Expert Q&A: A Healthy Diet for Type 2 Diabetes
An interview with Hope Warshaw, MMSc, RD.
What is prediabetes and what should people do if they're diagnosed with it?
Prediabetes is an in-between stage -- blood glucose is higher than normal
but not high enough to fit the diagnosis of diabetes. The diagnosis of
prediabetes should be a clear message that you're currently on the road to type
2 diabetes. If you don't take action now, you have a greater than 70% chance of
developing type 2.
But this doesn't need to happen. Results from several studies, including the
Diabetes Prevention Program, suggest that a small amount of weight loss -- 5%
to 7% of your body weight combined with 150 minutes a week of physical activity
-- can help slow down the progression. If you catch it early and do something,
you can really have an impact on either preventing or delaying the onset of
What is the relationship between being overweight and type 2 diabetes?
It's a pretty direct relationship. About 80% of people with type 2 diabetes
are overweight. Excess weight leads to insulin resistance, and insulin
resistance leads to elevated blood pressure, abnormal blood lipids and
Do people with type 2 diabetes need to eat snacks throughout the day to control their glucose?
No, but there's a lot of confusion about this. Experts used to tell people
to eat snacks because the only medications we had to treat high blood glucose
levels could cause the side effect of hypoglycemia, or low blood glucose.
Regular meals and scheduled snacks were a way of limiting the problem. But now
there are several newer medicines that lower blood glucose without that side
effect. Plus, people have blood glucose meters and can check their glucose at
If snacking is your natural way of eating, there's nothing wrong with one or
two snacks a day. For instance, if a healthy snack in the afternoon -- like an
apple and some reduced-fat cheese -- prevents you from being so famished at
dinner that you gorge yourself, go ahead.
But people with diabetes should ditch the idea that they need to eat
snacks. It can be counterproductive. Some people find all the snacks really
inconvenient. Other people sit down for a snack and overeat, or they make
unhealthy choices because they don't have anything better around.
Can people with type 2 diabetes eat sweets?
Yes, people with diabetes can enjoy sweets. There's an old idea that sweets
are verboten for those with diabetes, but that's no longer correct.
It's true that the carbohydrates in sweets can raise your glucose levels,
but an equal amount of starch would have similar effect. I don't think people
with diabetes need to run around looking for sugar-free candies or insist that
their families bake them sugar-free deserts.
However, you have to be smart about sugary foods and sweets. Sweets pack in
a lot of calories and they tend to be high in fat, particularly in unhealthy
saturated fat. So anyone with diabetes needs to be careful about how many they