One serving from each group should contain 12 - 15 carbohydrate grams. (Patients can find the amount of carbohydrates in foods from labels on commercial foods and from a number of books and web sites.)

The dietitian creates a meal plan that accommodates the patient's weight and needs, as determined by the patient's record, and makes a special calculation called the carbohydrate to insulin ratio. This ratio determines the number of carbohydrate grams that a patient needs to cover the daily pre-meal insulin needs. Eventually, patients can learn to adjust their insulin doses to their meals.

Patients who choose this approach must still be aware of protein and fat content in foods. These food groups may add excessive calories and saturated fats. Patients must still follow basic healthy dietary principles.

The Glycemic Index. The glycemic index helps determine which carbohydrate-containing foods raise blood glucose levels more or less quickly after a meal. The index uses a set of numbers for specific foods that reflect greatest to least delay in producing an increase in blood sugar after a meal. The lower the index number, the better the impact on glucose levels.

There are two indices in use. One uses a scale of 1 - 100 with 100 representing a glucose tablet, which has the most rapid effect on blood sugar. [See Table: "The Glycemic Index of Some Foods," below.] The other common index uses a scale with 100 representing white bread (so some foods will be above 100).

Choosing foods with low glycemic index scores often has a significant effect on controlling the surge in blood sugar after meals. Many of these foods are also high in fiber and so have heart benefits as well. Substituting low- for high-glycemic index foods may also help with weight control.

One easy way to improve glycemic index is to simply replace starches and sugars with whole grains and legumes (dried peas, beans, and lentils). However, there are many factors that affect the glycemic index of foods, and maintaining a diet with low glycemic load is not straightforward.

No one should use the glycemic index as a complete dietary guide, since it does not provide nutritional guidelines for all foods. It is simply an indication of how the metabolism will respond to certain carbohydrates.

Low-Carbohydrate Diets. Low carb diets generally restrict the amount of carbohydrates but do not restrict protein sources. Popular low-carb diet plans include Atkins, South Beach, The Zone, and Sugar Busters.

• The Atkins diet restricts complex carbohydrates in vegetables and fruits that are known to protect against heart disease. The Atkins diet also can cause excessive calcium excretion in urine, which increases the risk for kidney stones and osteoporosis.
• Low-carb diets such as South Beach, The Zone, and Sugar Busters rely on the glycemic index. Foods on the lowest end of the index take longer to digest. Slow digestion wards off hunger pains. It also helps stabilize insulin levels. Foods high on the glycemic index include bread, white potatoes, and pasta while low-glycemic foods include whole grains, fruit, lentils, and soybeans.
• The Mediterranean Diet is a heart-healthy diet that is rich in vegetables, fruits, and whole grains as well as healthy monounsaturated fats such as olive oil. It restricts saturated fat proteins like red meat. In studies of patients with type 2 diabetes, a low-carb version of the diet (restricting carbohydrates to less than 50% of total calories) worked better than a low-fat diet in promoting weight loss, reducing A1C levels, and improving insulin sensitivity and glycemic control.

According to the American Diabetes Association (ADA), low-carb diets may help reduce weight in the short term (up to 1 year). However, because these diets tend to include more fat and protein, the ADA recommends that people on these diet plans have their blood lipids, including cholesterol and triglycerides, regularly monitored. Patients who have kidney problems need to be careful about protein consumption, as high-protein diets can worsen this condition.

Whole Grains, Nuts, and Fiber-Rich Foods

Fiber is an important component of many complex carbohydrates. It is found only in plant foods such as vegetables, fruits, whole grains, nuts, and legumes (dried beans, peanuts, and peas). Fiber cannot be digested. Instead, it passes through the intestines, drawing water with it, and is eliminated as part of feces content. The following are specific advantages from high-fiber diets (up to 50 grams a day):

• Insoluble fiber (found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and vegetable peels) may help achieve weight loss. Consuming whole grains on a regular basis appears to provide many important benefits, especially for people with type 2 diabetes. Whole grains may even lower the risk for type 2 diabetes in the first place. Of special note, nuts (such as almonds, macadamia, and walnuts) may be highly heart protective, independent of their fiber content. However, nuts are high in calories.
• Soluble fiber (found in dried beans, oat bran, barley, apples, and citrus fruits) has important benefits for the heart, particularly for achieving healthy cholesterol levels and possibly reducing blood pressure as well.
• Soluble fiber supplements, such as those that contain psyllium or glucomannan, may be beneficial. Psyllium is taken from the husk of a seed. It is found in laxatives (Metamucil), breakfast cereals (Bran Buds), and other products. Soluble fiber requires water to help dissolve, so people who increase their levels of soluble fiber should drink more water.

Fat Substitutes and Artificial Sweeteners

Replacing fats and sugars with substitutes may help some people who have trouble maintaining weight.

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Diabetes Diet Weight Control for Type 2 Diabetes

Review Date: 05/05/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)