Knowing what to eat with diabetes is one thing. Putting it into practice is another.

Putting diabetes nutrition advice into practice

Knowing what to eat with diabetes is one thing. Putting it into practice is another.

What I’ve learnt from more than 20 years working as a dietitian in diabetes management is that nutrition information and advice doesn’t automatically translate into changes in eating habits and behaviours.

When first diagnosed with Type 2 diabetes, most people want to know what to eat. A quick look online turns up countless opinions, contradictory advice, news stories, social media messages and people proclaiming to have the best diet or a quick solution. It’s hardly surprising this leads to confusion and frustration.

Many of my clients come to me having done lots of their own reading and research. Some have attended diabetes education programs or seen a dietitian before. They may know which foods and portions influence their blood glucose levels and have a reasonable understanding of healthy eating. However, they still struggle to put what they know into practice.

So what makes it hard to move from knowing stuff to doing stuff? What gets in the way?

Why more nutrition information isn’t always the answer
There’s more nutrition information available today than ever before, but having access to information doesn’t mean we’re able to apply it.

Sometimes people receive a handout of general recommendations, a list of foods to avoid or a prescribed meal plan. The information may be accurate and useful, but does it fit their budget, lifestyle, food preferences, cooking skills or family circumstances? And have they been given enough practical guidance to put it into action?

Information overload is a problem too. There’s only so much anyone can take in during an appointment, particularly when they’ve recently been diagnosed and are trying to understand several aspects of their health.

Education and awareness are important starting points. But people also need the chance to apply what they’ve learnt, work through difficulties and make adjustments when things aren’t going to plan.

Intentions fade, life gets busy, and Monday’s plans can become a distant memory by Wednesday.

What influences our everyday food choices?
Hunger, food preferences, work schedules, family routines, budget, convenience and what’s available at home all influence what, when and how much we eat.

Take afternoon snacking. You may know that yoghurt, fruit or another nutritious snack would be a useful choice. But it’s 4 pm, you’re hungry, you’ve had a busy day and there’s a chocolate bar sitting on the desk. What are you likely to choose?

Perhaps the bigger issue started several hours earlier. Did you have enough for lunch? Was there enough protein, fibre and carbohydrate to keep you satisfied through the afternoon? Did you skip lunch altogether because you were busy? If you’re regularly arriving at 4 pm extremely hungry, it may be worth looking at lunch rather than concentrating only on the snack.

Food enjoyment matters too. People sometimes think healthy eating means bland or unappealing food. Yet there are plenty of nutritious meals that are enjoyable, satisfying and relatively simple to prepare.

Start by understanding your own eating patterns
One of the most useful things you can do is become more aware of your usual eating behaviours. So much of what we do around food happens out of habit, without much thought. You might snack at your desk, eat in front of the television, grab something while preparing dinner or look for food when you’re bored. Other times, hunger is driving the decision because you’ve eaten very little earlier in the day.

Some questions worth asking:

• When am I most hungry during the day?

• Are my meals satisfying, or am I looking for something else soon afterwards?

• Where and when do I tend to snack?

• What happens to my food choices when I’m busy, tired or unprepared?

You might use a short food diary, a hunger rating scale or simply reflect on your usual routine. I often use these with clients to pick up patterns that otherwise go unnoticed.

Awareness creates choice. Once you understand what’s happening, you can consider what you might do differently. I’ve written more on this in How to build healthy habits that last with Type 2 diabetes.

Make it easier to put advice into practice
Being organised with shopping, meals and snacks makes a considerable difference.

Back to the 4 pm example: if lunch has been inadequate, could you adjust the meal, with more protein, high-fibre carbohydrate or vegetables? Could you have a planned snack on hand for days when lunch is early or you know you’ll be hungry?

Other simple strategies include:

• Cooking enough dinner to have leftovers for lunch the next day

• Having a few easy meal options available at home

• Preparing a shopping list based on the meals you intend to make

• Keeping suitable snacks at work or in your bag

• Preparing some ingredients ahead of time for busy days

I often encourage clients to think about where they’re having difficulty and what small adjustment would make that situation easier. For example, if you regularly buy takeaway because you arrive home late and haven’t planned dinner, perhaps keeping two or three convenient meal options at home would help.

You can have excellent nutrition knowledge, but if the foods you intend to eat aren’t available when you need them, putting that knowledge into practice becomes much harder.

Find solutions that fit your life
Advice needs to take into account the person receiving it. Two people with Type 2 diabetes may have similar nutrition goals but very different ways of achieving them. One may enjoy cooking and preparing meals for the week. Another may have limited time, little interest in cooking, or a family whose preferences need to be considered. Others have tight food budgets, cultural food traditions, shift work, travel or a lot of eating away from home.

For example, increasing vegetable intake could mean preparing fresh vegetables, using frozen or canned, adding vegetables to a family curry, or making extra portions to use over several meals. There are often several ways to work towards the same recommendation.

It also helps to review how the changes are working. Are your meals satisfying? Have you noticed any changes in hunger or snacking? Is meal preparation getting easier? What are your glucose patterns showing, where relevant? If something hasn’t worked as expected, consider what got in the way and whether another approach might suit you better.

The role of a diabetes dietitian
A consultation goes beyond information about which foods to eat and in what quantities. Evidence-based nutrition advice is important, but so is the art of communication and behaviour change.

In my consultations, I want to understand what someone is currently doing, what they already know, what they’re finding difficult and what changes would be realistic. We then work together on practical solutions for everyday situations and review how they’re going. Sometimes that involves portions and glucose patterns. Other times the focus is meal structure, hunger, shopping, food preparation or the habits influencing someone’s eating.

Ongoing support can also help when circumstances change or a plan that worked becomes difficult to keep up.

People don’t always need more information. They may need help working out how to use the information they already have.

Putting knowledge into everyday action
If you know what you should be doing with your eating but are finding it hard to follow through, take a closer look at what’s getting in the way. Start with a situation you regularly find challenging. What do you already know about it? What influences your choices? What could you try differently, and how will you know if it’s helped?

Changes to eating and lifestyle take time, and what works for you may change as your circumstances do. We’re playing the long game. Building the skills and confidence to make your own food decisions is what helps you manage your diabetes over the years ahead.

If you’d like help turning what you know into something that works day to day, you can book an online consultation, or start with my free Type 2 Diabetes Guide.