What is the relationship between diabetes and heart disease?

As a Lark DPP user, you learned that diabetes raises your risk for heart disease. You also may have learned about some ways to lower your risk for having a heart attack or developing heart failure. The mission about heart health touched on a few strategies, such as choosing healthy fats, getting more fiber, and improving fitness, but there is way more to learn about preventing type 2 diabetes and supporting a healthy heart when you have prediabetes.

Lark Diabetes Prevention Program (DPP) provides coaching on behaviors that lower diabetes risk, and these same lifestyle choices can also improve heart health. That may increase your motivation even more! Here is a bit about diabetes, your heart health, and how Lark DPP can help.

Blood Sugar and Your Heart

Diabetes is a risk factor for stroke and heart disease, including heart attacks and heart failure. Heart disease is the leading cause of death among older adults with type 2 diabetes, and people with diabetes are up to four times as likely to develop heart disease as those without diabetes.

There are a few reasons why high blood sugar can harm your heart and blood vessels. High blood sugar for a long period of time can cause damage to your blood vessels, similarly to how high blood sugar can lead to damage to your kidneys to cause kidney disease. Damage to the blood vessels in your eyes can impair vision, damage to the blood vessels in your feet or hands can cause peripheral neuropathy, and damage to other blood vessels can lead to a heart attack or reduced circulation.

There are other links between diabetes and heart health. Most people with diabetes also have hypertension, or high blood pressure, which is another major risk factor for heart disease and stroke. Diabetes and insulin resistance also put you at risk for high cholesterol, which is you guessed it! more bad news for your heart.

With all these links between diabetes and heart trouble, it is worth doing what you can to prevent or delay type 2 diabetes and to support a heart-healthy lifestyle. Luckily, most of the healthy choices you make can do double duty in lowering diabetes risk and improving heart health.

Weight Control as a Priority 

 Losing weight is a major focus in the Diabetes Prevention Program (DPP). You may have already set a goal weight and be working towards it. Lark DPP can coach you along the path to a healthier weight.

Why should you lose weight? If you are overweight and have prediabetes, losing weight can:

• Lower diabetes risk by over 50%.
• Lower total and bad LDL cholesterol levels.
• Lower blood pressure.

We are not talking about massive amounts of weight to get these benefits. Losing even 5 to 7% of your body weight (10 to 14 lb. if you weigh 200 lb.) can give you these effects.

Lark DPP already coaches towards a healthy weight loss diet. You are taking steps to lose weight every time you:

• Take smaller portions or take home half of your restaurant meal.
• Choose fruit instead of dessert.
• Steam or bake instead of fry.
• Drink water instead of soda.
• Trim fat off of meat before cooking.
• Take the stairs instead of the elevator.

Remember, weight loss may be a priority, but it should not take over your life. You are more likely to lose weight and keep it off when you approach weight loss with a healthy attitude. Aim for gradual weight loss and small changes in habits as you keep checking and tracking your weight when you use Lark.

Physical Activity as Daily Medicine

Physical activity is part of the DPP because it lowers risk for type 2 diabetes, but it also has a host of heart-healthy effects. People with prediabetes who achieve at least 150 minutes per week of moderate-intensity physical activity lower their type 2 diabetes risk by about half compared to not exercising.

When it comes to heart health, exercise is as powerful as medicine and it carries no harmful side effects. According to the 2018 Physical Activity Guidelines from the Department of Health and Human Services, increased physical activity can:

• Lower risk for cardiovascular mortality, cardiovascular disease, and heart failure.
• Increase good HDL cholesterol.
• Lower total and bad LDL cholesterol.
• Reduce blood pressure.
• Reduce chronic inflammation (a heart disease risk factor).

Moderate-intensity exercises can include activities such as brisk walking, hiking, swimming, water aerobics, cycling, gardening, playing tennis, and rowing. While the ultimate goal is to get at least 150 minutes per week, with more being better, the immediate goal is to do what you can. Start at your level and work up gradually. Lark can help you track your activity and see how it changes over time.

These are a few strategies that may help if you are having trouble getting started with an exercise program or if you still find it hard to get out the door each day to work out.

• Focus on the immediate benefits. The long-term promise of lowering diabetes and heart disease risk is nice, but you can exercise making you feel better right now! It increases energy, improves focus, and improves mood.
  
  
• Work towards a reward. Go ahead, bribe yourself. Promise yourself a new shirt, a massage, or tickets to a concert if you stick to your workout program for a couple of weeks.
  
  
• Find something you love. If you are having trouble getting active, it may be because you are trying the wrong activity. Keep trying new things until you find something you like. Or, experiment with your entertainment you may do best when you watch TV, listen to music, workout in silence, or chat with one or more workout buddies.
  
