The role of diet in the etiology of T2DM was proposed by Indians as mentioned earlier, who observed that the disease was almost confined to rich people who consumed oil, flour, and sugar in excessive amounts.30 During the First and Second World Wars, declines in the diabetes mortality rates were documented due to food shortage and famines in the involved countries such as Germany and other European countries. In Berlin, diabetes mortality rate declined from 23.1/100,000 in 1914 to 10.9 in 1919. In contrast, there was no change in diabetes mortality rate in other countries with no shortage of food at the same time period such as Japan and North American countries.31 Whereas few studies have found strong association of T2DM with high intake of carbohydrates and fats. Many studies have reported a positive association between high intake of sugars and development of T2DM.32 In a study, Ludwig33 investigated more than 500 ethnically diverse schoolchildren for 19 months. It was found that for each additional serving of carbonated drinks consumed, frequency of obesity increased, after adjusting for different parameters such as dietary, demographic, anthropometric, and lifestyle.
If you are at risk for diabetes or insulin resistance, be sure to get an annual testing for fasting blood glucose and hemoglobin A1c. If you see these rising over time, this is a sign that your body is having more trouble processing sugar. Your healthcare provider can provide further recommendations for medication and lifestyle changes that can reduce your risk of progressing to type 2 diabetes.

Eat Slower: Once we start eating, it takes about 15 to 20 minutes for our bodies to realize we are full. Eating too fast can lead to overeating, which can lead to a spike in blood sugar and/or weight gain…which can lead to greater insulin resistance. Consciously aim to eat slowly – give yourself at least 15 minutes – especially if you start a meal very hungry. If you are a fast eater or do not have a lot of time, eat 50% to 75% of your planned portion and then wait 10 to 15 minutes (call a friend, work a little, take a walk, anything). If you are still hungry, then eat half of what’s left. Repeat until you are satisfied, not stuffed. Pay attention to how much food it actually takes to make you full so if you are in a pinch, you can make sure your eyes don’t become bigger than your stomach.
If you choose to drink alcohol, remember: To drink with your meal or snack (not on an empty stomach!), to drink slowly or dilute with water or diet soda, that liqueurs, sweet wines and dessert wines have a lot of sugar, to wear your Medic Alert (Alcohol can cause hypoglycemia/low blood glucose), reducing alcohol can promote weight loss and help you lower your blood pressure.
It’s like packing your clothes into a suitcase. At first, the clothes go without any trouble. After a certain point, though, it is just impossible to jam in those last 2 T-shirts. You can’t close the suitcase. The luggage is now ‘resistant’ to the clothes. It’s waaayyy harder to put those last 2 T-shirts than the first 2. It’s the same overflow phenomenon. The cell is filled to bursting with glucose, so trying to force more in is difficult and requires much higher doses of insulin.

The first step is to eliminate all sugar and refined starches from your diet. Sugar has no nutritional value and can therefore be eliminated. Starches are simply long chains of sugars. Highly refined starches such as flour or white rice are quickly broken down by digestion into glucose. This is quickly absorbed into the blood and raises blood sugar. For example, eating white bread increases blood sugars very quickly.


Information from several clinical trials strongly supports the idea that type 2 diabetes is preventable. The Diabetes Prevention Program examined the effect of weight loss and increased exercise on the development of type 2 diabetes among men and women with high blood sugar readings that hadn’t yet crossed the line to diabetes. In the group assigned to weight loss and exercise, there were 58 percent fewer cases of diabetes after almost three years than in the group assigned to usual care. (10) Even after the program to promote lifestyle changes ended, the benefits persisted: The risk of diabetes was reduced, albeit to a lesser degree, over 10 years. (11) Similar results were seen in a Finnish study of weight loss, exercise, and dietary change, and in a Chinese study of exercise and dietary change. (12–15)


A terrific rule to follow is to use a luncheon size plate rather than a dinner plate.  This is an easy way to guide your portion sizes without having to think so much about it. Enjoy a glass of red wine or similar drinks only occasionally since your body treats alcohol more like a fat than a carb when it comes to calories. Eat a sound breakfast and try to eat a bigger lunch so the bulk of your calories are consumed by the midafternoon as a way to keep your blood glucose level in a healthy range, and lessen the chance of undesirable weight gain.1
Most of us ignored the manual, just plugged it in and tried to figure out the rest. That’s why we all had the blinking 12:00 on. Today, most new electronics now come with a quick start guide which has the most basic 4 or 5 steps to get your machine working and then anything else you needed, you could reference the detailed instruction manual. Instruction manuals are just so much more useful this way.
In recent times in Saudi Arabia, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity. Unfortunately, many Saudis are becoming more obese because of the convenience of fast foods, and this adds to the scary diabetes statistics.45 On the other hand, Saudis drink too many high-sugar drinks. In addition, Backman46 reported dietary knowledge to be a significant factor that influences dietary behaviors. In another study conducted by Savoca and Miller47 stated that patients’ food selection and dietary behaviors may be influenced by the strong knowledge about diabetic diet recommendations. Significant positive relationship was observed between knowledge regarding diabetic diet and the amount of calorie needs (r = 0.27, p < 0.05).48 The study concluded that knowledge regarding diabetic diet is essential and is needed to achieve better dietary behaviors. Results of study conducted in Saudi Arabia25 reported that more than half of the diabetic patients denied modifying their dietary pattern, reduction in weight and perform exercise.
Metformin’s effectiveness didn’t change significantly in older adults compared with younger adults (hazard ratio [HR] for developing diabetes at age 60-85 years vs 25-44 years=1.45; 95% CI, 0.98-2.16; P=.06). In contrast, lifestyle modification worked better in older adults than younger adults (HR at age 60-85 years vs 25-44 years=0.47; 95% CI, 0.28- 0.78;P<.01).

