Type 1 Diabetes Diet: What to Eat and What to Avoid

If you or Member of family has just been diagnosed with type 1 diabetes, you’re probably wondering how your diet will be affected by your condition. The good news? It really won’t change that much, especially if you’re already eating healthy foods. Here’s what you need to know about meal planning, eating patterns, and food choices when you have type 1 diabetes.

There’s no such thing as a “type 1 diabetes diet.” Actually, there’s no particular diet or eating pattern that’s recommended for any type of diabetes. People with type 1 diabetes can eat anything that people without diabetes eat. The difference is that your pancreas doesn’t make insulin, a hormone that allows your body to use sugar (glucose) for energy. This means you’ll have to dose insulin for the carbohydrates you eat because they raise your blood sugar levels.

Basically, you should aim for the overall healthy diet that is recommended for all people. You will want to include a ton of fruits and veggies, have at least half of your grains be whole grains, eat a moderate amount of lean protein, and limit added sodium and sugar.

Why Follow a Type 1 Diabetes Diet?

It’s about making sure your eating patterns are working to keep you healthy and your blood sugar managed. There are many factors that can affect how well your diabetes is managed. Eating well is one of the variables you can control, along with regularly monitoring your blood sugar, taking your medications as directed, and exercising frequently.

Usually, it’s kids who are diagnosed with type 1 diabetes. Although it can develop at any age, the two peak ages for a type 1 diabetes diagnosis are between 4 and 7 years old and between 10 and 14 years old.

Your doctor will likely recommend that you see a registered dietitian nutritionist (RDN) to help you figure out the best way to adjust your or your child’s eating patterns. If they don’t mention it, it’s a good idea to find one on your own. They are an incredibly helpful resource for tailoring an eating plan to your personal needs. Talk to your health insurer about finding an RDN in your network.

If you can, enlist an RDN who is a Certified Diabetes Care and Education Specialist (CDCES). An RDN CDCES can help you manage your diabetes along with your diet.

If you’re the parent of a child diagnosed with type 1 diabetes, you can help your child through the process based on age-appropriate readiness. For example, you could let your child test their blood sugar levels on their own while you watch. For dosing insulin, maybe you’re the one to do it at first, but your child could gradually take over.

It’s a good idea to learn how food impacts your or your child’s blood sugar levels too. For example, oatmeal is considered a healthy food overall—it’s a whole grain and has protein and fiber. But if a person with type 1 diabetes were to eat just plain oatmeal and nothing else and dose their mealtime (bolus) insulin 15 minutes prior to eating, their blood sugar might not be fully managed.

But if you mix the oatmeal with a scoop of peanut butter, which has protein and healthy fats, and a few berries for added fiber, now we’re talking a different impact. Pairing carbohydrates with protein, healthy fat, and fiber slows down the carbs’ digestion and their release into the blood, which helps keep your blood sugar stable.

When you have type 1 diabetes, the key is to learn how different foods affect your own blood sugar because not everyone has the same response to the same foods. And while no two days are the same in diabetes management, the idea is to start to better understand the impact of food on your unique body.

Expect that there will be a lot of trial and error, especially at first. Between knowing when to eat, what to eat, and how much to adjust your or your child’s insulin, it’s a tremendous balancing act that will take some experimenting to figure out your individual needs.

The Importance of Insulin

It’s vital to make sure you understand how insulin works and when to use it. Because your pancreas doesn’t make insulin anymore, you will be completely reliant on getting your insulin through an injection, pump, or inhalation. Insulin is how your body uses glucose from the foods you eat, so it goes hand in hand with meal planning.

There are different types of insulin, including:

• Short-acting or regular insulin starts working about 30 minutes after dosing, peaks around 2 hours, and works for 3 to 6 hours. The timing is essential with this type—if you wait to take it until you start eating, you probably won’t be able to mirror digestion. This can lead to a blood sugar elevation that isn’t manageable with the dose. In younger kids, however, this may be the best way to dose in the beginning because you often don’t know how much food they’ll eat. If they’re dosed for the full amount and they don’t eat all their food, they could actually end up with a low blood sugar level.
• Rapid-acting insulin starts working within 15 minutes, peaks at 1 hour, and works for up to 4 hours. This type is usually used 15 to 20 minutes before you eat.
• Intermediate-acting insulin takes between 1 and 3 hours to get into your bloodstream, peaks around 6 to 8 hours, and lasts for 12 to 24 hours.
• Long-acting insulin takes a few hours to start working. It doesn’t have a peak and works for up to 24 hours.
• Ultra-long-acting insulin takes around 6 hours to get into your bloodstream. It doesn’t peak either, and it works for 36 to 40 hours.

