People with type 1 diabetes mellitus (T1DM) may find that one of the most challenging parts of their condition is figuring out what to eat. According to the American Diabetes Association (ADA), there is no single diet or eating plan that will benefit all people with T1DM. Current height and weight, activity level, medications and other illnesses are important considerations. Additionally, each person has a unique lifestyle and food preferences, and should be involved with the healthcare team in developing an individualized eating plan. The overall goals are to achieve healthy levels of blood glucose, blood fats and blood pressure while maintaining a healthy body weight.
The amount and type of carbohydrates in food affect blood glucose levels, but the ideal amount of daily carbohydrate intake differs among people with T1DM. The ADA recommends that people on a flexible insulin therapy program learn to count carbohydrates so that they can determine the right dose of insulin needed based on their carb intake. For those who are on a fixed dose of insulin daily, the ADA recommends eating the same amount of carbohydrates at about the same time each day. Carbohydrates that come from vegetables, fruits, whole grains, beans and dairy products are preferred over carbohydrates from sugar-sweetened beverages like soda and low-fat or nonfat products that are high in added sugar.
For people with T1DM and normal kidney function, the recommended amount of dietary protein is the same as for people who don’t have diabetes. For those with diabetic kidney disease, the ADA recommends keeping daily protein intake at 0.8 g/kg of body weight. Your dietitian can help you determine how this amount translates into daily portions of protein-rich foods. The ADA also recommends not consuming less than this amount since lower levels of dietary protein do not help with blood sugar control, reduce the risk of heart disease or halt declining kidney function. Examples of good sources of protein include lean meats, poultry and fish, low-fat or nonfat dairy products, and vegetarian protein sources, such as tofu and beans.
The ADA recommends that people with T1DM follow the same dietary guidelines for fat intake as those suggested for people without diabetes. Monounsaturated and polyunsaturated fats from foods like nuts, avocados and olive oil are healthier sources of fat than butter or lard, which contain high levels of saturated fat. The 2015-2020 Dietary Guidelines for Americans state that a healthy diet limits the amount of saturated fats to less than 10 percent of daily calories. Saturated fat is found mainly in animal food sources, such beef, pork, chicken with skin, whole milk, cream and cheese. Foods high in trans fats -- such as doughnuts, cookies, and cakes -- should also be limited to maintain a healthy diet.
The recommendation to limit daily sodium to less than 2,300 mg is the same for people with T1DM and the general population. People with T1DM who have high blood pressure, kidney disease or are over age 51 may benefit from a further reduction in sodium intake. In these situations, the ADA recommends determining the daily sodium limit on an individual basis. Most sodium in the diet comes from packaged, processed and fast foods, such as lunch meat, bread, canned soup or pasta, pizza and fast-food sandwiches. Limiting these foods and choosing fresh and whole foods is recommended to reduce dietary sodium.
Vitamins and Minerals
The ADA states that the best way to get adequate amounts of vitamins and minerals is to consume them from nutritious food sources, such as fruits, vegetables and lean protein foods. There is no evidence that people with T1DM benefit from adding vitamins and supplements to their diet if they do not have a deficiency. In fact, there may be some safety concerns with long-term use of antioxidant supplements such as vitamin E, vitamin C and carotene. In some circumstances, vitamins or mineral supplements may be recommended, such as prenatal vitamins for pregnant women, iron supplements for anemia and calcium supplements for osteoporosis prevention .
Alcohol can either raise or lower blood sugar in people with T1DM, depending on how much is consumed and whether it is consumed with food. Drinking alcohol can increase the risk of delayed hypoglycemia in people with T1DM, so knowing the signs and symptoms of low blood sugar and monitoring blood sugar after drinking alcohol are important. The ADA recommends that people with T1DM who choose to drink do so in moderation, meaning no more than 2 alcoholic beverages daily for men and 1 drink for women. One alcoholic beverage is defined as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits.