When you think about diabetes, what is the first thing that pops into your head? Is it caused by having too much fat? Or how a person living with diabetes can’t eat bread, sugar, or carbohydrates? Or that they should stick to a high-fat diet to lose weight and control blood glucose? Do you ever think about how body fat affects insulin resistance? Let’s get into that.

Diabetes is a leading public health crisis affecting more than 30 million people in the U.S. People with diabetes have a chronic illness that requires them to control their elevated blood glucose levels, a result of a phenomenon known as insulin resistance. But what causes this condition to occur?

First, let’s talk about glucose. The sugars and starches in your diet are broken down into a simple energy form known as glucose. But how does glucose enter the cells in the body to be used as energy? When healthy, cells from the pancreas make the hormone insulin to help the body use blood glucose from food as energy or store that energy in the liver and muscles as glycogen (a short-term energy source). Insulin regulates the body and whether or not the extra glucose from food gets stored as fat.

Returning back to the health condition of diabetes (where this activity is impaired), it is important to note that not all cases of diabetes are the same. People with type 1 diabetes are unable to make insulin due to inactive beta cells, while those with type 2 diabetes can make insulin, but in these cases, the body doesn’t respond well to it causing glucose to remain in the blood.  Put simply, the excess sugar (glucose) in your blood is what is linked with the onset of diabetes.

90 to 95 percent of all new cases of diabetes are likely to be type 2 diabetes, which is likely caused by obesity, lack of exercise, high insulin resistance, and poor dietary habits.

Since the results of poor management of diabetes manifest in blindness, stroke, heart disease, and amputation, blood glucose levels need to be managed through a healthy diet and physical activity. This is because exercise causes insulin sensitivity (or simply, the opposite of insulin resistance) to increase, improving the muscle cells’ ability to use insulin and therefore take up glucose. When lifestyle changes are not enough to control blood glucose, people living with diabetes often inject medical insulin to further manage blood glucose levels. Yet, while proper diet and physical activity can help avoid these issues, another important focal point is to monitor your weight, particularly your fat mass.

Importantly, the way fat is stored in your body plays a major role in insulin resistance and sensitivity and therefore is tightly linked to your risk for diabetes.

What’s the Difference Between One Fat Cell and Another?

Often, Body Mass Index (BMI) is the primary tool medical professionals use to determine if their patients are overweight or obese, increasing the risk of diabetes. However, BMI doesn’t take into account how your body stores fat and how the storage of fat affects your health. Your fat can be stored subcutaneously or viscerally, also known as subcutaneous and visceral adipose tissue (SAT and VAT). SAT lies under the skin,is pinchable, and is visible to the eye. It’s also the fat that you generally see changes in when you improve your body composition with cardiovascular and resistance training. VAT can’t always be seen directly and hangs around your organs, making it more dangerous to your health and more strongly associated with metabolic syndrome and diabetes compared to subcutaneous fat. What contributes to the increase of visceral fat? While your gender and genetics do have an influence, a sedentary lifestyle with a lack of physical activity, a poor diet with excess calories from processed foods high saturated fat and carbohydrates, stress, smoking, and poor sleep habits all highly contribute to your disease risk.  

A study in Diabetes Care suggests subcutaneous fat has protective properties. Increased hip-to-thigh fat mass ratio is associated with lower risks of type 2 diabetes, independent of abdominal fat. But, subcutaneous fat storage is limited, so excess storage of fat results in fat deposition in the visceral space, muscles, and liver, which leads to organ dysfunction and insulin resistance.

The most interesting thing about visceral fat is that it actively contributes to the state of our health because it acts like an organ in your body, but instead of contributing to your health, it actively works against it. This is because visceral fat produces cytokines, protective substances that are secreted by your immune system, however, excess cytokine production causes inflammation and increases the risks of cardiovascular disease and negatively affects the cells’ sensitivity to insulin, further contributing to diabetes.

When it comes to fat cells, size matters in VAT’s case. Metabolic issues related to obesity were related to changes in fat cell size instead of fat cell number. Those with higher visceral fat were found to have enlarged fat cells, creating a greater propensity for those large fat cells to keep growing. Enlarged fat cells can increase the cell’s secretion of inflammatory cytokines, which may explain the link between obesity and insulin resistance.

