Living Well with Type 1 Diabetes

The current NHS advice on diabetes diet in 2022 in the UK emphasizes that no specific diet is required for individuals with diabetes.

Many individuals focus on the amount of carbohydrates in their meals and opt for a low-carb diet to control blood sugar levels.

The NHS (along with Diabetes UK) recommends a healthy, well-balanced diet that is low in fat, sugar, and salt, while also including plenty of fresh fruits and vegetables.

This guide evaluates the diet recommendations for individuals with diabetes and examines their practicality.

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The NHS offers the following dietary advice for individuals with diabetes: [147] [148]

• Include starchy carbohydrates with a low glycemic index (low GI)
• Increase the fiber intake in your diet
• Consume ample fruits and vegetables – at least 5 portions daily
• Reduce the intake of fat and saturated fat; opt for unsaturated fats
• Choose low-fat dairy products
• Opt for lean meat and avoid fatty processed meats
• Eat fish at least two times a week, with oily fish at least once
• Incorporate eggs and beans as sources of protein
• Cook food by grilling, baking, poaching, or steaming
• Avoid fatty or sugary snacks, and choose fruits, nuts, and low-fat yogurts instead
• Decrease sugar and salt consumption
• Limit alcohol intake
• Never skip breakfast
• Stay hydrated – aim to drink 1.6-2 liters of fluids daily

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Some of the recommendations have faced criticism from both patients and healthcare professionals.

Sensible advice includes consuming plenty of vegetables and fruits, reducing sugar and processed meat intake, consuming fish, and cutting down on alcohol.

However, some recommendations may lead to poorer dietary choices.

The NHS has endorsed the Low Carb Program to provide structured education and support to individuals with type 2 diabetes.

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The NHS suggests structuring meals around starchy carbohydrates, which might impact blood sugar levels.

Starchy carbohydrates can trigger issues with insulin resistance in individuals with type 2 diabetes.

Recommending a reliance on carbohydrates could exacerbate problems with insulin resistance.

Individuals with type 1 diabetes may benefit from a diet low in carbohydrates.

• Learn more about the discussion regarding NHS carbohydrate advice

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The NHS recommends reducing saturated fat intake without specifying sources.

Natural sources of saturated fat are regarded as healthy.

The NHS should advocate for reducing intake of processed fat sources that are high in calories.

Research into fat in the news

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Consuming full-fat dairy products has demonstrated health benefits compared to low-fat options.

Some low-fat products contain added sugar, salt, or artificial additives.

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Fruit, when consumed in moderation, is a healthy component of the diet.

Whole fruits are preferred over fruit juices due to their higher fiber content.

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Healthcare professionals have raised concerns about the diet recommendations for individuals with diabetes.

The Mediterranean diet presents a common ground between critics and the NHS.

The Mediterranean diet emphasizes fresh, unprocessed foods with natural fats.

Regularly monitoring blood glucose levels is crucial for most individuals.

Aim to check levels at least four times a day and keep them within the ideal ranges.

Video: How to check blood glucose level

Important: Diabetes and driving

If you drive, inform the DVLA about your diabetes and insulin use.

Adhere to DVLA regulations regarding blood glucose checks before and during driving.

Find out more

Carb counting

Understanding the carbohydrates in your diet is essential for managing blood glucose levels.

Explore carbohydrate counting through diabetes courses or applications.

Find out more

Taking insulin

Adjusting insulin doses based on your lifestyle and blood glucose levels is necessary when taking insulin.

Your diabetes nurse can provide guidance on the correct use of insulin pens or pumps.

Video: How to inject insulin

Learn more

Recognising and treating hypoglycaemia (hypos)

Hypoglycemia occurs when blood glucose levels drop too low.

Recognize the symptoms and promptly treat hypoglycemia.

Learn more about treating hypoglycemia.

– including steps to treat hypoglycemia

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Managing blood glucose levels is essential for individuals with type 1 diabetes.

