Nutrition Education for Diabetic Patients

Nutrition Education for Diabetic Patients

As incidence rates of diabetes and prediabetes rise, nurses will find themselves communicating with this patient population more often. How should nurses educate their patients on healthy nutrition for diabetes? 

More than 37 million people in the United States have diabetes, while more than 96 million US adults have prediabetes. Of those 96 million, more than 80% don’t know they have it. As of 2023, the Centers for Disease Control and Prevention estimate that diabetes is the eighth leading cause of death in the U.S. 

Recommended course: Diabetes Prevention and Management for Healthcare Professionals  

Despite its severity, patients can control and manage diabetes. Management practices include physical activity and proper dieting, in addition to the use of insulin and other medications.  

As the number of patients living with this disease continues to increase, nurses will continue to find themselves with opportunities to educate people on maintaining healthy eating habits as an adjunct to their ongoing care. 

Why is nutrition important for diabetes? 

According to CDC officials, there are a number of day-to-day triggers for elevating blood sugar that many patients ignore. These include lack of sleep, nose sprays and sunburn. There are also common food and drink culprits, such as artificial sweeteners and coffee/caffeine (with and without sweeteners), processed foods and starches. 

Additionally, skipping breakfast can increase blood sugar after lunch and dinner are consumed, and dehydration can result in a higher blood sugar concentration. The CDC recommends paying special attention to a few key areas: 

  • Carbohydrates 
  • Fats and cholesterol 
  • Proteins 
  • Vitamins and minerals 
  • Alcohol 

Nutrition for diabetes patients 

When it comes to carbs, the most should come in the form of fiber, advises the CDC. Examples include whole-grain breads and cereals, dried beans and peas, vegetables and fruits. 

Nurses should recommend fat-free foods to their diabetic patients as much as possible. Fruit juices should be limited to no more than 4 ounces daily. Patients should avoid fatty and high-cholesterol fried foods, as well as high-fat dairy, butter, margarine, and bacon. If they choose to eat nuts, advise them to choose unsalted nuts and limit the total consumed. Too much protein can lead to kidney disease more quickly, CDC officials warn. 

Research suggests that proteins from plants may be better than those from animals. Combine small portions of meat, fish or poultry (no more than 3 ounces at a sitting) with beans, peas, vegetables, fruits, grains, tofu and other soy products. Consider consulting a physician and/or nutritionist before adding vitamin or mineral supplements, as too high of a dosage may be harmful. 

Nurses should advise patients who drink alcohol to have only one beverage per day. They should consult a physician as well, since alcohol consumption can increase the risk of hypoglycemia. Patients with diabetes should never drink alcohol without eating something at the same time and should not drink alone. 

How to plan a meal for a diabetic patient 

According to officials with the American Diabetes Association (ADA), meal-planning education for patients should include instruction on the timing of meals along with how much to eat and which foods to choose.  

Meal plans should also take into account the patient’s likes, dislikes and lifestyle. It should serve as a guide to help meet any personal weight and blood glucose goals. A healthy eating plan will establish good eating patterns that are easy to follow in the long term. Examples of eating patterns include a Mediterranean diet, vegetarian (or vegan), low-carb, or low-fat. 

The Mediterranean style focuses on mostly plant-based foods and locally grown foods. Mall amounts of dairy are available, (for example, cheese, yogurt, fish and poultry). Olive oil is the main source of fat. Red meat is limited. Patients can consume wine in small amounts (1-2 glasses per day) with meals. 

The vegetarian eating pattern is also based on plant foods and meat substitutes with little or no animal products. Rich in vitamins, minerals and fiber, this diet is also lower in saturated fat and cholesterol. Within the vegetarian patterns are: 

  • Vegan, which calls for the avoidance of all meat, poultry, fish and seafood, eggs, and dairy products; lacto-vegetarian, which calls for no meat, poultry, eggs, fish or seafood 
  • Lacto-ovo vegetarian, which is similar to the lacto-vegetarian pattern but includes dairy products and eggs 
  • Low-carbohydrate, which focuses on non-starchy vegetables such as broccoli, green beans, kale, salad greens and protein foods like meat, poultry, fish, shellfish, eggs, cheese, nuts and seeds, fats (oils, butter, olives and avocado) 
  • Low-fat eating, which includes vegetables, fruits, starches, lean protein (such as chicken and turkey without the skin, fish and low-fat dairy products) 

According to the ADA, this eating pattern has been shown to improve heart health when overall calorie intake is reduced and weight loss occurs. 

Nutrition counseling for diabetes patients 

According to clinicians at the Mayo Clinic, incorporating a few dietary do’s and don’ts into a patient’s diet can help them manage the disease progression. For starters, encourage patients to eat three meals daily at regular, consistent times in an effort to assist the body in effectively using the insulin it produces or receives through medication. 

Recommended foods include “healthy” carbohydrates, foods that are high in fiber, “good” fats and certain types of fish considered to be “heart healthy,” such as cod, tuna, halibut, salmon, mackerel, sardines and bluefish. Cod, tuna and halibut tend to have less total fat, saturated fat and cholesterol than meat and poultry. 

Additionally, tuna, as well as salmon, mackerel, sardines and bluefish are high in omega-3 fatty acids, which promote heart health by lowering triglycerides. Fish can serve as a substitute for high-fat meats. Experts recommend that diabetic patients eat fish of the heart-healthy variety at least twice per week. 

Food to avoid with diabetes 

Patients should avoid fried fish and fish types that contain high levels of mercury, including tilefish, swordfish, and king mackerel. Other foods to avoid include high-fat dairy products and animal proteins, such as beef, hot dogs, sausage and bacon. 

Processed snacks, baked goods, shortening, and stick margarine contain trans fats, or trans-fatty acids, which raise LDL (i.e., “bad”) cholesterol and lowers HDL (i.e., “good”) cholesterol. Common sources of cholesterol include high-fat dairy products and high-fat animal proteins, egg yolks, liver, and other organ meats. Mayo clinic recommendations suggest having patients aim for no more than 200 mg of cholesterol daily, as well as less than 2,300 mg of sodium per day. (This number shrinks to less than 1,500 mg daily for those living with hypertension.) 

Good fats and fiber 

The healthiest of carbohydrates include fruits, vegetables, whole grains, legumes and low-fat dairy. Good sources of dietary fiber include vegetables, fruits, nuts, legumes, whole-wheat flour and wheat bran. 

“Good” fats are monounsaturated and polyunsaturated fats that can help lower cholesterol levels and are found in such foods as avocados, almonds, pecans, walnuts, olives, canola oil, olive oil and peanut oils. All of these items are high in calories, however, so they should only be consumed conservatively.