Type II diabetes mellitus (most often referred to as type II diabetes) is a disease in which your pancreas does not produce enough insulin (a hormone that helps our body maintain healthy blood sugar levels), or your body does not properly use the insulin it makes. As a result, glucose (sugar) builds up in your blood instead of being used for energy(1). ‘Blood sugar’ and ‘blood glucose’ are often used interchangeably.
Your body gets glucose from foods that contain carbohydrates (we’ll refer to these as carbs for this post), such as bread, potatoes, rice, pasta, milk and fruit. You body breaks down these carbs into glucose. To use this glucose, your body needs insulin.
If left untreated or improperly managed, diabetes can result in a variety of complications, including heart attack, stroke, kidney failure, blindness, problems with erection (impotence) and amputation1.
What Causes Type II Diabetes?
In a healthy person, the pancreas (an organ behind the stomach) releases insulin to help the body store and use the sugar from the food you eat. Diabetes happens when one or more of the following occurs:
• When the pancreas does not produce any insulin.
• When the pancreas produces very little insulin.
• When the body does not respond appropriately to insulin, a condition called “insulin resistance.”
Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin; however, the insulin their pancreas secretes is either not enough or the body is unable to recognize the insulin and use it properly (insulin resistance). When there isn’t enough insulin or the insulin is not used as it should be, glucose (sugar) can’t get into the body’s cells and builds up in the bloodstream instead. When glucose builds up in the blood instead of going into cells, it causes damage in multiple areas of the body. Also, since cells aren’t getting the glucose they need, they can’t function properly(1).
To understand why insulin is important, it helps to know more about how the body uses food for energy. Your body is made up of millions of cells. To make energy, these cells need food in a very simple form. When you eat or drink, much of the food is broken down into a simple sugar called “glucose.” Then, glucose is transported through the bloodstream to these cells where it can be used to provide the energy the body needs for daily activities.
While not everyone with type 2 diabetes is overweight, obesity and lack of physical activity/a sedentary lifestyle are two of the most common causes of this form of diabetes.
Type II diabetes is also believed to have a strong genetic link, meaning that it tends to run in families (2,3).
Other type II diabetes risk factors include the following: ,
• High blood pressure
• High blood triglyceride (fat) levels
• Gestational diabetes or giving birth to a baby weighing more than 9 pounds
• A diet that contains a high amount of refined sugars and carbs
• High alcohol intake
• Ethnicity: Certain groups, such as African Americans, Native Americans, Hispanic Americans, and Asian Americans, have a greater risk of developing type II diabetes.
• Aging: The risk of developing type II diabetes begins to rise significantly at about age 45, and rises considerably after age 65.
With a proper diabetes diet and healthy lifestyle habits, along with diabetes medication, if necessary, you can manage type II diabetes just like you manage other areas of your life
What are healthy blood sugar levels for people with diabetes?
If you have diabetes, you should try to keep your blood glucose (sugar) as close to target range as possible. This will help to delay or prevent complications of diabetes.
The following are the typical target ranges for those with diabetes:
Fasting blood glucose/ blood glucose before meals (mmol/L) – 6.0 to 8.0
Blood glucose two hours after eating (mmol/L) – 6.0 to 10.0
Risk of hypoglycemia (low blood sugar) (mmol/L) – Less than 4.0
Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to assist your body in controlling blood glucose more effectively.
If you are unable to keep your blood sugars within the target ranges, your doctor will typically prescribe medications to help keep blood sugar levels in check.
The most common medications include(5):
• Metformin (Glucophage, Glumetza, etc.) – most commonly the first medication prescribed, these work by improving insulin sensitivity and helping your body use insulin more effectively.
• Sulfonylureas – help your body to secrete more insulin.
• DPP-4 inhibitors – help reduce blood sugar levels, but tend to have a modest effect.
• GLP-1 receptor agonists – slow digestion and help lower blood sugar levels
Some people who have type 2 diabetes need insulin therapy as well. In the past, insulin therapy was used as a last resort, but today it’s often prescribed sooner because of its benefits.
Because normal digestion interferes with insulin taken by mouth, insulin must be injected. Depending on your needs, your doctor may prescribe a mixture of insulin types to use throughout the day and night. Often, people with type 2 diabetes start insulin use with one long-acting shot at night.
Insulin injections involve using a fine needle and syringe or an insulin pen injector — a device that looks similar to an ink pen, except the cartridge is filled with insulin.
There are many types of insulin, and they each work in a different way.
Options include (6):
|Types of Insulin and How They Work|
|Insulin type||How fast it starts to work (onset)||When it peaks||How long it lasts (duration)|
|Rapid-acting||About 15 minutes after injection||1 hour||2 to 4 hours|
|Short-acting, also called regular||Within 30 minutes after injection||2 to 3 hours||3 to 6 hours|
|Intermediate-acting||2 to 4 hours after injection||4 to 12 hours||12 to 18 hours|
|Long-acting||Several hours after injection||Does not peak||24 hours; some last longer|
Discuss the pros and cons of all medications with your doctor.
