Eating well with diabetes

Everything worth knowing about your insulin, your food, and staying well on both. Written for you, and meant to be dipped into rather than read in one sitting.

The whole thing in six lines

Eat well and eat enough. Nothing here asks you to cut down or go without.
Have something starchy at all three meals, because your insulin is counted against them.
Never skip a meal. This is the big one.
Protein at every meal, and a little more butter and cream than feels right.
A short walk after eating does more than almost anything else.
Tell your nurse you are eating this way before your insulin changes.

What's here

Your insulin, and what it needs from you
Changing from Lantus to NovoMix
Five things that make the biggest difference
What you can actually eat
A day of proper food, and four recipes
Putting a little weight on
Ten minutes that protects your independence
Why all this works
If something goes wrong: lows, sick days, driving
What to ask at your next appointment
Who says so

One thing to know before the rest

Most diabetes advice tells people to eat less and lose weight. This does the opposite, and deliberately. You are on the light side for your height, and at 79 that carries more risk than being a little heavier would. And the insulin you are moving to is measured against your meals, so eating less of them is the thing most likely to make you unwell. Everything here is built on those two facts.

Your new insulin, and what it needs from you

Worth understanding properly, because NovoMix 30 behaves quite differently from the Lantus you're used to, and the difference is the whole reason this page says what it says.

Lantus was one steady dose. It trickled away in the background all day at the same rate. It didn't much mind when you ate, or whether you ate.

NovoMix 30 is two insulins in one pen. About a third of it is fast, and it starts working within ten to twenty minutes, doing most of its work over the next few hours. The other two thirds is slower, and covers you through to your next injection.

What that means in practice

Inject, then eat within ten minutes. The fast part is already on its way by the time you put the pen down.
On a morning you are unsure you can face food, the leaflet allows it the other way round: eat first, then inject straight after. But if you end up eating a good deal less than usual, ring the surgery the same day. The dose was set for a normal-sized meal and it does not shrink to match a smaller one.
Never skip breakfast or your evening meal. Those are the two meals your doses are built around. Skipping one is the most likely way to have a hypo on this insulin.
And don't skip lunch either. The slower two thirds of your morning dose is still working right through the middle of the day, so lunch needs something starchy in it as well. It is easy to think only breakfast and dinner matter because those are the two you inject before. All three meals count.
Keep to roughly the same times each day. Predictable beats perfect.
Roll and tip the pen before every injection. NovoMix is cloudy rather than clear, because the slow part settles out. Roll it between your palms about ten times, then tip it gently end over end about ten times, until the liquid looks evenly white all through with no clear patch or sediment. If you skip this the dose is not what the dial says. Let it come up to room temperature out of the fridge first, it mixes far better.
Put a tick chart on the fridge. Date, and two boxes. The commonest cause of a bad low in people who have injected for years is not food at all, it is taking the same dose twice after being interrupted. Two different doses at two times of day is exactly the arrangement that catches people out, and five seconds a day removes the problem.
Same area, different spot. Where you inject changes how fast it works, so keeping it consistent is part of keeping the dose consistent. Use the same part of the body for the same injection each day, moving an inch or two within it rather than using the identical point. Ask your nurse to have a feel of the skin where you have been injecting: firm or lumpy patches make a dose behave unpredictably and are very easy to miss yourself.
Eat a similar amount each day, particularly of the starchy part. Your nurse will set your dose around what you normally have, so wild variation makes the dose wrong.

The two times of day to watch

Because of how this insulin peaks, lows are most likely at two particular points. Knowing when they are is half the battle.

Mid to late morning, roughly two to four hours after your breakfast injection. This is the main one. A small mid-morning snack often sorts it, and it's worth asking your nurse whether you should have one routinely.
Late evening and overnight, from the slower part of your evening dose. Test before bed while you're getting used to it.

If you ever genuinely can't face eating, don't simply inject anyway and hope, and don't skip the dose on your own either. Ring your surgery or diabetes nurse the same morning and ask what to do. On a changeover like this they will expect the call.

These first few weeks matter

Swapping from one insulin to a completely different kind is the point at which things are least predictable. Your team will expect to adjust the numbers once they see how you respond.

Test more often than usual for the first fortnight, especially mid-morning and before bed, and write the readings down. Take that list to your next appointment. It is by far the most useful thing you can hand them, and it is how the dose gets right quickly instead of slowly.

Changing from Lantus to NovoMix 30

You are on Lantus today and moving to NovoMix 30 shortly. That matters, because they are genuinely different animals, and advice that suits one can be wrong for the other.

The good news: you can start all of this now, and nothing needs changing again on the day you switch. It is written for the NovoMix you are moving to. On the Lantus you are on today none of it will do you any harm, though eating a bit more may run your sugars a little higher for a week or two, which is part of why your team is changing your insulin in the first place.

	Lantus (now)	NovoMix 30 (soon)
How it behaves	One steady dose, ticking over in the background all day. No peak	Two insulins in one pen. Part of it gets going quickly after you inject
When you inject	Once, in the morning	Twice. Before breakfast and before your evening meal
Does it mind when you eat?	Not greatly. It is forgiving	Yes. It expects food shortly after each injection
Skipping a meal	Not ideal, but unlikely to floor you	The most likely cause of a hypo. Don't
Cutting out bread and potatoes	Would lower your sugars. Not dangerous in itself	Would very likely cause lows. This is the important one

The one thing that must not happen

Read the bottom row of that table again, because it is the reason this page tells you to keep your bread and potatoes rather than cut them.

If you cut down on starchy food now while you're still on Lantus, and then switch to NovoMix while eating that way, your new doses will be too big for what you're eating. That is how people end up having hypos in the first fortnight on a new insulin. So keep your usual portions steady from today onwards, right through the changeover. Change the kind if you like. Do not change the amount.

The changeover itself

Never take both insulins on the same day unless your nurse has specifically told you to. When NovoMix starts, Lantus stops.
The first two weeks are the unpredictable bit. Expect your team to adjust the numbers once they see how you respond. That is normal, not a sign anything has gone wrong.
Test more often through the changeover, particularly mid-morning and before bed, and write it all down.
Ask before the switch: what to do if you go low, whether you should have a mid-morning snack, and who to ring in the first fortnight.

Five things that make the biggest difference

These come from eight specialists who work on this: an NHS professor, an NHS GP, hospital doctors and a couple of well-known outsiders. They're all named and introduced near the bottom of this page, along with exactly which of them agrees with what, because they don't agree on everything. If you only do the first thing on this list, that's still worth doing.

A short walk after your biggest meal Ten to fifteen minutes, starting within about half an hour of finishing. Round the garden, up the road, or even just about the house.

Why it works so well for you in particular: normally sugar needs insulin to get out of your blood and into your muscles. But when a muscle is working, it can pull sugar in without waiting for insulin at all. Walking after a meal opens a second door, one that doesn't depend on the insulin you inject. That's why a short walk can do more than it has any right to.

