Diabetes Type 2
Food, eating and diets
Controlling the symptoms of diabetes and managing the condition well, whether you are taking medication or not, means eating carefully and healthily. Some people said they only had to 'fine-tune' their diets to achieve lower blood glucose levels; others had gone to great lengths to change their eating habits. It took time for people to find out what worked for them; some relied on their wives/partners to cook the right kind of meals; others had worked out their own routines.
Lawrence explains his careful approach to weight control and diet.
And, and by instinct you then learn to read the labels - as soon as [laughs] you want to eat something the first thing you read is the label - you know what is the sugar content of a drink. So those sorts of things then come into play in terms of making sure you don't set yourself off. Now and then I get tempted and [laughs] and the sugars go high a bit but, because you know, you learn to control it, you can bring it down quickly enough, either in terms of the food you eat to try and absorb, or in terms of the frequency of eating.
As I was saying, you know the third aspect (the first aspect is in terms of the sugar content, the second aspect is in terms of the fat content) the third aspect that I always monitor is the metabolism rate, because that relates to your food digestion and that relates to your body weight and your blood sugar, and your blood pressure. So, you learn to play the tricks and know the rules.
How do you know your metabolism rate?
I don't have a medical or official calculation but I just notice, because I weigh myself regularly, so I know that if I know for a fact that if I eat a lot of bread I pick up a lot of weight, so I've cut out bread altogether and I stick to other things, but now and then when I do eat bread I notice that, you know I'm a bit more bloated and my weight picks up. So, and even the scale tells me that, you know I've put on a bit more weight, so it's my interpretation I could be wrong, I could be wrong but I think, [clears throat] that's where I know that my metabolism is sort of like, [in] a direct relationship, so when I eat the lighter foods or the easier foods I don't pick up any weight. So I have to check my weight, you know, every other day literally, yeah.
Mrs Singh describes the changes she has made to her daily diet (audio in Hindi).
Now, see, in the morning along with tea, I always eat roti [Indian flat bread], because my sugar goes down in the morning, so you feel like eating something. So, I don't eat bread, I eat roti, and inside I put margarine, but I don't fry it. So I eat that with tea, sometimes with a bit of pickle, or if not pickle then I may take some cooked vegetables with it, and eat it all together. So now I'm not hungry, I ate in the morning. Now about 3 or 4pm, at 3'30pm, I'll have tea, then with the tea I may eat some toast. Or if I don't feel like having toast then I may have some chevda [gujrati snack, crunchy spicy a bit like corn flakes but savoury], only sometimes, not all the time, sometimes I feel like having something crunchy so then I have some. I can't have the one with lots of chilli because with my pills for my blood pressure.
I maybe eat a biscuit, or a couple of biscuits. But most of the time I'll eat some bread, not anything else, that works the best, it satisfies my hunger so, then I don't eat this and that, you understand what I mean? So that's it. And then in the evening I make fresh food, vegetables or dal and vegetables, whatever I want to eat. Sometimes I cook chicken, but I don't put that much oil, sometimes in the oil onions, if I fry them in oil, then I drain all the oil, and after draining the oil properly then I cook the vegetables. So that is it, you just have to be a bit careful, so apart from that bhaji etc., we only have it occasionally, sometimes after 2 months we'll have it once, also samosas and so on are all off the menu, crisps also, all that is off. Just one thing, chevda, is what I like so that I eat sometimes. So then this is how my life is these days [laughs].
People found that even small adjustments to diet and eating habits - such as eating smaller portions, sitting down at the table to eat, avoiding snacks - could help.
Raj feels more energetic since he has been more careful about when he eats.
I do feel a difference. I do feel a lot more energetic and that sort of thing, because I think the sugar levels are being controlled. And the thing is before I used to eat any time, whenever I feel like it, but now I've got a timing on everything, what time I have to eat and what sort of things I have to eat. I have to make sure [and] by doing that, controlling my diet and everything, that has made a lot of difference to me. So I do feel a lot more energetic what I used to be and feel a lot more healthier.
What do you mean by timing?
