Current dietary recommendations in non-pregnant adults with diabetes include:
Nutritional education from a registered dietitian is recommended as best practice at diagnosis and then:
Annually for ongoing assessment of nutritional education needs
When starting bolus or premixed insulin
At any time if required
If a registered dietitian is not available then education should be provided on a diet with a moderate amount of nutrient dense and low glycaemic index (GI) carbohydrates
Advice should also be provided on foods that are not recommended and to reduce snacking to promote regular meals to avoid grazing
Reduce sugar intake in drinks
Aim for at least 30 g of dietary fibre per day
Consistent carbohydrate intake across the day and from day to day is likely preferred for those on bolus insulin and/or sulfonylureas
Food diaries are often useful for decision making
Recent evidence suggests that low-energy, low GI and modified macronutrient dietary approaches can be effective in achieving weight loss and remission of type 2 diabetes.
There is no conclusive evidence to suggest one dietary strategy is more effective than any other for achieving sustained weight loss and improvements in glycaemic control. The choice of dietary strategy will depend on many factors but particularly patient preference, tolerance, nutritional needs, income, comorbidities and cultural suitability. Different dietary strategies include:
Very low-energy diets (VLED) with meal replacement
Mediterranean diet
Dietary approach to stop hypertension (DASH) diet
Intermittent fasting
Low GI diet
Vegetarian diets
Commercial weight loss programmes
Very low-carbohydrate (ketogenic) diet
NB: Need to ensure adequate nutrition in young people, pregnant or lactating women or those considering pregnancy, and the elderly.
Dietary changes may also be required if comorbidities present:
Recommend reduced salt intake if hypertensive and/or diabetic renal disease
Switch saturated fats to mono- and polyunsaturated fats if high LDL cholesterol
Low potassium, phosphorus, and calcium intake may be required in significant diabetic renal disease if abnormal electrolyte levels