  
• Mix it up. You may simply need to get out of a rut. If you are getting bored, try changing up the intensity and length, and also do a variety of activities. You might try two or three different activities in a single week.

Keep logging your activity in Lark DPP to stay motivated and improve heart health.

Eating Right for Heart Health and Blood Sugar

Diet quality is the top risk factor for mortality and disability in the United States[2], affecting risk for everything from certain cancers and to arthritis and Alzheimer's disease. Needless to say, your diet affects blood sugar levels as well as heart health.

Early in the program, you may have learned about certain dietary factors and their effects on blood sugar. The Eat Well Mission talked about why vegetables, whole grains, healthy proteins, and healthy fats can lower diabetes risk. The more recent Lark DPP Mission, Heart Health, dug into health fats and fiber.

The following chart shows a range of healthy and unhealthy dietary factors. Increasing the healthy ones and lowering the unhealthy ones in your diet can

• Lower blood sugar
• Lower risk for type 2 diabetes
• Reduce insulin resistance
• Lower bad “LDL” cholesterol
• Lower blood pressure
• Lower triglycerides
• Lower risk for heart disease
• Raise HDL cholesterol
• Increase chronic inflammation, a risk factor for heart disease and diabetes

Eat More Non-starchy vegetables like Lettuce, tomatoes, bell peppers, mushrooms, eggplant, zucchini, broccoli, cabbage, green beans, spinach, kale, celery, artichoke, asparagus, cauliflower, carrots

Eat More Whole grains like Whole-wheat bread and pasta, brown rice, quinoa, teff, amaranth, barley, oatmeal, whole-grain breakfast cereals

Eat More Legumes like Beans, lentils, split peas, soybeans

Eat More Healthy fats like Nuts, peanuts, avocado, olive oil, flaxseed

Eat More Dietary fiber like Fruit, vegetables, whole grains, nuts, seeds, peanuts, legumes

Eat More Seafood like Salmon, tuna, trout, herring, shrimp, oysters, tilapia, halibut

Eat More Reduced-fat dairy products like Non-fat milk and yogurt, low-fat cheese

Eat More Potassium like Fruits, vegetables, yogurt, beans, winter squash, nuts

Have Less Saturated fat like Fatty red meat, poultry skin, butter

Have Less Sodium like Pickles, soup, canned goods, olives, cheese, fast food, many dressings and sauces

Have Less Fried foods like French fries, fried chicken, onion rings, doughnuts, mozzarella sticks, hash browns, fish sticks, fried shrimp

Have Less Trans fat Processed snack and other foods with partially hydrogenated oils

Have Less Sugar-sweetened beverages like Soft drinks, sports drinks, flavored coffee, sweet tea, fruit drinks

Have Less Refined carbohydrates like White bread, pasta, and rice, refined breakfast cereal

Have Less Processed meat like Ham, sausage, hot dogs, pastrami, pepperoni, bologna

It is certainly not easy to hit the dietary goals. In fact, fewer than 2% of American adults hit recommendations[3], so you certainly do not need to feel bad if your diet is not perfect. It may just mean that you have plenty of room for improvement – and every improvement that you make may lower diabetes risk and improve heart health!

Lark's nutrition coaching is designed to help you make small changes to improve your nutrition bit by bit. Healthy behaviors can become habit when you practice them over time. Once you establish one healthy behavior, you can move onto the next without much trouble. There is no need to pressure yourself to make all the changes at once. Instead,

• Log your meals and snacks in Lark so you can stay aware and get feedback.
  
  
• Think about making one or two small changes a day, such as choosing a whole grain instead of refined, or having a tuna or peanut butter sandwich instead of one with processed meat.
  
  
• Log in often and read all the lessons so you can learn more about diabetes and heart health.

More Healthy Habits

You can attack diabetes and heart health from almost any direction, and Lark is there for you whenever you want. Chat with your coach about stress and ways to manage it whenever you are feeling anxious. As you learned in the Mission, Heart Health, keeping alcohol consumption to moderation, if you choose to drink at all, can have benefits.

Sleep deprivation can increase insulin resistance and diabetes risk, as well as raise levels of chronic inflammation in your body. Log your sleep in Lark and go through the sleep coaching conversations to see how you can increase it if necessary to get optimal amounts. Adding more sleep may be a way to lower diabetes and heart disease risk while it gives you more energy every day.

Tobacco use is a major risk factor for both diabetes and heart disease. Those who smoke have a one-third higher risk for diabetes, and quitting smoking can lower heart disease risk by about half. If you are a smoker or you use other forms of tobacco and you want to quit, contact your healthcare provider for options. If you are given the choice, you can also opt in to Lark's Tobacco Cessation program to get ready to quit.