And the flip side, which matters because you take insulin. Those two doors are open at the same time, your mealtime insulin is still working hard just when you're walking. So take your hypo treatment with you if you're going any distance from the house, and check your blood sugar before and after for the first week or so until you know how you respond. Mention the walks to your nurse as well: exercise is one of the things that can mean a dose needs adjusting.
Change the kind of breakfast, not the size of it Sugary cereal, white toast and fruit juice turn to sugar very fast, first thing, when you are least able to handle it. So change what it is made of, not how much of it there is.

Porridge oats instead of sugary cereal. Seeded or granary toast instead of white. And an egg, some cheese or a pot of Greek yoghurt alongside it rather than instead of it.

The starch stays. Your morning injection is counted against it, and a breakfast of just eggs is the single most likely way to have a low on this insulin. The one thing to drop altogether is fruit juice, which is a straight loss with nothing to replace.
Protein at every meal, aim for a palm-sized piece Eggs, fish, chicken, meat, cheese.

Why this matters more now, not less: from around sixty onwards we lose muscle steadily unless we deliberately eat enough protein and keep using it. That muscle is what keeps you steady on your feet, and it's also where most of your blood sugar gets stored and burned. So more muscle means better blood sugar and fewer falls. One thing, two benefits, and the reason protein sits so high on this page.
Something starchy at every meal, every single day This is the opposite of what most diabetes advice says, and it is because of your new insulin.

NovoMix 30 goes to work soon after you inject it and needs something to work on. Inject, then eat within ten minutes. Not half an hour, ten minutes. The leaflet in the box says so, and it ties that ten minutes directly to avoiding a low. If you inject and then skip breakfast, or have only a boiled egg, your blood sugar will drop mid-morning.

Roughly the same amount each day is what matters most. A slice of toast, or two small potatoes, or a couple of spoons of rice. Not less than usual, not more, just steady. Your nurse sets your dose around what you normally eat, so keeping it predictable is what makes the dose right.

The change worth making is the kind, not the amount: seeded or granary bread rather than white, new potatoes rather than mash, porridge oats rather than sugary cereal. Same portion, gentler on your blood sugar.
Nothing sweet to drink, and a decent night's sleep Fruit juice and squash raise blood sugar as fast as fizzy drinks, sometimes faster. And a run of bad nights tends to make blood sugar harder to control the following day, because being short of sleep makes the body respond less well to insulin.

What you can actually have

You've been guessing, and there's no need. Here is the honest picture: the list of things you can eat freely is enormous, and the list to watch is short.

Eat freely. These barely touch your blood sugar

Aisle	What to fill your basket with
Meat and fish	All of it. Chicken, beef, lamb, pork, bacon, sausages (90%+ meat), ham, salmon, mackerel, sardines, cod, prawns, tinned tuna, kippers. Nothing here needs limiting
Eggs	Any amount, any way. Two or three a day is completely fine
Dairy	Butter, cheese of every kind, cream, crème fraîche, full-fat Greek yoghurt, mascarpone
Vegetables	Broccoli, cauliflower, cabbage, sprouts, green beans, courgette, aubergine, spinach, kale, leeks, onions, peppers, mushrooms, tomatoes, cucumber, celery, all salad leaves, asparagus, avocado
Nuts and seeds	Almonds, walnuts, pecans, brazils, hazelnuts, pumpkin and sunflower seeds. Nut butters with no added sugar
Store cupboard	Olive oil, tinned fish, olives, pickles, mustard, vinegar, tinned tomatoes, stock cubes, herbs, spices, tinned coconut milk for cooking
Fruit	Raspberries, blackberries, strawberries, blueberries. An apple, pear or satsuma with a meal

Have steadily, at all three meals

These are the ones your insulin is counted against, so you want them present and consistent rather than reduced. Choosing the gentler version of each is where the gain is.

Instead of	Choose
White bread, white toast	Seeded, granary, rye or sourdough
Mashed potato	New potatoes, boiled, skins on. Cold potato in a salad is gentler still
White rice	Basmati, or a mix with cauliflower rice
Sugary cereal, cornflakes	Porridge oats, or Greek yoghurt with berries and nuts
White pasta	Wholewheat, cooked firm rather than soft

The short watch list

Not banned, just worth knowing: sugar, honey, jam, cakes, biscuits, sweets, chocolate under 85%, fizzy drinks, fruit juice, dried fruit, and oat milk. That is genuinely the whole list.

Milk, and things to drink

The milk aisle is genuinely confusing, and some of the ones marketed as healthiest are the worst offenders. Unsweetened coconut milk is a very good find if you have come across it.

Milk	Verdict	Why
Unsweetened almond milk	Best	Almost no sugar at all. Fine in any quantity
Unsweetened coconut milk drink	Best	The one you found. Same story, almost no sugar
Unsweetened soya	Very good	Low sugar, and more protein than the nut milks
Double or single cream	Very good	Much less sugar than milk, and useful calories for you. Use it generously
Ordinary cow's milk	Fine in tea and coffee	Has natural sugar. A splash is nothing. A large glass is more than you'd think
Oat milk	The one to avoid	People assume it's the healthy choice. It has more sugar than cow's milk, because making it turns the oats into sugar
Anything "sweetened" or "original"	Check the label	On plant milks, "unsweetened" is the word that matters. "Original" usually means sweetened

The label trick, and the line most people read by mistake. In the "per 100g" or "per 100ml" column you will see Carbohydrate, and underneath it, indented, of which sugars. Read the top line, the Carbohydrate one. The "of which sugars" line only counts the sweet part and leaves out all the starch, which is why bread can show almost no sugar and still put your blood sugar up as much as a spoonful would. For drinks and yoghurts, under 5 on that top line is good and over 10 is really a treat.

To drink otherwise: tea, coffee, water, sparkling water, and any squash marked "no added sugar". Herbal teas. A small glass of wine with dinner. All fine.

What you can add to things

This is where people get needlessly gloomy. Almost nothing is off limits as an addition, because almost none of it is sugar or starch. Take the yoghurt as the example.

Your pot of Greek yoghurt

All of this is fine, and makes it a proper breakfast: pumpkin, sunflower, chia or flaxseeds · chopped walnuts, almonds, pecans or hazelnuts · a small handful of berries · cinnamon · a few drops of vanilla extract · desiccated or flaked coconut · unsweetened cocoa powder · a little grated lemon or orange zest · a spoonful of double cream if you want it richer · a scrape of smooth peanut or almond butter (the kind with no added sugar).

Only these are the problem: honey · maple syrup · granola or muesli · a fruit layer or compote · dried fruit and raisins · jam. All of those are sugar, and that's the only reason they're out.

The same logic applies everywhere. Pile whatever you like onto a salad, cheese, olives, avocado, bacon, seeds, mayonnaise, olive oil. Put a cheese sauce on the cauliflower. Roast the vegetables in goose fat. None of it counts, because none of it is sugar or starch.

These won't affect your blood sugar, add them freely

Flavour: all herbs and spices, garlic, chilli, ginger, mustard, vinegar, lemon and lime, pepper, hot sauce.
Richness: butter, olive oil, cream, crème fraîche, mayonnaise, cheese, pesto.
Texture: seeds of all sorts, nuts, olives, pickles, bacon.
Sweet-tasting but not sugar: cinnamon, vanilla extract, unsweetened cocoa, and sweeteners in tea or coffee if you like them.