How and when you take insulin will depend on your needs. Be sure to talk to your or your child’s doctor or RDN about any questions or concerns you have with insulin dosing.

The Importance of Exercise

Regular exercise is important for everyone, including people with type 1 diabetes. Exercise can help keep your diabetes controlled, promote weight loss, boost your mood, and lower your risk of heart disease and nerve damage, plus it has benefits for your overall health.

Adults should get at least 150 minutes of moderate intensity physical activity every week, such as dancing, housework, mowing the lawn, walking briskly, bicycling, or swimming. If you have a toddler, they should be getting at least 30 minutes of physical activity in during the day and not sitting for more than an hour at a time. Preschoolers, kids, and teens need 60 minutes of exercise or more every day.

When it comes to exercise with type 1 diabetes, timing is important too. When did you last eat? Do you need to dose down on your insulin because you’ll be playing or exercising? Or do you need a small snack that you don’t dose for because you’re being active and that snack will serve as the energy?

Monitoring your blood sugar before, during, and after you exercise is important too—activity can impact your blood sugar levels for up to 12 hours. You may need to adjust your dosing of insulin or have a snack before bed to avoid low blood sugar (hypoglycemia), depending on what activity you’ve done and the timing. Your doctor or RDN can help you find the right timing and necessary insulin adjustments for before, during, and after you exercise.

Your Recommended Blood Sugar Level

You, your doctor, and your registered dietitian will work together to keep your blood sugar level within a normal range. This can take some trial and error as adjustments are made. In general, your blood sugar level before you eat should be between 80 and 130 milligrams per deciliter (mg/dL), and it should be no higher than 180 mg/dL within two hours after you eat.

You’ll probably find that working with an RDN is invaluable, especially when you’re first starting out. They can help you learn what to look for on nutrition facts labels and how to estimate portions so you can better match your insulin to the food you’re eating.

The goal is for you to create healthy eating habits overall, so an RDN might talk to you about how you can improve your overall health with one or two small changes. From there, you add on. For kids, a small change might be finding a way to prepare non-starchy vegetables that they like (see below for more info). Non-starchy vegetables are minimal in their carb amount, so minimal insulin is required, and sometimes not at all. They’re also full of fiber, which can help manage blood sugar levels. By including veggies at meals, it’s a win-win for both overall health and blood sugar management.

Learning to count your or your child’s carbohydrates and monitoring blood sugar levels go along with eating. The American Diabetes Association (ADA) acknowledges that not everyone’s body responds the same way to different foods, and that includes carbs. In other words, the foods that might work well for one person to help manage their type 1 diabetes might not work as well for you. This is yet another good reason to work with an RDN to personalize your eating plan according to your body’s responses.

The good news is that people with type 1 diabetes can eat any and all foods. The key here is making sure you identify which foods contain carbs so that you’re making sure to dose your insulin based on the carbs you’re eating. Ultimately, you are the brains behind insulin dosing and managing your blood glucose levels.

In general, the dietary recommendations for people with type 1 diabetes are the same as for those without diabetes, with a few extra notes:

