The full Swiss Association for Nutrition article contains paragraphs on the symptoms, signs, complications, types and tests for diabetes. We assume that readers of this article are already familiar with these aspects, so we are not reproducing them here. We begin with the treatment of type 2 diabetes. Robert Griffith, Editor.

Treating type 2 diabetes

Treatment for managing type 2 diabetes consists of:

1. Balanced nutrition
2. Regular physical activity
3. Medication with pills and/or insulin
4. Comprehensive medical care and comprehensive treatment program

1. Balanced Nutrition

The foundation for treating type 2 diabetes is balanced nutrition. The following principles should be observed:

Appropriate calorie intake
For overweight diabetics with a high blood sugar, reducing weight can lower the blood sugar level. The nutritional recommendation of 1600 calories a day, given at the end of this article, can be used as a starting point for reducing weight. It's recommended, however, to create an individual nutrition plan with professional help. This is also useful for diabetics who are not overweight since it allows them to maintain their weight.

Bodyweight can be evaluated with the help of the body mass index (BMI). The BMI is calculated as follows: Body weight in kilograms divided by the body height in meters, squared. You can find out your BMI using the tool on these pages: click here

According to the World Health Organization (WHO), a body mass index between 18.5 and 25 is normal. A BMI over 30 means that the individual is substantially overweight, i.e. obese.

Mealtime intervals
The frequency of mealtimes should be adapted to individual needs and blood sugar levels. Carbohydrates should be consumed during the main meals; however, snacks may be advantageous in certain circumstances. And diabetics who are being treated with insulin can avoid the risk of low blood sugar during the night by having a late meal.

Abundant fiber-rich carbohydrates
The basis of balanced diabetic nutrition is provided by carbohydrate-rich foods (fruits, vegetables, starch, sugar). These should comprise approximately one-half of the daily consumption of calories. Carbohydrate-containing foods are broken down in the digestive tract in part into glucose and are absorbed into the blood through the intestinal wall. In addition to sugar, these food groups also provide important vitamins, minerals, secondary vegetable material and nutrient fibers.

It's important to select the "right" carbohydrate-containing foods. The speed at which a carbohydrate-containing food enters the blood in the form of glucose doesn't depend only on the type of carbohydrate. Factors such as fat content, protein, nutrient fibers, and the composition of the food substantially influence the absorption speed. For example, many whole-grain products are absorbed into the blood very slowly and cause a slower rise in blood sugar than refined products. Whole-grain bread, whole-grain cereals, whole-grain pastas and legumes are therefore preferable, just as fresh fruits are preferable to fruit juices. White sugar (saccharose = glucose + fructose) and glucose cause a very fast rise in the blood sugar level. Foods that contain pure carbohydrates (such as soft drinks or sodas) should therefore be avoided or consumed with caution. In addition to the type of carbohydrate, the amount of consumed carbohydrate is also important.

Vegetable fats are preferable
Since diabetics have a higher risk of atherosclerosis, animal fats should only be consumed in small amounts. Animal fats contained saturated fatty acids and frequently cholesterol, both of which promote the risk of atherosclerosis and hence cardiovascular disease. Vegetable oils (with the exception of palm oil and coconut oil) contain mono- and polyunsaturated fatty acids (olive oil, rapeseed oil) and are therefore preferable.

Moderate consumption of protein
Protein is important for building the body's own proteins. However, it's recommended to limit the consumption of animal proteins as they frequently are associated with fat and cholesterol. It's advantageous to eat vegetable proteins (grain, legumes, vegetables, nuts - although beware of fat in nuts!), as they contain many minerals, vitamins and nutrient fibers and also have no animal fats. For sources of animal protein, use lean products such as fowl, lean meat, fish and lowfat milk products. Milk products also help supply the required calcium.

Beverages including alcohol
Per day, you should drink 1.5-2 liters (50-70 oz) of liquid. Choose drinks without added sugar (such as natural mineral water, possibly with a slight amount of lemon juice, low-calorie beverages) because they often already contain a great deal of sugar.

