The current nutritional recommendations for patients with diabetes are as follows:
- sufficient to maintain or achieve ideal weight. Modest weight loss can result in a fall in insulin resistance, raised hepatic gluconeogenesis and blood pressure and a more favourable lipoprotein profile.
- should provide about 50% of total daily energy intake. It is accepted that although the diabetic diet should be high in complex carbohydrate with a low glycaemic index there is no need to impose a complete restriction on simple sugars in diabetics who are not overweight.
- provide 30-35% of total daily energy intake.
- saturated fatty acids should provide less than 10% of total daily energy intake.
- monounsaturated fatty acids should provide less than 10-15% of total daily energy intake.
- polyunsaturated fatty acids should provide no more than 10% of total daily energy intake.
- should provide 10 to 15% of total daily energy intake.
- protein intake should be higher in children, the elderly and pregnant and lactating women and lower in patients with microalbuminaemia.
- should be excluded from the diet of diabetics who are overweight or who have hypertension or hypertriglyceridaemia.
These recommendations are designed to provide all essential nutrients whilst minimising obesity, hyperinsulinaemia, hypertension and dyslipoproteinaemia. They are general guidelines and there are additional considerations in patients with type 2 diabetes and patients using insulin pumps or 'pen' injectors (intensified insulin therapy).
NICE state regarding type 1 diabetes (1)
- offer carbohydrate-counting training to adults with type 1 diabetes as part of structured education programmes for self-management
- consider carbohydrate-counting courses for adults with type 1 diabetes who are waiting for a more detailed structured education programme or are unable to take part in a stand-alone structured education programme
Glycaemic index diets
- do not advise adults with type 1 diabetes to follow a low glycaemic index diet for blood glucose control