Diabetes: Diet and lifestyle
More than 4.9 million people in the UK have diabetes. And according to Diabetes UK, it’s likely that 5.5 million people will be affected by 2030 (i).
Of the 4.9 million around 90 per cent have type 2 diabetes, which is when your pancreas doesn’t make enough insulin or when the insulin it does make doesn’t work properly. Approximately eight per cent have type 1 diabetes, which means they don’t make any insulin at all (about two per cent have rare types of diabetes).
The problem is we all need the right amount of insulin to live, as it allows the sugar (glucose) in our blood to be used by our cells to keep our bodies working. This lack of insulin (partial or total) leads to higher and higher blood sugar levels, which in turn can create any number of potential complications including problems with your heart, eyes, feet and kidneys.
There is, however, a major connection between diabetes and diet and lifestyle. In fact, research suggests that for some people, lifestyle factors such as having a healthy diet, being physically active and losing weight if you need to may reduce your risk of type 2 diabetes by about 50 per cent (i). Making lifestyle changes such as eating healthily and exercising can make a difference to how you feel if you have type 1 diabetes too (ii).
According to the National Institute of Health and Care Excellence (NICE), your doctor or nurse should give you information about a healthy lifestyle and what you can do to help keep your diabetes under control (iii). Meanwhile, read on to find out some of the things they may tell you about.
Who is most at risk of diabetes?
Diabetes UK estimates that around 13.6 million people are currently at an increased risk of type 2 diabetes in the UK (i). Some of us, however, are more likely to develop diabetes than others. Here are the main risk factors you should be aware of:
Age (generally speaking the older you get, the higher your risk)
Family history of type 2 diabetes
History of heart attack or stroke
History of gestational diabetes during pregnancy
Diagnosis of impaired glucose tolerance or impaired fasting glycaemia
Meanwhile the risk factors for type 1 diabetes aren’t exactly the same, though having a parent or a sibling with the condition does mean you’re more likely to develop it too. Other risk factors for type 1 diabetes include where you live, since you’re more likely to develop the condition the further you live from the equator; and your age, with children aged between four and seven years old, and between 10 and 14 years old being noticeably more susceptible to type 1 diabetes than others (though you can develop type 1 diabetes at any age).
To find out more about diabetes, including the symptoms to look out for and what causes it, take a look at our guide to diabetes causes and treatment.
Diabetes and your diet
Whether you have type 1 or type 2 diabetes, when you’re first diagnosed you may feel overwhelmed by all the new things you have to do every day to stay healthy. But when it comes to your diet, things are probably more simple and straightforward than you might think.
First of all there’s no such thing as a diabetes diet, since no two people with diabetes are the same. And while in the past people diagnosed with type 2 diabetes were often told to cut out certain foods, these days it’s simply all about eating a healthy balanced diet.
Healthier food choices don’t just help you manage your diabetes, they can help reduce your risk of heart problems, strokes and other health conditions too. Eating healthily means having a variety of foods, including some from each of the following main food groups every day:
Fruit and vegetables (aim for at least five portions a day)
Starchy foods (have some foods such as potatoes, rice, pasta and bread every day, preferably brown or wholegrain varieties and potatoes with the skins left on)
Protein foods (have some protein foods – such as meat, fish, eggs, pulses, beans and nuts – every day, and one or two portions of oily fish a week)
Dairy foods (have some dairy foods, such as cheese, milk and yoghurt every day, preferably lower-fat varieties)
Meanwhile try to limit foods that are high in fat and sugar, plus be aware of how much salt you’re eating (try to eat no more than 6g of salt a day – check the labels on any processed foods you eat, as they can contain high amounts).
Also try to keep your portion sizes on the smaller side, especially if you’re carrying too much weight (try using smaller plates if you struggle to serve up small portions). In fact losing weight can help you to manage your blood sugar as well as reduce your risk of diabetes complications such as heart disease and stroke. Losing weight may also improve your mood, give you more energy and help you sleep better.
However if you have diabetes and are trying to lose weight, it’s important to do so without skipping meals. So eat a healthy breakfast, lunch and dinner every day instead of going for long periods without eating.
What about diabetes and snacks?
