Intuitive Eating for Diabetes: Non-Diet Nutrition for Diabetes Management — Registered Dietitian Columbia SC

If you’ve been diagnosed with diabetes, it might feel like you have to be on a super strict diet for life. In reality, “all food fits” is still true for you. This post explores intuitive eating for diabetes with non-diet nutrition for diabetes management.

Intuitive Eating for Diabetes: Part Two - Non-Diet Nutrition for Diabetes Management

This post was brought to you by my lovely part time RD Kate Bennett! She is currently accepting new virtual clients on weeknights and evenings.

Welcome to part two of Intuitive Eating for Diabetes. In part one of Intuitive Eating and Diabetes, I discussed how diabetes doesn’t have to stop you from practicing intuitive eating, and in fact, intuitive eating can be a helpful adjunct to the medical treatment of diabetes. Intuitive eating is for everyone, even if you have a chronic health condition. While intuitive eating might look a little different for you, the principles are there for you to adopt in a way that best serves your mental and physical health. Remember, intuitive eating is a health promoting practice, one that puts your mental health right up there with your physical health AND cares a lot more about sustainable changes that improve the quality of your eating patterns, not quick “fixes.” Intuitive Eating leaves room for making adjustments to your eating habits to help manage chronic diseases, like diabetes, and gets you out of that restrict/binge cycle that’s so damaging to blood sugars in the long run.

In today’s post I’d like to provide some practical tips when it comes to eating with a diabetes diagnosis. You’ll find these tips are pretty general and nothing radical - remember there is no “diabetic” diet that works for everyone, and those radical changes aren’t exactly sustainable. But these changes can help when it comes to managing blood sugar over the long run. Incorporating medical nutrition therapy into intuitive eating can help you to make lasting changes while still honoring your own body’s needs. Nutrition interventions do not have to include pursuing weight loss or trying to follow rigid food rules. Putting weight loss and the ideals of the perfect diet to the side can help you focus on building lasting behaviors that help you manage your diabetes.

Insulin and Blood Glucose

Part one of Intuitive Eating for Diabetes broke down the difference between type 1 diabetes and type 2 diabetes. As a refresher:

The purpose of insulin is to get glucose (sugar) into the cells to provide the energy they need to do their usual functions. Basically, glucose powers your body to breathe, walk, talk, think and do every single thing your body does. With diabetes, some individuals are insulin deficient, producing little or no insulin, and they require insulin be administered via shots or pump. This is the scenario typically seen in type 1 diabetes (sometimes type 2 diabetes as well, as the disease progresses). Other individuals may be insulin resistant, meaning their body does not respond to insulin as well. They may require oral medications that make the body more sensitive to insulin, and may also benefit from changes to eating patterns and movement to improve the body’s sensitivity to insulin. This is the scenario in type 2 diabetes. With both types of diabetes, some individuals may eventually have both insulin sensitivity and deficiency.

Both insulin resistance and deficiency cause hyperglycemia, or high blood sugar, which over time can cause damage to blood vessels and nerves that can lead to the complications associated with diabetes. The aim of diabetes management, which involves a number of things (medication management, dietary adjustments, stress management, movement, etc) is to help keep blood sugar levels close to the normal range while minimizing the risk of hypoglycemia, or low blood sugar.

Non Diet Nutrition for Diabetes Management

Carbohydrates – The Body’s Fuel

Let’s start with carbohydrates. Carbohydrates are the body’s main source of fuel. All carbohydrates break down into glucose (sugar) in the body. Calling it glucose or sugar can make it sound scary, but remember that glucose is just an energy source, and an important one at that - it’s the only source of fuel your brain can use. In diabetes, without adequate insulin action, glucose remains in the blood, leading to hyperglycemia.

However, this does not mean that people with diabetes should not eat carbohydrates. In fact, low carbohydrate diets tend to be unsustainable and can lead to stronger cravings for carbohydrates. While in a controlled setting, reducing (not eliminating) carbohydrates might help lower blood sugar for some people, in the real world, it more often leads to chaotic eating patterns that cause major fluctuations in blood sugar that causes even more damage. Plus, people with diabetes need carbohydrates the same way people without diabetes need them - it is still the body’s preferred source of fuel. That said, a little extra thought about carbohydrates can be helpful to keep blood sugar close to normal range without risking low blood sugar.

Intuitive Eating for Diabetes - Non-diet nutrition management includes carbohydrates

If part of your medication regiment is dosing insulin based off the number of carbohydrates you consume, you will need to learn how to calculate the number of carbohydrates you eat. Refining those skills over time will help you more accurately dose your insulin. Remember that all types of carbohydrates can serve you to provide you with energy. When calculating carbohydrates, resist judging the carbohydrate number and thinking that less is better. Trust your body’s hunger signals to tell you how much food you need at a meal or snack - insulin dosing is there to help you be flexible around food. If you need more insulin to cover a meal, that’s OK!

Most people with diabetes do not have to dose insulin to carbohydrates. If that’s you, it’s helpful to aim to include carbohydrates with every meal and snack consistently throughout the day. Consistency is the key word here! If you’re unsure where to start, try making 1/4-1/3 of your plate a carbohydrate food, like grains, pasta, bread, potatoes, fruit or starchy vegetables. Utilize those intuitive eating skills of honoring hunger and fullness to determine the amount you may need at the time. If you feel disconnected from hunger/fullness cues, working with a non-diet dietitian can help. Remember, even though consistency is important, some days you may be hungrier than others and may need more carbohydrates (and food in general!) for that meal, and that’s okay.