Two honest caveats, because “freely” isn't quite the same as “without limit”.

Salt. Bacon, cheese, olives, pickles, stock cubes and soy sauce are all very salty, and blood pressure matters a great deal at our age, diabetes and blood pressure together are harder on the heart than either alone. So season with herbs, spices, garlic, lemon and pepper first, and treat the salty things as flavour rather than as the bulk of a meal. If you're on tablets for blood pressure, this is worth a sentence with your nurse.

And they do carry calories, which for you is the point rather than the problem. Butter and cheese are not weightless, and you are the one person this page is written for who genuinely needs those calories. The experts further down all want their patients to lose weight round the middle. You are not in that position and should not follow them there. Use the fat generously. There is a whole section below on doing exactly that, with numbers.

Fruit, how it fits

Fruit isn't banned, it just varies enormously. The rule is the same one: how much sugar is in it.

Best	Fine, one, not two	Now and then
Raspberries, blackberries, strawberries, blueberries. Lowest in sugar and highest in fibre. A small handful most days is fine.	An apple, a pear, a plum, a satsuma, a kiwi, a few cherries. Best eaten with a meal or after it, rather than on their own.	Banana, grapes, mango, pineapple, melon. Much higher in sugar. A few grapes rather than a bunch, half a banana rather than a whole one.

Two exceptions worth knowing. Dried fruit: raisins, dates, dried apricots, is fruit with the water taken out, so the sugar is concentrated into a much smaller mouthful. And fruit juice is the sugar of several pieces of fruit with none of the fibre that would have slowed it down, which is why it acts almost exactly like a fizzy drink.

Shop-bought things that catch people out

None of these are forbidden, just check the label, because the sugar isn't obvious:

Sauces: ketchup, barbecue, sweet chilli, and most bottled salad dressings are surprisingly sugary. Mayonnaise, mustard and vinaigrette are not.
Jars of pasta sauce and shop soups: often sweetened, and soups are frequently thickened with potato or flour.
Anything labelled “low fat”: sugar is usually added back in to make up for the taste. Full fat is the better choice here, which takes some getting used to.
Anything labelled “diabetic”: these are rarely better than the ordinary version and cost considerably more. You can safely ignore that whole aisle.
Milk: contains natural sugar. Plenty in tea and coffee is fine; a large glass is more than you'd think. Cream has far less, which is why it appears so often here.

How much, exactly

No scales needed for most of it, your own hand is the measure, and it's already the right size for you. Where a number genuinely helps, it's given.

Half the plate, vegetablesBroccoli, cabbage, cauliflower, green beans, courgette, spinach, salad, peppers, mushrooms, leeks, tomatoes. Butter and olive oil on them encouraged.

Your palm, proteinAbout the size and thickness of your palm, not counting fingers. Roughly 100–150g, or a piece the size of a pack of cards.

A cupped handful, the starchy oneThese are roughly matched to each other: 1 slice of bread, or 2 egg-sized potatoes, or 2 heaped tablespoons of cooked rice or pasta. Rice and pasta are heavier going than they look, which is why it's two spoons and not three.

Your thumb, butter or oilAbout 15g, or a heaped teaspoon. This is what makes food taste of something and keeps you full.

The ones people most often get wrong

Item	What to buy or use	How much
Greek yoghurt	Full-fat, plain, unsweetened. Check the Carbohydrate line, not the sugars one: around 4 to 5g per 100g or less. Avoid anything marked low-fat, 0%, "fruit", or with a fruit layer, those have far more sugar.	About 150g, a large serving spoonful
Berries	Raspberries, blackberries, strawberries or blueberries, fresh or frozen. These are the lowest-sugar fruits. Grapes, bananas and dried fruit are much higher, so keep those occasional.	A small handful, roughly 8–10 raspberries, or 12–15 blueberries, or 3 strawberries
Nuts	Almonds, walnuts, pecans, brazils or hazelnuts. Plain or lightly salted, not honey-roasted or coated. Cashews are higher in carbohydrate, so less often.	A small cupped handful, about 30g, roughly 20 almonds or 8 walnut halves
Bread, when you have it	Seeded wholemeal or a dense rye. White, and most supermarket "brown", behave almost the same as sugar.	1 slice, not 2
Dark chocolate	85% cocoa or higher. At 70% there's roughly twice the sugar.	2 small squares, about 20g
Sausages	Check the front of the pack for the meat percentage, 90% or more. The cheaper ones are largely rusk, which is bread.	2 sausages
Cheese	Any real cheese, cheddar, stilton, brie, feta. Avoid processed slices and spreads.	A piece about the size of 2 thumbs, roughly 30–40g

A day of proper food

None of this is diet food. All of it is meant to be enjoyed.

Read this before you use the meals below

Every meal below includes something starchy: a slice of toast, a slice of bread, a couple of small potatoes. That is deliberate and it matters.

Let's be straight about what this is. Eating this way, you'd be having somewhere around 60 to 90 grams of carbohydrate a day. Most people have closer to 200. Diabetes UK calls anything under 130 a low-carbohydrate diet, so that is what this is, said plainly rather than dressed up as something gentler.

So please make one change at a time, and sort the insulin first

This is important and it is easy to miss. Your NovoMix doses of 10 and 8 units will have been worked out against what you eat now, not against these menus. Start eating this way and start the new insulin in the same fortnight, and the doses will be too big for the food.

So before the switch, tell your nurse you are planning to eat this way, and roughly how much less bread and potato that means. Ask her to set your starting doses against the new way of eating rather than the old. If she would rather you settled on the insulin first and changed the food a few weeks later, do it her way. That is the safer order. The one thing that must not happen is you quietly eating less while the dose stays where it is.

And on NovoMix 30 the starch stays, permanently. This is not a holding pattern until your dose is sorted. Your insulin is dosed against these meals, so taking the starch out is what would make you go low. Steady and predictable is the goal, not smaller.

Breakfast

Scrambled eggs, 2 or 3, with butter, smoked salmon or mushrooms alongside, and 1 slice of seeded toast.

Or, 150g plain full-fat Greek yoghurt with a small handful of berries and chopped walnuts, with a slice of toast alongside. Or a 3-egg mushroom and cheese omelette with toast. Or 1 kipper with a poached egg and toast.

What's changed here is the balance, not the toast. Before, breakfast might have been mostly toast or cereal with very little else. Now it's mostly egg or fish, with a slice of toast. Same meal, different proportions, and that is where most of the benefit comes from.

Lunch

One tin of mackerel or sardines on a big salad with olive oil and lemon, and 1 slice of seeded bread or a few new potatoes.

Or, a ploughman's: a 40g piece of cheddar, 2 slices of ham, pickle, a few tomatoes, half an apple and 1 slice of seeded bread. Or a large bowl of chicken soup with a tablespoon of cream stirred through, with bread alongside.

Dinner

One or two chicken thighs with mushrooms, buttered greens, and 2 or 3 small new potatoes.

Or, a salmon fillet with lemon butter, green beans and a few potatoes. Or a portion of cottage pie with cauliflower in the mash. Or 2 good sausages with onion gravy, buttered cabbage and a small scoop of mash.