• Eat lots of fruits and veggies.
• Include whole grains, legumes, and low-fat dairy (or dairy substitutes such as soy.
• Aim for foods that are low in saturated fat, trans fats, and cholesterol.
• Swap red meat for lean meats, fish, eggs, legumes, nuts, seeds, and soy products.
• Make sure you’re getting enough fiber (25 to 30 grams per day)—it can help control your blood sugar levels.
• Avoid highly processed foods and eat as many whole foods as possible. Examples of whole foods are fresh fruits and veggies, whole grains, eggs, nuts, beans, fish, and shellfish.
• Though you can have artificial sweeteners in moderation, work on decreasing your consumption.
• Increase your water intake if needed. Most people need around four to six cups a day, but this may be different depending on your overall health and whether you eat foods that are high in water (like yogurt and most fruits and vegetables). Talk to your doctor if you’re not sure how much water you should be getting.
• Avoid foods with added sugar most of the time.
• Watch out for foods or drinks that say they’re sugar-free or fat-free. Compare the label with a similar product that isn’t sugar- or fat-free to decide which is better for your needs based on calories, carbs, fiber, and fat.
• Foods with less than 20 calories and 5 grams of carb per serving are considered “free foods” because they won’t affect your weight and you won’t need more insulin.
• If you choose to drink alcohol, do it in moderation (one serving max per day for women and two servings max per day for men). Be sure to monitor your blood sugar in case you need to change your insulin dose.
• Watch your portion sizes. The idea is to eat reasonable amounts no matter what the food is.

The Plate Method

One way to help you balance your foods is called the Plate Method. It works like this:

• Fill half of your plate with non-starchy vegetables such as broccoli, salad greens, green beans, asparagus, cucumbers, carrots, or celery.
• Fill a quarter of your plate with lean protein such as poultry, eggs, fish, shellfish, lean beef or pork, cheese, tofu, beans, hummus, or falafel.
• Fill the remaining quarter with carb (starchy) foods such as whole grains, starchy veggies (acorn or butternut squash, potatoes, green peas, sweet potatoes, or parsnips), legumes, fruit or dried fruit, or dairy products such as milk, yogurt, or soy milk.

The ADA’s Diabetes Food Hub is a good resource for recipes, nutrition information, and meal planning.

There are no foods that need to be avoided. What’s really important is understanding the impact foods have on your blood sugar levels so you’re able to manage them. That said, no one—with or without diabetes—needs to drink a gallon of Hawaiian Punch every day or eat large quantities of foods that are fried or high in sugar and sodium either.

Up until about 20 years ago, eating at specific times that coordinated with your insulin was crucial for diabetes management. Thankfully, insulin has improved drastically and specific time frames for eating aren’t needed anymore. When you dose your insulin as your doctor directs, it works similarly to the way your pancreas would.

Like everyone, you should eat when you’re hungry. This means it’s important to be in tune with your hunger cues. Just be aware that high blood sugars (hyperglycemia) can mimic the hunger sensation. If you eat and shortly afterward you feel hungry, it’s important to check if your blood sugar level is high.

Every day is different, so it’s important to think of when your meals will happen and make sure to account for when you had a dose of insulin. You may need to dose for the meal you’re having, and if you’re going to eat something else that also needs to be covered with insulin, make sure to keep track of how much insulin you have on board (in your body). Insulin pumps can sometimes help with this because they are able to deliver continuous doses, but ultimately, you’re the one in control of how much to dose.

A registered dietitian can help you create an individualized meal plan. This is specific to you, so it won’t look like everyone else’s. It’s about when you’re hungry and what fits your needs and lifestyle best. Do you want to eat two meals and one snack each day or are you a three-meals-a-day person?

For kids, it’s a bit different. It’s important that they get all the calories they need to grow and stay active. Their meal plan typically involves three meals plus snacks.

A diet is really just a way of eating, also called an eating pattern. The ADA’s most recent consensus statement on nutrition for diabetes notes that there’s no evidence to support a specific eating pattern for people with type 1 diabetes. Until there is strong evidence that a certain eating pattern is helpful, the ADA recommends focusing on the three elements that most healthful eating patterns have:

1. Eat lots of non-starchy vegetables.
2. Minimize added sugar and refined grains (white flour, white rice, and white bread).
3. Pick whole foods over highly processed foods whenever possible.

The bottom line is that a successful eating pattern is one that you’re going to follow and that works for you in the long term. In other words, you’re free to choose any eating pattern, including one of the ones listed below.

Pro Tip: Work with an RDN or diabetes educator to customize whichever eating pattern you choose. Your RDN can help make sure that you’re getting all the nutrients you need, your blood sugar stays controlled, and you’re getting the right number of calories.

Low-Carb Diet

Meal planning for diabetes already involves lower carbs. The problem with a “low-carb” diet is that there’s not a specific definition of what that is. An eating pattern that’s lower in carbs—26% to 45% of total calories from carbohydrate—does benefit some people. But remember that everyone responds to carbs differently. Be sure to work with an RDN if you want to try lowering your carbs more.

