EATING PLAN FOR TYPE 2 DIABETES

Thiseatingplanislowinrefinedgrainsandsugar,lowinsaturatedandtransfatandhighinfibre.Itfocusesoneatingregularlytimedmealsandselectinglowglycemicindexfoods.

Type 2 Diabetes affects how your body uses and stores glucose. Glucose comes from digestion of sugars and starches in the foods we eat. Our body produces a hormone called insulin that it uses to remove glucose from our blood. In Type 2 diabetes our body may not be making enough insulin or our body is not properly responding to the insulin it is making. Glucose levels in our blood rise and can cause both short term and long-term effects on our body.

• Symptoms include: unusual thirst, frequent need to urinate, weight change, lack of energy, blurred vision, frequent infections, cuts and bruises that are slow to heal, tingling in the hands and feet.

• Risk factors include: being overweight, a parent or sibling with diabetes, having diabetes while pregnant (gestational diabetes), impaired glucose tolerance or impaired fasting glucose, high blood pressure, high cholesterol, polycystic ovary syndrome, being of Aboriginal, Hispanic, Asian, South Asian or African descent.

Did You Know? Morethan3 million Canadians have diabetesandmorethan90% of these have Type 2 Diabetes.

Tips to Help Keep Your Blood Sugar levels in a Healthy Range1. Eatthreebalancedmealsperday,nomorethansixhoursapart.

Limitaddedsugarsandsweets.2. Eatacombinedtotalofatleast7servingsofvegetablesandfruit

eachday.3. Eatyourfruitratherthandrinkingitasjuice.4. Includesmallportionsofwhole-grainstarchyfoodsateachmeal.5. Eatlowerglycemicindexfoods.See ‘Go Low GI’.6. Drinkwaterinsteadofregularpopandfruitdrinks.Tea,coffeeandlow

caloriejuicesandbeveragesaregreattoo.7. Includeleanproteinchoicesateachofyourmeals.8. Makelowerfatchoices,avoidfryingyourfoodsandlimitaddonfats

suchasbutter,margarineandoil.9. Moveyourbodyforatleast30minuteseveryday–walkingisgreat!10. Ifyouareoverweight,trytolose5to10%ofyourpresentweight.

Blood Glucose Target Ranges Fasting: 4.0 -7.0 (empty stomach or no food for at least 3 hours)Postprandial: 5.0-10.0 (2 hours after a meal)

Type 2 Diabetes FACTS – Focus on Carboyhdrate, Fibre and Glycemic Index• Overtime,highbloodsugarcausesdamagetoyourbloodvesselsandcanresultinblindness,heartdisease,kidney

problems,circulationproblems,nervedamageanderectiledysfunction.• Bychoosingappropriateportionsofcarboydratecontainingfoodsandselectingonesthathavemorefibreandalower

glycemicindex,youhelpimproveyoubloodglucosecontrol.

Go Low GI – Foods and Their Glycemic IndexGlycemicindexisascale(0-100)rankinghowquicklyacarbohydratecontainingfoodwilldigestintoglucoseinourblood.HighGIfoodsbreakdownquicklywhereaslowGIfoodsbreakdownslowly.WithlowGIfoodsyoufeelfulllongerandyoubody’sinsulinhasmoretimetoperformitsjobandremoveglucosefromtheblood.

Hint: HintlowGIfoodsaregenerally‘closetothefarm.’

