How to Choose a Healthy Type 1 Diabetes Diet

Nutrition plays a critical role in managing type 1 diabetes successfully. The food you eat has a powerful and immediate effect on your blood sugar and plays an especially large role in your long-term health.

There’s no one-size-fits-all approach to an ideal diabetes diet. It’s possible to take healthy approaches to various eating patterns, from low-carb and Mediterranean diets to vegan and vegetarian lifestyles.

Many other factors, including additional health conditions and your preferences, culture, and religion, all significantly shape what works best for you.

A thoughtful approach to nutrition with type 1 diabetes can help you improve your blood glucose, A1C, blood pressure, and cholesterol levels, achieve and maintain a healthy weight, and delay or prevent diabetes-related complications, including retinopathy, neuropathy, and nephropathy.

Many people with type 1 diabetes feel pressure to switch to a rigorous diet to best manage their condition. Keeping your blood sugar in range after meals is one of the central challenges of life with diabetes, and it’s natural to think a strict eating plan is the best way to do it.

No matter which diet you decide to try, Hayley Miller, MD, the medical director at Mountain States Diabetes in Missoula, Montana, who was diagnosed with type 1 diabetes as a child, cautions against extreme versions of any eating plan.

• Focus on nonstarchy vegetables and lean proteins, like chicken, turkey, and fish
• Choose high-quality carbohydrates, like whole grains, legumes, fruit, and low-fat dairy
• Reduce added sugars and refined grains, like white flour
• Choose minimally processed whole foods and ingredients
• Limit saturated fat, added sodium, and sugar-sweetened beverages
• Prioritize dietary fiber and nutrient-dense whole foods

Miller suggests using a continuous glucose monitor (CGM) to see what happens to your blood sugar when you consume certain foods. “CGMs can really help anyone see the impact of specific foods versus just being told by your doctor what you should or shouldn’t eat,” she says.

Miller also points out how much easier it is to overeat highly processed foods than whole food choices. “[Processed] food is engineered to be this way. These food products break down faster, they’re easier to chew, they’re easier to swallow, and they don’t fill you up the same way whole foods do, so you don’t get the normal signals of satiety,” she says.

“All three of these diets really echo the same message: More real food, less processed junk,” says José.

Guidelines for these diets all encourage the consumption of:

• Fruits and vegetables (aim for four to five servings of each per day)
• Whole grains, like brown rice, oats, and quinoa
• Low-fat or fat-free dairy, like milk, yogurt, and cheese
• Lean proteins, like poultry, fish, beans, and lentils
• Healthy fats, like olive oil, avocado, nuts, and seeds
• Unsweetened beverages, like water, seltzer, and tea, with artificially sweetened products in moderation

These diets also encourage you to eat less:

• Processed foods high in sodium
• Sugary sweets and sweetened beverages
• Red and processed meats
• Full-fat dairy and foods high in saturated fat

By following these dietary guidelines, people with type 1 diabetes can not only manage their condition successfully but also protect their overall health.

Miller adds that any diet can and should include flexibility for treats and splurges, too.

“If we put a food completely off-limits, it creates an all-or-nothing approach that demands impossible perfection,” she says. “If you can’t be perfect, then you might give up completely. It doesn’t need to be this black and white. We simply need to look at what happens when we consume certain foods, how they affect blood sugar levels, and be more thoughtful around foods that have a bigger impact.”

Some people with diabetes reason that they should reduce or eliminate carbs from their diet.

Carbohydrates have an immediate impact on your blood sugar levels because they break down into glucose during digestion. People with diabetes are taught to be keenly aware of how many carbohydrates they consume at every meal.

“I don’t have any patients who have been able to maintain a really low-carbohydrate diet beyond three months because they get sick of it,” says Miller.

“You cannot simply put everyone with diabetes on a low-carbohydrate diet,” says Miller. “For some people with diabetes, a low-carbohydrate diet contains too much protein, particularly if you have kidney disease. And the more you restrict carbohydrates, the more likely you’re eating significantly more saturated fat, which comes with risks and potential impact on your heart health.”

While strict low-carbohydrate diets can lead to a dramatic improvement in blood glucose levels, Miller stresses that blood glucose is just one factor to consider. “If you look at what actually kills people with diabetes, it’s heart disease,” she says. “You can’t just focus on blood glucose levels and ignore everything else.”

Rather than restricting yourself to a certain number of carbohydrates per day, Miller encourages people with diabetes to focus on the quality of carbohydrates they consume.

“If you’re sitting on an airplane and you decide you’re going to have two bags of chips and cookies, that’s 170 grams of very refined, processed carbohydrates,” she says. “That’s much different than eating a sweet potato, then heading out for a 30-minute jog.”

Miller also suggests looking at the bigger picture. “Not every meal needs to contain 60 grams (g) of carbohydrates,” she says. “Maybe your breakfast is very low carbohydrate, but you eat more carbohydrates at lunch. We don’t need to box people in with strict carbohydrate counts.”

“It’s not about eating the perfect diet seven days a week,” says José. “There’s certainly room for dessert, pizza, or chips in life with diabetes, but ideally, these foods are a small percentage of your day.”