People with type 1 diabetes may need to eat small snacks between meals to help keep their blood sugar at the right level. But if you have type 2 diabetes it isn’t usually necessary to snack between meals unless you take insulin and/or certain medications that increase your risk of hypoglycaemia (or hypos – which is when your blood glucose becomes very low: read more about hypos in our guide to diabetes.)
However, snacking regularly can make it harder for you to maintain a healthy weight. So try to choose healthy, low-fat and low-calorie options, such as fresh fruit, raw veggies and hummus, oat cakes, dark chocolate rice cakes and natural low-fat yoghurt.
"Diabetes Diet" myths
Many medical conditions are subject to myths and misunderstandings, and diabetes is no exception, especially when it comes to what you eat.
Arguably the most-often repeated myth is that diabetes is caused by eating too much sugar. But this is far from the truth, since diabetes develops when there’s a problem with your body’s production of insulin.
Meanwhile here are some of the other myths you may come across…
If you have diabetes you can never eat sugar again
Having diabetes doesn’t mean having to follow a completely sugar-free diet. In fact people with diabetes should be able to enjoy a wide variety of foods too, including some with sugar. That’s because having the odd small slice of cake every now and again won’t affect your health or long-term diabetes management significantly. Sugary drinks, on the other hand, are best avoided.
If you have diabetes, you can't eat carbohydrates either
This also isn’t true. Whether you have diabetes or not, eating the right type of carbohydrate is essential for good health. Carbs provide your body with its main source of energy, and wholegrain carbs – such as brown rice, whole wheat pasta, oats, fruit and vegetables – are considered particularly important for health, especially where your heart is concerned. Foods containing refined carbs, on the other hand, have little to no nutritional value (these include sweets, chocolate, cakes, pastries etc), which is why you should only have them occasionally. Also refined carbs raise your blood sugar levels quickly, while wholegrain carbs affect them more slowly.
People with diabetes should only eat 'diabetic' foods
So-called ‘diabetic’ foods are usually sweet foods where the sugar has been replaced by sweeteners. However, experts don’t recommend ‘diabetic’ foods for people with diabetes because these foods are often high in fat and calories, they can have a laxative effect and they may still affect your blood glucose levels (ii). Instead, if you want to treat yourself go for a small portion of the real thing every now and then.
Everyone with diabetes has a problem with their weight
While being overweight can increase your risk of developing type 2 diabetes, it doesn’t mean everyone with diabetes is overweight (or that everyone who’s overweight will develop diabetes). In fact there are lots of other risk factors that play an important part in whether or not you could develop the condition (see above for details).
Diabetes and exercise
Besides making sure your diet is as healthy as it can be, it’s important to stay active. Physical exercise can help you to manage your weight, and according to the NHS if you have type 2 diabetes it can even help lower your blood sugar levels (iv).
There are several other ways exercise can be good for you too, says Diabetes UK (v), including:
It helps your body to use insulin more effectively
It keeps your heart healthier by improving your blood pressure and your cholesterol levels
It increases your energy
It helps you get a better night’s sleep
It’s good for your joints and your flexibility
It helps reduce your stress levels and improves your mood by releasing endorphins (or so-called ‘happy’ hormones)
What is the best exercise for diabetics?
Generally speaking, the exercise you enjoy the most is the best type for you because it means you’re more likely to stick at it as opposed to activities you don’t like very much. Finding your ideal type of exercise also means looking for something that fits in with your day-to-day life.
But it’s not all about doing one type of exercise. It’s a good idea to do a variety of different things that have different benefits for your health. For instance, some exercises make you breathe harder and get your heart pumping (brisk walking, dancing, doing aerobics or swimming, for instance), while others concentrate on improving the strength of your muscles (such as lifting weights, using resistance bands, lifting and carrying children or doing heavy gardening) or the flexibility of your muscles and joints (yoga, Pilates, t’ai chi etc). Aim to do some of each, as this will stop you getting bored too. However if you have diabetes complications such as heart problems, speak to your GP or a member of your diabetes care team about the type of exercises that are safe for you to do before you embark on any type of exercise regime.
Not sure where to start? Take a look at the NHS Fitness Studio exercise videos page, where you can explore different types of exercises.
It’s also important to try to be more active in general when you’re at home, when you’re out and about and while you’re at work. For instance, climb the stairs at home or at work for a quick exercise boost regularly throughout the day, walk or cycle to the shops instead of driving, and try to make a habit of standing up and walking around whenever you’re on the phone (if you have a mobile or cordless phone, that is).