See the keto diet, Atkins diet, Dukan diet, and Bulletproof diet for examples of low-carb diets.

Keto Diet

In general, ketogenic (keto) diets are high in fat (60% to 85%), low in carbs (5% to 10%), and moderate in protein (15% to 30%). Eating this way forces your body to use fat for its main energy source rather than carbs. This increases ketones in your blood, putting you into a state of ketosis.

Research shows that keto diets are beneficial for people with type 2 diabetes. They’re becoming more popular among people with type 1 diabetes too. The problem is that there isn’t enough evidence to show that this eating pattern is safe or effective for type 1 diabetes.

If you decide to try a keto diet, you’ll need to closely monitor your ketones to watch out for and prevent diabetic ketoacidosis. This is a dangerous condition that can develop when the level of ketones in your blood gets too high.

You’ll also need to check your blood glucose levels more often on this diet. This can help prevent hypoglycemia, a condition that occurs when your blood sugar gets dangerously low. On the other end of the spectrum, blood glucose levels that are over 250 mg/dL can be a sign that you’re developing diabetic ketoacidosis.

There’s one big caution about this eating pattern—if you’re taking an SGLT2 inhibitor such as canagliflozin (Invokana), dapagliflozin (Forxiga), or empagliflozin (Jardiance), you shouldn’t try keto. It can lead to diabetic ketoacidosis and hospitalization.

Atkins Diet

Like the keto diet, Atkins is a low-carb eating pattern that emphasizes protein and fats. In fact, the Atkins 20 diet calls itself “the original keto diet.”

Atkins requires you to track your carbs using the net carb system. To calculate net carbs, subtract a food’s fiber content from its total carb content. For example, one-half cup of cooked asparagus has 3.7 grams of total carbs and 1.8 grams of fiber, so its net carb value is 1.9 grams.

There are four phases in Atkins. You can start with any of the first three if weight loss is your goal.

• Phase 1: The first phase lasts a minimum of two weeks, and you eat only 20 grams of net carbs per day. Most of your net carbs—12 to 15 grams—should come from vegetables such as green beans, cucumber, asparagus, broccoli, and celery. This phase lasts a minimum of two weeks. This can cause some side effects such as headache, fatigue, dizziness, weakness, and constipation.

Otherwise, you’ll eat protein at every meal such as fish, poultry, shellfish, meat, cheese, and eggs and drink a minimum of eight glasses of water daily. Foods you’ll avoid include fruits, nuts, breads, pasta, grains, baked goods, and alcohol.

• Phase 2: In the second phase, you’ll stick with a minimum of 12 to 15 grams of net carbs from the veggies in phase 1. You’ll be able to gradually add carbs with a high amount of nutrients back in as you lose weight, and you’ll still avoid sugary foods. This phase lasts until you’re about 10 lbs. from your target weight.
• Phase 3: This phase lasts until you reach your goal weight and involves gradually adding more foods into your diet. This increases your net carbs.
• Phase 4: The last phase lasts the rest of your life. You’re supposed to keep eating the same way you were at the end of the third phase to maintain your weight.

Dukan Diet

The Dukan diet is somewhat similar to the Atkins diet because they’re both low-carb diets. And like Atkins, Dukan has four phases.

But there are some differences. For instance, with Dukan, you don’t need to count carbs. Dukan emphasizes low-fat, high-protein foods, while on Atkins, you can have full-fat dairy, fatty meats, and cheese.

There’s not much scientific evidence that this eating pattern is effective, although you can probably lose weight at first. Dukan may not give you all the nutrients you need either, plus it has the same long-term risks as any high-protein diet.

Bulletproof Diet

This diet is another low-carb eating pattern that’s similar to a keto diet. The goal is to eat few enough carbs to put your body into ketosis. The Bulletproof diet also involves intermittent fasting and focusing on healthy fats such as avocado, pure coconut oil, and grass-fed butter.

There hasn’t been much research on this diet, so it’s not clear how helpful or healthy it is.

Vegetarian or Vegan Diet

A vegetarian diet means you don’t eat any meat, poultry, or fish. A vegan diet is a stricter type of vegetarian diet in which you don’t eat any animal products either, such as eggs, cheese, or milk.

