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Meeting Blood Glucose Targets with Diet and Exercise

Questions abound for Type II diabetics and others who would like to control their blood glucose levels. Can they be completely controlled via dietary choices? How can the risk of heart-attack or stroke be reduced? Can medication be avoided? Will hypoglycemia occur if a meal is missed after taking medication? Those who decide, after discussions with their medical provider, to control levels using dietary means, can follow this road map.

Step 1: Define the goals

In addition to managing weight, a glucose-controlling diet has two important goals: to get fasting blood sugar within a normal range, and to keep after-meal levels from spiking into ranges enabling nerve damage. The NIH/ADA recommendations put the normal fasting range at 70-130mg/dL, but this 2003 study suggests that, in individuals with impaired glucose tolerance, damage to beta cells in the pancreas begins at levels as low as 100mg/dL. Likewise with after-meal levels: while the NIH/ADA values suggest keeping levels below 180mg/dL, this study links neuropathy pain with glucose levels above 140mg/dL. Whatever target goal is chosen, smart consumption of carbohydrates will be key to achieving it, so the next step is to determine the amount and types of carbohydrates to ingest.

Step 2: Know the carbohydrate limits

Carbohydrates are the food components which most directly affect blood sugar levels, and will be the linchpin that limits dietary choices. Recent research suggests that foods whose insoluble fiber consists of resistant starch increases insulin-sensitivity even several meals later (especially in males). Also, fruits and vegetables with fiber and fat components tend to be digested more slowly, helping to keep blood sugar levels from spiking to unhealthier levels.

Working with a dietitian is the best way to get a starting point for the number of grams per meal that can be eaten without raising blood sugar past the target limit. (Typical amounts for a 200-lb male with impaired glucose tolerance consuming three meals and two snacks per day are 45 grams per meal, 15 grams per snack). Smaller, more frequent meals can be eaten if larger-sized portions cause levels to spike. Testing with a blood glucose meter 2 hours after a meal will be required to fine-tune this amount.

The most healthful sources include beans, especially black beans, kidney beans, and navy beans (high in resistant starch). Greens such as broccoli, romaine lettuce, cabbage and kale are also highly-nutritious, high-fiber carbohydrate choices. Avoid non-wholegrain breads and pastas that use refined flours- their lower fiber and protein content make them poor carbohydrate choices.

A wealth of nutritional breakdown information on a wide variety of foods can be found at the World’s Healthiest Foods site.

Step 3: Get enough protein and exercise

Sufficient amounts of protein should also be consumed at each meal, both for nutritional balance and muscle repair. Some is needed to offer a balanced diet that will stave off hunger pangs, and how much more is largely affected by type and intensity of exercise. In addition to reducing circulating blood glucose, this study on insulin-resistant women found that adding resistance training led to higher insulin response by muscle fibers than aerobic exercise alone, making protein important for muscle building and repair. (Numerous other studies have shown exercise improves insulin response in non-insulin-resistant males and other animals.)

Protein levels at 66-75% the number of grams of carbohydrates (using the previous example, 30-35 grams per meal, 10 grams per snack) offer a balanced starting point, enabling lean muscle and dietary balances to be maintained. This is typically 4-5oz serving of meat, or 4-5 egg whites, or 1 1/2 cups of unsweetened yogurt.

Step 4: Include fat and fiber

Since the fat component won’t directly affect after-meal blood sugar levels, the limitation here is avoiding trans fats and ensuring the extra calories won’t cause weight gain. Good sources include fats found in whole foods (nuts, avocados, olives, etc.), canola oil, and ocean-sourced fatty fish such as salmon.

It may also be beneficial to supplement with fish oil as well, since this study of non-insulin-dependent diabetic patients showed significantly reduced fasting and circulating blood sugar levels after six months of taking fish oil daily. The tested supplementation levels were 2.7 grams per day for two months followed by 1.7 grams per day for four months.

Consuming high-fiber vegetables at each meal, especially low-glycemic ones such as celery, black-eyed peas, or kale, will slow the digestion of carbohydrates and help stabilize blood glucose levels.

Step 5: Put it all together

There are a wide variety of delicious meals that conform to these guidelines: chili with beans & onions, tacos with guacamole, pork chops with navy beans & apples, and salmon with black-bean salsa. They can be made at home to avoid the preservatives and additives that frozen-food manufacturers often add. Leftovers can be stored in smaller portions to make snacking within these guidelines quick and easy.