As for the amount of exercise you should do, the NHS recommends the following (vi):
If you’re an adult aged 19 - 64 you should aim to do at least 150 minutes of moderate activity a week spread evenly over four to five days or every day, as well as strengthening activities that work all the major muscle groups on at least two days each week.
Older adults should also aim for the above, but they are advised to do activities that improve their flexibility too (vii).
If you’re not very active, aim to increase the amount of exercise you do very gradually until you reach the recommended level. Meanwhile if you’re concerned about how exercising may affect your blood sugar, especially if you’re taking any medication for your condition, ask your GP or diabetes nurse for advice.
You may, for instance, have to check your blood sugar before you start exercising, as well as take steps to make sure your blood sugar doesn’t become too low while you’re working out. If your blood sugar is too high, being physically active could actually make them higher, so if you’re in any doubt at all speak to a healthcare professional before you start.
What changes can diabetics make to their lifestyle?
Eating healthily and staying active are two important things that can help you manage your diabetes. However there are other lifestyle changes you could make that can also be beneficial, including the following:
If you smoke, your risk of developing some of the complications linked with having diabetes is even higher, including problems with your heart, kidneys, eyes and feet. Ask your GP or diabetes nurse for advice on quitting, including how stop smoking aids like patches, lozenges and gum could help you control cravings for nicotine. Read more about giving up smoking in our guide.
Control your alcohol intake
Drinking too much alcohol can cause problems for anyone, including people with diabetes, as it can contribute to weight gain and even affect your blood sugar. Stick to the government’s recommendation of no more than 14 units of alcohol each week on a regular basis, spreading your intake evenly over at least three days instead of having them all together. It’s also a good idea to eat something when you’re drinking if you take insulin or other medicines for your diabetes, as drinking on an empty stomach can make it more likely that you’ll have a hypo (viii). Meanwhile try to avoid low-alcohol wines, as they can have more sugar than ordinary wines, as well as low-sugar beers and ciders, as these may have less sugar but they can contain more alcohol.
There are more general tips on managing your alcohol intake in our guide to alcohol misuse.
Stress isn’t good for your blood sugar levels, plus it may affect your ability to manage your diabetes as well as you should. If you’re finding life stressful, look for things that help you feel calmer and more relaxed – such as an absorbing hobby or doing some deep breathing or yoga – then make these things part of your daily routine. Nobody can avoid stress completely, but having even a little time away from it can be beneficial.
If you’re carrying too much weight, now’s a good time to get to grips with losing some. Not only does losing weight help you manage your blood sugar levels, but it can also help reduce your blood pressure and cholesterol levels. If you have diabetes experts advise aiming for a weight loss of between five and 10 per cent of your current body weight to see significant health benefits (ix).
Find out more about losing weight and how it can benefit you by reading our guide to the facts about weight loss.
What are the best supplements for diabetics?
Eating a healthy, balanced diet can help give you the nutrients your body needs to stay healthy, but there can be a place for supplements too, since some may help with blood sugar control and help reduce the risk of certain diabetes complications. However if you have diabetes it’s important to check with your GP before starting to take any supplements, especially those that can have an effect on your blood sugar levels. That’s because there’s a risk your blood sugar levels may become too low, which increases your risk of having a hypo.
It’s also important to realise that nutritional supplements should never be used as an alternative to conventional diabetes medicines or medical care – though it’s usually fine to take them alongside conventional treatments if your doctor gives you the go-ahead. One that could be particularly helpful is a multivitamin and mineral product, because even with all the best will in the world few of us have the perfect diet all of the time. Taking a multivitamin can make sure your body is getting all the essential nutrients it needs even on those occasional days when your diet isn’t quite as healthy as it should be.
Find out more about multivitamin supplements and which one might suit you best by reading our guide to multivitamins and daily requirements.
Some other supplements you may want to consider include the following:
A natural remedy used in traditional Chinese medicine for centuries, cinnamon is also often recommended by natural therapists for those with type 2 diabetes, as there is some evidence it may help improve blood sugar levels (x).