Timing because there are certain things like before I didn't used to have any breakfast or anything like that. You know, I used to eat in the evening or, you know, afternoon, whenever I feel like it. But now I know being a diabetic person I have to have breakfast, only certain food. And then I have to have a certain time my lunch and dinner, just to make sure my diet is all controlled. Not like, you know, when I feel like it I eat it. Because if I do that, my sugar levels go high or low, either way. Just with being a balanced diet, I know I'm going to have breakfast in the morning, that will keep my sugar level right till lunchtime. When I have, at lunchtime they'll keep me there. And with taking the medicine, that will help me a lot as well. Because the thing is that the medicine I'm taking in the morning and the evening, that keeps the sugar level balanced, you know. If I eat say any time my food or something like that, that will affect the sugar level a lot. Because if I, say if I eat at 10 o'clock or something like that, you know, instead of breakfast or something like that and the timing between the, my breakfast and my lunch is very short, that sort of things, that will affect all my sugar level. Because by 10 o'clock my sugar level will be down. If I have food at that time, obviously I'll be hungry, I'll eat a bit more, and that makes my sugar level a lot more higher. So I have to make sure my timing and my, all my food and everything is right, you know, all balanced out.
Malcolm describes the high carb, low sugar, low fat diet that seems to work for him.
So can you describe your diet in some detail?
It's a normal healthy diet. I have gone… I swing from being ultra careful to perhaps not being as good as I ought to. But I don't, there's no fad foods with me or sugar-free jams and, you know, all the rest of it, just a normal healthy diet. Weetabix or Shreddies or something for breakfast. At the moment because I'm on a diet, I have two apples and a banana for lunch. And then the wife cooks a good wholesome evening meal. I tend to you know, I'm one of these people that I can't have one digestive biscuit, I have to have half a dozen you know. So I try not to, you know sneak out into the kitchen at sort of 9 o'clock at night. But yes, a normal healthy diet. Alcohol - I love red wine - but I only drink that on a weekend. I don't smoke. So, yes, so there's no special diet, just a healthy diet that we should all eat. High carbohydrate, low sugar, low fat.
So I mean if you could just imagine somebody who maybe doesn't know this, then how would you describe this high carbohydrate/ low sugar diet?
Bread, pasta, potatoes, boiled potatoes are okay. Cut out all the fried food, the crisps and the chips, and all the sugary, you know, saturated sugar food. So yes, but there's no need to go out buying sugar-free this and sugar-free chocolate and all the rest of it. Because it's, generally if it's sugar-free it's full of fat anyway. So, yes, and takeaway foods are a once-a-month treat. But yes, cut out the fats and the sugars, that's the main thing. And plenty of pasta, potato, bread, in the right proportions. And obviously five pieces of fruit a day. Which in fact I do quite enjoy fruit. I eat too many bananas. I should only have one banana a day, but I'll sometimes have two or three. Because they're quite high in natural sugar. Which I didn't realise till a while ago, so I was eating a banana thinking I'm doing the right thing, but in fact it wasn't.
Several people we talked to were controlling their diabetes by diet and exercise and didn't take any medication. Others were taking anti-diabetic tablets such as metformin. Some of those who had transferred from tablets to insulin said they liked having more flexibility about what and when they ate.
Kathy does not take any medication for her diabetes and has found it quite easy to change her diet.
I had a little sheet what to eat - as I just say - more fruit, more vegetables, wholemeal cereals or fruit. I don't have cereals except I have porridge or wheat, shredded wheats. Re-educate my palate more or less. So cottage cheese, yoghurts, this kind of thing, baked potato with yoghurt, thick Greek yoghurt and herbs in it which is nice, which is really nice.
So to re-educate the palate, little things but I don't feel that I deprive myself in any way. If it does me good fine. Because I don't really feel 'I can't have this, I'm diabetic,' no, no.
They gave me enough information so far and to know more not how shall I say this, I know enough about it actually. And I feel the fabric of your body as such if you put in quality food, then it keeps the fabric whole. So it's, it's like a woven cloth, when you wear it out, it tears you see, so this sort of thing. And I think I'm going in the right direction. That's how I feel. I hope so.