Potatoes and diabetes, what should I avoid?

Can I eat potatoes with prediabetes? 

Every carb counts when you have diabetes, so does it matter whether you choose honey or sugar? Are sweeteners okay at all with diabetes? Honey and sugar are both sweet carbohydrates, but they do have some differences that can help guide decisions. Lark for Diabetes can offer more help with healthy eating and other smart choices for lowering blood sugar.

What is the Difference With Honey and Sugar?

White and brown sugar come from extracting and refining sucrose from sugar cane or sugar beets. Honey is made from nectar by honeybees. The composition of sugar is constant, but the composition, as well as flavor and color, of honey varies depending on the flowers used to make it.

Sugars in Honey vs. Sugar

Honey and sugar are both sweet, but they have slightly different components. Sugar is made up of a type of simple carbohydrate called sucrose. Each molecule of sucrose has one molecule of glucose bound to one molecule of fructose. Overall, sugar or sucrose is 50% glucose and 50% fructose.

Honey, on the other hand, is about 35% glucose and 40% fructose. It has about 9% sucrose, and smaller amounts of some other simple carbohydrates. Though sugar and honey are both mainly made up of glucose and fructose, honey tastes sweeter because most of its glucose and fructose is not bound together into sucrose.

Calories and Other Nutrients in Honey vs. Sugar

Each tablespoon of sugar has 46 calories. Each tablespoon of honey has 64 calories. Sugar is devoid of essential vitamins and minerals, while honey has a several. However, they are present only in tiny amounts. For example, you would need to eat 20 cups of honey to get 100% of the daily value for potassium or zinc. That would include about 20,000 calories, or enough calories for almost 2 weeks.

Glycemic Index of Honey and Sugar

The glycemic index, or GI, indicates how fast and how much blood sugar levels will rise after eating a food with carbohydrate. The higher the GI, the faster and higher your blood sugar level will rise for a specific amount of carbohydrate.

The glycemic index of sucrose, or sugar, is 65. The glycemic index of honey varies because the exact composition of honey varies. One study found it to be 61. Since the glycemic index of honey can vary from low to high, and there is no way to tell before you eat it if it is low or high, it is not safe to assume that it is low. Instead, it is safer to assume that honey will affect your blood sugar similarly to white sugar.

Research on Potential Benefits of Honey

Honey has a reputation for being healthier than sugar, and there is a certain amount of research on this. It appears to be effective as an antimicrobial and for healing wounds after surgery.

When compared to sugar, honey appears to be better at protecting against obesity and high triglycerides and cholesterol [4]. It also may increase insulin sensitivity and lower blood sugar, which are especially important in type 2 diabetes.

Still, these results may be taken with a grain of salt. Some of the research has been done in rats, not humans, and the results may not be the same in people. In addition, some of the studies have included high doses of honey that have been substituted for high doses of sucrose. The great results may mean not that honey is a superfood, but that it is less bad than sucrose.

Is Honey Really That Much Healthier?

In the amounts most people use sugar or honey, honey probably is not that much healthier than sugar.

If you have diabetes, your body has trouble metabolizing carbohydrates properly. Keeping your carbohydrate intake moderate and consistent can help keep blood sugar in check. Honey is a high-carbohydrate food, so it does count towards your carbohydrate goals for meals and snacks.

Having too much honey or other high-carbohydrate food can challenge your body. It can lead to spikes in blood sugar and, over time, increases in glycated hemoglobin (A1C). Too many grams of carbohydrates at one time compared to the amount you usually have can also lead to changes in how much medicine you need if you are on insulin.

Another concern with honey is its calorie content. If you are overweight or obese and have type 2 diabetes, losing a few pounds can lower blood sugar levels. Gaining extra weight can raise blood sugar. With 64 calories in each tablespoon, honey is a calorie-dense food. (In comparison, a tablespoon of cottage cheese has 7 calories, and a cup (16 tablespoons) of broccoli has 40 calories.)

Is Honey Okay If I Have Diabetes?

Honey can be okay for many people with diabetes. For many people, it can fit into a moderate or low-carb diet in small amounts and with other nutritious foods. As always, be sure to ask your doctor if you are not sure if a certain food is okay for you to eat, and how best to fit it into your diet.

Tips for Eating Honey with Diabetes

It is best to be aware of any honey you may be adding to foods because the calories, carbohydrates, and sugar can add up quickly. Just a few items that may call for honey include tea, peanut butter sandwiches, ricotta or hard cheeses, teriyaki sauce, and salad dressings. Without caution, honey in all these foods can contribute hundreds of calories without realizing it.

