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Diabetes – The facts and myths

What is diabetes?

Diabetes is a serious, lifelong condition where blood glucose levels become too high.

Diabetes affects up to 27% of care home residents

There are two main types of diabetes – type 1 and type 2.

With type 1 diabetes, the body doesn’t produce any insulin at all. Type 2 diabetes happens when the insulin the body makes either doesn’t work properly or not enough is produced.

What all types of diabetes have in common is that they cause people to have too much glucose (sugar) in their blood. We all need some glucose. It’s what gives us energy. We get glucose when our bodies break down the carbohydrates that we eat or drink. And that glucose is released into our blood.

We also need a hormone called insulin. It’s made by our pancreas, and it’s insulin that allows the glucose in our blood to enter our cells and fuel our bodies. 

If you don’t have diabetes, your pancreas senses when glucose has entered your bloodstream and releases the right amount of insulin, so the glucose can get into your cells. But if you have diabetes, this system doesn’t work. 

Diabetes complications

Over a long period of time, high glucose levels in your blood can seriously damage your heart, your eyes, your feet and your kidneys. These are known as the complications of diabetes.

But with the right treatment and care, people can live a healthy life. And there’s much less risk that someone will experience these complications. 

Living with diabetes is difficult. There are so many factors to consider and it can be stressful knowing what’s best.

Diet

The Eatwell Guide People with diabetes should follow a healthy balanced diet, the same advice given to the rest of the population

2 . There is no need for a special ‘diabetic’ diet and sugar doesn’t have to be avoided. The Eatwell Guide shows the different types of foods and drinks, and in what proportions, to have a healthy, balanced diet

3 . The proportions shown represent food intake over a period of time (a day or week), not necessarily each meal. The Eatwell Guide divides the foods and drinks you provide for your residents into five main groups. Try to offer a variety of different foods from each of the groups to help them get the wide range of nutrients their body needs to function properly. Diabetic Food Since July 2016, manufacturers are not allowed to label food as ‘diabetic’ or ‘suitable for diabetics’

Eating from the main food groups 

How much you need to eat and drink is based on your age, gender, how active you are and the goals you’re aiming for. But no single food contains all the essential nutrients your body needs.

That’s why a healthy diet is all about variety and choosing different foods from each of the main food groups every day.

And when we say balanced, we mean eating more of certain foods and less of others. But portion sizes have grown in recent years, as the plates and bowls we use have got bigger. And larger portions can make it more difficult for you to manage your weight. We’ve got more information for you about managing a healthy weight.

We’ve highlighted the benefits of each food group below – some help protect your heart and some affect your blood sugar levels more slowly – all really important for you to know. Get to know them and how healthy choices can help you reduce your risk of diabetes complications.

You can learn more about a healthy diet for diabetes with our Food Hacks section in Learning Zone.

What are the main food groups?

Fruit and vegetables

Having diabetes doesn’t mean you can’t have fruit. Fruit and veg are naturally low in calories and packed full of vitamins, minerals and fibre. They also add flavour and variety to every meal. 

Fresh, frozen, dried and canned – they all count. Go for a rainbow of colours to get as wide a range of vitamins and minerals as possible. Try to avoid fruit juices and smoothies as they don’t have as much fibre.

If you’re trying to limit the amount of carbs you eat, you might be tempted to avoid fruit and veg. But it’s so important to include them in your diet every day. There are lower carb options you can try.

Fruit and vegetables can help protect against strokeheart diseasehigh blood pressure and some cancers – and when you have diabetes, you’re more at risk of developing these conditions.

Benefits

  • Help to keep your digestive system working well
  • Help protect the body from heart disease, stroke and some cancers

How often?

Everyone should aim to eat at least five portions a day. A portion is roughly what fits in the palm of your hand. 

Examples of what to try

  • sliced melon or grapefruit topped with unsweetened yogurt, or a handful of berries, or fresh dates, apricots or prunes for breakfast
  • mix carrots, peas and green beans into your pasta bake
  • add an extra handful of peas to rice, spinach to lamb or onions to chicken
  • try mushrooms, cucumber, spinach, cabbage, cauliflower, broccoli, celery and lettuce for lower carb vegetable options
  • try avocados, blackberries, raspberries, strawberries, plums, peaches and watermelon for lower carb fruit options

Check out our recipes to help you eat a healthy diet for diabetes – we’ve got lots of delicious main meals packed full of vegetables, and fruity breakfast options.

Starchy foods

Starchy foods are things like potatoes, rice, pasta, bread, chapattis, naan and plantain. They all contain carbohydrate, which is broken down into glucose and used by our cells as fuel. The problem with some starchy foods is that it can raise blood glucose levels quickly, which can make it harder for you to manage your diabetes. These foods have something called a high glycaemic index (GI) – we’ve got loads more information about this.

There are some better options for starchy foods – ones that affect blood glucose levels more slowly. These are foods with a low glycaemic index (GI), like wholegrain bread, whole-wheat pasta and basmati, brown or wild rice. They also have more fibre, which helps to keep your digestive system working well. So if you’re trying to cut down on carbs, cut down on things like white bread, pasta and rice first. 

