Diet and Nutrition

Nutrition and Diabetes

10/15/2004

Question:

What are nutrition guidelines for older adults with diabetes using insulin and the oral pills

Answer:

Thanks for your question. The nutrition guidelines for older adults with diabetes using insulin and oral antidiabetic medications will vary depending on your exercise level and intensity of diabetes management.

Many older adults who require insulin in addition to oral antidiabetics may wish to count carbohydrates. Foods containing carbohydrates raise blood sugar the most. Most servings of carbohydrates (such as fruit, bread, pasta, rice or starchy vegetables like corn or peas) contain ~ 15 grams of carbohydrate. Most individuals with diabetes should consume between 3-4 servings of carbohydrate (or 45-60 grams) per meal. Smaller servings of carbohydrate containing foods (i.e. 1-2 servings) may be consumed between meals as part of a snack. The amount of carbohydrate you eat each day depends on your calorie needs. People that are very physically active will need to eat more calories and carbohydrate than those that are sedentary.

Ideally, carbohydrates that are good sources of dietary fiber should be eaten more frequently. Fiber helps slow the release of glucose (sugar) into the blood, thus providing better blood sugar control. Examples include fresh fruits and vegetables, whole grain breads and cereals and dried beans or legumes. Simple carbohydrates (those that are broken down quickly and raise blood sugar) should be limited. These include white bread, potatoes, pasta, rice, fruit juice and regular desserts and soft drinks.

With all carbohydrates, servings sizes count. The serving size for cooked pasta and rice is 1/3 cup. For most starchy vegetables (like peas, corn and dried beans), the serving size is 1/2 cup. A small sized piece of fruit contains 15 grams of carbohydrate. Milk also contains ~12 grams of carbohydrate per cup. A regular 12 oz can of soda contains 40 grams of carbohydrate (all of it table sugar).

Another suggestion for older adults with diabetes is to limit fat intake and choose healthy fats. Individuals with diabetes are at higher risk for developing cardiovascular disease. Foods high in fat such as red meat, processed meat (bologna, bratts, metts, bacon, sausage, lunch meat), whole milk dairy products (cheese, ice cream, whole milk), high fat desserts, gravy and butter should be limited in the diet. Trans or partially hydrogenated fat from margarine, fast food and most commercial snack foods and crackers should also be limited in the diet.

Healthier fats (those that come from vegetable or plant sources) should be consumed more frequently, but in moderation. These include canola, olive, peanut oil and avocado.

Meals should be regularly timed along with medications. Skipping meals or overindulging at meals will result in either hypo (low) or hyper (high) blood sugar. Meals should be equal in size, spaced between 4-6 hours apart and at about the same time each day. With most antidiabetic medications, meals should be eaten within 30-60 minutes after medication is taken or immediately after. Talk to your doctor or pharmacist about the type of insulin and medications you are using. A registered dietitian or CDE (Certified Diabetes Educator) can also be a great help in meal planning and insulin adjustment. Ask your doctor for a referral.

Finally, try to maintain a healthy body weight through regular physical activity and healthy diet. Blood sugar responds to weight loss as well as weight gain. Weight gain typically results in an increase in blood sugar due to insulin resistance by the fat cells, whereas weight loss improves insulin sensitivity and blood sugar. A weight loss of just 10 pounds can make a huge difference in blood glucose control. For more information, visit the American Diabetes Association web site at www.diabetes.org.

Related Resources:

American Diabetes Association

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Response by:

Lisa Cicciarello Andrews, MEd, RD, LD
Adjunct Faculty
University of Cincinnati