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When incorporating fiber rich foods in your diet, which helps with blood sugar control – remember to stay hydrated with enough daily water intake.  Drink water with meals and snacks and keep a water bottle with you to take sips throughout the day.  Staying well hydrated helps with regularity and promotes blood sugar control.  Aim for 60-100 fluid ounces per day.
According to the study conducted by Bani25 in Saudi Arabia, majority of the patients 97.3% males and 93.1% females were unaware about the importance of monitoring diabetes, with no significant gender difference. Diabetes knowledge, attitude, and practice were also studied in Qatari type 2 diabetics. The patients’ knowledge regarding diabetes was very poor, and their knowledge regarding the effect of diabetes on feet was also not appreciable.26 Results from a study conducted in Najran, Saudi Arabia27 reported that almost half of the patients did not have adequate knowledge regarding diabetes disease. Males in this study had more knowledge regarding diabetes than female patients. Diabetes knowledge among self-reported diabetic female teachers was studied in Al-Khobar, Saudi Arabia.28 The study concluded that diabetes knowledge among diabetic female teachers was very poor. It was further suggested that awareness and education about diabetes should be urgently given to sample patients. The knowledge of diabetes provides the information about eating attitude, workout, weight monitoring, blood glucose levels, and use of medication, eye care, foot care, and control of diabetes complications.29