Nutritional Management of Type II Diabetes
Adopting a healthier lifestyle and managing blood glucose levels can help prevent or control type II diabetes, and can significantly reduce complications such as heart disease, stroke, kidney disease, etc.
Traditional Nutritional Management
Traditionally, diabetes is managed by a diet that gives a certain amount of carbs in grams per meal and snack. This is typically referred to as carb counting (7).
*The general guidelines are:
Women: 45 grams of carbs per meal and 15 grams of carbs per snack
Men: 60 grams of carbs per meal and 30 grams of carbs per snack
*These guidelines are flexible depending on factors such as the age, weight, height, and activity level of the person following the plan.
Given with this diet, is a list of carb-containing foods, and how much of that food would give you 15 grams of carbs. This is referred to as the carb exchange list, which makes it easier for people to ensure that they are getting the recommended amount of carbs per meal and snack.
Examples of ‘carb exchange’ foods that contain 15g of carbs:
• ½ cup of cooked beans, peas or lentils
• ½ cup cereal
• ½ a bagel
• 1 slice of bread
• 3 cups of plain popcorn
• 5 crackers
• ½ cup fresh fruit
• 1 cup of milk
• ¾ cups yogurt
Additional Nutrition Recommendations for Blood Sugar Management:
• Have a variety of carbs per meal. For example, have one carb choice that is a grain or complex carb, one that is a fruit, and one that is dairy; rather than having all 45g come from bread or grain products.
• Choose mostly low glycemic index, or ‘complex’ carbs that are higher in fibre (such as whole grains, quinoa, beans, sweet potato, etc.)
• Include a protein source with each meal and snack.
• Not go longer than 4-6 hours between meals (blood sugar can drop too low), but also not eat meals too close together (blood sugar can build up and get too high).
• Monitor blood sugar levels and work with your healthcare team to identify how your body responds to food and to ensure that your blood sugar levels stay at healthy levels.
The above diet and recommendations have been traditionally used to maintain optimal blood glucose levels for someone with diabetes.
Also, the diet should promote weight loss, which in and of itself helps to improve insulin sensitivity and maintain healthy blood sugar levels.
Low Carb Diets and Type II Diabetes
There has been emerging support over the past several years for a low carb diet (LCD) or a very low carb diet (VLCD) in the nutritional management and sometimes complete reversal of type II diabetes (8,9). Again, carbs are broken down by the body into sugar, directly leading to high blood sugars. Eat fewer carbohydrates and you will typically end up with less sugar in your blood.
Before you start a low-carbohydrate diet, talk with your healthcare provider. If you are taking blood sugar-lowering medications, or type I diabetes, then eating fewer carbohydrates without lowering your medication dosage may cause dangerous low blood sugars.
A low-carb diet limits foods that are high in carbohydrate such as grains (breads, pasta, rice, tortillas) and sweets (cookies, cakes, sugary drinks, fruits) and starchy vegetables (potato, carrots, beets).
There is no one way to follow a low-carb diet. Generally, people try different amounts of carbohydrates until they reach an amount per day that works for their energy, taste preferences and blood sugar levels. Some people with diabetes on a low-carb diet eat as few as 20 grams of carbohydrates per day while others may eat up to 100 grams.
Many people on a low-carb diet eat a wide variety of foods and simply replace or limit grains or starchy vegetables and fruits to small portions once or twice a day. They fill up on non-starchy vegetables, healthy fats, and protein sources instead.
A simple way to start getting the hang of low-carb eating is to learn how to build your plate.
First, make sure you have some kind of source of protein like grilled chicken, fish, tofu, or red meat. Then add a serving of low-carb vegetables like broccoli or add a leafy green salad. Then depending on how few carbs you plan on eating, add one more serving of something else:
• Very low-carb eaters may add something like a serving of nuts or olives–something that contains fat and very little carbs.
• Other low-carb eaters may avoid grains but add in a portion of a root vegetable like carrots or sweet potato, or they may add tomatoes, some lower-carb fruit, or some legumes.
• Still other low-carb eaters may choose to add a serving of whole grains. The best types are unprocessed like brown rice, quinoa, bulgar, barley, millet and sorghum. It helps to omit or limit processed or refined grains like white pasta, wheat bread, wheat or corn tortillas, and oatmeal.
The key is to try different quantities of different foods and check your blood sugar to see how it responds to the way you are eating. You also want to have enough energy and be satiated after a meal. Filling your plate with plenty of protein, healthy fat and fiber tend to make a very satisfying meal.
What diet should you try?
