What Do I Eat Now? Your Diabetes Diet Questions Answered

A healthy diabetes diet may not be as restrictive as you think. Here's what you need to know about choosing the best foods at home and when eating out.

By Beth W. Orenstein

Medically reviewed by Lindsey Marcellin, MD, MPH

Your doctor tells you that you have type 2 diabetes and a million questions pop into your head, most of them centered on your new diet. There is some good news: A healthy type 2 diabetes diet isn’t as restrictive as you might think, says Andrew J. Drexler, MD, professor of medicine in the David Geffen School of Medicine at UCLA and director of the UCLA Gonda Diabetes Center. “It’s fundamentally a healthy, balanced diet with the elimination of really only simple sugars.”

It’s important that you learn what you can and can’t eat, because following a healthy diet will help you control your diabetes. “Your diet is a very important part of reducing your risk for developing the complications of type 2 diabetes, such as heart disease, eye disease, and kidney disease,” says Elizabeth Mayer-Davis, PhD, RD, president of health care and education for the American Diabetes Association and a professor in the departments of nutrition and medicine at the University of North Carolina at Chapel Hill.

Here are answers to some of the most common questions you may have when you’re first diagnosed with type 2 diabetes.

1. How can I find out what to eat?

“My recommendation is to take a diabetes education program,” Dr. Drexler says. “The ADA has a series of recognized programs that look at all aspects of diabetes and provide an overview of what you need to know about diabetes and how to take care of yourself.” Find one near you, he advises. The ADA also offers a wealth of information on its Web site. Also, ask your health care provider to suggest a certified diabetes educator or a nutritionist who specializes in diabetes, or contact the American Association of Diabetes Educators.

2. How do I plan my meals?

“It’s really a matter of eating healthy meals and a balanced diet,” Drexler says. Some key things to keep in mind include:

• You want lots of vegetables in your diet, especially those that are not starchy. Think broccoli, zucchini, and green beans.
• Choose whole grains such as brown rice and whole-wheat pasta over refined grains such as white rice and regular spaghetti.
• Have heart-healthy fish, such as salmon, tuna, mackerel, and sardines, at least twice a week.
• Choose lean cuts of meat, such as pork loin or sirloin, and white-meat chicken or turkey — don’t eat the skin.
• Cook with liquid fats like canola or olive oil rather than solid fats like butter and lard.
• Choose fat-free or 1 percent milk, and low-fat cheese.
• Avoid processed foods and snacks such as potato chips or commercially prepared baked-goods.

“It’s very important that you plan your meals for the week and go shopping with a grocery list,” says Susan Weiner, RD, MS, CDE, a certified diabetes educator in New York City. “If you don’t have the right ingredients, you won’t make healthy choices.”

3. Can I ever eat sweets again?

Yes, you can, says Mayer-Davis, but with two caveats. One is “in moderation.” Moderation is important, she says, because weight management is important when you have diabetes, and sweets tend to be high in calories. The second involves timing. Talk to your doctor or diabetes educator to know when to take your medications if you’re going to have a small slice of birthday cake or a piece of candy from Halloween. You may need to adjust the timing so that your blood sugar doesn’t spike.

4. How do I count carbohydrates?

Carbohydrates can have the biggest impact on your diabetes because almost all of the carbohydrates you eat are broken down into glucose — an important source of fuel for your body, but also the culprit in causing health complications from diabetes. You will find the most carbohydrates in honey and molasses, breads and crackers, pasta, fruits, starchy vegetables like potatoes and corn, milk, and yogurt. Your diabetes doctor may have you count carbs to help keep your blood sugar under control. Some people find that if they eat too many carbs, their blood sugar rises dangerously high. If you take insulin before meals, you may need to count carbs to determine just how much insulin you need.

Counting carbs means you need to know how many grams of carbohydrates are in the foods you eat. That information is on the nutrition label on packaged foods and is listed by serving size, so calculate how much you’re eating. You can look up carb counts for fresh produce on the Web. “There are all sorts of resources online for people who are counting carbs,” Mayer-Davis says.

As a rule, the following servings contain about 15 grams of carbohydrates:

• 4 ounces or one small piece of fresh fruit
• Half an English muffin
• ½ cup of beans or starchy vegetables
• 3 ounces or a quarter of a large baked potato

The counting doesn’t have to be exact, Drexler says. “We want people to be good rather than be perfect.”

Spread your carbohydrates throughout the day rather than overload at one meal and then consume few or none at another. “That will help in regulating blood sugar,” Weiner says.

5. Can I drink alcohol?

The answer to this question is the same as for sweets, Mayer-Davis says. “People with diabetes can consume alcohol in moderation." she says. "That’s one drink per day for women and up to two for men.” She adds that some people may need to adjust their insulin dose if they’re drinking alcohol.

Avoid mixing alcohol with sugary high-carb beverages such as sweetened iced tea or fruit juices, Weiner advises, and don't drink without eating, as that could cause fluctuations in your blood sugar levels.

Remember, too, that alcohol has 7 calories per gram. “You don’t want to drink your calories,” Weiner says.

6. What's the GI and why is it important?

“The glycemic index (GI) indicates how rapidly a carbohydrate is digested and released as glucose into the bloodstream,” Weiner explains. Foods with a high GI raise your blood sugar more than those foods with a medium-to-low GI.

However, the GI doesn’t consider the amount of carbohydrate in a particular food. For that, you need to know its glycemic load (GL). “A food’s glycemic load is a better indicator of how a carbohydrate food will affect blood sugar,” Weiner says.

The healthiest eating choices are those foods with a low GI and low GL. These foods tend to be higher in fiber, which can help keep you fuller longer.

Foods with a high GI and high GL can cause your blood sugar to spike. You feel full when you eat them, but your blood sugar drops quickly and you’re hungry all over again. If you eat again to satisfy your renewed hunger, you could gain weight.

Good food choices with low GIs and GLs include brown rice, peas, beans, nuts, seeds, old-fashioned oatmeal, and most fruits and vegetables.

7. Can I eat out if I have type 2 diabetes? In some ways, it’s harder to dine out when you have type 2 diabetes because you don’t know what the chefs put in the food, Drexler says. “Sometimes they put more sugar in their sauces to make their foods taste better.” He suggests testing your blood sugar after eating at the restaurant.

When ordering from a restaurant menu, try to follow the same basic guidelines you do at home. Skip the rich sauces and select broiled or grilled dishes. “Go online and look up the restaurant’s menu before you eat there — always know what to expect before you go to a restaurant,” says Weiner. If you don’t see items on the menu that you can eat, choose another restaurant. Always ask that sauces or dressings be put on the side so you can limit how much you eat. Most restaurants today are willing to accommodate people’s special diets. Says Mayer-Davis: “It’s getting easier to eat out and not blow your diet.” Restaurants tend to serve large portions, she notes, so you may want to share your meal or take half home for lunch the next day.

Also make a point of noting what time you will be eating. You may need to take your medication closer to when your meal will be served. “Ask the wait staff when you order when you can expect your food," Weiner suggests. "You may need to eat something so that you don’t have a low blood sugar reaction while waiting for your meal.”

8. How can I lose weight if I have diabetes?

Portion control is the key. “There is no magic bullet or no special diet recommended,” Mayer-Davis says. You need to follow a healthy diet, make sound food choices, watch how much you eat, and be physically active.

Weight loss requires a lifestyle commitment, Weiner says. You have to learn to make wise food choices and eat healthy all the time, not just when you’re trying to lose weight. Yo-yo dieting — losing and gaining weight — is worse than not losing it at all. “The important thing is to stay away from fad diets and diets you can’t live with,” adds Drexler.

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