Now that we have discussed how visceral fat can increase insulin resistance and lead to or exacerbate diabetes risk, let’s move on to talk about how medical insulin affects fat storage in diabetic patients.

Does Insulin Therapy Affect Body Fat?

Generally, the answer is yes, insulin therapy has a positive impact on body fat but it remains a conundrum among people living with type 2 diabetes because medical insulin is associated with weight gain. This may seem strange since we now know that weight gain can contribute to insulin resistance. So how would more insulin then increase weight gain?

It is first important to note that most people conflate weight gain or loss with fat gain or weight loss. While that can be the case, the situation is a bit more complicated than that, especially with diabetes.

When you have poorly controlled diabetes and have high blood sugar,  glucose is excreted out of the body as urine because it’s unable to be absorbed by the kidneys. Frequent urination, one of the signs of diabetes, then results in weight loss. This can cause people to think that they are getting healthier or even losing fat, when really it is water and muscle loss. On the other hand, if you’re a person with diabetes who injects insulin, you may have noticed a little weight gain and found it difficult to lose weight. This is because once you begin taking insulin, your cells are more receptive to glucose which results in increased glucose storage. When glucose is stored as glycogen, water is also stored, resulting in weight gain. While a few studies, such as this one from the Journal of Nutrition and Metabolism suggest that body weight gain from insulin therapy is entirely composed of fat mass and not fat-free mass, further research is necessary to determine how insulin therapy can impact muscle gain over time. In addition, the researchers of this article didn’t feel the increase of fat mass offset the overall benefits of insulin.

As mentioned earlier, one of the contributors to type 2 diabetes is excessive body fat, particularly visceral fat. A study from the journal Endocrine Research highlights the results of early intensive insulin therapy on body fat distribution, lean body mass, and beta cell function in persons newly-diagnosed with type 2 diabetes. After 12 weeks of intensive insulin treatment, the participants’ SAT and VAT were measured. Body weight and fat mass slightly increased, but the ratio to VAT to SAT decreased. This means that insulin therapy shifted fat storage away from visceral to subcutaneous fat, in turn improving insulin sensitivity.

So if you have diabetes, it is recommended to control it through a combination of insulin therapy, proper diet, and exercise. If you don’t currently have diabetes, diet and exercise may be your best tools to help reduce your risk.

What Can I Do to Improve Insulin Sensitivity and Reduce Body Fat?

For starters, evaluate your diet and exercise habits. If you don’t exercise regularly and are eating a diet high in saturated fat, processed sugar, and carbohydrates, and excess calories, start changing those habits. Do exercises that require your muscles to work, which includes a combination of both resistance and cardiovascular exercise. Your muscle cells love glucose and need it to help feed those muscles with the energy they need to perform. It doesn’t matter if you’re lifting heavy weights or light weights — your muscles will still uptake the glucose out of your blood.

Having a higher ratio of muscle mass is associated with lower insulin resistance and improved insulin sensitivity. But hey, if weights aren’t your thing, try walking! Walking can improve your HbA1c levels, which is used to measure your average blood sugar from over a period of 8-12 weeks. Walking requires no equipment, can be done anytime and is free. As long as you’re exercising regularly, your efforts will be beneficial to insulin sensitivity that could persist for up to 72 hours after exercise in people living with diabetes, meaning these positive benefits likely extend beyond the exercise session even in healthy populations. Whatever you do, just find a way to move your body every day and switch to a diet high in fiber and abundant in fruits, vegetables, and lean meats.

If you’re a person living with diabetes, get familiar with the glycemic index (GI), which provides a scale to determine how significantly foods with carbohydrates raise your blood glucose. While this doesn’t mean that you should avoid carbohydrates altogether, it is good to keep in mind, especially for those who have a family history of diabetes. Lower GI foods raise your blood glucose slower than high GI foods. Generally, fat and fiber lower the GI of food and the more food processed or cooked, the higher the GI. Fibrous foods such as steel-cut oatmeal, stone-ground wheat bread, legumes, sweet potatoes, corn, most fruits, and barley are low GI foods, whereas high GI foods include white bread, white rice, corn flakes, instant oatmeal, and white potatoes. Whole wheat, rye, and pita bread and brown rice, couscous, and quick oats are considered medium GI foods.

