A few simple things that genuinely help, and some proper food worth looking forward to. Nothing to count, nothing to download, nothing to give up entirely.
Because you take insulin, some of what's on this page is safe to start tomorrow and some of it isn't: not until your dose has been looked at. Muddling the two is the one way this goes wrong, so they're kept separate throughout.
Stage one. Start whenever you like. No dose change needed.
Stop drinking anything sweet · walk for ten to fifteen minutes after your main meal · put a proper portion of protein in every meal · keep the bread and potatoes exactly as they are for now.
Stage two. Only after you've spoken to your nurse or doctor.
Cutting down the bread, potatoes, rice and pasta. This is the part that lowers your blood sugar most, which is precisely why your insulin dose has to come down alongside it rather than afterwards. There's a whole section further down on why.
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.
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.
“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.
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:
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.
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.
| Item | What to buy or use | How much |
|---|---|---|
| Greek yoghurt | Full-fat, plain, unsweetened. The label should say around 4–5g sugar 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 |
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.
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.
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 still have calories. None of this raises your blood sugar, which is the point, but butter and cheese are not weightless. One of the two things every specialist on this page agrees on is losing a little fat from round the middle, so use the fat generously enough to enjoy the food, and not so generously that it works against you. A thumb of butter on the vegetables, not a quarter of a pack.
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.
None of these are forbidden, just check the label, because the sugar isn't obvious:
None of this is diet food. All of it is meant to be enjoyed.
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. Once you're eating this way, you'd be having somewhere around 60 to 90 grams of carbohydrate a day. Diabetes UK calls anything under 130 grams a low-carbohydrate diet: so that's what this is, and I'd rather say so than dress it up as something gentler. It is not a “keto” diet, which is far stricter again, but it is genuinely low carbohydrate and your insulin will need to reflect that.
Which is why the starch stays in until your dose has been reviewed. Take starch out while your insulin is still set for your old way of eating and you will go low. Do it the other way round, dose first, food second, and it works. That is the entire reason this page is in two stages.
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.
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.
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.
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.
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.
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.
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:
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.
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:
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.
This is the one situation you cannot manage alone, so show this bit to whoever you live with, or a neighbour, and keep a copy by the phone.
If you become too drowsy or confused to eat or drink safely, or can't be woken, they must:
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.
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:
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:
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.
Because you take insulin, these are the law rather than suggestions.
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.)
The version that stops you missing toast. The trick is low heat, and taking them off before they look ready.
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.
One pan, very little fuss, and it tastes like something you'd order out.
Nothing is missing from this one. The cauliflower disappears completely into the potato.
Freeze 3 portions in separate dishes. That's three evenings where nothing has to be decided.
The quickest proper dinner here, and one of the best things you can eat.
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.
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 was worked out to match the way you eat now. Insulin's job is to move sugar out of your blood and into your body. Someone worked out how much you need based on roughly how much carbohydrate you have in a day.
So if you eat noticeably less carbohydrate but keep taking the same amount of insulin, there is now more insulin than there is sugar for it to deal with. The insulin doesn't know that. It carries on doing its job, and pulls your blood sugar down too far.
That's the whole reason. It isn't caution for the sake of it, and it isn't about asking permission. Change the food without changing the dose and the sums no longer add up. Cutting the carbohydrate is the treatment, but the dose has to come down to meet it.
Which is why the clinics that do this properly lower the medication first, and accept blood sugars running a little high for a week or two while things settle. They would rather see you a bit high and safe than have you drop too low at home. Dr Sarah Hallberg's clinic worked this way, and Dr David Unwin's NHS practice in Southport does too: both of them are 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 new numbers, because they depend on which insulin you take, how much, and when. But now you know what you are asking them for, and why, which usually makes for a much better conversation than simply saying you'd like to eat differently.
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, and in the order set out at the top of this page. Stage one first, the drinks, the walk, the protein, with the bread and potatoes untouched. Then, once your dose has been reviewed, cut the starchy portion to about half of your usual and hold there for a few weeks before considering going further.
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:
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.
Both of these are reasonable things to ask, and knowing why you're asking makes the conversation a much better one.
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.
It would be dishonest to pretend this page is nothing but a summary of other people. Three things on it are decisions I made, and you should be able to see them and disagree if you want to:
Everything else is theirs, and where they disagree the table below says so rather than picking a side quietly.
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.
Being straight with you about these two, because they are the most famous of the eight and they turn up everywhere online.
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.
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're generally said to believe. Where the recordings don't settle something, it says so instead of guessing. Two claims that were on an earlier version of this page came out when their own words didn't back them up.
| 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 I have deliberately not leaned on anything from the lower half.
Every one of those eight is keen on losing weight from round the middle. For someone in their forties or fifties, that's right, and it's the strongest agreement in the whole table.
In your late seventies it is not the goal, and I'd rather say so plainly. Past about seventy-five, losing weight tends to take muscle with it as well as fat, and muscle is what keeps you steady on your feet, out of hospital, and living in your own home. Being a little heavier than the charts prefer is genuinely safer at your age than being underweight. Frailty is the thing to avoid, not a few extra pounds.
So the aim here is not the scales. It's steadier blood sugar, less insulin, and staying strong. If your weight happens to settle a little while you eat this way, no harm done. But don't chase it, don't skip meals to help it along, and if you lose weight without meaning to, half a stone or more, or clothes going loose, tell your doctor. At your age that's something to look into rather than 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.