LOW GI FOODS (55 OR LESS) CHOOSEMOSTOFTEN

MEDIUM GI FOODS (56-69) HIGH GI FOODS (70+) CHOOSELESSOFTEN

Whole grain bread Couscous White bread

Pumpernickle bread Rye bread Instant mashed potatoes

Oatmeal Instant Oatmeal Corn Flakes, Rice Krispies

All-Bran cereal Shredded Wheat Refined, sweetened cereals

Converted rice Cream of Wheat Instant rice

Brown & Basmati rice Whole grain crackers Bagels

Bulgur, Barley, Quinoa Pita bread Waffles/pancakes – made with white flour

Firm cooked pasta Long grain white rice Soda crackers

Beans, peas, lentils Apricot, banana French fries

Apples, peaches, pears Cantaloupe Dried dates/figs

Grapefruit, oranges Pineapple, raisins Sweetened fruit juice

Berries, cherries, grapes Canned fruit in juice Parsnips, pumpkin

Kiwi, Mango, Plum Cranberry juice Rutabaga, turnip

Avocado New potatoes Broad beans

Sweet Potato Beets Refried beans

Carrots, broccoli Sweetened condensed milk Ice cream

Cauliflower, corn Soft drinks

Leafy vegetables Glucose

Low fat milk, soymilk, yogurt and cottage cheese

Tips for using the Glycemic Index• Thinklowandslow-choosefromthelowandmediumGIfoodsmostoften.• Balanceyourchoiceswithleanproteinchoicesandhealthyfats.Proteinandfatalsoslowthedigestion,keepyoufeeling

fullandslowthereleaseofglucoseintoyourblood.• Moredetailscanbefoundonlineatwww.gidiet.comorwww.diabetes.ca/files/glycemicindex_08.pdf

Did you know?TheGlycemicIndexdietwasdevelopedbyDavidJenkins,aprofessorofnutritionandreasearcherattheUniversityofToronto.

*Adaptedfrom“TheGIDiet”RickGallop

See it to Believe it!1 tsp = 5 grams sugar

Balancing Carbohydrates (‘Carbs’)Alongwiththeglycemicindexapproach,itisimportanttounderstandandcontroltheamountofcarbohydratesyoueatanddrinktobettermanageyourbloodglucose.

Herearesometips:1. Carbohydrateisthenutritiontermusedforstarch,sugarandfibre.2. Spacingyourcarbohydratesoverthedayhelpsyourbodytokeepastableglucoselevel.3. Starchchoicesthatarehigherinfibrecontributelesstoraisingyourbloodglucose.UsetheNutritionFactspaneltochoose

cereal,bread,crackers,riceandothergrainorstarchchoicesthathaveatleast2gramsoffibreperserving.4. Breakfastshouldbe1/3starchorgrain,1/3fruitand1/3protein.5. Lunchandsuppershouldbe1/2vegetables,1/4starchand1/4protein.6. Snackchoicescanhelppreventdipsinbloodglucosethatcanoccurifyourmealsaremorethan4hoursapartorifyouare

veryactive.7. Choosesnackswithabout20gramsofcarbohydrate.Fruit,vegetables,highfibregranolabars,wholegraincrackerswith

cheeseorpeanutbutterarejustafewoptions.

Sugar and Refined Starches • Tablesugar,brownsugar,honey,maplesyrupandmolasses

areallsimplesugarsandtheyallhave5gramsofcarbohydratesor“carbs”inateaspoon.

• Simplesugarssuchastheseand‘white’orrefinedstarchesbreakdownquicklyandcausebloodglucosetorisequickly.

• Aquickriseinbloodglucosecanoftenbefollowedbyanequallyquickdrop.• Thiscanleadtocravingsformoresugaryfoodsandfeelingsofhungerandfatigue.• Aimtochoosepackagedfoodswithlessthan10gramsofsugarperserving• Avoidaddingsugar,reducetheamountorsubstituteanon-sugarsweetenerforbakingsuchasSplenda(sucralose)

The Canadian Diabetes Association has an excellent summary sheet on sugars and sweetners. Finditonlineatwww.diabetes.ca/files/en_sweeteners_final.pdforcall1-800-BANTINGtorequestacopy.

Did you know?Astandardcanofregularpopcontainstheequivalentof10tspofsugaranda2Lbottleofpophas1½cupsofsugar!Wateristhebestbeverageforquenchingyourthirst.