The GI is a useful tool, but also remember not all carbohydrates are created equal and some nutritious foods have a higher GI than foods with little nutritional value. For example, according to the ADA, oatmeal could have a higher GI than chocolate but oatmeal is a good source of fiber and helps lower cholesterol. To make it simple, have a good balance of low GI and high GI foods and watch your portion sizes. As you learn about the GI Index, consult your nutritionist or dietitian for specific recommendations on how many carbs and which carb sources are ideal for your personal diabetes treatment plan.

So what does this mean for you?

We’ve talked a lot about fat in the body and understand by now that the kind of fat and how it’s stored is critical. But what about fat in your diet? Should you limit the consumption of fatty foods to help reduce your risk of diabetes?

The answer to that is you should limit the consumption of saturated-fatty foods. Your body absolutely needs fat such as omega fatty acids, mono- and polyunsaturated fats to help fight against insulin resistance and reduce the risks diabetes-related complications such as heart disease and stroke.

In summary, this is why people with type 2 diabetes or those who are at risk for type 2 diabetes need to be aware of the effects of insulin on body fat distribution. It’s essential to know visceral fat is more dangerous than subcutaneous fat. Fat storage beyond subcutaneous storage capacity results in ectopic fat deposits in the liver and muscles and can lead to increased insulin resistance as well. Nevertheless, a healthy diet with foods low on the Glycemic Index and regular exercise ranging from resistance training to simply walking can improve insulin sensitivity and reduce body fat.

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T’ara is a Nutrition Education graduate from American University who is passionate about mindful eating, diabetes management and living healthy through healthy cooking. She is the founder of Cooking to a T, a blog dedicated to making healthy, homemade and delicious food and blogging about living with type 2 diabetes.

You’ve probably heard again and again that a diet overhaul through healthy eating, eating right, or cutting back on sugar is one of the major steps to take in preventing or managing diabetes.

These tips sound easy on paper, but it can be an uphill battle in real life because nutrition experts can’t even agree on what “healthy eating” means. And then there’s sugar. A lot of fruits are actually sugar. Should you avoid fruits too?

Asking yourself these questions multiple times a day makes it even more challenging. Every day, you have to decide what to eat. Will you eat at home or cook your own meals? Which snacks are healthy in the vending machine? Should you try making your own snacks?

Whether you’ve been diagnosed with diabetes recently or want to prevent diabetes because it runs in your family, you’ve probably gone through countless websites and online forums on what to eat but still feel lost and overwhelmed.

What foods can you eat if you’re a diabetic?

This article is written and designed to make you feel less overwhelmed when making diet and nutrition decisions that are “diabetes-friendly”. Overall, you’ll learn about the right food choices for people with diabetes and eventually stop second-guessing your meal plans.

What Happens to People With Diabetes?

Imagine you’re about to eat a couple of moist and fluffy carrot muffins. The carbohydrates from the muffin is broken down by digestive enzymes into glucose, a simple form of sugar and a source of energy. The breakdown of carbs to glucose increases your blood sugar levels.

The human body is a wonderful machine. Nature designed your body to withstand various forms of stress, make adaptations (like building muscle after lifting weights), and maintain homeostasis (the ideal internal state). When your body is doing its job in sustaining homeostasis, your pancreas produces a hormone called insulin to help manage the sudden spike of blood sugar levels after helping yourself to two (and a half!) carrot muffins.

What does insulin do to your body?

Insulin facilitates the transport and storage of the energy-boosting glucose to cells, tissues, as well as organs. These include your body’s glucose storehouses like your skeletal muscles and liver.

Once your blood sugar returns to baseline levels as glucose is absorbed in the body, the pancreas will start producing glucagon instead of insulin. Glucagon tells your liver to let go of the stored sugar. This typically happens in between meals.