It is crucial to always have quick-acting substances, such as sugary drinks, sweets, or glucose tablets, to raise blood glucose levels. Ensure that your family and friends can identify and respond to hypoglycemia. Carry medical identification, such as a bracelet or card indicating type 1 diabetes. Be mindful of when you may need to check blood glucose levels more frequently, such as in hot weather or during menstruation. Check blood glucose levels before, during, and after exercise – you may need to increase carbohydrate intake and decrease insulin dosage to prevent hypoglycemia. Consider obtaining a continuous glucose monitor if you do not already have one. Follow guidelines for managing illness and adjusting insulin dosage. Inform medical personnel of your type 1 diabetes and insulin usage if you require hospitalization or surgery. When traveling internationally, carry a diabetes-related letter and follow advice on traveling with insulin. Reach out to your diabetes team with any inquiries or concerns. Avoid excessive alcohol consumption and adhere to recommended guidelines. Manage type 1 diabetes by planning for school, work, travel, dining out, and physical activity. With appropriate treatment and support, you can lead a normal life. Stay vigilant to prevent long-term complications such as heart disease, nerve damage, and eye issues. Manage blood glucose levels to minimize the risk of complications and other autoimmune diseases. Expect an improved quality of life with advances in diabetes treatment and technology.

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Ensure that you manage your blood glucose levels before and during pregnancy to promote the health of both you and your baby. Seek additional support and care from your diabetes team when planning for pregnancy. Diet plays a crucial role in managing type 1 diabetes. Make healthier food choices by selecting options lower in saturated fat, sugar, and salt to manage blood fats, pressure, and attain a healthy weight. Consult with a registered dietitian for tailored advice and meal plans. Depending on your insulin regimen, you can be flexible with your carbohydrate intake and meal schedules. Carb counting aids in stabilizing blood sugar levels and allows for a wider range of food choices and mealtime flexibility. Maintain a balanced diet with healthier carbohydrate options and practice portion control. Include five servings of fruits and vegetables, and substitute low-fiber carbohydrates with whole grain varieties. Look for high-fiber options on food labels. Consider meal suggestions like whole grain cereal with milk, eggs and whole grain toast, unsweetened yogurt with fruit, sandwiches on whole grain bread, bean salads, or nutritious soups with crispbreads.

To help manage blood glucose levels, consider consuming a small snack between meals. However, be mindful of portion sizes to effectively manage your weight. Opt for healthier snack choices like unsweetened yogurt, unsalted nuts, seeds, fruits, and vegetables, instead of unhealthy snacks like chips, biscuits, and chocolates.

This section provides information on managing food, physical activity, and glucose levels in diabetes. Children’s diabetes dietitians are available to educate you on these aspects and provide personalized advice tailored to your needs.

Additionally, you can access videos and websites for more information. Follow-up appointments with dietitians will be scheduled as needed after your hospital discharge.

Consider downloading the Digibete app, supported by the NHS, for diabetes management guidance. Use clinic code 6EUXO to access the app.

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Type 1 diabetes (T1D) results from the pancreas’s inability to produce insulin, which is essential for regulating blood glucose levels, muscle function, and growth. Carbohydrates are converted into glucose in foods, which is then transported to body cells for energy production under the influence of insulin.

Insulin acts as a key to facilitate glucose entry into cells. Without insulin, symptoms such as fatigue, excessive thirst, frequent urination, and weight loss may occur.

In addition to managing glucose levels, insulin plays a vital role in tissue growth and repair.

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Managing type 1 diabetes involves replacing insulin through injections or an insulin pump, alongside the use of continuous glucose monitoring (CGM) systems. Background insulin is crucial for maintaining cell function, while meal-related insulin is produced to regulate rising glucose levels.

• Insulin Pump: Use a hybrid closed-loop system to deliver continuous, customizable insulin doses based on glucose monitoring. Fast-acting insulin is administered before meals.
• Injections: Administer long-acting and fast-acting insulin based on glucose levels and meal content. Calculate insulin doses using a bolus calculator.

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Effective management of food, physical activity, and diabetes requires:

• Consuming a well-balanced diet
• Engaging in daily physical activity
• Following a meal routine with consistent insulin administration
• Consistently monitoring glucose levels
• Understanding how diet and activity impact glucose levels

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Children and adolescents diagnosed with type 1 diabetes have the opportunity to indulge in a wide range of foods as long as they focus on a well-rounded diet that is packed with essential nutrients. Opting for healthier food choices not only helps in managing blood sugar levels but also promotes overall health and well-being. While treats can still be enjoyed, it is important to consume them in moderation while taking insulin.

Foods play a crucial role in providing the necessary nutrients for growth, development, weight management, and heart health. Making wise food choices most of the time without completely restricting any specific food items is key.

• Carbohydrates
• Proteins
• Fats
• Vitamins and minerals
• Fiber

What is healthy eating?

