose pre-diabetes, healthcare professionals may perform either the 75 g oral glucose tolerance test or fasting plasma glucose (FPG) test, or measure your % hemoglobin A1C. Those who have two consecutive FPGs in the range of 100-125 mg/dL, are diagnosed with pre-diabetes. People with pre-diabetes are at an increased risk of developing type 2 diabetes later in life, unless they make some lifestyle changes.2,4

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Nutrition and Diabetes

Nutrition plays a significant role in the overall management of diabetes. It is possible to take good care of yourself and help manage your diabetes if you understand what to eat, how much to eat, and when to eat.

Choosing nutrient rich foods in appropriate portion sizes and healthy sources of carbohydrates can help keep your blood sugar levels in your target range. Frequent self-monitoring of blood glucose can be used (with proper instruction) to keep track of the effects of meals and activity levels on blood sugar levels.

It is important to work with your healthcare team to make adjustments to food intake, physical activity, and medication (if needed) to keep blood sugar as close to normal as possible.4

Carb counting is key!

Carbohydrates turn into glucose in the body and therefore affect blood sugar levels more than fat or protein containing foods. This does not mean that you have to give up all carb-containing foods; however, monitoring your total carbohydrate intake is essential. Choose carbs that come from nutrient-dense sources like fruit, vegetables, dairy, legumes and whole grains, along with controlled portion sizes. Carbohydrate counting is a useful strategy for managing diabetes. One “Carb Choice” is equivalent to 15 grams of carbohydrates. Eating 5 – 6 small meals per day with a specific amount of Carb Choices is often recommended.

To determine the optimal amount of Carb Choices needed in your diet, consider working with a Registered Dietitian Nutritionist (RDN).5


There are two main types of sugars in the diet: naturally occurring and added sugars. Naturally occurring sugars are inherent in foods and include fructose (found in fruit) and lactose (found in milk). Added sugars include any sugars or caloric sweeteners that are added to foods or beverages during processing or preparation of food. Some examples of added sugars are table sugar, brown sugar, honey, or high fructose corn syrup. Limiting added sugars and instead focusing on carbohydrates from vegetables, legumes, whole grains, fruit, and dairy products is a smart choice for blood sugar management.2,6

Oncology protein recommendation

Protein is an essential part of meal planning for people with diabetes, but did you know experts recommend increased protein intake for older adults? A healthy 65 year old woman weighing 150 pounds would need about 75 grams of protein per day.

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Protein is an essential nutrient that is needed in the diet every single day, and unlike carbohydrates and fats, protein cannot be stored in the body. In the nutritional management of diabetes, protein appears to increase insulin response without increasing blood glucose concentrations. It also helps to reduce hunger and improve satiety. Protein is found in various food sources that are either animal- or plant-based. Some examples of animal sources of protein are chicken, beef, eggs and milk, while legumes, soy, whole grains like quinoa, and nuts are plant sources. When incorporating protein into a diabetes meal plan, look for protein sources that supply unsaturated fats like low-fat dairy, lean meats, poultry, legumes, fish and eggs.7-10


When incorporating fat into a diabetes meal plan, you should focus on foods that supply “healthy fats” while limiting “unhealthy fats” such as trans and saturated fats. Choose from mono and polyunsaturated fats, and omega-3 fats.

Examples of healthy fat food sources include avocado, oils (olive and flaxseed), olives, nuts (almonds, cashews, pecans, peanuts, walnuts), seeds (pumpkin, sunflower, flaxseed) and fatty fish such as salmon and albacore tuna.11


People with diabetes should monitor their sodium intake, since they are more likely to have high blood pressure. Some examples of high-sodium foods include canned soups, canned vegetables, cold cuts, pizza, savory snacks, salted nuts, cereals, and some condiments such as soy sauce, ketchup, mustard and pickles. One teaspoon of salt contains 2,300 mg of sodium. Sodium intake should be less than 2,300 mg per day, especially for those with high blood pressure. Check nutrition labels as sodium is found in a vast majority of the foods we eat every day even if we never pick up the salt shaker.12-14


Women with Type 1 or Type 2 diabetes should consume no more than 1 drink a day and men should consume no more than 2 drinks a day. Alcohol should be consumed with a meal or snack that includes carbohydrates, since alcohol alone can put someone at risk for low blood sugar. Other beverages can also affect blood sugar levels. Avoid sugary drinks like regular soda, fruit punch, fruit drinks, energy drinks, and sweet tea. Instead, choose from water, unsweetened teas, plain coffee, low-fat or fat-free milk, or juice (4 ounces or less), and aim for 8 cups per day of non-caloric beverages.4-15

  1. Joslin Diabetes Center. General Diabetes Facts and Information. 2017.
  2. CDC. National Diabetes Statistics Report. 2017.
  3. Mayo Foundation for Medical Education and Research (MFMER). Mayo Clinic, Diseases and Conditions, Diabetes Symptoms & Causes.
  4. American Diabetes Association. Standards of Medical Care in Diabetes 2019. Diabetes Care 2019;42(S1):S1-S193.
  5. National Institute of Diabetes and Digestive and Kidney Diseases. Carbohydrate Counting. 2017.
  6. American Heart Association. Sugar 101. 2017.
  7. Hamdy O, Horton ES. Curr Diab Rep. 2011;11(2): 111-9.
  8. Richter CK, et al. Adv Nutr 2015;6(6): 712-28.
  9. Campbell AP, Rains TM. J Nutr. 2015;145:164S-9S.
  10. American Diabetes Association. Healthy Food Choices Made Easy - Protein. 2019.
  11. American Diabetes Association. Healthy Food Choices Made Easy – Fats. 2019.
  12. Franz MJ, et al. JAND. 2017;117(10): 1659-1679.
  13. Joslin Diabetes Center. Steps for Staying Healthy: Blood Pressure. 2017.
  14. USDHHS and USDA. 2015-2020 Dietary Guidelines for Americans. 8th edition. December 2015. Available at:
  15. Evert AB, et al. Diabetes Care. 2019;42:731-754.

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