A vegetarian diet can be beneficial for people with type 1 diabetes, but how beneficial depends on what foods you choose to eat. For instance, if you eat a lot of simple carbs such as potatoes, pasta, white rice, white bread, and starchy foods, this can cause high blood sugar levels.

But if you focus on eating veggies, fruits, whole grains, nuts, and legumes instead, your body’s response to insulin and your blood sugar levels can actually improve. Vegetarian diets can also help you lose or maintain weight and lower your risk of heart disease, a common complication of diabetes.

Plant-Based Diet

A plant-based diet is not the same as a vegetarian or vegan diet, although it sounds similar. Most of what you eat is plant-based, but you can also have beef, poultry, fish, eggs, and dairy products, though you’ll eat less of them and not as often.

A plant-based diet consists of eating mostly these foods:

• Whole grains, such as brown rice, popcorn, oatmeal, whole wheat bread and pasta, and whole grain cereals
• Fresh fruits and vegetables
• Legumes (peas, beans, peanuts, and lentils)
• Unsalted nuts
• Healthy oils such as olive oil

Processed foods, refined grains, snack foods, and beverages that are sweetened with sugar are off limits in this diet.

Examples of a plant-based eating pattern include the Indian diet and the Mediterranean diet.

Indian Diet

A traditional Indian eating pattern is mostly plant-based and includes food from all the food groups: vegetables, fruits, nuts, and seeds; whole grains; pulses (legumes); dairy; fats such as coconut oil and ghee (clarified butter); and a variety of spices, such as turmeric, cumin, coriander, and saffron. Eggs, poultry, fish, and meat are also part of this eating pattern, though they’re eaten less often.

An Indian diet is a healthy option as long as you follow the general dietary guidelines for healthy eating above, including observing recommended portion sizes.

Mediterranean Diet

The Mediterranean diet is considered one of the best eating patterns for anyone, including people with diabetes. The American Heart Association recommends this eating pattern for lowering the risk of heart disease and stroke. It has also been shown in studies to reduce the risk of metabolic syndrome, diabetes, certain cancers, depression, and improve mental and physical function in older adults.

The Mediterranean diet is a good eating pattern because it focuses on eating lots of fruits, vegetables, whole grains, beans, and legumes. Sugar, highly processed foods, saturated fats, sugary beverages, refined carbs, and fatty meats are limited.

You can also eat potatoes, seeds, fish, poultry, and low-fat or fat-free dairy products in moderation. This diet recommends olive oil as your main source of fat, along with healthy fats from avocados, nuts, and oily fish such as salmon and sardines. You can drink wine with your food too—one glass a day for women and one to two glasses a day for men.

Paleo Diet

A paleo diet consists of foods that are similar to what humans during the Paleolithic era may have eaten. Basically, this includes foods that were hunted and gathered, such as:

• Lean meats, particularly wild game or grass-fed animals
• Fish
• Fruits
• Vegetables
• Nuts and seeds
• Fruit and nut oil

Foods you avoid with the paleo diet include:

• Dairy products
• Legumes
• Grains, such as oats, barley, and wheat
• Potatoes
• Salt
• Highly processed foods

Some of the potential benefits of a paleo diet are:

• It can help you lose weight or maintain your weight.
• If you eat lots of fruits and vegetables and get plenty of fiber, potassium, and antioxidants, most of your nutritional needs should be met.
• It may improve your blood sugar, at least for a while.

A few of the concerns involved with a paleo diet include:

• It can be expensive.
• Some of the foods may be harder to get, such as grass-fed animals and wild game.
• Avoiding dairy products means you’ll have to find other calcium food sources and/or take calcium and vitamin D supplements. If you aren’t getting enough calcium, your risk of osteoporosis, bone fractures, and rickets (soft, weak bones) is higher.
• It may be difficult to stay on because it restricts many foods.
• Because it’s high in saturated fats, you may develop higher cholesterol levels over time.
• The low number of carbs in this diet could lead to diabetic ketoacidosis.

It’s especially important to consult with an RDN if you plan to try a paleo diet because of the potential risks to your health.

