When is the Right Time to Eat with Diabetes?
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Presentation: The Top 5 Nutrition Controversies
Speakers at this ADA Scientific Sessions presentation included: Maureen Chomko, RD, CDCES (Neighborcare Health); Alison Evert, MS, RDN, CDCES, (UW Medicine – Primary Care Clinics), Gretchen Youssef, MS, RDN, CDCES (Medstar Health)
There are a few very common questions people with type 2 diabetes ask about food:
- “What can I eat with diabetes?”
- “How many meals and snacks can I eat per day?”
- “When should I eat?”
Experts discussed the most logical and helpful approaches to nutrition for people with type 2 diabetes.
To begin, it’s important to keep three critical factors in mind when it comes to type 2 diabetes:
- Gradual beta-cell function loss
- Gradual loss of first phase insulin response
- Individual levels of insulin resistance
Keep these factors in mind when considering the answer to the most commonly asked questions about nutrition for people with type 2 diabetes.
Three meals and snacks per day?
The common advice given is to eat three meals and three snacks per day—but is that actually effective? Dr. Alison Evert delved offered some insight that could help with your routine.
We know that eating plans should be individualized; but there’s very little recent data about how often you should eat due to short clinical trials, trials being inconclusive, as well as these trials being done decades ago.
However, there is one technique many healthcare professionals use to help patients feel satiated while also keeping their blood glucose levels in the range: coordinating meal times and plans with medications.
- Taking metformin and GLP-1 mediations can decrease nausea.
- Taking insulin with food reduces the risk of low blood sugar (hypoglycemia).
The larger the meal or the less frequent a person eats, the more likely they’ll experience larger fluctuations in blood sugar levels.
Other the other hand, advice like eating three meals and three snacks per day can be harmful to people with diabetes who aren’t hungry. It may also lead to consuming unnecessary calories and increase their risk of experiencing high blood sugars.
Should you eat breakfast?
According to Dr. Evert, if you skip breakfast, you might want to reconsider.
Skipping breakfast can increase a person’s risk of type 2 diabetes, heart disease, higher blood pressure, high cholesterol and triglycerides, and lead to an increase in body fat.
Instead, small research studies show that high-energy breakfasts combined with low-energy dinners can improve glucose numbers. By “low” and “high” energy, Evert is referring to carbohydrates and overall calories in any given meal. Paying specific attention to the size and nutrients in your breakfast, for instance, is worthwhile because eating a balanced meal earlier in the day staves off the chances of eating larger, higher-calorie meals later in the day.
A Quick Note for the Intermittent Fasters
For the intermittent fasters who may be reading this, you’re probably wondering if it’s safe or effective to help you reach your blood glucose levels. The answer? It can be, but there are different ways of fasting.
Some examples of fasting schedules include:
- 16/8: 16 hours of fasting, eight hour-window of eating
- 5/2: Eating normally five days a week and fasting (eating approx. 600 calories) two days per week
- A 24-hour fast once per week: fast for a full 24 hours one day per week
- Read more about intermittent fasting and diabetes
Before considering fasting of any kind, talk to your doctor. Your insulin regimen or other medications may lead to hypoglycemia if you skip a meal. Long-term fasting may gradually reduce your insulin needs, which means you may need your doctor’s guidance in reducing your insulin or medication dosages.
Fasting with any type of diabetes should be done with caution and guidance from your healthcare team.
How We Consume Our Macros
Dr. Evert mentioned some interesting, yet unsurprising facts about the number of macronutrients we consume as a society. Generally, the breakdown looks like this for the average American who does not have diabetes:
- 50 percent of our calories come from carbohydrates
- 42 percent comes from lower-quality processed carbohydrates
- 16 percent come from protein
- 33 percent comes from fat
Over the last 18 years, we are eating fewer added sugar products and more whole grains, poultry and nuts.
The average person with diabetes eats similarly to the general public:
- 45 percent of daily calories come from carbohydrates
- 36-40 percent come from fat
- 16-18 percent of protein
There’s no optimal mix of macros or calories for people with diabetes, per the American Diabetes Association’s Nutrition Consensus Report. There’s no ideal frequency, either.
These are common questions, but the answer really is it depends on the person and their goals.
The primary question for you should be: what do you want to do with your health and what are some potential solutions and tools to help you reach your goals?
Dr. Evert provided some examples:
- Improve glucose?
- Solutions/Tools: blood glucose meter (BGM)/continuous glucose monitor (CGM), trial and error mindset and data tracking
- Lipids and blood pressure?
- Solution/Tools: Knowing which eating patterns that may benefit you best (DASH Diet, Mediterranean diet, Vegan, etc.)
- Weight loss?
- Reducing calories/portion sizes and intake of certain macros, identifying behaviors around food and exercise and developing a structured eating plan
Diabetes management is largely about troubleshooting and finding the right tools to help you reach your goal. You are your own detective when managing your own diabetes.
Remember: it’s more about what eating works best for you and what you can sustain long-term. If it’s easier for you to eat smaller meals more often—great! If you feel better eating fewer, larger meals—great!
As long as you’re reaching your blood glucose management goals safely and have spoken with your healthcare team, you should feel empowered to do what works for you. Don’t be afraid to experiment, adjust and create what works for you!