Intuitive eating for diabetes means pasta is still on the table!

Fiber and Diabetes Management

When choosing what to eat, remember that fiber is your friend! Studies have shown that fiber can help reduce A1c and fasting blood sugar. Fiber slows digestion, essentially allowing glucose to more slowly enter the blood stream, making it easier for your body to process it. Fiber is found in a variety of foods, such as whole grains (ex: oats quinoa, brown rice, barley), fruit (particular ones with edible skin), potatoes (sweet and white), and other starchy vegetables, beans, vegetables, nuts and seeds. Try to include a source of fiber most of your meals and snacks.

That said, just because high fiber foods are helpful for blood sugar control, that doesn’t mean that lower fiber foods are bad for you. White bread, white rice, white pasta and other foods made with white flour can still be on the table! This is where protein and fat come in, which we’ll get to in a minute.

I encourage my clients with diabetes to consider what high fiber sources of carbohydrates they actually enjoy, and try to focus on those. For example, if you like potatoes, winter squash, beans, and whole grain bread, but HATE brown rice and whole grain pasta, focus on including the ones you like more frequently.

You can still eat white bread if you have diabetes. This BLT was paired with a tomato and cucumber salad. It might have been a bit more blood sugar friendly if it had more protein in it, but that’s OK!

Protein and Fat in Diabetes Management

Along with carbohydrates, don’t forget protein and fat. Both can help slow the absorption of glucose into the blood stream and lead to a more steady supply of energy, similar to fiber. This will help you avoid “roller coaster” blood sugar numbers. Consuming carbohydrates without protein and fat may lead to quick spike in blood sugar followed by a drop. If that drop gets too low, your body will release glucose from the liver to rescue you from hypoglycemia, which may result again in an elevated blood sugar. This chaotic pattern may leave you feeling pretty junky and fatigued.

Protein and fat are also important for a more filling meal, so pairing carbs with fat and protein is helpful for everyone, not just people with diabetes. Sources of fat include oils, nuts and seed, nut butter, butter, avocado, coconut, and dairy. Sources of protein include eggs, cheese, meat, poultry, beans, fish, nuts and nut butter

This fried rice has brown rice for carbs, tempeh for protein, sesame oil for fat, and carrots, cauliflower rice and peas for fiber.

Intuitive Eating for Diabetes: Find an Eating Routine that Works for You

There’s no right or wrong number of meals or snacks to eat each day for diabetes - different patterns work for different people with different schedules. But do try to eat something every 3-4ish hours. This advice is given to people without diabetes as well, because it is what most bodies need to run efficiently. When in touch with your hunger/fullness cues, you will likely find yourself feeling hungry every 3-4ish hours anyway. You can work within that framework of eating every 3-4 hours to find what works best for your schedule. This will help stabilize blood glucose levels, getting off the roller coaster glucose levels caused by irregular eating patterns. It will also help prevent extreme hunger and the resulting hypoglycemia, as well as overeating (and possible hyperglycemia) caused when you eat when you’re overly hungry.

Don’t stress if you miss the mark and go longer than that, or it for some reason you eat more frequently. Some days time can get by you and some days you might be more or less hungry than others. Instead, get curious. If you tend to go longer than 4-5 hours without eating, ask yourself why. For many people it is because life gets busy and it’s hard to take a moment to eat. The tendency to push hunger sensations to the side too often can lead to us not being able to recognize them at all. Sometimes you have to practice eating on a regular schedule before you can recognize feelings of hunger. If you tend to consistently eat more frequently than every 3 hours, it might be helpful to consider whether you’re eating enough, or whether your meals contain a good balance of fat, protein and carbs with fiber. Working with an RD can help you learn a more flexible structure for filling meals and snacks.

Balanced snacks are essential for diabetes management - and just being a non-hangry human being!

Stay Curious with Intuitive Eating for Diabetes!

When it comes to intuitive eating for diabetes, be curious, not judgmental! As I mentioned in Part 1 of Intuitive Eating for Diabetes, diabetes can behave differently on different days, and looks different on different individuals. Not all recommendations work as one size fits all! When you have a high or low blood sugar, think of it as a learning experience where you are getting to know your body better. No judgement needed. Like I said in part one, it is so important to give yourself grace and avoid placing blame on yourself when your blood sugars aren’t just where you want them. Remember, blood sugars are affected by things outside of food, like stress, sleep, physical activity, hormones, medications, etc. If your blood sugars are high are low, it doesn’t necessarily mean you ate something “wrong.” And even if the reason your blood sugars are high or low is due to something you ate, there’s still no reason for judgement - it can still be a place for curiosity and learning!

Don’t Be Afraid of Medication

If you’re finding yourself needing to engage in what feels like highly restrictive behaviors to keep your blood glucose under control, it may be time to advocate for changes to or the addition of medication. Engaging in disordered eating habits can also have damaging effects to your physical and mental health. Advocate to your health practitioner that your mental health is as important as your physical health, thus you shouldn’t have to sacrifice one to achieve the other. Medication can help you be more flexible around food, so don’t feel like an increase means you’ve failed. Having a HAES RD in your corner to help advocate for your health can also be helpful.

If you have a diagnosis of diabetes, I hope this was helpful for you! Because diabetes can be complicated and intuitive eating is a foreign concept in our diet-obsessed world, it may be helpful for you to work with a HAES and intuitive eating dietitian. We work with clients throughout the US and out of our Columbia, SC office, and would be happy to help you eat with confidence while managing diabetes. Learn more about our practice philosophy and reach out if interested in working together.