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What people with diabetes need to pay attention to

Ketogenic diet, the Planetary Health Diet, the DASH diet or a vegan lifestyle are a megatrend. We asked Dr. what exactly is behind the current food trends and whether they are also suitable for people with diabetes. Nicola Haller, diabetes consultant DDG, nutritional medicine (BLÄK), medical educator and board member FKBD, Regionalgesellschaft e. V. of the DDG, asked.

Conscious eating is currently very popular.[[1]Health, environmentally friendly and resource-friendly production[[2]but also the fact that 37 percent of people in Germany want to lose weight[[3]determine more than ever what ends up on our plate. Extremely low-carbohydrate diets, avoiding animal products or a diet that is good for the figure AND the planet are currently particularly popular. But how suitable for everyday use are these food trends really and can people with diabetes also benefit from changing their diet? What do you need to pay particular attention to?

Nutrition is an important component of diabetes therapy because what we eat has a direct influence on blood sugar levels and insulin requirements. For decades, there were precise quantities of carbohydrates, protein and fat for people with diabetes. But things are different today, explains Dr. Nicola Haller: “The aim of patient-oriented nutritional therapy is to keep the glucose level in the target range for as long as possible and to avoid strong fluctuations, especially after meals. In order to achieve this goal, an individual nutritional concept is developed that, in addition to the metabolic situation, necessarily takes into account personal health needs and… Preferences are taken into account. This also offers people with diabetes the opportunity to easily try out special diets and trends.” An important prerequisite: The supply of all relevant nutrients should be guaranteed.

The German Diabetes Society recommends[[4,5]a menu that contains a large proportion of vegetables and fruit rich in fiber and vital substances, supplemented by lean sources of protein, vascular-protecting fats and healthy whole grain products. “A varied, balanced nutritional management is important in order to avoid a deficiency of vitamin B1, B12, folic acid, vitamin D, vitamin C and magnesium and zinc in the case of a metabolic disease. I therefore recommend that a change in eating habits is accompanied by the supervising diabetological practice “also to adjust diabetes therapy if necessary,” advises Dr. Nicola Haller.

Change in diet: Always keep an eye on your glucose levels

Less bread, pasta or potatoes, more meat and fish or avoiding animal foods – a new menu also affects the amounts of carbohydrate units (KE) consumed. This and the quality of the carbohydrates have a big influence on how quickly glucose levels rise after a meal and how much insulin the body needs to bring it back into balance. “In principle, regular glucose measurements are essential for monitoring the progress of diabetes therapy in order to avoid acute complications such as hyperglycemia and hypoglycemia as well as long-term consequential damage caused by fluctuations in glucose levels. This becomes even more important due to the effects of a change in diet on the need for insulin or blood sugar-lowering medication. Continuous Glucose control measuring systems with an optional alarm function, such as the FreeStyle Libre system from Abbott, are very helpful because they transmit the current glucose values ​​and trends to the affected person’s smartphone up to the minute and the values ​​can be shared with the practice. This enables insulin therapy to be adjusted quickly. says Dr. Nicola Haller. The diabetes consultant would like people with type 2 diabetes who are not dependent on insulin to be able to use continuous glucose monitoring during phases of lifestyle modification. “Users of a sensor-based glucose measuring system can see on their smartphone what positive effects, for example, a low-carb diet or exercise have on high glucose levels. This biofeedback has a learning effect and can have a motivating effect on diabetes management.”

Four nutrition trends under the microscope:

1. Ketogenic diet

The principle: This diet is an extremely low-carbohydrate and rather high-fat diet. Popular forms of “keto diet” range from low carb forms with 50 to 150 grams of carbohydrates per day to very low carb forms with less than 50 grams of carbohydrates per day. By avoiding bread, potatoes, pasta, fruit with more than 15 g of sugar per 100 g, sugary drinks and other carbohydrate sources, the body is forced to meet its energy needs from other energy sources (in this case the breakdown of body fat), as with fasting cover. This creates ketones, which the brain uses as “fuel”. The food trend actually has a long history, as a ketogenic diet was used to treat epilepsy 100 years ago.