Some people held strong opinions about the best ways to tackle weight loss and control blood glucose levels. Specific dietary regimes (e.g. the GI diet) had worked for some people; others said that cutting out fatty foods and takeaways and eating more vegetables worked for them. Several people said they now used different ingredients in their cooking and tried to find ways round dietary limitations. (See 'Resources' section for more sources of information.)
Tina has had weight problems since infancy and tried many diets but says what worked for her is...
So you, you were obviously overfed as a baby?
What kind of diet did you have when you were growing up?
It was probably, oh, it was probably just basic. It wasn't lots of junk food like it is nowadays because there wasn't really that much junk food around. But it was probably quite, maybe not that healthy, I mean lots of sort of snack foods and my grandmother spoilt me to death. She used to do a lot of baking on a Sunday and we used to eat it all the week through then you know and so, and it was all the things you know, that people you know liked eating. I mean I can't remember now sort of apple turnovers and apple pies and sort of you know like lots of pastry things she used to bake. So yeah it probably wasn't that healthy.
I went on various diets; probably lost stones over the years but put it all back on again as soon as I stopped. You know, I went to various slimming clubs, tried all the diets that were the diet of the moment. And lost some, lost weight probably I mean probably lost a couple of stone each time 2 or 3 stone maybe, always put it all back on, and then a bit more [sighs].
It's hard isn't it. So what's worked? What do you find has worked because you've obviously got your weight more under control?
Yeah. The thing that's worked is not being on a diet! Because as soon I think as soon as you're on a diet, and as soon as you say 'diet' you're deprived, you want to eat the food that you think you're not supposed to be eating. So now what I do, I only do healthy eating, and I don't eat processed food. I never eat junk food, I don't eat takeaways, I have 5 fruit and vegetables every day. All the time never, never 'not do that' always 'do that'. And I still overeat because I'm still overweight [and] I know I overeat. I've got you know, I've probably got a bigger appetite because I'm overweight - I don't know - but I do overeat and I do know that still, but I'm not as bad as I used to be and I don't eat all the things. I mean I used to eat like yoghurts - I don't eat fruit yoghurts any more because they've got loads of sugar in them.
You know I'm very careful about what I eat really, and I'm very aware much more aware what's hidden in foods. So I' Yeah and I cook from scratch. I cook meat, vegetables, potatoes every day, and so that makes a big difference I think, because I used to get a lot of processed food.
When she started following the GI diet Pamela found her glucose levels lowered quickly. When she...
So the first day I did it, I amassed all this information and I got the right things. And the very next day my bloods dropped from 13 to 8, just literally overnight. And I thought 'It works - it actually works.' And then over the next I suppose two weeks it went down to about 5.5. And it now sort of goes between 5.1 and 7 depending on how good I am with the diet. And I talk about it as a diet, it's actually a healthy way of life. I don't feel as if I've had to give up a lot, because I still have the odd chocolate, the odd bar of chocolate, piece of cake, but in a much more planned way.
So I find that like today, I go to college on a Tuesday evening, and the food, it's a small college, very very good food. And they always do afternoon tea with home-made cakes, and I allow myself a piece of cake on a Tuesday. But I will not have had a lot of food before I went. And when we have the main meal later on in the evening I will just balance it. Just about, you know, not having too many what I used to call the foods that are really, are comfort foods for me, like bread and potatoes and cakes, chocolate. So I think it was because it worked so quickly that it you know, encouraged me to go on.
I also knew I had to lose weight. And I realised that there isn't a correlation between where my blood sugar levels are and weight loss. So although I had dropped from 13 to 5 in two weeks, I actually hadn't lost any weight. And I really sort of thought, 'Now why, what am I doing, why am I not? I'm not eating any processed foods; I'm eating fruit and veg and, you know, everything in its right quan-.' And then I realised that I was eating too much. It was the quantity. It's not actually what you eat so much, for me - I obviously can't speak for everybody else - but for me it's not what I eat, it's how much. It's the quantity. And so I cut my portions down, not ridiculously, but just cut them down, and I started to lose weight. And I have in the last six months lost over two stone in weight. So that's coming, that's another benefit as well. Although weight loss wasn't a priority for me, it's actually quite nice and it's made me fitter.
