Specific diabetic dietary guidelines have been developed by the American Diabetes Association and the American Dietetic Association to improve the management of diabetes.

Key principles are to:

• Achieve weight control through reducing calories.
• Individualize guidelines for carbohydrates based on the type of diabetes you have and the control of your blood sugar levels.
• Reduce intake of dietary fat (specifically saturated fat).

There are two main forms of diabetes. The nutritional goals for each one are different.

With type 1 diabetes, studies show that total carbohydrates have the most effect on the amount of insulin needed and the maintenance of blood sugar control. A delicate balance of carbohydrate intake, insulin, and physical activity is necessary for the best blood sugar levels. If these are not in balance, there can be wide swings in blood glucose levels. If you have type 1 diabetes and are on a fixed dose of insulin, the carbohydrate content of your meals and snacks should be consistent from day to day.

Weight and growth patterns are a useful way to determine if a child with type 1 diabetes is getting enough nutrition. Try not to withhold food or give food when a child is not hungry.

With type 2 diabetes, the main focus is on weight control, because 80 - 90% of people with this disease are overweight. A meal plan, with reduced calories, even distribution of carbohydrates, and replacement of some carbohydrate with healthier monounsaturated fats helps improve blood glucose levels.

Examples of foods high in monounsaturated fat include peanut or almond butter, almonds, walnuts, and other nuts. These can be substituted for carbohydrates, but portions should be small because these foods are high in calories.

In many cases, moderate weight loss and increased physical activity can control type 2 diabetes. Some people will need to take oral medications or insulin in addition to lifestyle changes.

Children with type 2 diabetes present special challenges. Meal plans should be recalculated often to account for the child's change in calorie requirements due to growth. Three smaller meals and three snacks are often required to meet calorie needs.

Changes in eating habits and increased physical activity help reduce insulin resistance and improve blood sugar control. When at parties or during holidays, your child may still eat sugar-containing foods, but have fewer carbohydrates on that day. For example, if birthday cake, Halloween candy, or other sweets are eaten, the usual daily amount of potatoes, pasta, or rice should be eliminated. This substitution helps keep calories and carbohydrates in better balance.

For children with either type of diabetes, special occasions (like birthdays or Halloween) require additional planning because of the extra sweets.

A registered dietitian can help you best decide how to balance your diet with carbohydrates, protein, and fat. Here are some general guidelines:

FAT

Reduce the amount of dietary fat. The current American Diabetes Association guidelines advise that less than 7% of calories should come from saturated fat. These are the fats that raise LDL ("bad") cholesterol. Dietary cholesterol should be less than 200 mg per day. Additionally, intake of trans-unsaturated fats should be minimized. These are better known as partially hydrogenated oils. Reducing fat intake may help contribute to modest weight loss.

PROTEIN

Keep protein intake in the range of 15 - 20% of total calories. Choices low in fat are recommended such as nonfat dairy products, legumes, skinless poultry, fish and lean meats. A portion of poultry, fish, or lean meat is about the size of a deck of cards.

CARBOHYDRATES

Carbohydrate choices should come from whole-grain breads or cereals, pasta, brown rice, beans, fruits, and vegetables. Increasing dietary fiber is a general guideline for the entire population rather than specifically for people with diabetes. Carbohydrates differ in their calorie content, and thus affect weight and blood glucose control. Learning to read labels for total carbohydrate rather than sugar provides the best information for blood sugar control.

SUGARS

Limit sources of high-calorie and low-nutritional-value foods, including those with a high content of sugars. Sugar-containing foods should be substituted for other carbohydrate sources (such as potatoes) instead of just adding them on to the meal.

American Diabetes Association. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008;31:S12-S54.

American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31:S61-S78.