Benefits

  • The fibre helps to keep your digestive system healthy
  • Some affect your blood sugar levels more slowly
  • Wholegrains help protect your heart

How often?

Try to have some starchy foods every day.

Examples of what to try

  • two slices of multigrain toast with a bit of spread and Marmite or peanut butter
  • brown rice, pasta or noodles in risottos, salads or stir-fries
  • baked sweet potato with the skin left on – add toppings like cottage cheese or beans
  • boiled cassava, flavoured with chilli and lemon
  • chapatti made with brown or wholemeal atta.

Try our chapatti recipe – just one option for a tasty lunch.

Protein foods like beans, nuts, pulses, eggs, meat and fish

Meat and fish are high in protein, which keeps your muscles healthy. But a healthy diet means less red and processed meat – they’ve been linked to cancer and heart disease. Oily fish like mackerel, salmon and sardines have a lot of omega-3 oil, which can help protect the heart. 

Benefits

  • Helps keep your muscles healthy
  • Oily fish protects your heart

How often?

Aim to have some food from this group every day. Specifically at least 1 or 2 portions of oily fish each week. But you don’t need to eat meat every day.

Examples of what to try

  • a small handful of raw nuts and seeds as a snack or chopped with a green salad 
  • using beans and pulses in a casserole to replace some – or all – of the meat
  • eggs scrambled, poached, dry fried or boiled – the choice is yours
  • grilled fish with masala, fish pie, or make your own fishcakes
  • chicken grilled, roasted or stir-fried

We’ve got lots of healthy recipes to choose from – like our bean stew or try one of our fish dishes.

Dairy foods and alternatives

Milk, cheese and yogurt have lots of calcium and protein in – great for your bones, teeth and muscles. But some dairy foods are high in fat, particularly saturated fat, so choose lower-fat alternatives.

Check for added sugar in lower-fat versions of dairy foods, like yoghurt. It’s better to go for unsweetened yoghurt and add some berries if you want it sweeter. If you prefer a dairy alternative like soya milk, choose one that’s unsweetened and calcium-fortified.  

Benefits

  • Good for bones and teeth
  • Keeps your muscles healthy

How often?

We all need some calcium every day.

Examples of what to try

  •  a glass of milk straight, flavoured with a little cinnamon or added to porridge
  •  natural or unsweetened yogurt with fruit or on curry
  •  cottage cheese scooped on carrot sticks
  •  a bowl of breakfast cereal in the morning, with skimmed or semi-skimmed milk
  •  a cheese sandwich for lunch, packed with salad
  •  a refreshing lassi or some plain yogurt with your evening meal

Oils and spreads

We need some fat in our diet but we need less saturated fat. This is because some saturated fats can increase cholesterol in the blood, increasing the risk of heart diseases and stroke. These less healthy options are butter, palm nut oil and coconut oil.

Healthier saturated fats are foods like olive oil, vegetable oil, rapeseed oil, spreads made from these oils, and nut butters.

Benefits

  • Unsaturated fats help protect your heart

Examples of what to try

  • A drizzle of olive oil on your salad 
  • Peanut butter on your wholemeal toast 

4 . Diabetes UK have not advised the consumption of ‘diabetic’ products for years because they offer no benefit to people with diabetes.

This is because:

• These foods can be expensive

• They can also be as high in fat and calories as standard products

• They can still raise blood sugar levels

• They contradict general healthy eating advice, which is to eat foods high in sugar and/or fat less often and in small amounts

• Some diabetic foods can have a laxative effect if eaten in excess

older people and diabetes

Most areas of care in diabetes are relevant to all age groups but there are some specific changes due to growing older which might affect your diabetes.

Food choices

In some cases dietary advice for the older person with diabetes may differ from general recommendations. Older people in care homes are often more likely to be underweight than overweight and there is a high rate of undernutrition. It may not always be appropriate to reduce the fat, salt and sugar for every older person with diabetes. Poor or irregular eating can often be a cause of hypos.

Poor oral health, effects of some drugs on the digestive system, limited mobility, dexterity or vision can all cause discomfort associated with eating. Fluid intake is often lower in older people which can cause dehydration, particularly during bouts of illness. People at risk should have a nutritional assessment and individual advice from a dietitian to address areas of concern such as needing extra calories, meal supplements and replacements, weight reduction, low salt diet or manageable foods.

Nutritional assessment and diet should form part of your individual care plan if you live in a care home. Personal food preferences are important in any diet plan and older people with diabetes should be able to continue to enjoy a wide variety of foods. Staff, including catering staff in older people’s care homes, should have training so they have an understanding of the specific needs of individuals with diabetes.

Keeping active

Keeping active in later life helps to strengthen muscles, maintain mobility and balance and improves insulin sensitivity. It can help you to continue to self-care, can improve your mental well-being and prevent falls. You can aim to be as active as you are able.