Here you will find further information about the ketogenic diet and the expert’s conclusion–

2. Vegan diet

The principle: The number of vegans in Germany has doubled since 2015. When motivating people to change their diet, the main focus is on animal welfare, climate and environmental protection and improving health. The concept is easy to explain: you avoid all animal foods such as: B. Meat, poultry, fish, dairy products, cheese, but also honey. Retailers have responded to the increased demand. The range of vegan products or plant-based meat substitutes based on soy, lupine or pea protein is continually increasing in supermarkets.

Here you will find further information about the DASH nutrition and the expert’s conclusion.

3. Planetary Health Diet

The principle: In order to ensure a healthy diet for people on this earth by 2050, a fundamental change in agriculture and also in the way we eat is necessary, researchers from all nations in the world agree.

For this purpose, 37 scientists from different disciplines and countries have developed the “Planetary Health Diet” based on the current state of research in the field of health and sustainability. The menu mainly consists of a colorful mix of fruits and vegetables, whole grain products, legumes, nuts and unsaturated fats. As a small supplement, there are moderate amounts of fish and seafood as well as poultry, while starchy vegetables such as potatoes and cassava, dairy products, red meat, sugar and saturated fats should play no or only a minor role.

Here you will find further information about the Planetary Health Diet and the expert’s conclusion

4. DASH diet

The principle: The acronym DASH (Dietary Approaches to Stop Hypertension) is a concept that the American National Institutes of Health developed as a lifelong nutritional approach to heart health and which is often referred to as the “best diet”.[[6]According to studies, the menu, which was developed to prevent and treat high blood pressure, is also interesting for those who want to lose weight or people with type 2 diabetes, because DASH helps with weight loss and has a beneficial effect on the blood vessels.[[7]A lot of plant-based food, whole grain products, fat-free and low-fat dairy products, fish, poultry, legumes, nuts and healthy vegetable oils are recommended. To do this, foods that are rich in saturated fatty acids (e.g. processed meat products, full-fat dairy products), as well as sugary drinks and sweets should be avoided and salt consumption should be reduced to 2.3 mg daily. (The DGE recommendation is 5 g daily)

Sources

1. Federal Center for Nutrition (BZfE), Trend report nutrition 2022

2. Federal Ministry of Food and Agriculture (BMEL), Germany as it eats – the BMEL Nutrition Report 2023

3. Statista, Statista Global Consumer Survey,What are the most popular resolutions for 2024

4. German Diabetes Society eV (DDG eV), S3 guideline therapy for type 1 diabetes, version 5 – guideline report

5. German Diabetes Society eV (DDG eV), Statement by the Nutrition Committee of the DDG on the Consensus Report: Nutrition Therapy for Adults with Diabetes or Prediabetes

7. Dal N, Bilici S, Dietary Modulations in Preventing Cardiometabolic Risk in Individuals with Type 2 Diabetes, 2024, Current Nutrition Reports,

8. Bahr L. S et al., The ketogenic diet – what it can do, how it works and how it works, zkm 2018; 2: 22–29, available online at:

9. Buehler L. A et al. Ketogenic diets in the management of diabetes: safe or safety concern? 2021, CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 88 • NUMBER 10, doi:10.3949/ccjm.88a.20121

10. Kossoff EH et al, Optimal clinical management of children reiving dietary therapies for epilepsy: Update remmendations of the international Ketogenic Diet Study Group, Epilepsia Open. 2018;3(2):175-92

11. Dunn T et al. Diabetes Res Clin Pract. 2018 Mar;137:37-46.

12. Federal Center for Nutrition, Planetary Health Diet – strategy for a healthy and sustainable diet, available online at:

13. Data is available. Abbott Diabetes Care.

14. Placing a FreeStyle Libre 3 sensor requires inserting the sensor filament under the skin. The sensor can be worn for up to 14 days.

15. A sensor can only be activated and used with the FreeStyle Libre 3 reader or the app. A change is not possible after the sensor has been activated.

16. The FreeStyle Libre 3 app is only compatible with certain mobile devices and operating systems. Before you want to use the app, please visit the website www.FreeStyleLibre.de for more information about device compatibility.

17. Guerci B et al. Important decrease in hospitalizations for acute diabetes events following FreeStyle Libre®system initiation in people with type 2 diabetes on basal insulin therapy in France. Presented at EADV, 20-22 September 2022, Stockholm, Sweden

Caption: Dr. Nicola Haller, diabetes consultant DDG.
Image source: Abbott 2024

last edited: October 21, 2024