Lark for Diabetes can help you stay aware of the honey you are consuming when you log your foods. In addition, your Lark coach can offer insights, such as noticing that you had a lot of honey on a day when your blood sugar is higher than normal, for example.

With about 15 grams of carbs in each tablespoon of honey, a tablespoon counts as 1 of the 2 or 3 servings of carbs you might be aiming for in each meal. When planning meals and counting carbs, remember to count honey along with other carbohydrates such as fruit, bread, cereal, and other grains, beans, and starchy vegetables.

It is good to keep in mind that wholesome honey is different from honey-flavored foods, or foods with a small amount of honey and a large amount of refined carbohydrates or solid fats. For example, honey ham is high in sodium and nitrates, honey-flavored cereal and graham crackers, often has more sugar than honey, and honey mustard dressing and teriyaki sauce may be high in sodium and high fructose corn syrup.

As when eating other carbohydrates, it is best to eat honey with a source of protein, fiber, and/or fat to keep blood sugar from spiking too fast. These are some ways you might consider using honey.

• In a dressing with olive oil, vinegar, dijon mustard, and spices, over a green salad with chicken or garbanzo beans.
• In teriyaki sauce with low-sodium soy sauce, ginger, garlic, and sesame oil, used with salmon or in a stir fry with shrimp or chicken and vegetables.
• With olive oil as a glaze for roasted chicken and root vegetables such as onions, carrots, and sweet potatoes.
• With peanut butter on a slice of whole-grain bread.
• With blue cheese and walnuts.

Honey and Hypoglycemia in Diabetes

Hypoglycemia is a condition with low fasting blood sugar. People with diabetes who have mild hypoglycemia, or blood sugar between 54 and 70 mg/dl, may be asked to immediately consume 15 grams of carbohydrates, such as sugar.

It is important to remember that honey may be slower to digest than sugar because of a potentially lower GI. That means it is not appropriate as a treatment for hypoglycemia. Other good options, beside sugar, are fruit juice, hard candies, and jelly beans.

When thinking about honey versus sugar when you have diabetes, honey may be a better everyday choice for sweetening foods. Lark for Diabetes can help you follow a healthy diet for lowering blood sugar, along with taking other steps to lower risk for diabetes.

When you have type 2 diabetes, it's important to keep your immune system strong now more than ever. Here are some foods that can help.

With the COVID-19 pandemic still raging, it has never been more important to focus on immune system strength, especially when you have a condition like type 2 diabetes. The Centers for Disease Control and Prevention (CDC) notes that people with underlying conditions, including diabetes, may be at a higher risk for serious health problems if infected by the novel coronavirus. Time to make your health a top priority and armor up.

In addition to well-studied immune boosters like adequate sleep, consistent exercise, and stress-relieving strategies, supercharge your immune system by adding nutrient-rich, low-carbohydrate foods to your plate that will also keep your A1C on target.

The American Diabetes Association (ADA) emphasizes that carb counting can help people with type 2 diabetes manage their blood sugar, especially when injectable insulin is being used. Everyone's carb goals are different it ultimately depends on your weight, age, activity level, and whether you are taking any medication.

 On average, though, the CDC advises that people with diabetes get about 45 percent of their calories from carbs, and that most women need about 45 to 60 grams (g) per meal, while most men need about 60 to 75 g per meal.

Because everyone's nutrition and carb needs can be different, talk with your healthcare team about the right eating approach for you. Then fill your plate accordingly with any of the following diabetes-friendly and disease-fighting foods.



1 Chickpeas Provide Satiating Fiber and Immune-Boosting Zinc

Protein is essential for strengthening the immune system, as it works with key immune-boosting micronutrients like vitamins A, D, and E, as well as zinc, iron, and selenium, says Julie Cunningham, MPH, RD, a certified diabetes care and education specialist in Hendersonville, North Carolina.

With that in mind, consider the humble chickpea, a plant-based source of protein that is also a powerhouse when it comes to zinc. A ½ cup serving has 1 milligram (mg) of zinc, according to the U.S. Department of Agriculture (USDA), which is about 9 percent of the daily value (DV).

White blood cells need zinc to function, according to a review published in December 2016 in the Archives of Biochemistry and Biophysics. What's more, zinc is a boon to the heart, according to a study published online in February 2018 in BioMed Research International. That's important for people with diabetes because the CDC notes that over time, high blood sugar can negatively affect your heart.

Although chickpeas are high in carbs a ½ cup serving has about 20.2 g they're also an excellent source of fiber, offering 6.55 g, or about 26 percent of the DV per cup, notes the USDA. The latter characteristic makes them ideal for people with diabetes, Cunningham notes.