If you're peckish between meals

A piece of cheese. A small handful of nuts. A pot of plain Greek yoghurt. A few olives. A boiled egg. A slice or two of cold meat.

All of these are fine and none of them will send your levels up much.

To drink

Water, tea, coffee. As much as you like.

If you take sugar in tea, going from two spoons to one, then to none over a few weeks, works far better than stopping all at once.

One practical thing nobody warns you about

Eating less bread and potato while eating more meat, eggs and cheese can leave you constipated in the first week or two. It's the commonest reason people give this up, and it's easily headed off.

Keep the vegetables generous, that's where the fibre is now coming from. Drink plenty through the day. And the seeds, nuts and berries genuinely help, which is another reason they keep appearing. If it doesn't settle within a fortnight, mention it at the surgery rather than putting up with it.

And the things you'd miss

Two squares of dark chocolate and a proper cheeseboard are both fine and should stay. Giving up everything you enjoy does not work and never has, what happens at breakfast every single morning matters far more than what happens on a Saturday night.

Alcohol needs real care, and this is the bit people don't know. A small glass of wine, 125ml, is fine, but always with a meal, never on an empty stomach. While your liver is busy dealing with alcohol it stops releasing the emergency sugar it would normally use to catch a low, so it can't rescue you while you sleep. The effect can last well into the night.

So if you've had a drink, always test before bed: and then:

Below about 7: have a starchy snack before you settle down. A slice of toast, a couple of crackers with cheese, or a yoghurt.
Comfortably in range: a small snack is still the safer choice, because the reading tells you where you are now, not where you're heading.
Running high: don't add food on top of it. Just be aware a low can still arrive later in the night, and test again if you wake.

Ask your nurse what number she'd want you to use as the cut-off, because it depends on your insulin. But the principle holds: alcohol's effect arrives later, so a normal reading at bedtime is not the reassurance it looks like.

Four recipes worth cooking

Breakfast · 5 minutes

Proper creamy scrambled eggs

The version that stops you missing toast. The trick is low heat, and taking them off before they look ready.

You need

3 eggs
A knob of butter, about 15g
1 tablespoon of double cream or crème fraîche
Salt, pepper, and chives if you have them

How

Beat the eggs with a fork. Don't salt them yet.
Melt the butter in a small pan over low heat, lower than feels right.
Add the eggs and stir slowly and constantly with a wooden spoon. It takes three to four minutes and can't be rushed.
While they still look a little too loose, take the pan off the heat completely. They carry on cooking.
Stir in the cream, season, and eat straight away.

To make it a proper meal: 2 slices of smoked salmon on the side, or a handful of mushrooms fried in butter first, and a slice of seeded toast, which is the starchy portion for this meal.

Dinner · 25 minutes · Serves 2 · Freezes well

One-pan creamy chicken and mushroom

One pan, very little fuss, and it tastes like something you'd order out.

You need

2 chicken thighs, skin on (about 250g)
150g mushrooms, thickly sliced, about 6 chestnut mushrooms
1 small onion, sliced
1 clove of garlic, chopped
150ml double cream
1 teaspoon of Dijon mustard
A knob of butter, salt, pepper, and thyme if you have it

How

Season the chicken well. Brown it skin-side down in the butter over medium heat until properly golden, about 6 minutes. Turn it, give it 3 more, then lift it out.
In the same pan, soften the onion for about 4 minutes, then add the mushrooms and cook another 5. Let them take on real colour rather than just softening.
Add the garlic for 30 seconds, then the cream and mustard. Stir up all the brown bits from the bottom of the pan, that's where the flavour is.
Put the chicken back, turn the heat low, and let it bubble gently for 10 minutes until cooked through, no pink in the middle.
Serve with green beans or buttered cabbage, and 2 or 3 small new potatoes, that's the starchy portion for this meal.

Dinner · Makes 4 portions · Comfort food

Cottage pie with a lighter mash

Nothing is missing from this one. The cauliflower disappears completely into the potato.

You need

500g beef mince
1 onion and 2 carrots, diced small
1 tablespoon of tomato purée
1 beef stock cube in 200ml hot water
1 tablespoon of Worcestershire sauce
For the top: 2 medium potatoes (about 300g) and half a cauliflower (about 300g)
30g butter, 2 tablespoons of cream, 50g grated cheddar

How

Brown the mince properly, in two batches if the pan is small, so it colours rather than steams. Lift it out.
Soften the onion and carrot in the same pan for about 8 minutes.
Return the mince and stir in the purée, stock and Worcestershire sauce. Simmer uncovered for 25 minutes until thick.
Meanwhile boil the potatoes and cauliflower together for about 15 minutes until both are soft. Drain them very well and let the steam escape for a minute, this is the step that matters.
Mash with the butter and cream, and season generously.
Spread over the mince, fork the top, scatter over the cheese, and bake at 200°C (180°C fan) for 25 minutes.

Freeze 3 portions in separate dishes. That's three evenings where nothing has to be decided.

Dinner · 15 minutes · Serves 1

Salmon with lemon butter and green beans

The quickest proper dinner here, and one of the best things you can eat.

You need

1 salmon fillet, skin on, about 130g
100g green beans, a large handful
A knob of butter, about 15g
Half a lemon

How

Pat the salmon dry and season the skin well. That's what makes it crisp.
Put it skin-side down into a cold non-stick pan, then turn the heat to medium. Starting cold is the whole trick.
Leave it alone for 6 to 7 minutes while the skin crisps and the flesh turns pale from the bottom upwards. Turn it for 1 minute, then lift it out.
Boil the beans for 4 minutes, drain, then toss them in the pan with the butter and a good squeeze of lemon. Add 2 or 3 small new potatoes alongside as the starchy portion.
Pour the lemon butter over the salmon.

One chicken, three meals

Roast a chicken on Sunday. Sunday: a roast dinner. Monday: cold chicken with coleslaw or salad. Tuesday: simmer the carcass with an onion and a carrot for about an hour to make stock, then make soup with the last of the meat.

Three meals from one shop and one proper cooking session, which helps enormously on the days when cooking feels like too much.

Making it taste good

None of the flavour needs to come from sugar, and food that tastes of nothing is food you won't keep eating.

Brown things properly. Meat and mushrooms in a hot pan until they take real colour. That colour is flavour, and most home cooking stops too early.
Season properly, at the end as well as the start. Your blood pressure is good, so salt is not the worry it would be otherwise, but do lean on herbs, garlic, lemon and pepper for most of the flavour as noted further up, and let the salty things be an accent.
Something sharp cuts richness. Lemon, vinegar, mustard, pickle, a few capers. It's what stops creamy things feeling heavy.
Garlic, herbs and spices are free. Rosemary with lamb, thyme with chicken, dill with fish, smoked paprika on almost anything.
Roast vegetables rather than boiling them. Toss in olive oil, hot oven, until the edges catch. Different food entirely.
Cinnamon and vanilla make yoghurt taste sweet without any sugar in it.

How to eat more without raising your blood sugar

This is the part that matters most for you, because you could do with a few more pounds on. Fat adds calories without touching your blood sugar at all, which makes it the perfect tool for exactly your situation. Protein is nearly as good, though a very large plateful does nudge your sugar up slowly a few hours later, so fat is the one to lean on hardest.

