How do I cook for someone with diabetes?

Cooking for someone with diabetes is much less specialised than people expect. There is no separate diabetic diet, no need for special products, and the food is generally what anyone would benefit from eating. What does matter is the carbohydrate content, being consistent about it, and being able to tell the person what is in the meal.

Safety

Step by step

1. Ask, rather than assume.Type 1 and type 2 are managed differently, and individuals within each differ enormously. Some count carbohydrate precisely and dose insulin against it; some manage by portion and timing. The most useful question is simply: what do you need to know about the meal?
2. Focus on the carbohydrate, not on sugar alone.All carbohydrate raises blood glucose — bread, rice, pasta, potatoes and cereal as much as sugar, often more by quantity. A meal described as low-sugar can be very high in carbohydrate. That is the practical starting point.
3. Prefer higher-fibre versions of the same thing.Wholegrain bread, brown rice, wholewheat pasta, oats, pulses, potatoes with the skin on. Fibre slows the release, so the same amount of carbohydrate has a gentler effect. It is a swap rather than a restriction.
4. Serve protein, fat and vegetables alongside.A plate with protein, some fat and plenty of vegetables slows the whole meal's absorption compared with the same carbohydrate eaten alone. Half the plate as non-starchy vegetables is a good and easy default.
5. Be consistent about portions.Someone dosing insulin against their meal is helped enormously by predictability. Serving the same amount of rice each time, or leaving the carbohydrate portion for them to serve themselves, is more useful than getting the food theoretically perfect.
6. Tell them what is in it.Say what the carbohydrate elements are and roughly how much — 'about 60g of rice dry weight each, and there is flour in the sauce'. Hidden carbohydrate in sauces, marinades and dressings is what makes a meal hard to judge.
7. Do not buy special diabetic products.So-called diabetic foods are not recommended, are expensive, often contain as much fat and energy as the ordinary version, and can cause digestive upset from sugar alcohols. Ordinary food in sensible amounts is the current advice.
8. Treat pudding as a portion question.Dessert is not forbidden. A smaller portion, eaten as part of a meal rather than alone, is what usually matters. Fruit-based puddings and anything with dairy or nuts in it have a gentler effect than a plain sugary one.
9. Know what a hypo looks like if they use insulin.Shakiness, sweating, confusion, irritability or sudden hunger can mean low blood glucose. The response is fast-acting sugar — glucose tablets, fruit juice, ordinary sugary drink — followed by a longer-acting carbohydrate. Anyone at risk will know their own plan; make sure something suitable is in the house.

Tips

• Diabetes UK is the reference organisation and publishes practical, current eating guidance that is worth reading rather than working it out from general principles.
• Cooking and cooling carbohydrate — potatoes, rice, pasta — increases resistant starch, which has a somewhat gentler effect. Reheating does not undo it. A potato salad and a batch-cooked rice dish both benefit.
• Timing can matter as much as content for someone on insulin. Being an hour late with dinner is a bigger deal than it is for other people.
• Alcohol can cause delayed low blood glucose several hours later, which is worth knowing if you are hosting.

Common mistakes

• Removing all sugar and adding more of everything else — A sugar-free dessert made with white flour delivers a similar carbohydrate load, and often more fat. The total carbohydrate and the portion are what matter, not the presence of the word sugar.
• Making decisions on their behalf — People manage their own diabetes daily and know their own numbers. Serving them a smaller portion without asking, or refusing them pudding, is unhelpful and slightly insulting. Give them the information and let them decide.

Questions people ask