Alpha lipoic acid
A powerful antioxidant, alpha lipoic acid is a fatty acid that may help control blood sugar levels (xi) as well as improve insulin sensitivity in people with type 2 diabetes (xii). However, if you have diabetes always consult your GP before taking alpha lipoic acid as it may enhance insulin activity and increase your risk for hypos.
Some experts believe people who have diabetes also have low magnesium levels (xiii), possibly because diabetes or some of the medicines used to treat it may cause magnesium deficiency. Elsewhere researchers have discovered magnesium may help with blood sugar control (xiv).
Curcumin – a compound found in the curry spice turmeric – is thought to have several potential health benefits, including the ability to reduce blood sugar levels . However to date most studies have been carried out in animals rather than humans, which means the available evidence is weak. There is, however, a study that looks at the effects of taking curcumin in people with diabetic foot ulcers (xv). The findings suggest curcumin may improve blood sugar control – though there was no significant evidence that it helped with wound healing.
High-strength fish oils
Omega-3 fatty acids – particularly EPA and DHA, two omega-3s found in oily fish such as salmon, trout, sardines and mackerel, as well as fish oil supplements – are widely considered helpful for general health and wellbeing. There is also some evidence they may help reduce levels of triglycerides in the blood, which is thought to be a risk factor for diabetic nerve damage (diabetic neuropathy), a common complication in people with diabetes (xvi). Fish oil supplements are widely available, but vegetarians and vegans can get these beneficial omega-3 fats too by taking supplements that contain omega-3 oils derived from marine algae.
Fenugreek seeds have been used as a traditional medicine for centuries in Ayurvedic medicine. These days, herbal practitioners recommend supplements made from fenugreek seeds to people with diabetes, as the seeds may help increase the body produce insulin. There is also some evidence fenugreek seeds may be helpful in controlling type 2 diabetes and reducing insulin resistance, though supporting studies to date are small in scale (xvii). However, don’t take fenugreek if you’re pregnant or breastfeeding.
Best known for helping the body absorb calcium, vitamin D – and particularly having low levels of it – is increasingly being linked with type 2 diabetes (xviii). Researchers are also examining the association between vitamin D deficiency and diabetic neuropathy, with one small-scale study finding that people with type 2 diabetes and diabetic neuropathy have significantly lower levels of vitamin D than those who don’t have neuropathy and those who don’t have diabetes (xix).
Unfortunately vitamin D deficiency is thought to be common in some countries including the UK, which explains why Public Health England advises adults and children over the age of one year old to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xx). However if your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may need to take vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.
The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.
Found in dark-skinned fruits such as blueberries, cranberries, raspberries, blackberries and red grapes – as well as vegetables such as red cabbage, red onions and aubergines – anthocyanidins and their derivatives anthocyanins are potent antioxidant compounds. They may be useful for people with diabetes and diabetic neuropathy as they may help strengthen and repair the walls of veins and capillaries by protecting collagen in the body (collagen being the structural protein that gives blood vessels their strength).
Anthocyanidins are also available in supplement form (choose a product that combines anthocyanidins with vitamin C, as vitamin C supports the body’s ability to produce collagen).
Your diet and lifestyle can play a big part in how well your diabetes is controlled as well as reduce your risk of developing diabetes complications such as heart problems, eye problems, kidney disease and nerve damage. This guide offers information on what you can do right now to be healthier while living with diabetes, including how important diet and exercise are and the potential benefits of taking nutritional supplements. Find out more about a wide range of health and wellbeing conditions by taking a look around our pharmacy health library.
(i) Available online: https://www.diabetes.org.uk/professionals/position-statements-reports/statistics
(ii) Available online: https://www.diabetes.org.uk/diabetes-the-basics/types-of-diabetes/type-1
(iii) Available online: https://www.nice.org.uk/guidance/ng28/ifp/chapter/diet-and-lifestyle
(iv) Available online: https://www.nhs.uk/conditions/type-2-diabetes/food-and-keeping-active/
(v) Available online: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/exercise
(vi) Available online: https://www.nhs.uk/live-well/exercise/
(vii) Available online: https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/
(viii) Available online: https://www.diabetes.org.uk/guide-to-diabetes/enjoy-food/what-to-drink-with-diabetes/alcohol-and-diabetes
(ix) Available online: https://patient.info/diabetes/type-2-diabetes/type-2-diabetes-diet
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.