Easy additions that add up

Butter on everything. Vegetables, eggs, fish. A generous knob, not a scrape.
Cream into soups and sauces. A couple of tablespoons stirred in at the end.
Cheese grated over things. Vegetables, soup, eggs, salad.
Olive oil on salads, poured properly rather than dribbled.
A handful of nuts mid-morning, for the calories. Worth being clear though: nuts are fat and protein, so they will not bring you back up if you are already going low. For that you need something sugary, as in the low blood sugar section. If mid-mornings are a problem, ask your nurse whether you should have something starchy then instead, like a slice of toast or a couple of oatcakes.
Full-fat Greek yoghurt with cream stirred through, berries and chopped nuts. A proper pudding, and one of the best things you can eat.
An extra egg. Three instead of two costs nothing and adds real protein.
Avocado, half of one with anything savoury.

And if a meal ever feels too big, eat it in two halves rather than leaving it. Half at the table, half an hour or two later. Getting it eaten matters more than getting it eaten at once.

Putting a little weight on, without changing a single dose

This is the most useful section on the page for you, and there is a number attached so you can tell whether it is working.

Fat is the one thing you can add freely. It carries more than twice the calories of anything else, and it does not raise your blood sugar at all, so adding it does not upset the dose your nurse has set. Extra bread or potato would upset it. A very large amount of extra meat raises your sugar slowly over three or four hours. Fat does neither, and it is the only one that does neither.

Any three of these most days is about four hundred extra calories

A thumb of butter on the vegetables, about 110
A tablespoon of olive oil over the salad or roast veg, about 120
Two tablespoons of double cream in the soup, the sauce, the coffee, or stirred into yoghurt, about 130
A small handful of nuts mid-morning, about 190
A 40g piece of cheddar, about 165
An extra egg, about 80

Kept up, that is roughly a pound a fortnight. About half a stone by Christmas, which is the right pace. Slow puts on muscle as well as fat. Fast does not.

If your appetite is not what it was

Appetite often takes a while to come back after a spell of illness, and after a hard few weeks it can go altogether. If big plates feel like too much at the moment, do not force them. Forcing meals tends to put people off eating entirely, which is the opposite of what we want.

Small and often works better than large and dutiful. Six little things across the day will get more into you than three proper meals you cannot face. A boiled egg. A slice of cheese. A pot of yoghurt with cream stirred in. Half a sandwich. A handful of nuts. A milky coffee made with cream.

Two things to keep hold of even on the days you don't feel like eating. Have something starchy with your morning and evening injections, even if it is only a slice of toast, because those doses are counted against it. And if you genuinely cannot eat for most of a day, ring the surgery rather than pressing on. That is exactly the sort of day they want to know about.

Spread it through the day rather than loading one meal. One very rich meal all at once slows your stomach down and pushes the rise later into the evening, which is harder on this insulin than the same food split across three.

One thing worth expecting

Insulin is the hormone that lets your body hold on to what you eat. People often put a little weight on once their insulin is properly covering their meals, and your new one covers them better than the old one did. If that happens, it is the treatment working. It is not something to correct.

Weigh yourself once a week

Same day, same time, first thing, before breakfast. Write it down next to your blood readings. Once a week is plenty, daily is just noise.

Dr Unwin, one of the eight named further down, weighs his patients relentlessly and says a small change caught early is the whole game. For his patients the alarm is a pound going on. For you it is the exact opposite. A pound coming off is the thing that matters. If the line drifts down two weeks running, or your rings and clothes start going loose, ring the surgery rather than waiting for the next appointment.

Five ways to make the same food gentler, without eating less of it

None of these change how much you eat, so none of them upset your dose. They only change how fast the same food arrives.

Eat the plate in order Meat or fish and the vegetables first, the bread or potato last. Same plate, same amount, different order, and the rise afterwards is noticeably smaller. The easiest thing on this page, and it costs nothing.
Never eat the starch bare Butter on the toast, olive oil on the bread, butter on the potato. Dry bread raises your sugar faster than the same bread buttered. This is the same instruction as "eat the fat", arriving from a different direction.
Something sharp alongside Vinegar, lemon, pickle or a proper vinaigrette with the starchy part of a meal slows it down. A ploughman's with pickle is already doing this.
Cooked and cooled counts for less Potatoes boiled, cooled and eaten cold in a salad are gentler than the same potatoes hot. Cold potato salad is a proper option rather than a compromise. Reheating them undoes most of it.
The coarser version of the same thing Jumbo or steel-cut oats rather than fine quick-cook. A dense seeded loaf rather than soft brown. Pasta cooked firm rather than soft. Same food, bigger pieces, slower rise.

Ten minutes that protects your independence

Protein only becomes muscle if the muscle is asked to do something. This is the other half of the protein instruction, and at your age it matters more than any of the food does.

Nothing that needs a gym, and nothing that needs you to be bendy. Most days:

Stand up from a dining chair and sit back down, five times, without using your hands. Rest, then again. This one movement predicts how well people your age stay on their feet better than almost anything else.
Rise onto your toes at the kitchen sink, ten times, holding the worktop lightly.
Carry the shopping. Two bags to the kitchen rather than one at a time, twice over. Carrying weight is training, not a chore to get out of.
Stand on one leg while the kettle boils, a hand on the worktop, ten seconds each side.

Once a month, count how many chair stands you manage in thirty seconds and write it next to your weight. If that number goes up, the plan is working, whatever the blood readings are doing that week. Women well past seventy do build strength and bone doing exactly this, so it is genuinely not too late. Keep your hypo treatment nearby, same as with the walks.

Why all this works

This is the part worth understanding, because once you have it you won't need anyone's list. You'll be able to look at any food at all and work it out yourself.

Only one thing in food raises your blood sugar much: carbohydrate.

Carbohydrate means sugar, but it also means starch, and that's the bit that surprises people. Bread, potatoes, rice, pasta, cereal, flour, and anything made with them, all get turned into sugar by your body within about half an hour. As far as your blood is concerned, a slice of bread and a spoonful of sugar are doing a fairly similar job.

Fat doesn't raise it directly at all. Butter, cream, olive oil, the fat on the meat, none of that turns into sugar, and it never was the problem it was made out to be.

But fat does change the timing, and that's worth knowing. A very rich meal, something like a big creamy curry, fish and chips, or a large cheese-heavy plate, slows everything down. The rise comes later and lasts longer, sometimes for several hours after you'd have expected it to settle. If you test two hours after a meal like that and it looks fine, it may still climb afterwards. Worth mentioning to your nurse if you notice it, especially on nights you've eaten richly.

Protein sits in between, and it's worth knowing why. A palm-sized piece won't do much. But a very large amount of protein does raise blood sugar, slowly, gently, over about three to five hours rather than in the first half hour. Your body can turn spare protein into sugar when it needs to.

So the question to ask about any food

“How much sugar or starch is in this?” That gets you almost all of the way, almost all of the time.

The one refinement: if you find your readings creeping up a few hours after a meal rather than straight after it, a very large plate of meat or fish can be the reason. Worth mentioning to your nurse if you see it, because it's the sort of thing that's easy to misread. Dr Bernstein, one of the eight further down this page, and the one who worked all this out on himself while taking insulin, took protein seriously enough to account for it in his own doses.

