High protein, high calorie eating in Diabetes

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Introduction

A high calorie, high protein diet is sometimes needed to help to make sure you get enough nutrition, prevent weight loss, or help you to gain weight if needed. This may be because you have been losing weight due to an illness, you have only been able to eat small amounts or because you are recovering from a procedure such as surgery.

In situations like those, it can be helpful to follow a high protein, high calorie diet because:

• It can help with wound healing and speed up recovery from surgery.
• It can help you regain muscle tissue that you may have lost.
• It gives your body’s immune system energy to work, and to help you fight infections.
• It can make you stronger so that you are less likely to have an injury if you suffer from a fall.

What about my diabetes?

Because you have diabetes, you have probably been encouraged to follow a low fat, low calorie diet for some years, and it can be difficult to understand why that needs to change at the moment. When your body needs to “re-fuel” following an illness or weight loss, or when you are unable to eat much, it is very important to get enough calories and protein to keep you well nourished.

As you will see in this booklet it is possible to eat high calorie foods, whilst avoiding foods high in sugar. Meal patterns may change (eating little and often) until you have recovered and you may be advised to increase your intake of fatty foods as they can be an important source of energy during illness.

If you become concerned that your blood glucose is too high please contact your practice nurse / GP / diabetes specialist nurse. Once you regain your normal appetite then you may
gradually return to your usual diet.

When you have a small appetite you may only feel like eating small amounts at meal times. This means it is important to keep some snacks and drinks at hand to have between meals. Try to eat and drink something every 2 to 3 hours.

Ideas for Nourishing Light Meals and Snacks

• Cheese and crackers
• Nourishing drink (see below)
• Banana
• Toast with baked beans / cheese / mackerel / avocado / eggs / low sugar nut butter
• Greek Yoghurt with berries
• Ham / cheese omelette
• A handful of nuts
• Sandwich made with granary bread and a high protein filling, e.g. ham, cheese, chicken, egg, fish, hummus
• Protein based ‘Cream of’ soup or pulse based soup with a slice of granary or rye bread, or a bread roll
• Hot chocolate made with cocoa powder
• Low sugar malted milk drink
• Nut butter on oatcakes
• Cream cheese on rye crackers
• Mini cheese
• Lean cooked meats
• Olives

Carbohydrates

You do not need to cut these out completely when you have diabetes. Sources of carbohydrate include

• Starches: breads, rice, pasta, potatoes, cereal
• Added Sugars: cakes, biscuits, drinks, ready made sauces or soups, condiments such as chutney, ketchup, BBQ sauce
• Fruit (Fructose): all fruits, dried fruit, fruit juice or smoothies
• Milk sugars (Lactose): all milk, yoghurts

If you have Type 1 diabetes you should adjust your insulin according to your carbohydrate intake at meals.

If you have Type 2 diabetes try to limit carbohydrates to no more than 1 fist size portion per meal. Some Type 2 diabetes medications mean that you do need to have some carbohydrates at each meal (e.g. Gliclazide, twice daily mixed insulin such as NovoMix 30, Humulog Mix 25/50, Humulin M3) If you take other tablets or are on basal bolus insulin or once daily insulin only then you can have carbohydrate free meals.

Try to limit added sugars, avoid fruit juice and keep fruit to 1 handful at a time.
Try to choose slow release, high fibre carbohydrates:

• Granary or rye bread
• Basmati or brown rice
• Wholemeal pasta
• Other grains such as quinoa, buckwheat, couscous
• Sweet potatoes
• Boiled potatoes with skin on
• Oats
• Oat or rye crackers

Protein

Protein is a very important nutrient to help maintain or repair muscle and lean body mass. It does not directly affect blood glucose levels. Try to include 1 source of protein at each meal.

Sources of protein include:

• Meat
• Fish
• Chicken
• Eggs
• Cheese
• Beans / pulses
• Tofu, Quorn, tempeh, seitan

Fats

Fats Are a good source of calories when trying to gain weight. Try to include some healthy fats with meals or as snacks

• Avoid fats in processed foods e.g. cakes, pastries, pies, processed meats
• Nuts and nut butters including almonds
• Seeds can be added to salads, soups or porridge
• Olive oil can be used for salad dressings
• Avocado in salads or spread on toast

Fortifying food

When you have a poor appetite it can be difficult to increase the amount you eat at meals in order to take in extra energy. Instead of eating more food you can fortify meals with high calorie extras

Examples of food fortifiers:

• Add oil or butter to potatoes and vegetables. Use oil or butter to fry meat, fish or eggs.
• Add grated cheese to pasta dishes, omelette, soups, salads, potatoes, vegetables and use as a topping on oven-baked dishes, e.g. shepherd’s pie.
• Add cream to scrambled egg, soup, sauces, puddings, and fruit.
• Add mayonnaise, cream cheese or peanut butter to sandwiches, bread, toast, crumpets or crackers.
• Add nuts, seeds, avocado, full fat yogurt, dried fruit, custard or chopped egg to a variety of foods.
• Add nut butters to porridge
• Have low sugar nut butter or avocado on toast instead of just spread or a high sugar option like jam.

Nourishing drinks

Drinks can be a really useful way to get some nourishment without the feelings of fullness you may get with eating. In place of some of your usual drinks try milk or soup.

Milk is very nourishing. Try using a pint (568 ml) of full cream milk each day. It could be used in cold or hot drinks, sweet and savoury sauces, milky puddings, in milkshakes or as a drink on its own. To make it more nourishing, try adding 4 tablespoons of skimmed milk powder to 1 pint of milk. This is known as Fortified Milk and contains extra protein.

Soup can be a comforting and nutritious drink. The thicker, creamy varieties with some beans, dumplings or croutons provide some extra energy. Cupasoup type soups or broths tend to be lower in calories.

Nutritional supplement drinks

It is better to use everyday foods and nourishing drinks first but if you are not managing enough food or enough variety of foods, then supplement drinks can be used between meals or as part of a meal.

Dietary supplements that do not need a prescription such as Complan or Build-up/Meritene can be found in chemists and in some supermarkets. They have some extra energy, protein, vitamins and minerals. There are a range of sweet milkshake style flavours, and savoury soup-style flavours. They can be made up with milk or with water, depending on what you prefer, but using milk will add more goodness. Soup options will likely be lower in sugar.

Prescribed Nutritional Supplements

If following the previous advice is not enough to meet your nutritional needs you may need to have some prescribed nutritional supplement drinks. Your dietitian can advise you on the correct supplements to suit your needs and organise a prescription with your GP.

Handy tips

Prepare meals in advance when you feel like cooking. Make and freeze extra portions that can be used when you don’t have the energy to cook.

Ready-made meals can be useful on days when you don’t feel like cooking.

If you rely on others to help to prepare your meals keep a flask of nourishing drink and a snack nearby to have between meals.

Avoid filling up on large drinks with your meals: try having a drink half an hour before or after.

Meal providers and deliveries

If you are feeling unwell or don’t have the strength to cook it can be useful to have some help with your meals.

Ready prepared meals can be bought from most shops, and you can heat these up at home.

These companies deliver frozen ready prepared meals to your home. You can telephone them to ask for information or a brochure:

Wiltshire Farm Foods 01444 881926
Sussex FarmHouse Meals 0845 070 2222
Oakhouse Foods 0845 643 2009

For hot meal deliveries you can contact your local council and ask about Meals on Wheels.

This company also delivers hot meals:

Martins (Shoreham, Worthing Littlehampton, Findon Valley) 01903 202525