What if you’re eating too many muffins (and carbs!) that is way more than your glucose-storing organs can handle?

People with Type 1 diabetes have issues with their pancreas not producing insulin, therefore, these individuals have slightly different concerns. Most of the time, Type 1 diabetics need to control their glucose levels with lifelong insulin therapy.

In Type 2 diabetes, your pancreas will end up producing insulin in frequent outbursts. When this happens more often than normal, your cells eventually become less sensitive to insulin. Consequently, they become “comfortably numb” to your body’s signals that there are excess blood sugar levels in your body. This is what happens in individuals with insulin resistance or Type 2 diabetes. This type of diabetes can be managed or prevented by making changes in your diet.

Why You Need to Focus on Your Diet

Why focus on diet you ask?

While exercise, getting enough sleep, genetics, and other factors can also play a role in the development of diabetes, it all begins with the quality (what you eat) and quantity (how much) of your food.

According to the Centers for Disease Control and Prevention (CDC), one of the most important ways to prevent a diabetic diagnosis is to control your weight. And if weight loss is your ultimate goal, diet is a more effective strategy for promoting fat loss. However, this doesn’t mean that you should jump up and cancel your gym membership. After all, working out has other benefits that go beyond weight loss such as boosting self-confidence.

Now that we’ve settled the matter on why we’re focusing on diet and nutrition in staving off or managing diabetes, let’s take a deeper look at which diets are worth trying out if you are trying to tackle diabetes.

Which Diet Works Best In Managing Diabetes?

If you ask the American Diabetes Association, there’s no such thing as the ultimate diabetes diet. Instead of following a strict diet regimen, the organization encourages everyone to opt for an eating pattern that fits their medical needs, lifestyle, and goals.

An eating pattern describes the foods or groups of foods that a person can choose to eat on a daily basis over time. For a diabetic patient, blood sugar level is a major factor influencing their diet decisions and eating patterns.

Plant-based Eating Pattern

What makes plant-based effective in reducing diabetes risk?

A plant-based eating pattern relies mostly on plant foods, like leafy greens, high-fiber fruits, whole grains, nuts, seeds, and vegetables. Researchers believed that a whole-food, plant-based diet works in reducing the risk of Type 2 diabetes because it also helps improve insulin uptake, or effectiveness, through weight loss, reduction in saturated fat intake, promotion of a healthy gut microbiome, and an increase in fiber consumption.

Can going plant-based all the way help manage your blood glucose levels? Most likely yes. 

A study used and endorsed in the 2015–2020 Dietary Guidelines for Americans revealed interesting findings.

For 20 years, researchers at The Harvard T.H. Chan School of Public Health used the findings of three prospective cohort studies in the country and collected dietary data.

The researchers found out the following:

• People who consumed predominantly plant-based foods and minimal animal products, lowered their risk for developing type 2 diabetes by 20 percent.

• Consumption of a plant-based diet that emphasized healthy plant foods (nuts, vegetables, fruits) was associated with larger risk reductions (around 35 percent) in diabetes, while consumption of a plant-based diet high in less healthy plant foods was associated with a 16 percent increased diabetes risk.

So does that mean that vegetarians are less likely to develop diabetes? Not necessarily.

The researchers emphasized that the study is not focused on vegetarian or vegan diets (which can include less healthy plant products, such as sweetened foods and beverages), but rather plant-based foods. However, you could follow a plant-based diet all your life and still develop diabetes.

While it’s difficult for many individuals to completely give up some or all animal-based foods and become vegetarian, it is important to understand how gradually increasing plant foods in your diet and decreasing intake of animal foods can significantly reduce diabetes risk.

Going Plant-Based via the Mediterranean Diet

If there’s one specific diet that highlights plant-based food minus the sugar-laden vegan or vegetarian meat substitutes, the Mediterranean diet is the way to go. In this type of diet, the emphasis is placed on whole grains, fruits, vegetables, legumes, nuts, herbs, spices, and healthy fats.