Nicky enjoys cooking and now makes her own bread, tortillas and muffins without using flour.
And there's a kind of pasta - I don't know if I'm allowed to mention brand names here - but there's a kind of pasta 'Dream Fields' pasta. It's an American invention, patented. What they claim to have done is locked away the carbohydrate content somehow... God knows how, but it works for about half the diabetics I know who've tried it. You know, there's a couple hundred people who I talk to regularly on the diabetic forums. And for about half of them it works fine, and I'm one of them, luckily. So I've now discovered a source of buying this stuff in bulk in the UK, and you know, we eat it perhaps once or twice a month as a, as a nice change of pace.
I make my own bread now, again based on linseed and vital wheat gluten. Thank goodness I don't have one of the common comorbidities which is coeliac because, you know that would really make my life very difficult. My tortillas are nicer than anything I can buy in the shops, I have a little stash of chocolate almond flour muffins in my freezer for when I need a muffin-fix. You know, I really do not go without anything these days. If I fancy it, I find a way of making it.
Mrs Patel has always been vegetarian and now tries not to eat food containing ghee or flour.
But instead of eating three chapattis, we eat two chapattis. Just reduce your food intake, that is what I do. And fruit and vegetables are okay. We don't eat eggs, no fish, no cheese, so only vegetables and plain flour what we, I mean, mould into chapatti and rice.
So where's your protein?
Protein is from the dal.
Lentils. But as far as what I understand, too much protein is not good for us as well because that converts into carbohydrates, and then the breakdown of that is little heavier for the body to break it down to sugar level. So protein we try to not eat so much, a little bit less than normal.
Not everyone wanted to stop eating the food they loved. Several people said they felt unhappy about having to restrict themselves because the enjoyment of good food was one of 'life's pleasures'.
Darren finds controlling his diet and his weight extremely difficult and says that diabetics need...
No, that's not true, I have some great things in my life. I have a fantastic wife, I have brilliant children and I have the job I've always wanted to do. I have it all in some ways, but' There's that little thing that you want and you enjoy doing and that no one else knows about, and you know for some people it's the crafty cigarette, for some people it's a drink at lunchtime. For some there is something and I, and I really wish [laughs] I really wish it wasn't true. I really wish I was a better, holier person and I suppose I should with my job title, but the reality is that they were taking away my vice. They were taking away, they were taking away my little thing, my [laughs] what you know, [laughs] you know, it's not very sinful is it, a bag of sweets? But that's what, that's what, that's what diabetes has done for me is taken away my weird enjoyment.
Eating healthily was seen by most people as a good idea, but some people found that food cooked without salt, sugar or fats tasted 'bland', 'boring' and even 'disgusting'. Several people said they rewarded themselves with 'treats' every so often, which included takeaways and chocolate. Spices are not on their own bad for you but spicy food often contains lots of salt, sugar and fat.
Sylvia tries to follow the advice from her diabetes nurse but misses all the tasty things she...
And what about the food itself that you've grown up on. What did you eat as a child?
I mean because my nurse has said to me if, if I'm going to have to have rice let it be basmati and not the easy-cook rice which is what I do cook a lot of the easy-cook rice but what I tend to do now, if I cook that, I won't have none for myself. Because you know she says that's high in sugar, where the basmati has got sugar but it wouldn't be so high. I've got to get used to like the brown rice and I've bought the brown rice and it's still sitting in my cupboard [laughs]. It's never been opened. I bought brown pasta and I found that so dry and boring, you know.
I like a lot of coleslaw, I make my own coleslaw, but I put sugar in it [laughs]. You know, everyone loves it with sugar in, it just gives it that little, you know, so that I find hard. I mean I did go out and I bought some Canderel because it's says suitable for diabetics and I made coleslaw on Sunday and I shoved that in it [laughs]. So'
Tasted all right but [laughs] not quite the same.
And what about kind of food you have for dinner?