That one question explains everything else on this page. It's why you can eat as much broccoli as you like but a potato counts. Why cheese is a free snack and a biscuit isn't. Why the fruit juice is worse than the actual fruit. And why you can add almost anything you fancy to a pot of yoghurt, except the sweet things.

Why the butter is allowed

Most of us were told for forty years that fat was the thing to cut. For blood sugar, that turns out to be aimed at the wrong target, fat doesn't raise it. Sugar and starch do.

The fat is doing three real jobs here:

It keeps you full, so you're not hungry again an hour later.
It slows down whatever you eat alongside it, so nothing hits your blood sugar as sharply.
It makes vegetables worth eating: and you'll eat far more of them buttered than plain.

If you take the fat out, the food gets dull and nobody keeps it up. So please don't skip it, the butter on the cabbage is part of the plan, not a lapse from it.

Why the dose and the food have to move together

This is the most important thing on the page to actually understand rather than just follow, so here is the whole of it, plainly.

Your insulin dose is worked out to match the way you eat. Insulin's job is to move sugar out of your blood and into your body. Someone works out how much you need based on roughly how much carbohydrate you have at each meal.

So the two are a matched pair. Change one without changing the other and the sums stop adding up. Eat noticeably less than the dose was set for and there is more insulin than there is sugar for it to deal with. The insulin does not know that. It carries on doing its job and takes you too low.

That is the whole reason this page tells you to keep your usual portions rather than cut them. It is not caution for its own sake. On NovoMix 30 your doses are counted against your meals, so keeping the meals steady is what keeps the dose right. Steady is the goal, not smaller.

And if the food ever does change, the dose changes first. That is the order the best clinics work in: they lower the medication ahead of any change and accept blood sugars running a little high for a week or two while things settle, rather than risk you dropping too low at home. Dr Sarah Hallberg's clinic worked this way, and Dr David Unwin's NHS practice in Southport does too, both named further down this page. Hallberg was blunt about it: people who change the food without adjusting the medication first can get into trouble quickly.

Only your nurse or doctor can work out the numbers, because they depend on which insulin you take, how much and when. But now you know what you are asking for and why, which usually makes for a much better conversation.

Please read this bit

If you take insulin or tablets for your diabetes, these changes will bring your blood sugar down. That's exactly what we want, but it also means your dose may need to come down, and ideally before you start rather than after.

So please mention to your doctor or diabetes nurse that you're planning to eat this way. Both Dr Hallberg's clinic and Dr Unwin's NHS practice, the two places with the best published results at doing this, always lower the medication first and let the levels run a little high for a while, rather than the other way round.

Ask her which kind of insulin you're on, this one really matters. If it's a premixed insulin taken twice a day, names like NovoMix 30, Humulin M3 or Insuman Comb, then the dose is built around you eating a certain amount of carbohydrate at breakfast, at roughly the same time each day. Those are very commonly used because they're simpler, and they are less forgiving of you changing your breakfast. If that's what you take, changing breakfast is the single change most likely to give you a mid-morning low, so it needs the dose sorted first rather than second. If instead you take a long-acting one plus separate injections at meals, there's more room to adjust.

Three things to check with your nurse before you start. First, if any of your other tablets are dapagliflozin, empagliflozin, canagliflozin, Forxiga, Jardiance or Invokana, say so before you cut down on carbohydrate. Those tablets work by making you pass surplus sugar out in your urine. That means your reading can look perfectly normal while your body is actually short of fuel, and when it's short of fuel it starts breaking down fat in a way that turns the blood acidic. It's called ketoacidosis, it's serious, and the normal-looking reading is exactly why it gets missed. Second, ask whether you should have ketone strips at home, and what number to test at.

Never stop your insulin, least of all on a day you're ill or off your food. It feels logical to take less when you're not eating, but illness does the opposite of what you'd expect: your body releases stress hormones that push blood sugar up, so you often need more insulin on a sick day even while eating almost nothing. Stopping it is the single thing most likely to turn a bad day into a hospital admission. There's a full sick-day plan below, ask your nurse to go through it with you and write down your own version before you ever need it.

Change things gradually. Start with the easy wins: nothing sweet to drink, a short walk after meals, more protein at every meal, and a bit more food overall. Leave your usual bread and potato portions exactly as they are. On this insulin they are not the problem, and steadiness is what makes your dose work.

Test more often at the start: before each meal and before bed for the first two weeks, and any time you feel odd. Write the numbers down and take them to your next appointment.

And here is what those numbers are telling you, because writing them down is only useful if you know what you're looking for:

Any reading under 4 needs treating first and reporting second. Treat it as in the low blood sugar section, then write it down. It is not a sign of progress and it is not something to put up with: on this insulin it means the dose and the food have come apart, and only your nurse can put them back together. Ring her if it happens more than once. Do not try to fix it yourself by eating extra starch at every meal, and do not skip the next injection.
Feeling low more often than you used to: same signal, same call, even if the numbers look borderline.
Readings going up instead: worth a call too. It usually means something else is going on, not that the food is wrong.
If your morning reading is high, it is not last night's dinner. Your liver makes sugar all night whether you have eaten or not, and in diabetes it makes rather more than it should. So a high morning number is mostly your liver's doing, not a verdict on your evening meal. It is never a reason to eat less at dinner. Write them down and ring your nurse, because it is usually the evening dose that wants looking at. Cutting your dinner to fix a morning number leaves you with less food and the same insulin on board, which is how people go low in the night.
And it may need lowering more than once. If you lose a little weight over the coming months, your body becomes more responsive to insulin, so the dose that was right in week three can be too much by week twelve. This isn't a one-off adjustment; it's worth reviewing every few months while things are changing.
Anything above about 15, or feeling genuinely unwell with it: ring your surgery or 111 the same day rather than waiting. Ask whether you should be checking ketones.

One thing to mention if it applies. If you've ever been told anything about your kidneys, even that they're being “kept an eye on”, say so when you discuss this plan. It doesn't stop you eating this way, but it can change how much protein is sensible, and it also affects how long insulin stays in your system, which matters for lows.

Please don't stop or change any medicine on your own.

If something goes wrong

Worth reading now rather than when you need it. Nothing here is likely, but all of it is easier if you have seen it before.

If your blood sugar goes low

Worth reading now rather than when you need it. A low, a "hypo", usually means a reading below 4.

It can feel like: shaking, sweating, going pale, a thumping heart, sudden hunger, tingling lips, anxiety, confusion, irritability, blurred vision, or feeling wobbly and vague. Left longer it can cause slurred speech and behaviour that looks like drunkenness.

One thing to know as we get older. These warning signs can fade with age and after many years on insulin, so a low can arrive with much less notice than it used to. If you're noticing them less than you once did, tell your nurse. That is important information and usually means a dose needs changing.