A meta-analysis of 15 studies found that increasing fiber intake can help reduce fasting blood sugar, which is a measure of blood sugar management. A high-fiber diet is also associated with healthier weight and improved insulin sensitivity, which can further help stabilize blood sugar, according to the authors of an article published in July 2018 in Nutrients. 

If you're currently following a low-fiber diet, just be sure to increase your intake gradually, and sip plenty of water while you do it. Otherwise, you may experience a stomachache, gas, and bloating, notes the Mayo Clinic.

How to enjoy the m Cunningham suggests blending chickpeas into a homemade hummus, adding lemon juice, and using nonstarchy veggie sticks, such as celery and bell peppers, instead of crackers for a quick snack.



2 Fatty Seafood Offers Immune-Supportive, Heart-Healthy Omega-3s

The omega-3 fatty acids found in some types of fish such as salmon, sardines, herring, and mackerel  enhance the functioning of immune cells, says the Sparta, New Jersey based Erin Palinski-Wade, RD, CDCES, author of 2 Day Diabetes Diet and a consultant for Swisse Wellness.

Although a review and meta-analysis published in August 2019 in the BMJ found that omega-3s have little or no effect on type 2 diabetes directly, Palinski-Wade says they can have significant benefit when it comes to better immune function. 

EPA, a component of omega-3s, may enhance the activity of white blood cells, which strengthens the immune benefits, she notes. A past study suggests this effect can not only be significant, but can also happen fairly quickly within a week, those researchers found.

Plus, these seaworthy choices offer established heart benefits, notes a review published in the May June 2013 issue of the Indian Journal of Endocrinology and Metabolism. Fatty fish appear to lower inflammation, thereby improving blood vessel function and decreasing triglycerides, according to the Mayo Clinic.

When prepared without sauces, fatty fish can be a great low-carb food to add to your diabetes diet. According to the USDA, a 5-ounce serving of salmon contains only 5 g of carbs.

How to enjoy it Oven-baked fish is super simple and very quick, the Food Network says. Put spices or a tablespoon of fruit salsa on top, along with a splash of lemon or vinegar, and seal the fish in an aluminum foil pouch. Bake at 450 degrees for about 15 minutes, until the fish is flaky.



3 Carrots Are Packed With Vitamin A and Low on the Glycemic Index

Vitamin A can help support the immune system through a variety of cellular processes, and one top source is carrots, says Cara Schrager, MPH, RDN, a certified diabetes care and education specialist and the clinical programs manager at the Joslin Diabetes Center in Boston.

"Carrots contain beta-carotene, which is a major source of vitamin A," she says, so much so that the common garden vegetable actually gave the phytonutrient its name. Furthermore, Schrager says, they contain a low glycemic load, meaning they are unlikely to cause a blood sugar spike.

They're helpful for eye health, an important consideration for those with diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Over time, diabetes can cause eye damage that leads to poor vision and puts you at higher risk for issues like cataracts and glaucoma. Research published in Nutrients has found that the beta-carotene in carrots, along with lutein, provides antioxidants that can help prevent eye damage.

How to enjoy them Schrader suggests grating carrots into tomato sauce or ground meat, or snacking on baby carrots. According to the USDA, about .. of a cup (or 85 g) offers 586 micrograms (mcg) of vitamin A, or about 65 percent of the DV.



4 Brazil Nuts Help Support Thyroid Function, Thanks to Their Selenium

Selenium is another important mineral for those with type 2 diabetes, says Cunningham, because it supports thyroid health. According to the American Diabetes Association, both diabetes and thyroid disease are endocrine issues, so those who grapple with thyroid issues could have a more difficult time with blood glucose control.

Selenium plays a critical role in regulating thyroid hormones, the NIH says. Because research has found that those with diabetes have a higher prevalence of thyroid disorders, it's helpful to keep your thyroid function up to scratch with good nutrition.

Cunningham recommends a small serving of Brazil nuts to get what you need. According to the Cleveland Clinic, that's 4 medium-size Brazil nuts (about ½ ounce). In addition to being a single protein serving, the USDA notes that 4 Brazil nuts offer 383.2 mcg of selenium, or nearly 7 times the DV. That same serving size of Brazil nuts contains only 2.35 g of carbs.

How to enjoy them Because it takes so little to get benefits from Brazil nuts, Cunningham suggests including one in your snack rotation, or you can also slice a Brazil nut in thin strips and put it on a salad or over steel-cut oatmeal.



5 Walnuts Supply Vitamin E and Healthy Fats

Another important micronutrient is vitamin E, says Schrager, because it's a powerful antioxidant that helps protect the immune system. Research has further noted that this vitamin can improve glycemic control in people with diabetes.