Decoding Food LabelsTheNutritionFactstablefoundonthesideofpackagedfoodcanhelpyoumakebetterfoodchoices.Alwayschecktheservingsizefirstandconsiderthisinrelationtohowmuchofthefoodyouusuallyeat.

Lookforchoiceswithlessfat,saturatedfat,cholesterolandsodium.Lookforchoicesthatgiveyoumorefibre.Learn more about using food labels to make healthy choices on the web:Health Canada –www.hc-sc.gc.ca/fn-an/label-etiquet/nutrition/cons/index-eng.phpHealthy Eating Is In Store for You –www.healthyeatingisinstore.ca

Did you know?Fibreisacarbohydratethatdoesnotraisebloodsugar.UsingtheNutritionFacts,youcansubtractthegramsofFibrefromthegramsofCarbohydrate.Onlycounttheremainingcarbohydratetowardyourmealplan.

How Many carbs are right for me?• Carbsareoneoftheenergynutrients.Weallhavediferentenergyneedsbasedonouractivities,age,gender,goals

tomaintainorloseweightjusttonameafew.• Ingeneral,mostadultsneed45to60gramsofcarbohydratespermeal.• Usingfoodlabelswillhelpyoutochoosefoodstoprovideaboutthisamountofcarbohydratepermeal.• Toplanyourmealyoushouldknowthatineachofthefollowingfoodsthereareabout15gramsofcarbs:

– 1sliceofbread(thesizeofaCDcase)– ½cupofcereal– 1pieceoffruit(thesizeofatennisball)– 1cupoflowfatmilk

• Vegetablesareverylowincarbsandareoftenconsidered‘free’–loadup!

Exchangelistsindicatingtheportionsoffoodtoprovide15gramsofcarbohydrateareavailable.Askaregistereddietitianformoredetails.

Ifyouareusinginsulintocontrolyourbloodsugars,youmaywanttolearnmoreaboutbalancingyourcarbohydrateswithanapproachcalledCarbohydrateCounting.Asktospeakwitharegistereddietitian.

Fibre• Whenreadingfoodlabelslookforfoodshigherinfibre.• Breadchoicesshouldhaveatleast2gramsperslice.Cerealchoicesshouldbe4gramsormoreperserving.• Granduallyincreaseyourfibreintakeandaimfor30gramseachday.• Fibreisacarbthatdoesnotdigest.WhenreadingtheNutritionFactstable,subtractthefibregramsfromthetotal

gramsofcarbstodeterminethecarbsthatcontributetoyourmeal.

To Reduce WeightIfyouareoverweightagradualreductionof5-10%ofyourinitialweightcaninprovebloodglucosecontrol.Suggestionsinclude:• Eatsmallerportionsoffoodsandrememberthebalanceoffoodsonyourplate:1/4protein,1/4starch(including

potatoes),1/2vegetablesforlunchandsupper• Eat3mealsperday,nomorethan6hoursapart.Don’tskipmeals.Snackwithfruitbetweenmeals.• Choosefoodslowerinfatandsugar.Eatingstrategiesincludinglowglycemicindexchoicescanbehelpful.Learn

morefromaregistereddietitian.• Aimforamaximumweightlossof1-2lbs(0.5-1kg)perweek.

“Waist loss” is as important as weight loss. For tips on how to trim your waist see our ‘Waisting Away – Healthy Weight Management’ nutrition fact sheet. Staying Healthy with DiabetesBeingoverweightorobesemakesyourbodymoreinsulinresistant.Thismakescontrollingbloodsugarsmorechallenging.Excessweightanddiabetesarebothrisksfactorsforheartdisease.

FormoredetailsonWeightManagement,CholesterolorHypertensionsee:Eating Plan for Hypertension,Eating Plan for High CholesterolandWaisting Away - Healthy Weight Management.AllareavailablefromtheOttawaCardiovascularCentrewebsite.Gotowww.ottawacvcentre.com.