What to do:

Take something sugary straight away. What you need is 15 to 20 grams of fast-acting sugar, which is roughly: 150ml of pure fruit juice (a small carton), or 4 jelly babies, or 4 to 5 large glucose tablets. Tablet sizes differ between brands, so check the packet once and write on it how many you need, some of the smaller ones take six or seven.
Wait 15 minutes, then test again.
Still under 4? Have the same amount again and wait another 15 minutes.
Once you're back above 4, if your next meal is more than an hour away, have a slice of toast, a small banana, or a couple of biscuits to keep it steady.

Always keep something sugary within reach: in your handbag, by the bed, and in the car. This is the one situation where the sugary thing is exactly right.

If you can't help yourself

This is the one situation you cannot manage on your own, so it needs sorting out in advance rather than in the moment. Show this part to someone, and keep a copy by the phone.

If you live on your own, this is the important bit

Being on insulin and living alone means one thing needs arranging: somebody notices if you go quiet. Not because anything is likely to happen, but because it is the one problem you cannot solve yourself once it starts.

Agree a daily check-in with someone. A phone call at roughly the same time each day, and an understanding that if you don't answer they come round or ring someone who can.
Make sure at least one person nearby has a key, or knows where one is.
Tell a neighbour or two that you take insulin and what a hypo looks like. Most people are glad to be asked.
Carry something that says you have diabetes and take insulin — a card in your purse, or a bracelet.
Ask your nurse about a personal alarm, the kind worn on the wrist or round the neck. Your council may provide one.
Keep your phone charged and by the bed, with the numbers you would need already in it.

If you already have some of this in place, good. If not, the daily call is the one to arrange this week.

If you become too drowsy or confused to eat or drink safely, or cannot be woken, whoever is with you must:

Not put any food or drink in your mouth. You could choke.
Roll you onto your side into the recovery position.
Give glucagon if you have it and they've been shown how.
Ring 999: straight away if there's no glucagon or they don't know how to use it, if you haven't come round within 10 minutes of it, or if you'd been drinking alcohol.

Two things worth sorting now, while you're well. Ask your nurse whether you should have glucagon at home, there's a nasal powder as well as an injection, and the nasal one is far easier for someone untrained to give. And carry something that says you have diabetes and take insulin: a card in your purse, or a bracelet.

Sick days, the plan to have ready before you need it

Being unwell is the situation where insulin-treated diabetes turns serious fastest, and it's the one people most often get wrong by doing what seems sensible. Ask your nurse to write your own version of this down and keep it in the kitchen.

The rules that don't change:

Keep taking your insulin. Always. Even if you're eating nothing at all. You may well need more than usual, not less.
Keep drinking. Small sips, often. Aim for a glass an hour if you can manage it.
If you can't face food, take your carbohydrate as fluid instead, milk, soup, or ordinary (not diet) lemonade or squash. This is the one time sugary drinks are useful.
Test your blood sugar more often: roughly every four hours, including overnight if you're unwell.

Ketones. Ask your nurse for ketone strips and for your own numbers, because being treated as Type 1 means these matter. As a general guide: test whenever you're ill regardless of your reading, and any time your glucose is above about 14 and not coming down. Below 0.6 is normal. Above 1.5 needs advice the same day. Above 3 is an emergency.

One important exception to “never stop your medicine”. If you take dapagliflozin, empagliflozin, canagliflozin, Forxiga, Jardiance or Invokana, the usual advice is to pause those tablets while you're ill, dehydrated or not eating, while carrying on with your insulin. Get your nurse to confirm this for you in writing, because it's the opposite of the rule for insulin and it's easy to muddle.

Ring 999 or go to A&E now: not 111, not the surgery tomorrow, if any of these appear:

Vomiting, or unable to keep fluids down
Stomach or tummy pain
Deep, heavy or rapid breathing
Very drowsy, confused, or difficult to rouse
Breath smelling sweet, like pear drops or nail varnish

Those together suggest something called ketoacidosis, which needs hospital treatment and gets worse quickly. It is much better to be sent home from A&E having been checked than to wait it out at home.

If you drive

Because you take insulin, these are the law rather than suggestions.

Tell the DVLA you're treated with insulin, if you haven't already.
Test at least twice a day, even on days you're not driving.
Test just before every journey. Don't drive at 4 or below. Between 4 and 5, have something fast-acting first, glucose tablets, sweets or a sugary drink, not toast. The phrase people use is “five to drive”.
Test at least every two hours on a longer journey, pulling over safely to do it.
If you go low at the wheel: stop as soon as it's safe, switch the engine off and take the keys out of the ignition, treat the low, then wait at least 45 minutes after you're back above 5 before driving on. The reason for the wait: your blood sugar recovers within minutes, but your brain's judgement and reaction time take considerably longer to catch up. You will feel completely fine well before you actually are, which is precisely what makes it dangerous.
Keep your meter, your hypo treatment and your diabetes ID in the car.

You must tell the DVLA if you have two or more severe hypos while awake in a twelve-month period, if you have even one while driving, or if you start to lose the warning signs. (Night-time hypos are counted differently, your nurse can explain how that applies to you.)

Two things worth asking at your next appointment

Both of these are reasonable things to ask, and knowing why you're asking makes the conversation a much better one.

“Have my GAD antibodies and C-peptide been checked?” Two simple blood tests, and it's worth knowing what each one shows.

GAD antibodies show whether your own immune system is attacking the cells in your pancreas that make insulin. If it is, that's Type 1, and it can begin slowly in later life, which is why it is sometimes taken for Type 2 for years.

C-peptide shows how much insulin you are still making yourself. Your body produces it in equal amounts alongside your own insulin, so measuring it is a way of counting what your pancreas is still managing to do.

Together they answer the question your team is currently undecided about, and it matters practically, not just on paper. If you are still making a fair amount of your own insulin, there may be real room to reduce what you inject. If you are making very little, then insulin stays essential, and knowing that saves you chasing something that was never on offer. A scan cannot show any of this, because it happens at a level far too small to see. Ask for the actual numbers rather than “they were fine”.
“Could I try a sensor for a while?” A Libre is a small patch worn on the back of the upper arm for a fortnight at a time. It reads your sugar continuously, so instead of a few finger-prick numbers you get the whole picture, including the hours you are asleep. On the insulin you are moving to, the two things most worth seeing are the mid-morning dip and what happens between midnight and six, and those are exactly the ones finger-pricks miss. Ask whether you could have one for a month while the new doses are being settled.
“I'm changing to NovoMix 30. What should I do if I go low mid-morning?” A fair question and one they will respect, because it shows you know how this insulin behaves. Worth asking at the same time whether you should have a routine mid-morning snack, and what they want you to do on a day you genuinely cannot eat.

The short version

Do

Eat more, not less. You could do with a few more pounds on. Aim for three meals and something in between, and if your appetite is poor at the moment, small and often beats large and dutiful.
Walk after your meals. Ten to fifteen minutes. The best single thing on this page.
Have a palm-sized piece of protein at every meal. It protects your muscles and your balance.
Eat the butter and the olive oil. Fat is what keeps you full and makes food taste of something.
Three meals a day at roughly the same times. NovoMix 30 is built around your breakfast and evening meal, so regular beats perfect.
Tell your nurse or doctor that you're eating this way, before you start.
Keep something sugary within reach at all times, for a low.
Keep the things you enjoy. Good cheese, dark chocolate, a glass of wine with dinner.