"Walnuts are an excellent source of vitamin E, as well as a great source of omega-3 fatty acids, which help reduce inflammation," she says. "Walnuts contain very little carbohydrates, and therefore have a minimal impact on glucose levels."

If you're aiming to lose or maintain weight, walnuts are for you. According to a small study published in January 2018 in Diabetes, Obesity and Metabolism, walnuts may activate a part of the brain involved with appetite and impulse control.

According to the USDA, 1 oz of walnut halves (about 14) offer 0.198 mg of vitamin E, which is about 5 percent of the DV.



6 Bell Peppers Contain Vitamin C and Are Low in Carbs

Bell peppers are packed with vitamin C, says Schrager, and that helps boost your immune system and eliminate free radicals, which can cause damage to cells. According to the USDA, one cup of sliced red bell pepper offers 117 mg of vitamin C, or 130 percent of the DV.

A study in the November 2018 issue of Diabetes, Obesity and Metabolism involving vitamin C supplements linked the nutrient to improved blood glucose levels in people with type 2 diabetes, and helped manage blood pressure as well.

"Because bell peppers are a nonstarchy vegetable, they have a minimal effect on glucose levels," she says.

Another benefit to vitamin C is better skin health and wound healing, because it's involved with the formation of collagen, according to a report published in Nutrients in 2017. The ADA notes that diabetes can affect skin, and that skin issues are sometimes the first sign of diabetes.

How to enjoy them Schrager suggests chopping up raw bell peppers and adding them to a range of dishes, like scrambled eggs or a fresh veggie salsa for baked fish, or cut into thin strips as a crunchy snack.



7 Lentils Are Another Healthy Option for Zinc and Fiber

Another good source of zinc, lentils are also full of fiber, which helps boost satiety and keeps blood sugar steady, says Schrager. Lentils come in several colors, including brown, green, red, yellow, and black.

"The fiber acts as a prebiotic for healthy gut bacteria," she adds. "Our gut bacteria has been shown to strengthen our immune system."

Lentils and legumes (beans) are a great pantry item, dried or canned, she says, and they provide a good amount of protein as well. According to the USDA, ¼ cup of dried lentils contain 30 g of carbs and 15 g of fiber (60 percent of the DV). Lentils are a low-glycemic-index food, making them suitable for people with diabetes.

This is another good pick for those who are trying to lose weight, since the increased satiety means you feel full for longer, and that can decrease the temptation to keep snacking, lowering your daily calories as a result, says Schrager.

How to enjoy them Lentils are a great add-in for soup, especially because you can put together one that also has numerous types of veggies. For example, they pair well with onions, cauliflower, and bell peppers, as this low-carb recipe from Wholesome Yum demonstrates.

One Last Thing About Boosting Immunity and Managing Diabetes

Focusing on keeping your blood sugar levels steady through nutrient-dense food choices like these is always crucial for those with type 2 diabetes, but it's especially important at a time like this, when you definitely want to avoid unnecessary doctor's office visits and urgent care appointments.

Keep your immune system strong with these healthy choices, and as always right now, wash your hands and stay home.

Nuts can be a good snack for people with type 2 diabetes because they may help prevent heart disease, keep blood sugar controlled, and even aid weight loss.

When you're looking for a satisfying diabetes-friendly snack, it's hard to beat nuts. "Nuts are a super snack food for people with diabetes because they're the total package low in carbs and high in protein, fiber, and healthy fat and they create a feeling of fullness," says Cheryl Mussatto, RD, founder of Eat Well to Be Well in Osage City, Kansas.

Nuts: A Good Choice for Diabetes and Your Heart

The healthy fat in nuts protects your ticker, says Melissa Joy Dobbins, RDN, CDE, a spokesperson for the American Association of Diabetes Educators. That's important because people with type 2 diabetes are 2 to 4 times more likely to die of heart disease than those without it, according to the American Heart Association.

Heart-healthy monounsaturated and polyunsaturated fats found in nuts can lower your LDL, or "bad" cholesterol, Mussatto says. "At the same time, nuts also raise levels of ‘good,' or HDL, cholesterol," she says. "This cholesterol acts sort of like a sanitation worker, removing cholesterol from the tissues for disposal, which prevents plaque buildup in the arteries."



What's more, nuts help regulate blood sugar, which makes them a better option to reach for than, say, pretzels, when afternoon hunger strikes, Mussatto says. 

Many kinds of nuts have this effect: Almonds have been shown to slow down the blood sugar response when eaten with carbohydrate-rich foods, according to a small study published in the journal Metabolism that focused on healthy people without the disease. 

A study published in March 2011 in the European Journal of Clinical Nutrition found similar results for pistachios when eaten by healthy volunteers.