Protein

Fruit

Protein

Vegetables

StarchStarch

Breakfast Lunch & SupperPortions to Live By • Oneservingofwholegrainsis1/2cupcooked,notthe

3ormorecupsservedinmostrestaurants!Toomuchofagoodthingisnotagoodthing.

• FormoredetailsonhealthyportionsseeEating Well with Canada’s Food Guideonlineatwww.healthcanada.gc.ca/foodguide.

FOODS TO CHOOSE FOODS TO LIMIT OR AVOID

Whole Grains• Wholeandmultigrainbreads,wholewheatpasta,

brownrice• Low-fatandmultigraincrackers• Low-sugar,whole-graincereals• Oatmeal,bran,bulgur,buckwheat• Low-fat,wholegrainbakedgoodswithaddedbran

oroatbran

• Whitebreads,croissants,sweetrolls,high-fatwhitecrackers,waffles

• Short-grainandminuterice– whiterice• Sweetenedrefinedcereals• Commercialmuffins,cakes,doughnuts,Danish

pastries,high-fatcookies• Avoid“white”foods(whiteflour,whitesugar)

Milk and Alternatives• Dairyproductswithlessthan1%fat• Cheeseshouldbe10-20%MF

• Milkproductshigherthan1%fat• Cheesehigherthan21%MFandcreams

Type 2 Diabetes Eating PlanChoose Low Glycemic Index Foods Whenever Possible!

Vegetables and Fruit – with lots of colour• Darkgreenleafyvegetables• Eatanabundancefresh/frozenvegetables• Unsweetened,fresh,frozenorcannedfruits

• Parsnip,pumpkin,whitepotatoes(highGI)• Driedfruitsandfruitsinheavysyrup• Sweetenedfruitjuices

Meat and Alternatives• Fish(cannedinwater,fresh,frozen),seafood• Skinlesschickenandturkey• Leanmeatswithfattrimmed,wildgame• Leancoldcuts(butwatchthesaltcontent)• Legumes,tofu• Eggs(uptoeightperweek)

• Fishwithbutterorbreading• Friedchicken,poultrywithskin,wings• Fattymarbledmeats,ribs,regulargroundmeats,

organmeats• Highfatprocessedandcannedmeats:bacon,

sausages,patés,bologna,salami,wieners

Meat and Alternatives• Olive,canola,soybean,sesame,sunfloweroils(3tsp• orlessperday)• Non-hydrogenatedsoftmargarinesLow-calorie

dressingsandmayonnaise• Lightpeanutbutter,nuts(watchsaltandcalories)• Unsaltedseeds:flax,pumpkin,sunflower• Defattedgravyandlow-sugarcondiments• Cocoapowderorasmallpieceofdarkchocolate

• Hydrogenatedoils,coconutandpalmoils• Shortening,butter,lard,hardmargarines• Peanutbutterwithpalmorhydrogenatedfat• Nomorethan1/4cupnutsperday(highcalories)• Heavygravy,creamsauces,high-sugarcondiments• Chocolateandcarob

Sweets (in very small amounts)• Sugarsubstitutesandartificialsweeteners,lowsugar

jams/jellies/syrups• Sugar-freecandies,gelatins,gum• Low-sugarandhighfiberbakedgoods• Low-fatandlow-sugarfrozendessert

• Sugarandregularjams,jellies,syrups,candies,gelatins,gum,honey

• Regularcakes,pies,cookies• No“white”foods(whiteflour,whitesugar)• Regularfrozendesserts

Snack Foods• Popcornwithoutsalt,butter,orhydrogenatedoils• Chooselowfat,lowsugarsnackfoods

• Regularpopcorn,chips,pretzels,cheesies,cornchips

Eating Plan for Type 2 Diabetes, December 2010DanielleAldous,BSc,RD(FromOriginal2006HeleneCharlebois,BsC,RD&JasnaRobinson,DI)©ContinuingMedicalImplementation®Inc.