Well I tend to make like lamb and pork, I don't really tend to eat [those] myself now because obviously they're quite fatty. My nurse has told me to avoid these and to eat things like chicken and turkey without the skin. So that is what I've tend to cook for myself and you know, I'll cook them lamb or pork, you know, or stuff like that. And they don't want what I'm cooking for myself because I have to have so much, I have a lot of vegetables as well. I love cheese, and my nurse has said to me not to do, and I love prawns and you know, they're, she's told me not to have prawns either, so I just find it hard. I found in the beginning I was really sticking to it well. I'd eat salmon, mackerel, chicken and turkey - because I hated turkey before - but she said to me try and eat turkey, that would be good for you. So I had turkey and no they weren't interested in all these vegetables and things like that, they wanted their food.
And I found in as well, if I was cooking rice I wasn't putting a lot of salt in, you know, oh no, they want salt in their rice, you know, so I just end up cooking something for them and something separate for me.
Sallie has lost weight on her new diet but doesn't enjoy it much and still has cravings for...
So what are you eating?
I am not eating anything I like at all. It's all absolutely bloody disgusting (sorry I swore).
What kind of things' What is the most disgusting meal that you have had to eat that you have prepared for yourself? Give me an example of something?
Really disgusting? Well, I'm having Bran Flakes with banana in which isn't my sort of thing really. And I'll have that for lunch sometimes, because I have had my Rice Krispies for breakfast. But I am trying to do the old fruit and veg thing you know. But like roast without the roast potatoes and Yorkshire pudding, it's not the same really.
Can you not even have one roast potato?
Yeah, most probably. But I think, like it's only been like this for the last two weeks. There's no way I am living like this for the rest of my life. I can't. You know, I have got to have treats now and again.
We went out for a meal on Saturday evening, and I had a starter and a main meal and my youngest son had chocolate fudge cake. And I said, 'Can I have a mouthful please, just one?' And he made such a fuss about giving me this one mouthful, but then his girlfriend gave me a mouthful, but in the meantime I had turned funny big time, I could have come home you know spoilt everybody's night - that's how much it meant, just having this one mouthful - but I knew that if I had had one to myself, I would have, you know, undone all my good work, and it's never worth it. But that one mouthful was very, very nice indeed. I didn't want to swallow it. I just wanted to keep it in my mouth. But apparently all these urges leave you if you stay off it long enough. But having said that, I have got my two tins of Roses [chocolates] all ready for Christmas.
Eating less and giving up what were described by many people as 'comfort' foods was said to be hard when they felt low.
For ten years Zoe didn't eat properly or manage her diabetes very well but her new partner...
I mean I was lucky, I went on the internet and found my partner and he's kind of grounded me. He's made me realise that your health really is the main thing that you've gotta cope with. And I don't know how I've gone through that ten years with the way I've treated my diabetes, because in a way I've found out all the things with it I can do, and I feel I've cheated sometimes because I've, managed to keep my sugars down by what I've eaten instead of the medication.
Gugu feels more structured help with food might help. She feels tired after work and doesn't...
I mean it's that as well, and I think I'm sort of like got a very sedentary life as well these days, for someone of my age you know. I sort of tend to come home from work - I'm tired, the journey coming back from work is like two and a half hours long - I get in, I'm exhausted. I mean, who's going to start cooking healthy options? You know, when you can get a big, fat burger out of the freezer, shove it in the bloody' You know oven and make some oven chips? You know, things that I never used to actually eat.
It helped if partners and family members changed their attitudes to food and went along with the new diet and eating patterns. (see 'Home and Social Life').
Eating properly during working hours could be difficult, and several people said that they struggled to resist biscuits at work. Others found it especially hard to resist food and alcohol at weddings and parties.
Duncan explains that he doesn't want diabetes to dominate his life and so takes a 'broad-brush'...
So, I mean I don't know' back here I try and do everything Marks and Spencer's just down the road, which does lots of good healthy food. So I try the 5-a-day, although I quite often don't manage it, sometimes I manage considerably more than that. So to that extent I'm certainly not perfect and I manage. My friend with diabetes said you can have a doughnut occasionally as long as you view it as a special treat, and so I mean I tend to do that - more than I should I expect.