For those people already diagnosed with diabetes, regularly eating tree nuts can also improve blood sugar management, according to a meta-analysis published in September 2014 in the journal PLoS One.



Why Portion Control Is Key

Though these results may seem like enough to secure superfood status for nuts, there's one other thing to be aware of: Nuts are high in calories. So eating too many can lead to weight gain, which is why experts suggest measuring out 1-ounce portion sizes instead of digging into an open bag.

Keep in mind that how nuts are prepared can influence how healthy they are. Avoid nuts that are coated in salt Dobbins notes that sodium is bad for your blood pressure and sugar. 

More bad news if you love the sweet-and-savory combo: Chocolate-covered peanuts and honey-roasted cashews are high in carbs and not the best choice when you have diabetes, Dobbins says. Try dry-roasted or raw nuts instead, which are flavorful but still healthy.

As for which nut to choose, here are four of the best for people with diabetes, roughly ranked in order of healthiness:



1. Walnuts
Serving size: about 14 shelled halves

According to a small randomized controlled study published in July 2017 in the journal Diabetes, Obesity & Metabolism, walnuts may help promote feelings of fullness, preventing unhealthy food cravings and potentially aiding weight loss. 

Another study published in April 2013 in The Journal of Nutrition found women who ate walnuts had a lower risk of type 2 diabetes. "The fiber, the protein, and the good fats help manage hunger and blood sugars," Dobbins says.

Walnuts are also a rich source of alpha-lipoic acid (ALA) and may help reduce inflammation, Mussatto says, making walnuts her absolute favorite nut to recommend. Inflammation is tied to diabetes, as well as other conditions, like Alzheimer's disease and heart disease.



2. Almonds
Serving size: about 23 nuts

Almonds help control glucose levels and reduce the risk of cardiovascular disease for people with type 2 diabetes, according to a study published in April 2011 in the journal Metabolism. 

Dobbins notes they also have more fiber than other nuts 3.5 grams, to be exact — making them a good source of fiber. "Fiber helps keep you full, keeps your blood sugars more stable, and is good for your digestion," Dobbins adds.

One more reason almonds are superstars for people with diabetes: One serving offers 20 percent of your daily magnesium recommendation. That's helpful Mussatto says, because many people with diabetes are deficient in this mineral, which promotes healthy bones, normal blood pressure, blood glucose control, and good muscle and nerve function.



3. Pistachios
Serving size: about 45 nuts

"Pistachios' trio of fiber, protein, and good fats help keep you fuller longer, making them a smarter bet than carbohydrate-heavy snacks," Dobbins says.

There are a few studies that have found improved blood sugar in people with diabetes who eat pistachios as a snack, including a randomized controlled crossover study published in August 2014 in The Review of Diabetic Studies.

Enjoy them as a standalone snack or build them into your meals. Dobbins suggests subbing them in for croutons on a salad, or using crushed pistachios instead of breadcrumbs on baked chicken or fish.



4. Peanuts
Serving size: about 28 peanuts

Even peanut butter has a lot going for it: According to a small study published in June 2013 in the British Journal of Nutrition, obese women with type 2 diabetes who added peanut butter to their breakfast had better glucose concentrations and appetite control for up to 8 to 12 hours. Consider that a good reason to add a spoonful to your morning oatmeal or smoothie.

Why choose fiber? 

Certain fiber-filled foods can help you manage your weight, blood sugar, heart health, and more.   Focus on Fiber, Balance Your Blood Sugar



Ready to give your health a clean sweep? 

Then consider fiber nature's broom, says Toby Smithson, RDN, LDN, CDE, spokeswoman for the Academy of Nutrition and Dietetics and author of Diabetes Meal Planning and Nutrition for Dummies.

Found in plant-based foods, fiber is a carbohydrate that the body can't digest, which helps slow the rise in blood sugar following a meal. There are two types of fiber soluble and insoluble, and they've both got big benefits. Foods high in soluble fiber become gummy or sticky as they pass through the digestive tract, helping to reduce the absorption of cholesterol, Smithson explains. Insoluble fiber doesn't dissolve and promotes bowel regularity.

Other benefits include weight management, because fiber can help you feel more full and satisfied, and better regulation of blood sugar levels. And since people with diabetes are at double the risk for cardiovascular complications, fiber's ability to lower cholesterol and blood pressure levels is a great way to improve heart health. To get the recommended 20 to 35 grams per day, include these fiber-rich gems in your type 2 diabetes diet.

Love Your Lentils



Lentils are colorful legumes packed with both fiber and protein. About 40 percent of the total carbohydrate in lentils is fiber, leading to a lower blood sugar response, says Jill Weisenberger, RDN, CDE, an Academy of Nutrition and Dietetics spokeswoman and author of 21 Things You Need to Know About Diabetes and Your Heart and The Overworked Person's Guide to Better Nutrition.