Evidence is inconclusive for an ideal amount of carbohydrate intake for people with diabetes, because different diets work for different people.
There are studies that show that people with diabetes can achieve success on both low-carbohydrate and high-carbohydrate diets(10). Those pursuing high-carb diets are often recommended to follow a more vegetarian or vegan diet, or the Mediterranean diet that are high in complex carbohydrates, protein and fiber.
Sample Meal Plans
Sample Carb Counting/Carb Exchange Meal Plan:
(This is an example of a plan that has 45 grams of carbs per meal)
1) ½ cup cooked porrdge, with 1 tbsp sultanas, with ½ cup of milk and one boiled egg on the side (or scramble egg into the oatmeal)
2) ½ an English muffin with 1 tbsp peanut butter and ½ a banana, with three slices of turkey bacon
3) ¾ cup plain yogurt with ½ cup berries, 1 tbsp raisins and 1 tbsp of sliced almonds
4) 1 slice of whole grain toast with ½ an avocado and a fried egg, 1 cup of milk and one ½ cup fruit
Lunch and Dinner Options:
1) 2 slices whole grain bread or 1 whole grain wrap with 120g sliced turkey or chicken breast, lettuce, spinach, sliced tomato, 1 tbsp light mayo, and 1 small apple (for vegetarian, omit apple and have ½ cup black beans or chickpeas instead of meat)
2) 2/3 cup cooked wild rice, 1 cup of milk, 1 cup cooked broccoli with chicken or fish or tofu and a small fruit on the side
3) Green salad with a handful of lettuce or spinach, chicken, ½ cup cooked quinoa, ½ cup berries, ¼ an avocado and a glass of milk
4) 2 small corn tortillas, ½ cup refried beans, 2 tbsp guacamole, shredded lettuce, 2 tbsp salsa and 2 tbsp plain Greek yogurt or sour cream
Snack Options: (15 grams carbs per snack)
1) 3 cups plain popcorn with 2 tbsp unsalted nuts
2) 1 small apple with 2 tbsp nut butter
3) 1 slice of whole grain bread with nut butter
4) 5 whole grain crackers with cheese
5) ¾ cup yogurt with 2 tbsp unsalted nuts
Sample Low Carb Meal Plan:
1) Chia seed pudding with 2 tbsp unsalted almonds and a handful of berries
2) Two egg muffin cups with three slices of turkey bacon
3) Omelet with various vegetables, fried in butter or coconut oil
4) Bacon, and eggs scrambled with a handful of spinach
1) Smoothie with coconut milk, berries, almonds and protein powder
2) Green salad with chicken or fish, 2 tbsp nuts and/or seeds and olive oil dressing
3) Hamburger without the bun with a green salad and olive oil dressing
4) Steak or grilled chicken or fish with 1-2 cups steamed veggies (or sautéed in olive or coconut oil)
1) Plain Greek or Icelandic (lower carb) yogurt with ½ cup berries and 2 tbsp unsalted nuts
2) A boiled egg and handful of nuts
3) A piece of fruit with 2 tbsp nut butter
4) Deli meats with 1-2 oz cheese
5) Tuna mixed with avocado, lemon juice, salt and pepper wrapped in a lettuce leaf
1 – Diabetes Australia (2015). What is Diabetes? Available from: https://www.diabetesaustralia.com.au/what-is-diabetes
2 – Diabetes Australia (2015). Type 2 Diabetes. Available from: https://www.diabetesaustralia.com.au/type-2-diabetes
3 – World Health Organization (2017). Diabetes. Available from: http://www.who.int/mediacentre/factsheets/fs312/en/
4 – Diabetes Australia (2015). Blood glucose monitoring. Available from: https://www.diabetesaustralia.com.au/blood-glucose-monitoring
5 – Joslin Diabetes Center (2018). Oral Diabetes Medications Summary Chart. Available from: http://www.joslin.org/info/oral_diabetes_medications_summary_chart.html
6 – American Diabetes Association (2018). Insulin Basics. Available from: http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-basics.html
7 – Diabetes Australia. National Diabetes Services Scheme (2016). Carbohydrate Counting and Diabetes. Available from: https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/685c04ca-60d7-49bc-b596-09cc29d61a1b.pdf
8 – Gannon, M. C., & Nuttall, F. Q. (2004). Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes. Diabetes, 53(9), 2375-2382. Available from: http://diabetes.diabetesjournals.org/content/53/9/2375.short
9 – Yancy, W. S., Foy, M., Chalecki, A. M., Vernon, M. C., & Westman, E. C. (2005). A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutrition & metabolism, 2(1), 34. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
10 – Dyson, P. (2015). Low Carbohydrate Diets and Type 2 Diabetes: What is the Latest Evidence? Diabetes Therapy, 6(4), 411–424. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674467/