You know I know I ought to be counting calories all the time, and this, that and the other and making sure, but I just do it in a very broad-brush way and as I say I tried to eats lots of' Drink fruit juice, although fruit juice has got fruit sugar. It just gets' You know as I say I'm just not prepared to make myself miserable and let my life be taken over by diabetes to the extent that I spend all the day planning meals.
I mean I've got a diabetic cookbook and that sort of thing, but again, you know its' I... most of the things I get are prepared but luckily Marks and Spencer's have now started doing the good 'nutritionally balanced meals', which' I had one last night, roast pork and vegetables, it was very you know easy - four minutes in the microwave - and it was actually was lots of vegetables, and whatever. I think it probably was' It certainly looked healthy from what they said on the packet.
Dietitians and dietary advice
Most of the advice people were given about food, drink and exercise came from dietitians and diabetes nurses based at the GP surgery. Almost everyone acknowledged that the advice was sensible and said that the nurse helped them keep on track. But a few other people said they wanted more specific advice tailored to their needs or wanted more structure to help them and found most dietary advice too general. Some had seen or said they would consider seeing a nutritionist privately. Several people wondered what the difference was between nutritionists and dietitians. Registered dietitians are the only nutrition professionals to be statutorily regulated, and governed by an ethical code. The title dietitian can only be used by those appropriately trained and who have registered with the Health & Care Professions Council. The title nutritionist can be used by anyone, qualified or not, giving nutritional advice.
Pamela felt the advice to eat a yoghurt during important meetings at work was inappropriate for...
I found that, when I went to the dietitians… Lovely women, but had no concept of my lifestyle. Somebody suggested I mean I go to meetings, (and they're quite senior level meetings, which doesn't make them any different from other meetings, [at] any meeting this could happen) and I said, “But sometimes they overrun or whatever.” And somebody suggested I ate a yoghurt in the meeting. Now… Yes, I could do, you know - women can breastfeed if they want to - but on the whole you don't. There's a bit of a credibility issue. And it also highlights that you have a condition and do you want people to know that you have a chronic condition? I don't as a whole mind, but I don't think I necessarily want, you know, the Director General of the Department of Health R & D to know that I'm a diabetic. And sort of some of the suggestions were quite inappropriate.
Andy attended a morning workshop about diet but says it told him nothing he didn't know already.
I was comfortable that I was eating pretty healthy and I sort of sat down, a very uncomfortable morning because I do struggle sitting with my back, in this room for a couple/three hours while this woman was giving us all this information. Now, there were a lot of other people there that really needed the information so it was good, it was that just from my perspective it was a waste of a morning, but it was right that the health authority did it. And I was also referred to the my GP practice, I've got a diabetic nurse so see her. And [she] talks through things and says reassuring things and pats you on the back and, you know, well that sort of hand-holding and 'huggy' type of stuff.
Local support groups or clubs for people with diabetes had helped some people to alter their diet, but younger people said that they felt out of place at these clubs (see Darren above).
Not everyone felt they understood the rationale for certain dietary advice; for example some people wondered how replacing meat and cheese (i.e. protein) with carbohydrates and so eating more pasta, breakfast cereals and also oatmeal biscuits (e.g. Hobnobs) could possibly help with weight loss. One woman said that pasta and oatmeal actually raised her blood glucose levels.
Ken thinks that the information about eating more carbohydrates is extremely confusing.
NHS choices recommends you should:
- increase your consumption of high fibre foods, such as wholegrain bread and cereals, beans and lentils, and fruit and vegetables
- choose foods that are low in fat – replace butter, ghee and coconut oil with low fat spreads and vegetable oil
- choose skimmed and semi-skimmed milk, and low fat yoghurts
- eat fish and lean meat rather than fatty or processed meat, such as sausages and burgers
- grill, bake, poach or steam food instead of frying or roasting it
- avoid high fat foods, such as mayonnaise, chips, crisps, pasties, poppadums and samosas
- eat fruit, unsalted nuts and low fat yoghurts as snacks instead of cakes, biscuits, bombay mix or crisps
A few people with co-morbidities (other health conditions) said they had been given conflicting advice about what to/not to eat and felt that dietary advice could be given more thought.
Last reviewed March 2016.
Last updated March 2016.