Ottawa Cardiovascular Centre502-1355BankStreetOttawa,ONK1H8K7Phone: (613)738-1584Email: admin@ottawacvcentre.com

Other Nutrition Fact Sheets Available: EatingPlanforHypertensionEatingPlanforHighCholesterolEatingPlanforHeartFailureHealthyWeightManagementPotassiumModifiedEatingPlanPlease visit www.cvtoolbox.com for more information

Alcohol• Limitalcoholtolessthan2drinksperday(1drink=12ozbeeror1.5ozliquoror4ozwine)• Alcoholisnotrecommendedifyou:

– havehightriglycerides(typeofbloodfat)– haveliverproblems– arepregnantorbreastfeeding

• Ifyouchoosetodrinkalcohol,remember:– Todrinkwithyourmealorsnack(notonanemptystomach)– Todrinkslowlyordilutewithwaterordietsoda– Thatliqueurs,sweetwinesanddessertwineshavemoresugar– TowearyourMedicAlertindicatingthatyouhavediabetes–alcoholcancausealowbloodsugarreactionwhich,ifleftuntreated,mayrequiremedicalattention

SupplementsCheck with your Doctor, Dietitian or Pharmacist before starting a supplement. • Heart Healthy Mixture =1/3groundflax,1/3oatbranand1/3psyllium.Use2Tablespoonsperdayaddedtofoods

orbeverages.Thefibreinthisblendisgoodforbothyourheartandbloodglucosecontrol.• For high triglycerides (atypeoffatinthebloodmorecommonlyhighwithdiabetes):

Omega 3 supplements –adding2000to4000mgofEPA+DHAfromfishoil.Thisshouldbedoneunderthesupervisionofyourdoctor.

Move your body, burn the glucose• Aimtobeactivefor30minutesatleast5daysperweek(150minutes/wk).Startwithbriskwalkingfor10minutes

afewtimesperdayandincreasegraduallyfromthere.Besuretohaveyourdoctorsapprovalbeforeengaginginanexerciseprogram.

• Strengthexercisescanbeincluded2-4timesperweektokeepthebonesstrongandbuildleanmuscle.• Aleanerbodyisbetterabletousetheinsulinitproducestomanagebloodglucose.• Measureyourbloodsugarbeforeandafterexercise.Typicallyyourreadingsafterexercisewillbelower.• Bepreparedincaseyourbloodsugardropstoolowduringorafterexercise.Treatmentsarelistedbelow.• Ifyoutakemedicationsthathaveariskofcausinglowbloodsugaritisbesttoexercisewithsomeoneandtakeacellphone

withyouforemergencies.Letsomeoneknowwhereyouwillbeandapproximatelywhenyouwillreturn.TakeemergencyglucosewithyouandwearyourMedicAlert.

Keeping active can lower your blood sugar, lower your blood pressure, help you lose weight, help you feel better reduce the amount of medication you need, relieve tension or stress, improve your heart and lung function and improve your muscle tone! Look at all those benefits!

Recognize and be ready to treat low blood glucoseUsuallyweareconcernedaboutbloodglucosebeingtoohighbutcertainmedications*,exercise,amissedmealoranillnesscancauseyoutoexperiencealowbloodsugar.• Whatislow?Abloodglucosebelow4.0• Symptoms:shakiness,fatigue,excessivehunger,headache,blurredvisionordizziness,coldclammyorsweatyskin,pale

colourinface,weakness.• Treatment:

– Take15gramsoffastactingcarbohydratesuchasglucosetabs,3packetsofsugardissolvedinwater,¾cfruitjuiceorregularpop,6LifeSavercandiesor1tablespoonofhoney.Wait15minutes.Ifsymptomsdonotresolvetreatagain.

– Ifsymptomsresolvebutthenextmealismorethananhouraway,haveasnackwith15to20gramsofcarbohydrateandsomeproteinsuchas½asandwichorcheeseandcrackers.

* Medications more likely to cause a low blood sugar include Amaryl, Diabeta, Diamicron, Gluconorm and Insulin.