Food groups can be divided into five categories according to the Eatwell guide, aiming for a well-balanced diet by including various food groups in appropriate proportions. Starchy foods, fruits, vegetables, dairy, proteins, and healthy fats all contribute to a diet that is rich in nutrients. Limiting non-essential foods like chocolates and biscuits to occasional treats is recommended.

Staying well-hydrated by drinking enough water, particularly when blood sugar levels are high, is important. The dietary needs of children vary depending on their age, activity level, and gender.

Tips for eating well and having good routines

• Start the day with a nutritious breakfast containing slow-absorbing carbohydrates and protein.
• Have three balanced meals that include starchy foods, fruits, vegetables, and whole grains.
• Allow a gap of at least two hours between meals and avoid eating overnight to manage weight.
• Avoid consuming milk and fruit juice between meals to control blood sugar levels.
• Limit sweet treats to post-meal occasions and refrain from daily intake.
• Keep mealtime durations to a maximum of 30-40 minutes with minimal distractions.
• Establish a consistent bedtime routine for optimal growth and overall health.

Which foods affect your glucose levels?

Foods rich in carbohydrates have a significant impact on blood sugar levels, affecting post-meal glucose readings. The type of carbohydrate and the composition of the meal also play a role in determining the body’s response to glucose.

What is carbohydrate counting?

When administering insulin, it is important to align it with carbohydrate intake. Carbohydrate counting allows individuals to adjust their insulin doses based on the amount of carbohydrates consumed. Considering the protein, fat, and fiber content in addition to carbohydrates is essential for accurate insulin dosing.

Carbohydrate counting is beneficial for maintaining stable glucose levels and preventing fluctuations in blood sugar.

Glucose targets and ranges

Aim for blood glucose levels between 3.6-6.9mmol/L during fasting and pre-meal periods, and below 9mmol/L after meals. Ideal glucose levels for individuals without diabetes range from 3.6-6.9mmol/L.

It is important to monitor blood glucose levels within the range of 3.9-10mmol/L and avoid prolonged periods below 3.9mmol/L. Fluctuations in glucose levels are common, even in individuals without diabetes.

What will you see on your sensor when you eat?

After consuming food, blood glucose levels naturally rise, with certain foods causing a quicker increase than others. The rise in glucose levels should be under 9mmol/L 2-3 hours after meals, aiming to keep the increase below 3mmol/L. If glucose levels rise excessively, adjustments in insulin dosage may be necessary.

• The insulin dosage may not always match the amount of carbohydrates consumed.
• Insulin may start working before food is eaten.

Meals containing fats or proteins might lead to delayed rises in glucose levels. Carbohydrate counting helps in adjusting insulin doses according to carbohydrate intake. Utilize digital scales, portion cups, the Carbs & Cals book, and app for assistance.

How to carbohydrate count

Carbohydrates are present in foods that contain starch, natural sugars, and added sugars. With the exception of glucose itself, all carbohydrates are converted into glucose after consumption. It is important to count the carbohydrates to match the insulin doses.

Be aware of the carbohydrate content in grains, starchy vegetables, legumes, fruits, dairy/milk, and sugary foods. Non-carbohydrate foods such as vegetables, certain fruits, dairy, proteins, and fats do not need to be counted but can impact glucose levels.

1. Which foods contain carbohydrate?

For accurate carbohydrate counting, it may be necessary to weigh or measure portions. Use the Carbs & Cals book/app, food labels, restaurant information, or other apps to determine the carbohydrate content.

To ensure precise calculations, use known carbohydrate content and portion size to calculate your servings accurately. Adjust for cooking methods and utilize standard measurements. Restaurants and the Carbs & Cals app can provide assistance when dining out.

Expect higher fat and protein content in restaurant meals, which can affect glucose levels and require different insulin doses compared to homemade dishes.

How to carbohydrate count a recipe

Preparing homemade meals is a healthier choice than relying on store-bought options since you have control over the ingredients. Utilize information from Carbs & Cals® for carbohydrate counting and increasing fiber intake. Initially, cooking and counting carbohydrates may seem challenging.

Information from Carbs & Cals® is valuable for a variety of foods. Enter the weight of homemade portions into the app to calculate carbohydrates. Diabetes dietitians can assist with analyzing recipes.

To calculate the carbohydrate content of a recipe, identify the ingredients that contain carbohydrates, calculate the total amount, and divide by the number of servings. For example, the carbohydrate content per serving of a lasagna recipe is 39g.