DM is the fourth among the leading causes of global deaths due to complications. Annually, more than three million people die because of diabetes or its complications. Worldwide, this disease weighs down on health systems and also on patients and their families who have to face too much financial, social and emotional strains. Diabetic patients have an increased risk of developing complications such as stroke, myocardial infarction, and coronary artery disease. However, complications such as retinopathy, nephropathy, and neuropathy can have a distressing impact on patient’s quality of life and a significant increase in financial burden. The prevalence reported from studies conducted worldwide on the complications of T2DM showed varying rates. The prevalence of cataracts was 26-62%, retinopathy 17-50%, blindness 3%, nephropathy 17-28%, cardiovascular complications 10-22.5%, stroke 6-12%, neuropathy 19-42%, and foot problems 5-23%. Mortality from all causes was reported between 14% and 40%.71 In a study, researchers found that 15.8% incidence of DR is in the developing countries. The prevalence of DR reported from Saudi Arabia, Sri Lanka, and Brazil was 30%, 31.3%, and 35.4%, respectively; while in Kashmir it was 27% and in South Africa it was 40%. The prevalence of DR 26.1% was observed among 3000 diabetic patients from Pakistan; it was significantly higher than that what was reported in India (18%) and in Malaysia (14.9%).72-76 Studies conducted on diabetes complications in Saudi Arabia are very few and restricted. A 1992 study from Saudi Arabia showed that in T2DM patients; occurrence rate of cataract was 42.7%, neuropathy in 35.9% patients, retinopathy in 31.5% patients, hypertension in 25% patients, nephropathy in 17.8% patients, ischemic heart disease in 41.3% patients, stroke in 9.4% patients, and foot infections in 10.4% of the patients. However, this study reported complications for both types of diabetes.77
In contrast, white bread, white rice, mashed potatoes, donuts, bagels, and many breakfast cereals have what’s called a high glycemic index and glycemic load. That means they cause sustained spikes in blood sugar and insulin levels, which in turn may lead to increased diabetes risk. (22) In China, for example, where white rice is a staple, the Shanghai Women’s Health Study found that women whose diets had the highest glycemic index had a 21 percent higher risk of developing type 2 diabetes, compared to women whose diets had the lowest glycemic index. (23) Similar findings were reported in the Black Women’s Health Study. (24)
Eat every two to three hours. Spreading your energy needs throughout the day allows for healthier choices to be made and your blood sugar to stabilize. Work towards achieving a healthy meal pattern of breakfast (the first meal), followed by a small snack, then lunch (mid-day meal), another snack, dinner (last-meal of the day) and sometimes a small end of the day snack.
When overweight diabetic patients drop some weight by trimming down ‘serving sizes’ and calories, insulin sensitivity improves, thereby optimizing drug therapy. The fundamental principle behind maintenance of body weight is the energy balance. This group should be encouraged to maintain their current weight by: Maintaining current ‘serving sizes,’ eating about the same amount of food each day, eating at about the same times each day, taking their drugs at the same times each day, and exercising at the same times each day. These patients should also endeavor to choose their daily foods from starches, vegetables, fruits, and protein, while limiting the amount of fats.[41,42,43,44,45]
Most people with diabetes find that it is quite helpful to sit down with a dietitian or nutritionist for a consult about what is the best diet for them and how many daily calories they need. It is quite important for diabetics to understand the principles of carbohydrate counting and how to help control blood sugar levels through proper diet. Below are some general principles about the diabetic diet.
If you are like me, going to the gym is not your favorite pass time. Physical activity with diabetes is so beneficial. Being active, however, does not mean having to work out. There are tons of ways to sneak in exercise in your everyday activities. For example, when grocery shopping, park at the end of the lot so you have to walk a longer distance to and from the store. If you enjoy watching tv, stand up and walk in place during the commercials. Take the stairs instead of the elevator as often as you can. If you enjoy dancing, instead of at- home work out videos, put on your favorite tunes and dance away! There are so many different ways to be active without “working out”!
Fruits constitute a commercially important and nutritionally indispensable food commodity. Being a part of a balanced diet, fruits play a vital role in human nutrition by supplying the necessary growth regulating factors essential for maintaining normal health. They have been especially valuable for their ability to prevent vitamin C and vitamin A deficiencies. Fruits and vegetables are good source of vitamins, minerals, flavonoids (anti-oxidants), saponins, polyphenols, carotenoids (vitamin A-like compounds), isothiocyanates (sulfur-containing compounds), and several types of dietary fibers. The fruits and vegetables not only prevent malnutrition but also help in maintaining optimum health through a host of chemical components that are still being identified, tested, and measured. They prevent various chronic diseases like stroke, hypertension, birth defects, cataracts, diabetes, heart disease, cancers, diverticulosis, obstructive pulmonary disease (asthma and bronchitis), and obesity etc.[53,54,55,56] Diets that are high in insoluble fiber may offer the best protection against this disease. Fruits and vegetables are high in cellulose-a type of insoluble fiber. Diets that are high in fiber may be able to help in the management of diabetes. Soluble fiber delays glucose absorption from the small intestine and thus may help prevent the spike in blood glucose levels that follow a meal or snack. The long-term effect may be insignificant, however, due to the many other factors that affect blood glucose. The effects of the fruit and vegetables on the human health allowed to once again measuring the enormous stakes.[57,58,59,60] More and more emphasis is put on the importance of the diversity of food, and in particular of the fruit and vegetables. This new and effective approach to diabetes is remarkably simple. Here are 4 simple steps to managing your blood sugar (and weight, blood pressure, and cholesterol) with diet.[61,62,63,64,65,66,67,68,69,70]