Don't

Don't change or stop any medicine yourself. Ever, and especially not insulin. That conversation belongs with your nurse.
Never skip breakfast or your evening meal. On NovoMix 30 those are the two your doses are counted against. This is the most likely single cause of a low.
Don't start any supplements you've seen online without asking first, berberine especially, and also cinnamon, chromium and alpha-lipoic acid. These genuinely do lower blood sugar, which sounds helpful, but that is exactly the problem: on top of your insulin they can take you too low. Berberine is the one you'll see pushed hardest online.
Don't cut out the bread and potatoes at any of your three meals, lunch included. Your insulin is counted against them. Swap to the seeded or new-potato version by all means, but keep the portion.
Don't drink alcohol on an empty stomach, and test before bed if you've had a drink.
Don't drink anything sweet: juice and squash are the easiest thing to miss. Except when treating a low, when they're exactly right.
Don't aim for perfect. Breakfast every morning matters far more than any single meal out.

Who says so

This comes from eight people who have all worked on this, and the useful thing about them is that they disagree with each other about almost everything except a couple of points. Those couple of points are what this page is built on.

Three places this goes further than the experts do

Most of what follows is simply what these specialists agree on. Four things go further than that, and it is only fair that you can see which:

Protein is emphasised more than the eight collectively justify: because muscle and balance matter enormously in your seventies, and most of them were working with younger people losing weight fast.
The walk is ranked as the single best thing: that ordering is mine, not theirs.
Keeping your bread and potatoes rather than cutting them is a straight reversal of what nearly all of them advocate. I have done it because of NovoMix 30, which is dosed against your meals and which none of these people were writing about.
Telling you to gain weight rather than lose it contradicts the one thing every single one of them agrees on. That is because of your weight specifically, not because I think they are wrong in general.

Everything else is theirs, and where they disagree the table below says so rather than quietly picking a side.

So that the rest of this section makes sense, here is who they are. They are not equals, and I have said plainly which are which.

The four whose results are published and checkable

Professor Roy Taylor: Newcastle University. He and Professor Mike Lean at Glasgow ran the trial called DiRECT, and that trial is the main thing the NHS's own Type 2 diabetes remission programme is built on. As establishment as it gets.
Dr David Unwin: an NHS GP in Southport, doing this with his own patients since 2013. Over 150 of them have come off their diabetes medication altogether. He won NHS Innovator of the Year for it, and gives all his patient advice away free. If you mention one name to your nurse, make it his.
Dr Sarah Hallberg: ran a large American study of people with Type 2 diabetes eating this way. Of those in it who were already on insulin, 94% reduced it or came off it within the first year. She insisted medication be lowered before the food changed, which is where that instruction on this page comes from. She died in 2022.
Dr Richard Bernstein: an American doctor who had Type 1 diabetes himself for 79 years and lived to 90. He trained as an engineer first and worked much of this out on himself, then went to medical school at 45 so that doctors would take him seriously. His approach was built for people on insulin, which is why it matters most here.

Two doctors who write about it rather than run trials

Dr Jason Fung: a Canadian kidney specialist who explains the whole thing very clearly. The Diabetes Code is his book and it's an easy read.
Dr Peter Attia: an American doctor turned author, more focused on living longer generally than on diabetes specifically.

And two who are not doctors at all

Being straight with you about these two, because they are the most famous of the eight and they turn up everywhere online.

Gary Brecka: not a doctor, and says so himself. He used to work out life expectancy for an insurance company, now runs a wellness business, and sells supplements.
Dr Eric Berg: a chiropractor rather than a medical doctor. Enormous following online. Also sells supplements.

They are right about the basics, cut the sugar, eat protein, walk, sleep, which is why they are in the eight. But this is where the “don't start supplements” warning further up comes from. When someone recommends a pill and also sells that pill, the recommendation is worth rather less. Nothing on this page needs you to buy anything.

What they actually agree on

This table is built from 119 recordings of these nine people talking, around 620,000 words of their own material, rather than from what they are generally said to believe. Where the recordings do not settle something, it says so rather than guessing.

Advice	Who backs it
Cut sugar and refined starch	All eight. Taylor gets there by cutting calories overall rather than carbohydrate specifically, but he ends up in the same place
Lose fat from around the liver and middle	All eight agree, but see the note just below the table, because this is the one place your age genuinely changes the answer
Move after meals	Seven of the eight. Taylor is the exception, he asks people not to increase exercise while actively losing weight, because it tends to make them eat more
Keep track of your HbA1c and your home readings	All the doctors, though they favour different measurements. Bernstein wanted frequent finger-pricks; Taylor watches weight; Unwin watches HbA1c
Plenty of protein	Split. Brecka, Berg and Attia push it hardest. Hallberg says adequate but moderate, and warns that too much turns into sugar. Taylor's own programme is far lower in protein than this page suggests
Strength and movement	Split. Attia, Brecka and Berg push it hardest. Taylor is more cautious, he found people starting an exercise programme during weight loss tended to eat more to compensate
Sleep as a lever	Only some of them discuss it at all. Attia and Brecka treat it as a real factor; several of the others simply never raise it
Fasting or a set eating window	Fung yes, strongly, it's the centre of his approach. Bernstein preferred three regular meals at set times instead. The others vary

The top two rows are the ones every single one of them agrees on: cut the sugar and refined starch, and lose fat from round the middle. Where the eight fall out is further down the list, and nothing here leans on anything from the lower half.

The one place all eight are set aside, and it is about you specifically

Every one of them is keen on losing weight from round the middle. For a heavier person in their fifties that's right, and it's the strongest agreement in the whole table.

For you it is not just unnecessary. It would be harmful, and I want to be blunt about it. At 49 kilos and 5 foot 4, you are right at the bottom of the healthy range, close enough to underweight that it's the thing I'd most like to change. Past seventy-five, being on the light side carries more risk than being a stone or two heavy. Weight comes off muscle as well as fat, and muscle is what keeps you steady on your feet and living in your own home.

So please read every food suggestion on this page as “have this as well”, never “have this instead”. Nothing here is a diet. If you finish a meal still hungry, eat more. Butter on the vegetables, cream in the soup, cheese on top, a proper pudding of Greek yoghurt and berries. All of that is helping.

And if you lose weight without meaning to, even a few pounds, or your clothes start going loose, tell your doctor rather than waiting for the next appointment. At your age and weight that's something to investigate, not something to be pleased about.

Two exceptions, and you should know I've made them both.

Protein sits higher on this page than the full agreement justifies. That is deliberate: protecting muscle and balance matters enormously at your age, and the two who disagree. Fung and Taylor, were mostly working with younger people trying to lose weight quickly. Different problem, different answer.

Sleep is the other one. Only four of the eight discuss it at all, so it's in the top five here on the strength of the general evidence rather than because they all back it. The other four don't contradict it, they simply don't write about it. I've kept it in because it costs nothing to act on, but you should know it isn't on the same footing as the top two.

On “HbA1c”, in case nobody has explained it. It's a blood test that shows your average blood sugar over about the last three months, so a single good or bad day doesn't move it. You may know it as “my diabetes number”. It's the one worth asking for by name.