3. How to work out your insulin dose

Determine the insulin dose based on the carbohydrate content of the food. Your insulin-to-carbohydrate ratio may vary with each meal. Adjust the ratio if blood sugar levels are not within the target range 2 hours after eating.

The insulin-to-carbohydrate ratio indicates how many grams of carbohydrates are covered by one unit of insulin. Use a bolus calculator programmed with the ratio for precise dosing.

Changes to the bolus calculator may be necessary over time due to growth or lifestyle changes. The app myLife can assist with calculating insulin doses.

4. Glycaemic index (GI)

The glycemic index (GI) measures how quickly a food affects blood glucose levels. Foods with a low GI, such as beans, may require less insulin, while those with a high GI can cause rapid spikes in glucose levels.

Including whole grains, low-fat, and low-GI foods in your diet can help in maintaining stable glucose levels. Educate yourself further on the glycemic index for improved meal planning.

5. Mixed meals

Proteins and fats do not have an immediate impact on blood glucose levels but may affect them over time, especially in larger quantities. The carbohydrate-to-insulin ratio should account for the impact of regular portion sizes.

Meals rich in fats or proteins may lead to elevated glucose levels 3-5 hours after eating, requiring additional insulin. Identify and adjust for such meals with the help of Carbs & Cals®.

Activity and lifestyle

Leading an active lifestyle involves reducing sedentary behavior and engaging in daily physical exercise. Individuals between the ages of five to eighteen should aim for at least 60 minutes of activity each day, with a maximum of two hours of screen time or sitting.

• Boosts self-esteem and social skills.
• Enhances coordination.
• Improves overall health, fitness, and quality of sleep.
• Enhances school performance and attention span.
• Strengthens bones and muscles, promotes healthy weight management, and enhances mood.

Children with diabetes should follow these guidelines with the support of their families for activity suggestions.

What types of activity?

Engaging in any form of movement is beneficial! Strive to incorporate at least 10 minutes of moderate to vigorous activity daily to reach the recommended 60 minutes. Activities like brisk walking are advantageous for glucose levels as they utilize glucose in the muscles as fuel.

Activity and diabetes

Physical activity facilitates the movement of glucose into muscles, reducing blood glucose levels during and after exercise. Regular activity may potentially decrease the need for insulin. Keep a record of how physical activity impacts your glucose levels for better management.

Intense physical activities may pose challenges in managing blood glucose levels. Consult specialists for guidance on exercise and diabetes management.

When starting to be physically active:

• Always carry your Diabetes ID.
• Check blood glucose levels before starting and have snacks if levels are below 7mmol/L.
• Adjust insulin doses according to activity levels.
• Carry water and snacks for during exercise.
• If you have eaten within 90 minutes before exercise and taken your usual insulin, you may need an extra snack during the activity.
• If using an HCL system, activate the activity mode 1-2 hours before planned exercise or immediately at the beginning of unplanned activity.
• If planning to exercise after a meal, reduce your insulin dose before eating by 25-33% with HCL or 25-50% with injections.
• Monitor glucose levels every 30 minutes during exercise and have a snack if levels drop.
• If using an HCL system, deactivate the activity mode after exercise.
• For late afternoon or evening activities lasting over 60 minutes, have a bedtime snack with carbohydrates and protein, such as fruit and yogurt, with reduced insulin.
• Review sensor glucose profiles to understand the effects of exercise on glucose levels and make adjustments if necessary.
• Regularly monitor blood glucose levels to understand the impact of physical activity on your body.

Snacks for activity

To maintain stable blood glucose levels during exercise, consider consuming additional carbohydrate snacks in the following situations:

– When there is no reduction in mealtime insulin before exercise or if active insulin falls within the target range.

– When blood glucose levels are between 5 and 10mmol/L, planning for over 60 minutes of activity, and experiencing a drop in levels before exercise.

Examples of exercise snacks:

• Sports drinks (for activities lasting over 60 minutes)
• Fruits/dried fruits
• Jelly sweets
• Jaffa cakes
• Cereal bars

How much do you need?

If you have taken insulin within 2 hours before exercise, consume 7-20g of carbohydrates to stabilize blood glucose levels based on your individual levels and trends.

For hybrid closed loop systems, begin with 7-10g snacks every 20-30 minutes; for injections or manual pumps, start with 10-15g snacks every 20-30 minutes.

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