And it may be even more important for people with diabetes to limit the protein sources associated with long-term cardiovascular issues, particularly red meat and processed meats.

A common misconception, however, is that protein doesn’t raise blood glucose levels.

Though none of these recommendations are unique to people with diabetes, your individual protein needs may change if you develop diabetic kidney disease.

“If you’ve been diagnosed with any stage of kidney disease, work closely with your healthcare team to determine the safe amount of daily protein for your body,” says José. “Eating a lot of protein doesn’t cause kidney disease, but the kidneys are responsible for filtering waste products when you digest protein.”

With reduced kidney function, José says those waste products can build up in your bloodstream and lead to unpleasant symptoms, like nausea and fatigue.

Fats to eat more of include:

• Monounsaturated fats, like from olive oil, avocado, almonds, peanuts, and cashews
• Polyunsaturated fats, such as from sunflower oil, soybean oil, and corn oil
• Omega-3 fatty acids, such as from salmon, tuna, sardines, flaxseeds, chia seeds, and walnuts

Fats to limit include:

• Saturated fats in fatty cuts of red meat, butter, lard, full-fat dairy, coconut oil, and palm oil
• Trans fats found in processed baked goods, fried foods, and anything with “partially hydrogenated oils” on the ingredients label

“Think about pizza,” says José. “When you’re dosing insulin for pizza, you’re counting the carbohydrates in the crust, the tomato sauce, and possibly some of the toppings, but there’s so much fat in the cheese and any meat toppings, so you have to consider it, too. This fat will definitely slow down how quickly the carbohydrates digest and hit your blood sugar, and that delay could mean some of the carbohydrates hit within the first couple hours after eating while the rest hit four, five, even six hours later.”

Most beverages with calories — from soda and wine to iced coffee and fruit juice — offer little or no nutritional benefits. And for people with type 1 diabetes, these drinks will probably only make your blood sugar management more challenging. The healthiest beverage choices are almost always zero-calorie, starting with water.

The ADA doesn’t recommend a specific quantity of fluid daily for people with diabetes. The amount can vary significantly based on your age, activity level, environment, and other health conditions. However, the ADA does offer a few tips for staying properly hydrated:

• Start your day (and each meal) with a glass of water.
• Aim for light yellow urine. Darker means you need more fluids.
• Carry a reusable water bottle and sip often.
• Add flavor with fruit, herbs, or a splash of sparkling water.
• Eat hydrating foods, like fruits and vegetables.
• Drink extra in hot weather or when exercising.
• Limit alcohol and caffeine consumption.

A simple habit like drinking more water can make a meaningful difference for your long-term health.

While vitamins, minerals, and other dietary supplements are often marketed to people with diabetes, experts caution against using these products, some of which can actually be harmful.

There’s little evidence that most supplements provide the benefits they claim, says Miller. Instead, she recommends prioritizing real, whole food in your diet to get the vitamins and minerals you need each day.

“I’d much rather people get their nutrients from real food, because your body can absorb and use them properly, whereas this isn’t guaranteed with supplements,” says Miller. “Some vitamins, for example, can’t be absorbed unless they’re paired with other vitamins and minerals. Food does this work for you naturally.”

Eating with type 1 diabetes can feel overwhelming. Every meal involves the work of counting carbohydrates, considering the impact of fat and protein, anticipating past or future physical activity, and dosing insulin.

“There’s no other condition where you have to think about food all day, every day,” says Miller. “It can be exhausting.”

However, a few small habits and strategies can make a significant difference in the daily work of juggling nutrition, insulin, and blood glucose targets, according to Miller:

• Consistency Eating the same foods consistently can make insulin dosing more predictable and minimize blood glucose fluctuations.
• Meal Prep Chopping raw vegetables to keep on hand for snacks and preparing your meals ahead of time can prevent you from grabbing lower-quality foods impulsively.
• The 80/20 Rule The whole day doesn’t need to be perfect. Strive to eat mostly whole, real foods for 80 percent of the day, leaving room for that less-than-perfect choice.
• Enjoy Your Food Your diet doesn’t need to be boring or rigid to be healthy and beneficial. Find new foods, explore new recipes, and have fun with it.

“As a nutrition expert and doctor who has also lived with type 1 diabetes for decades, my approach to nutrition has changed dramatically over the years,” says Miller. “I used to be a diet zealot, but I’ve realized that it’s okay to go through phases of not thinking so much about trying to eat really well. It’s normal to go through phases of being tired of the focus on eating really healthy foods all day long, and that’s okay.”

• A type 1 diabetes–friendly diet is one that is personalized to your individual needs and preferences that can be maintained over the long term.
• Instead of strict diets, experts recommend moderate, customizable approaches that prioritize whole, minimally processed foods while limiting saturated fat, added sugar, and refined grains.
• Eating fewer carbs can help your blood sugar control, but it won’t work for everyone. If you enjoy eating more carbohydrates, choose fiber-rich options, like whole grains and legumes.
• Eating with type 1 diabetes can get stressful due to the constant need to count carbs, calculate insulin doses, and weigh other blood sugar factors. Don’t set yourself up for failure by expecting perfection: Your diet needs to be satisfying and sustainable.