Alcohol is not necessary for health, but it is not forbidden to diabetics. It's important to restrict the consumption of alcohol to a moderate level. 1-2 glasses of wine are allowed per day. Be careful of beer, dessert wines and liqueurs; they contain sugar and therefore will cause the blood sugar to rise. Alcoholic drinks should be consumed with food and not on an empty stomach; they can otherwise trigger rebound hypoglycemia (low blood sugar).

Sweets
Sugar-containing foods may be consumed by diabetics if they are eaten in place of other carbohydrate-containing foods during a meal (mixture of foods). However, the intake of sugar per day should not exceed approximately 50 g.

Products for diabetics
Diabetics do not require special foods. Generally, diabetic chocolates, cookies or cakes are very rich in fat and contain sugar substitutes that can cause gas and diarrhea. If you want something sweet, you can eat regular products. However, you must maintain a stable metabolism. You should also only consume small amounts of sweets as a dessert after a meal, and not on an empty stomach.

2. Regular Physical Activity

Regular physical activity lowers your blood sugar, improves the efficiency of your body's own insulin, and helps reduce excess weight. It is important for people not used to physical activity to start slowly, taking regular exercise that is gradually increased. The intensity should be adapted to the individual's physical and psychological makeup. Daily physical activity lasting 30 minutes is best. This can also be done in three periods of 10 minutes (such as 10 minutes fast walking to the store, 10 minutes of intense housework, 10 minutes of bicycle riding).

3. Medication with Pills and/or Insulin

If the blood sugar level is not normalized by regular activity and nutrition tailored to diabetics, treatment with pills must be considered. Overweight diabetics should try to lose weight before starting medication. Pills never replace balanced nutrition.
Today, there are numerous pills with different effects. For example, there are those that improve the efficiency of insulin which are particularly useful for diabetics with insulin resistance; there are medications that delay the digestion of carbohydrates in the intestine, which primarily affects the blood sugar level after eating; and there are medications that promote additional release of insulin from the pancreas.

However, pills never cure diabetes. You can expect that sooner or later, they will not be enough. Frequently, after years of medication with pills, insulin is required for treatment. This medication must be injected and is always effective.

4. Comprehensive Medical Treatment

Comprehensive medical treatment includes self-monitoring one's blood sugar level, regular 3-monthly checkups with a physician who can treat diabetes (regularly checking the HbA1c, blood pressure, and blood lipids) and watch for later complications), and provide continuing education. Hospital diabetic clinics and regional support groups are also helpful.

To change your lifestyle habits (nutrition, activity), you need professional support in which behavior is changed in small steps over a long period. It's beneficial for patients with type 2 diabetes to be treated in the context of a program, as these are more successful than individual consultations.

Why diabetes therapy?

The goal of diabetes treatment is to improve quality of life. Tiredness, lethargy and ongoing thirst can restrict the daily activities of a diabetic. The aim of therapy is to reduce blood sugar to a normal level over the medium-term. The typical symptoms of diabetes will disappear, and diabetics can become more involved in life with more energy.

Another goal is to maintain independence by reducing possible complications and the long-term effects to the eyes, kidneys, nerves and circulatory system through careful treatment.

Hypoglycemia

Hypoglycemia is also called "hypo" or "low blood sugar." This is a frequently occurring complication that can arise in diabetics treated with insulin or drugs. Hypoglycemia can manifest itself by many different symptoms, such as tingling around the mouth or at the tip of the tongue, heart palpitations, paleness, blurred vision, slurred speech, double vision, abnormal behavior and unstable gait. The reasons for this can be excessive physical activity, skipping meals, too much or incorrect medication (insulin/pills) and alcohol. In such a situation, it's important to respond quickly and consume carbohydrates that are quickly absorbed into the blood, such as 3-6 packets of sugar, 3-6 sugar cubes, 1-2 dL (1/2 - 1 cupful) of a sweetened beverage, soda, or orange juice, or a slice (20-40 g) of white bread. It's recommended that diabetics always carry packets of sugar or sugar cubes and notify the people they are with that they are a diabetic.