Long bouts of hot, sweaty exercise aren’t necessary to reap this benefit. Findings from the Nurses’ Health Study and Health Professionals Follow-up Study suggest that walking briskly for a half hour every day reduces the risk of developing type 2 diabetes by 30 percent. (18, 19) More recently, The Black Women’s Health Study reported similar diabetes-prevention benefits for brisk walking of more than 5 hours per week. (20) This amount of exercise has a variety of other benefits as well. And even greater cardiovascular and other advantages can be attained by more, and more intense, exercise.
High blood pressure may also be present with your diabetes. Limiting how much salt you eat can help keep your blood pressure low. Decrease the amount of salt you add during cooking and reduce salt in recipes, before adding salt at the table, taste first, try seasoning your food with (salt-free) herbs, spices, and garlic. Lemon juice brings out the natural saltiness of foods. Avoid processed foods that are high in salt (sodium chloride) such as canned or packaged foods and condiments such as mustard, watch for “Na” (sodium) on food labels. Chips, pretzels, and other such snacks are very high in salt, and check with your physician before using salt substitutes.
A major reason why many people who attempt to control type 2 diabetes with diet and exercise turn back to medications is that lifestyle adjustments are hard to maintain over the long term. Jitahadi became a licensed Zumba instructor with this in mind. "I said, 'I know me and I don't want to let life get in my way of taking care of myself because I've done that before,' " she says. She's a Zumba instructor at her local YMCA. For the past year, she's also been a diabetes prevention lifestyle coach there, helping others reduce their risk for the disease.
Jitahadi bought books on diabetes, nutrition, the glycemic index, and diabetes-friendly meals. Instead of slightly modifying her diet, Jitahadi decided to completely overhaul it. "I started realizing that what ['watch what you eat'] really meant was I needed to eat healthier, more balanced meals," she says. She wrote down everything she ate. And instead of dining out, she cooked meals from scratch. Jitahadi swapped white sugar for lower-glycemic sweeteners, traded in white rice for brown, lowered the amount of sodium she consumed, cut a lot of carbs, and made veggies the mainstay of each meal. (Her favorite: grated cauliflower sautéed with veggies and chicken or egg for low-carb fried "rice.")
Exercise can also help people with type 2 diabetes avoid long-term complications, especially heart problems. People with diabetes are susceptible to developing blocked arteries (arteriosclerosis), which can lead to a heart attack. Exercise helps keep your heart healthy and strong. Plus, exercise helps you maintain good cholesterol—and that helps you avoid arteriosclerosis.
Food sources of carbohydrates should always be eaten WITH a source of protein and or unsaturated (“healthy”) fat. Fat and protein digest more slowly which helps prevent blood sugar spikes. Examples of balanced snacks that combine carbohydrate foods with protein/fat include, apple with peanut butter; berries with plain Greek yogurt; whole wheat toast with almond butter; baked potato with cottage cheese.
Eat Slower: Once we start eating, it takes about 15 to 20 minutes for our bodies to realize we are full. Eating too fast can lead to overeating, which can lead to a spike in blood sugar and/or weight gain…which can lead to greater insulin resistance. Consciously aim to eat slowly – give yourself at least 15 minutes – especially if you start a meal very hungry. If you are a fast eater or do not have a lot of time, eat 50% to 75% of your planned portion and then wait 10 to 15 minutes (call a friend, work a little, take a walk, anything). If you are still hungry, then eat half of what’s left. Repeat until you are satisfied, not stuffed. Pay attention to how much food it actually takes to make you full so if you are in a pinch, you can make sure your eyes don’t become bigger than your stomach.
My specific tip for controlling diabetes with diet is to maintain a healthy lifestyle which includes fresh, mostly unprocessed foods from all food groups. Maintain a reasonable weight which may mean weight loss and stay active. The key here is: MAINTAIN any change you have accomplished. In my opinion and that of at least one of my clients you accomplish maintenance by being good to yourself and liking your lifestyle. Here is a quote from a client who has done well and I asked her for ‘tips’ to share. We can all find inspiration in her reply: “The biggest thing to change is your attitude. Be kind to yourself.
Eat healthy foods. Plan meals that limit (not eliminate) foods that contain carbohydrates, which raise your blood sugar. Carbohydrates include starches, fruits, milk, yogurt, starchy vegetables (corn, peas, potatoes) and sweets. “Substitute more non-starchy vegetables into your meals to stay satisfied for fewer carbohydrates and calories,” Compston says.
There are a few methods that can be used for diabetic meal planning. It is good to research more than one, but also important to remember that diabetic diet needs are going to vary based on your sex, age, activity level, medications, height, and weight. If you have not yet met with a registered dietitian, seek one out who can help you develop an individualized meal plan that will meet all of your specific needs.
You also might hear about alternative treatments for diabetes, such as herbal remedies and vitamin or mineral supplements. These practices can be risky, especially when people stop following the treatment plan their doctor has given them. So get the facts by talking to your diabetes health care team. They keep track of the latest research developments, and will introduce new products as they become available.
Fruit often gets a bad rap due to its carb content, but this food group can actually be great in a diabetes diet when chosen wisely and eaten in moderation. In particular, fruit can be a great replacement for unhealthy processed sweets, such as pastries, cakes, and cookies, while providing disease-fighting antioxidants, vitamins, minerals, and satiating fiber to boot.
If you choose to drink alcohol, remember: To drink with your meal or snack (not on an empty stomach!), to drink slowly or dilute with water or diet soda, that liqueurs, sweet wines and dessert wines have a lot of sugar, to wear your Medic Alert (Alcohol can cause hypoglycemia/low blood glucose), reducing alcohol can promote weight loss and help you lower your blood pressure.
To follow a healthy diet for diabetes, you must first understand how different foods affect your blood sugar. Carbohydrates, which are found to the largest degree in grains, bread, pasta, milk, sweets, fruit, and starchy vegetables, are broken down into glucose in the blood faster than other types of food, which raises blood sugar, potentially leading to hyperglycemia. Protein and fats do not directly impact blood sugar, but both should be consumed in moderation to keep calories down and weight in a healthy range.

Other medications such as metformin or the DPP4 drug class are weight neutral. While this won’t make things worse, they won’t make things better either. Since weight loss is the key to reversing type 2 diabetes, medications won’t make things better. Medications make blood sugars better, but not the diabetes. We can pretend the disease is better, but that doesn’t make it true.
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