Older people, including those with frailty, have been shown to benefit from light resistance and balance training. Exercise to build limb strength and flexibility for those who are housebound and confined to a bed or chair can be taught by a physiotherapist and supported by carers. Remember to check with your GP before starting any new exercise.

Hypos

Hypoglycaemia or hypo occurs at blood glucose levels of less than 4mmols/l. Older people may have added risk factors which can lead to hypo:

  • insulin or certain diabetes medication
  • chronic kidney problems
  • poor food intake
  • having other illnesses or conditions.

Many older people find their hypo warning symptoms become less obvious, and some have no symptoms at all. This may mean that the first signs noticed by a carer are:

  • inability to concentrate
  • personality change
  • morning headaches
  • sleep disturbance.

Hypos which go unnoticed can cause very unpleasant symptoms:

  • confusion
  • speech and self-care difficulties
  • poor appetite
  • aggressive behavior
  • unsteadiness and falls
  • losing consciousness
  • cognitive damage
  • heart attack or stroke.

Treatment

A hypo should be treated immediately in a conscious person with fast-acting glucose, such as a sugary (non-hot, non-milky) drink or some glucose tablets and followed up with something starchy like biscuits, a sandwich or the next meal. If someone is unconscious, call for medical help or an ambulance.

For older people in care homes a personal hypo box with hypo treatments and instructions for treatment can be kept at hand.

Prevention

To prevent hypos, it is helpful to have regular mealtimes and snacks containing carbohydrate and to be aware of hypo symptoms and what to look out for in individuals who may be at risk. Target levels for blood glucose control should not be too tight and medication must be right for the individual. This is something to discuss with the GP.

Blood glucose monitoring can help to identify older people who may be at risk of hypos but must always be looked at together with longer term blood results like HbA1c to give a clear picture.

Residential settings providing care for people with diabetes should have a diabetes policy which includes management and prevention of hypos, diabetes care plans for individuals and diabetes skills training for staff.

Catering tips

• Offer your residents regular meals, snacks and drinks throughout the day. This will help to control their appetite and blood glucose levels

• Base meals on starchy carbohydrates such as bread, rice and potatoes. Include some wholegrain varieties on your menu too such as brown rice, wholegrain bread, wholemeal pasta and leave the skins on potatoes for more fibre

• Although your residents need some fat in their diet, limit the amount of saturated fat that you offer your residents from foods like butter, cheese, processed meats, cakes and biscuits. Too much saturated fat can increase the risk of heart disease

• Help your residents eat at least 5 portions of fruit and vegetables each day. Serve them as accompaniments at each meal and offer as snacks too. Fresh, frozen, dried, juice and canned (in juice) varieties all towards 5 a day

• Have at least 2 portions of oily fish on your menu each week such as salmon, mackerel and sardines. Oily fish contains omega 3 fats which can help protect against heart disease

• Your residents don’t have to follow a sugar free diet. Sugar can be used in foods and in baking as part of a healthy diet. Offer your residents small and occasional portions of cakes, desserts and biscuits after a main meal. Look out for sugar free or no added sugar drinks

• Keep your residents hydrated, offer them at least 6-8 drinks each day. They should be available with every meal and regularly in between meals too. Water, milk, no added sugar squash, fruit juice (no more than 150ml) tea and coffee all count towards fluid intake

Myths

With lots of myths and claims surrounding diabetes, especially to do with food, it can be confusing to work out what you can and can’t eat.

Can people with diabetes eat cake?

Yes. Diabetes doesn’t mean you have to miss out on the joys of baking and cakes. Just think about portion sizes and how often you have them – to help you space out your portions, you can freeze most cakes and breads. Make sure you wrap items in foil and label them before putting into freezer bags. You could also try eating your desserts with some fruit, such as berries, to make them more filling and nutritious.

Can people with diabetes eat chocolate?

Yes. There’s no need to cut chocolate out of your diet completely if you have diabetes. You can still enjoy it as part of a healthy, balanced diet, or for special occasions. Try to eat small portions at a time because eating a lot in one go can affect your blood sugar levels. One tip is to go for 70% cocoa dark chocolate, as it’s a stronger taste and means you’re likely to eat a bit less. 

Can people with diabetes eat fruit? 

Although we know fruits and vegetables are good for us, people with diabetes are often told they can’t eat fruit because they are too sweet or contain sugar. All fruits contain natural sugar, but also contain a good mix of vitamins, minerals and fibre that we need to eat as part of a healthy, balanced diet. So yes, it’s really important people with diabetes eat fruit.

Can people with diabetes drink alcohol?

Most people with diabetes can safely drink alcohol in moderation, while eating a healthy, balanced diet and keeping active. It’s best to avoid drinking more than 14 units of alcohol a week – this is about the equivalent of six medium glasses of wine or six pints of lager. 

Can people with diabetes eat pizza?

Yes, although you should reduce your portion sizes to avoid affecting your blood sugar levels too much. You could also try making your own pizza, which is likely to be much healthier than one you’d buy as a takeaway, especially if you top it with lots of vegetables.