Recommended nutrition for overweight patients with type 2 diabetes

Many factors influence our nutrition: individual needs and desires, daily moods, our social surroundings, physical activity, the food that surrounds us, advertising, etc. Each person has an individual nutritional requirement. The following recommendations ensure a sufficient supply of energy, nutrients and health-promoting substances (in the form of a balanced mixed diet) and hence a healthy diet.

Frequently, type 2 diabetes occurs with obesity. For this reason, this daily plan corresponds to 1600 calories a day. It's meant as an initial suggestion. We recommend that you get together with a professional as soon as possible to develop an individual daily plan.

Italicized text is especially important for people who are obese.

Fats and oils
Per day 2 teaspoons (10 g) of a vegetable oil high in unheated unsaturated fatty acids (such as rapeseed oil, olive oil), for example for salad dressing.

Per day max. 2 teaspoons (10 g) frying fat or oil (such as peanut oil or refined rapeseed and olive oil) for preparing food.

Per day maximal 1 teaspoon (5 g) butter or margarine spread.

Per week, maximum of 1 fat-rich dish such as fried food, breaded food, cheese dishes, potato pancakes, sausages or cold cuts, cream sauce, cake, puff pastry, chocolate, etc.

Sweets and snacks
Enjoy in moderation. Maximum of one small portion per day after a main meal (such as one scoop of ice cream, three squares of a chocolate bar, one piece of cake, one handful of potato chips, ½ handful of salted nuts).

Meat, fish, eggs and legumes
Per week, two to four portions of meat (1 portion = 80-100 g or 3-4 oz); more is unnecessary, less is okay. Preferably low-fat meats!

Per week maximum one fish substitute: Salted meat such as pork, sausage or bacon.

Per month, maximum of one serving of offal such as liver, kidneys, entrails, sweetbread (1 portion = 80-120 g).

Per week, 1-2 portions of fish (1 portion = 100-120 g or 3½ -4 oz).

Per week, 1-2 eggs including processed eggs such as in baked goods, soufflés or sauces.

Milk and milk products
Per day, 2-3 portions of milk products (1 portion = 2 dL milk or 1 cup of yogurt, or 30 g [1 oz] hard cheese or 60 g [2 oz] soft cheese). Low-fat and reduced fat products are preferable!

Grains and potatoes
Per day, 3 portions of starch-containing side dishes (1 portion = 45 g cereals; 75 g bread; 180 g potatoes or 150 g cooked rice, grain, pasta or legumes). [30 grams = 1 ounce]
Whole grain products are preferable, as well as low-fat preparation.

Fruits
Per day, 3 portions of fruit at 100-150 g (3½ -5 oz), preferably raw (1 portion = 1 apple, 3 plums or a cup of berries).

Vegetables
Per day, 3-4 portions of vegetables of which at least one portion is raw, for example as a dip or a mixed salad (1 portion = 100 g [3½ oz] raw or 150-200 g [5-7 oz] cooked vegetable, 50 g [2 oz] leafy green salad or 100 g [3½ oz] mixed salad).

Beverages and alcoholic drinks
1.5-2 liters (50-70 oz) liquid per day; unsugared and low calorie drinks, alcohol-free drinks and calcium-rich mineral water are preferable (> 300 mg calcium per liter).

Note: Compensate for large losses of fluid (for example due to heavy sweating)

Alcohol: do not drink more than 1-2 glasses of wine per day. Beer, dessert wines and liqueurs are not suitable!

Nutrition for type 2 diabetes - Checklist

1. Reduce excess weight
2. Adapt caloric intake
3. Balanced nutrition with regular mealtimes
4. Regular exercise
5. Medications and insulin support balanced nutrition and increase one's sense of well-being
6. Carry glucose or sugar packets