Nutrition Strategies for Controlling Type 2 Diabetes


Published: 17 December 2015

The most important part of diabetes education is teaching your patient how to handle their nutrition. Many diabetic people are hardwired to eat the worst things for their condition, and you may find a great deal of resistance to the idea of changing their diet. Fortunately, there are some simple ways to control diabetes from the standpoint of nutrition. It is always better to control this condition with diet than with medication or injections.

You can teach one of three types of diet strategies to your patient: carb counting, exchange lists or glycaemic index. What you teach them depends on which one you feel they will find easiest to comply with.

Counting Carbohydrates

Counting carbohydrates, or carb counting, may be the easiest way to teach a patient to control their blood sugar with diet. With the presence of nutritional information on the side of just about every food packet, it has become easier to know how many carbs the patient is eating. The American Diabetes Association recommends that patients start with 45 to 60 carbohydrates per meal. The amount per meal should be titrated to the blood sugar readings to determine the ideal amount of carbs for each patient.

The teaching should then focus on how many carbs to eat. These numbers may upset a patient who is used to eating what they want. It is also important to point out that the number of carbs is measured in portion sizes on the side of the box. Patients need to be reminded that they need to stick to the recommended portion sizes in order to control their carbohydrate intake. Increasing the protein in their meals can be a good way to control hunger without adding carbs.

Exchange Lists System


The exchange lists system is preferable for those who are very particular about their diets and who like to have a wide variety of foods to choose from.

The exchange method is an older method of helping diabetic people eat better, but it allows for a wide variety of foods. This method is preferable for those who are very particular about their diets and who like to have a wide variety of foods to choose from. It is also based on a calorie-counting system. For instance, if a physician prescribed an 1800-calorie diet, then using this food exchange list the patient can easily count how many calories they are taking in.

There are many types of food groups: starches, fruit, meat and fats. Starches on the list have 15g of carbohydrates and 80 calories, provided they are eaten in the portions indicated on the list. Half a bagel, three graham crackers and an 85-gram potato are all substitutable on this list.

The fruit section includes 15 carbs and 60 calories, and a patient can eat one small banana, 1/2 cup of fruit cocktail, or 1/2 cup of canned peaches. Milk can have 12g of carbohydrates and 8g of protein. Calories depend on the fat content of the milk. The vegetable lists and meat lists have no appreciable carbohydrates associated with them.

Finally, the fats group have 5g of fat and 45 calories. These should be used sparingly and include one teaspoon of olive oil, one tablespoon of low-fat margarine and one slice of bacon

Glycemic Index

Getting the patient to pick better carbs is the whole purpose of this method and it can help keep the patient from needing injections for longer.

For those who need slightly more fine-tuning of their carbohydrate counting, the glycaemic index method is a way to help lower blood sugar results. For instance, the carbs in a chocolate bar are much more likely to cause a blood sugar spike than the carbs in a slice of wholegrain bread. In essence, not all carbs are created equal, and this method can help to drive that home for the patient. It may complicate carb counting, but once the patient understands how to count carbs it may not be much of a jump into considering a food’s glycaemic index.

The glycaemic index is based on how much the blood sugar rises when compared to a standard, such as glucose itself or a slice of plain white bread. Each food is then given a score to determine how much the carb will impact the blood sugar.

Low glycaemic foods are those such as wholegrain bread, oatmeal, sweet potatoes and most fruits. They score 55 or less on the scale. Medium foods include whole wheat bread, quick oats and brown rice. Finally, high-scoring items that rate 70 or more include white bread, bagels, cornflakes, white rice and saltine crackers.

Getting the patient to pick better carbs is the whole purpose of this method and it can help keep the patient from needing injections for longer.

Supporting Your Patient

When a patient discovers they have type 2 diabetes, it is often a shock to them. They may have suspected the diagnosis based on their symptoms, yet knowing for sure might still be upsetting. This will be exacerbated if they have a history of diabetes in their family or if they know someone who has died because of the condition. In addition to education, you may need to provide emotional support as well.

In choosing the correct method for assisting your patient, you need to take into account how well they are coping with their diagnosis and what is likely to work for their lifestyle.

[show_more more=”Show References” less=”Hide References” align=”center” color=”#808080″]


American Diabetes Association; Carbohydrate Counting

University of Arkansas; The Exchange List System for Diabetic Meal Planning

American Diabetes Association: Glycemic Index and Diabetes