High-Protein Diet

A high-protein eating pattern is defined as getting a large proportion of your calories (in some cases up to 50%) from protein. Following this eating pattern for a short time may help with weight loss, but using this diet long-term may cause health issues. For instance, if you’re following a diet that restricts carbs too much, you may not be getting enough fiber or other nutrients. If you’re picking proteins such as red meat, processed meats, and foods high in saturated fat, these can increase your risk of heart disease and high cholesterol. And if you have kidney disease, a high-protein diet can affect how well your kidneys function.

As with any eating pattern, pick your proteins wisely. Good options include lean meat, skinless chicken, beans, nuts, fish, low-fat dairy products, and soy protein. Avoid processed foods and aim for carbs that are rich in nutrients and fiber such as veggies, fruit, and whole grains.

Celiac/Gluten-Free Diet

Celiac disease is an immune reaction in the small intestine caused by eating gluten, a protein in wheat, rye, and barley. The only way to manage celiac disease is to follow a strict gluten-free diet.

According to the ADA, around 6% of people with type 1 diabetes have celiac disease too. Scientists think there might be a genetic link between these two conditions, which are both considered autoimmune disorders.

If you do decide to try a gluten-free eating pattern, be aware that right now, there’s no evidence to show that it has any health benefits or that it helps with weight loss. It’s also important to know that you may not get all the nutrients you need while following this diet, and it may cause weight gain.

Also, keep in mind that just because something is labeled “gluten-free” doesn’t mean it’s healthy or that it’s low in carbs. In fact, many of these products have lots of carbs, as well as added sugar. Instead, focus on eating lean meats, veggies, whole grains, and fruits with lots of fiber.

HCG Diet

The U.S. Food and Drug Administration (FDA) has advised people to avoid weight loss products that contain human chorionic gonadotropin (HCG). HCG is a hormone that’s produced by the placenta during pregnancy. It’s not approved for weight loss, though the FDA has approved HCG as a prescription drug to treat fertility problems.

Not only are the products unsafe, but the diet itself also restricts your calorie intake to only 500 to 800 calories a day. This low number of calories can actually be dangerous for your health. You could develop gallstones, an irregular heartbeat, electrolyte imbalance, and nutritional deficits.

You could also have side effects such as depression, irritability, fatigue, restlessness, a buildup of fluid, or breast swelling in boys and men. Your risk of blood clots is higher too.

This isn’t a good eating pattern for anyone to choose. If you have HCG products, get rid of them and stop following the diet recommendations. There are much better and healthier options you can pick.

Starvation Diet

In the early 1900s, before insulin was discovered, doctors used what they called “starvation treatment” to treat diabetes. This involved repeated fasting and long periods of undernourishment by severely restricting calories. While the treatment did relieve people’s symptoms and enable them to live longer, it was also hard to stay on, especially for growing children. Some patients starved to death. Thankfully, the discovery of insulin came along in 1922.

These days, a starvation diet is also known as a “fad diet” or “crash diet.” Merriam-Webster defines a starvation diet as “a diet that does not provide a person with enough food to be healthy.” This should be a clear caution that this isn’t a good eating pattern for anyone, especially long term.

If you want to lose weight, there are much healthier—and easier!—ways to do it. Talk to an RDN about how to cut back your calories while still getting all the nutrients you need.

Dieting to Lose Weight With Type 1 Diabetes

If you’re overweight, losing even just 5% of your total body weight can promote better blood sugar levels and other improvements in type 1 diabetes. But be aware that extreme diets, such as the starvation diet (see above), fasting, diet pills, and cleanses can be risky when you have diabetes.

A vegetarian, vegan, Mediterranean diet, or another plant-based eating pattern are all healthy ways to lose weight and still meet your nutritional needs. The Dietary Approach to Stop Hypertension diet, or DASH diet, is another eating pattern that’s healthy, balanced, and could help you lose weight.

Best Diet to Gain Weight With Type 1 Diabetes

If you’re underweight or your appetite isn’t great, you may need to focus on getting more healthy fat and calories. If weight loss is new and unexpected, it’s important to talk to your health care team to see if you need to make any changes in your diabetes management.

It’s also a good idea to talk to a registered dietitian if you need to gain weight. They can help you come up with an eating pattern that’s personalized just for you to healthfully add on some pounds.