A 2015 systematic review of studies on the efficacy of a Mediterranean diet on the management of type 2 diabetes and prediabetic states concluded that the diet was associated with better blood glucose management than other commonly used diets (including a low-fat diet), suggesting that it is suitable for the overall management of type 2 diabetes.

The diet ranked #1 (tied with the DASH diet) was noted as the best diet last year by U.S. News. The rankings were made after a panel of nationally recognized experts in nutrition, food psychology,  heart disease, and diabetes reviewed almost every diet profile out there.

While ranking diets from best to worst is not really the most accurate way to gauge which diet will work best for diabetic patients (and for everyone), you can use the rankings as your starting point in experimenting with your own eating patterns.

Increasing Insulin Sensitivity with Intermittent Fasting

One of the initial steps in preventing diabetes is to understand the concept of insulin resistance and insulin sensitivity. A major concern regarding poor dietary habits is that it can lower your body’s ability to manage the glucose being ingested from your food. This means that more insulin will be required to lower blood glucose, creating a state of insulin resistance.

The good news is 20-hour fasting periods (also known as Intermittent Fasting or IF) has been shown to increase insulin sensitivity.

As IF increases your insulin sensitivity, your body becomes more efficient and requires less insulin to lower blood glucose. In those trending towards developing diabetes, each 10 percent increase in skeletal muscle index (ratio of skeletal muscle to body weight), there was an associated 11 percent increase in glucose sensitivity. Because excess glucose may be stored as fat mass, improvements in insulin sensitivity can lead to better weight management. This is good news if you’re currently working to lose fat mass (and gain lean body mass later on) as part of your plans to change your body composition. It’s also worth noting that improving your body composition can help you stave off diabetes!

For more info on IF, we’ve written a comprehensive guide to intermittent fasting here. If you are prediabetic or diabetic, please consult your doctor before considering a fasted diet regimen.

How About Going Low-Carb to Manage Diabetes?

Going on a low-carb diet to potentially manage diabetes doesn’t necessarily mean ditching carbs altogether and eating mainly from fat or protein. In a nutshell, it means limiting or avoiding food that is primarily made of highly-refined carbs and grains.

According to the American Diabetes Association, there is no standard at this time for the grams of carbohydrate in a low-carb eating pattern for diabetic patients.

A 2015 review of related research on the subject revealed that although low carbohydrate diets lead to significantly greater short-term weight loss and improvements in glucose control (HbA1c) and triglycerides, it doesn’t have long-term benefits. As a whole, low-carb diets failed to show long-term improvements over higher carbohydrate intakes on weight loss or promoting healthy levels of glucose.

The bottom line is if you have Type 2 diabetes and are wondering if cutting back on your sugar intake can help manage the symptoms, the straight answer is: yes!

But there’s a caveat: sugar is not synonymous with carbs.  

In their nutrition recommendations for Type 2 diabetes patients, the American Diabetes Association doesn’t endorse cutting down on carbs but limiting added sugars or sweeteners from your diet. They further declared that there’s no reason to recommend that people with diabetes should avoid naturally occurring fructose in fruits, vegetables, and other whole foods. According to the ADA, the sugars from these sources usually accounts for only 3–4 percent of your daily energy intake.

Your Major Takeaways

In the end, it’s not about avoiding a specific macronutrient like carbs if you want to make your own version of a diabetic diet. Nor you should stick to what’s considered the “best diet” for the year.

Like there’s no one-size-fits-all healthy diet, there’s no such thing as the ultimate diabetes diet. A plant-based diet that’s hard to stick to for one diabetic patient might be easy for someone else. Plus, you also have to consider culture, body types, and the presence or absence of other disease states. As always, talk to your doctor first before embarking on a quest to find your own “best diabetic diet”.

Finally, if you’re looking to offset the negative effects of diabetes (or prediabetes), taking your body composition into account is also a priority. Work with a knowledgeable and experienced professional who can help determine your body composition and help you set goals to improve your body composition through diet and physical activity.

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Kyjean Tomboc is a nurse turned freelance healthcare copywriter and UX researcher.  After experimenting with going paleo and vegetarian, she realized that it all boils down to eating real food.