Written By Ava Froble, RDN
Reviewed by James Kelley, MD, MBA.
According to the CDC, more than 37 million Americans have diabetes. Of those millions, 90-95% have type 2 diabetes mellitus (T2DM). (1)
Diabetes care plans can be challenging to navigate, especially when it comes to understanding nutrition recommendations to best manage blood sugar and support optimal health outcomes. This article will review medical nutrition therapy recommendations for diabetes management and the potential benefits of Medically Tailored Meals (MTMs).
What is T2DM?
T2DM means the body has developed insulin resistance. Insulin is an important hormone that helps keep the body’s blood sugar at a stable level and transport energy (glucose) inside our cells. When the body becomes resistant to insulin, the hormone cannot be properly utilized for energy or managing blood sugar. While the exact causes of insulin resistance are unknown, genetic predisposition for T2DM, obesity, and/or physical inactivity can all contribute to insulin resistance. (2)
Individuals with T2DM must manage their blood sugar through nutrition and lifestyle changes, combined with medication and/or insulin injections. If diet is not considered throughout diabetes management, it could lead to dangerously low (hypoglycemia) or high (hyperglycemia) spikes in blood sugar and potentially adverse complications like renal failure, blindness, or heart disease later down the road. (3)
However, if improvements in nutrition and lifestyle are made (like increasing physical activity), individuals with T2DM can avoid long-term complications and go into remission. According to the American Diabetes Association, without taking diabetes medication, remission can be achieved if normal blood glucose levels are sustained for at least 3 months. (4)
Now, let’s consider nutrition recommendations for diabetes management.
Carbohydrates and the Divided Plate Method
Carbohydrates are the body’s main source of energy and are extremely important to all humans, with or without diabetes. Carbohydrates are starches, sugars, and fiber, which can be found in the form of pasta, bread/baked goods, chips, fruits and vegetables, whole grains, and dairy.
There are two different forms of carbohydrates: simple and complex.
Simple carbohydrates, such as white bread, chips/crackers, baked goods, apple sauce, and pasta are quickly absorbed into the blood stream and thus have an immediate impact on blood sugar (potentially causing a blood sugar spike).
Complex carbohydrates are richer in vitamins, minerals, and fiber. A few examples are whole grains (oatmeal, quinoa, barley, whole wheat bread, or whole wheat pasta) and starchy vegetables (peas, beans, corn, or potatoes). Non-starchy vegetables, like broccoli, dark leafy greens, tomatoes, and bell peppers, are also complex carbohydrates. However, non-starchy vegetables have a much lower carbohydrate content, and thus have less of an effect on blood sugar.
Fiber is an important component of diabetes management, as it can help to improve insulin sensitivity and slow the absorption of glucose into the bloodstream. The daily recommended fiber intake is around 25g for women and around 38g for men. (5)
Generally, people with diabetes should aim to eat well-balanced meals based on the Diabetes Plate Method, as recommended by the American Diabetes Association. (6) A sample meal based on this method could be: half a plate filled with oven roasted broccoli, bell pepper and onion; a quarter of the plate with grilled chicken breast (~3-4 oz); and the last quarter containing brown rice or a small baked sweet potato. This sample meal is rich in fiber from the non-starchy vegetables (important to promote insulin sensitivity), protein from the chicken (to maintain lean muscle mass), and carbohydrates (as needed to support the body’s energy needs).
This overview barely scratches the surface of an optimal eating pattern for diabetes management. Understanding and applying nutrition guidelines can be complex, stressful, and time-consuming – this is why resources such as ready-made meals have been developed to help people overcome barriers related to nutritious eating. MTMs provide a simple approach to supporting health needs for those with diet-related chronic conditions.
Medically Tailored Meals for Chronic Disease
Carbohydrate-controlled MTMs, in congruence with nutrition education, can help people more easily apply nutrition recommendations for diabetes management. MTMs also help break past nutrition barriers related to food insecurity, for people who cannot afford to eat food tailored to their conditions.
Considering food-insecure individuals are twice as likely to be diagnosed with T2DM, implementation of MTMs is a major step toward healthier communities. (7)
A 2017 study in San Francisco researched the impact of home-delivered meals on 53 food-insecure individuals with T2DM over a 6-month period. The 53 participants were given meals that met 100% of energy needs and the American Diabetes Association guidelines. The intervention resulted in improved diets (increased fruits and vegetables) and perception of self-management of diabetes, and decreased BMIs, HbA1c (average blood sugar over a 3-month period), emergency room visits, and hospitalizations. (7)
The study also found a great reduction in healthcare costs, lowering the cost of care per patient by an average of $1590.
As new cases of diabetes and other chronic illnesses are on the rise, it is encouraging to see the United States move toward a more preventative and whole-person approach to nutrition and healthcare. Access to nutrition education, quality food, and resources to live a healthy lifestyle are integral to management of chronic conditions. As Hippocrates once said, “Let food be thy medicine and medicine be thy food.”
Sources
- Type 2 Diabetes. Centers for Disease Control and Prevention Website. https://www.cdc.gov/diabetes/basics/type2.html#:~:text=Healthy%20eating%20is%20your%20recipe,them%20have%20type%202%20diabetes. Published April 18, 2023. Accessed June 8, 2023
- Insulin Resistance and Diabetes. Centers for Disease Control and Prevention Website. https://www.cdc.gov/diabetes/basics/insulin-resistance.html#:~:text=What%20Causes%20Insulin%20Resistance%3F,overweight%20to%20have%20insulin%20resistance. Published June 20, 2022. Accessed June 8, 2023.
- Type 2 diabetes. Mayo Clinic Website. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193. Published March 14, 2023. Accessed June 9, 2023.
- International Experts Outline Diabetes Remission Diagnosis Criteria. American Diabetes Association Website. https://diabetes.org/newsroom/press-releases/2021/international-experts-outline-diabetes-remission-diagnosis-criteria. Published August 30, 2021. Accessed June 9, 2023.
- Nutrition and healthy eating. Mayo Clinic Website. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948#:~:text=Women%20should%20try%20to%20eat,to%2038%20grams%20a%20day. Published January 5, 2021. Accessed June 9, 2023.
- Recipes & Nutrition – Eating right doesn’t have to be boring. American Diabetes Association Website. https://diabetes.org/healthy-living/recipes-nutrition. Accessed June 9, 2023.
- Rabaut LJ. Medically Tailored Meals as a Prescription for Treatment of Food-Insecure Type 2 Diabetics. J Patient Cent Res Rev. 2019 Apr 29;6(2):179-183.