Lentils boast more than 15 grams of fiber per serving, plus nearly 18 grams of protein, according to the U.S. Department of Agriculture (USDA). In a hurry? Opt for quick-cooking red lentils and use them in a soup or salad, Weisenberger suggests.

Go Bonkers for Beans



The trick for reaping the most benefit from beans? Pick a rainbow of them. A cup of cooked red kidney beans has about 13 grams of fiber, according to the USDA; a cup of black beans has about 15 grams; white beans, more than 18 grams. In addition to their high fiber content, beans, as well as lentils, have a starch that's resistant to digestion, meaning it doesn't get into the bloodstream quickly and affect blood sugar, Weisenberger says.

Plus, this starch is good news for good gut bacteria. When bacteria make a meal of resistant starch, some fatty acids are formed, she adds. These beneficial fatty acids promote better use of insulin and healthier colon cells. To get more beans into your diet, try tossing them into your favorite salad, soup, or entre.

Steam Up an Artichoke



Artichokes are tender, flavorful, and packed with fiber — one medium-sized artichoke has more than 10 grams, says the USDA. They're also a great source of blood pressure-lowering potassium and magnesium, as well as vitamin C and folate, Weisenberger says. To cook, she recommends removing the bottom leaves and cutting off the top third of the artichoke, removing the stem, and trimming the thorns from the top leaves. Steam for about 25 minutes over boiling water. Once cooled, pull off the succulent leaves and dip them in an olive-oil-based vinaigrette.

Pop Up Some Popcorn



Don't reach for a bag of chips when you want a salty snack air-pop fresh popcorn instead. Just skip the salt and butter (this isn't movie theater popcorn). Instead, drizzle with a bit of olive oil, sprinkle on some dried herbs, or add a dash of hot sauce. Three cups of air-popped popcorn contains more than 3 grams of fiber, the USDA reports. Popcorn is cholesterol-free and has almost no fat and very few calories. It's also a low-glycemic-index food, meaning that it's slowly digested and has a gradual impact on blood sugar levels.

Adore Avocados



Great mashed into dip or used as as a spread instead of mayo, avocados are a good source of both fiber and heart-healthy omega-3 fats. One cup of pureed avocado has more than 15 grams of fiber but also 368 calories and nearly 34 grams of fat, according to the USDA, so remember that a little goes a long way. Weisenberger suggests substituting 1 tablespoon of mashed avocado for 1 tablespoon of butter when baking and opting for a slice of avocado in place of cheese on your favorite sandwich.

More Peas, Please!



These starchy veggies, packed with vitamins A, C, and K, make great substitutes for rice and other grains, Weisenberger says. One cup of raw green peas boasts more than 7 grams of fiber, according to the USDA. Split peas are an especially good choice, as one cooked cup contains 16.3 grams of fiber, the Mayo Clinic reports. Toss peas into your favorite salad or pasta dish for added nutrients and fiber, or enjoy them on their own, sprinkled with a little fresh mint and parsley.

Score Big With Broccoli



A cup of chopped raw broccoli offers about 2.4 grams of fiber and nearly the same amount of protein, says the USDA. Plus, this cruciferous green veggie is rich in vitamins C, K, and folate and the mineral potassium. Weisenberger suggests steaming broccoli florets, tossing them with a garlicky olive oil, and mixing them into a pasta or casserole or adding it raw and crunchy into your favorite green salad.

Take a Bite out of Berries



Bite-sized and sweet, berries are loaded with fiber, antioxidants, and other nutrients. Raspberries and blackberries top the list of high-fiber choices, with more than 7 grams of fiber per cup. These tiny berries are loaded with health-boosting compounds, including those thought to help prevent certain types of cancer and improve the health of the heart, Weisenberger says. For a sweet dessert, enjoy berries topped with a few dark chocolate shavings.

Pick Pears



Green, red, or brown, all pears offer the same health benefits. A large pear contains about 7 grams of fiber, along with vitamin C and potassium, according to the USDA. For a fancy treat, drizzle a little balsamic vinegar over slices of a grilled pear, Weisenberger suggests. Enjoy this for dessert or serve the slices over salad greens at the start your meal.

Try Barley and Oatmeal



Both of these whole grains are good sources of fiber. Try barley in place of rice or pasta in your favorite dishes, and replace breadcrumbs with oatmeal in meatloaf or for coating baked chicken or fish. Both contain the fiber beta-glucan, which improves insulin action, lowers blood sugar, and helps sweep cholesterol from the digestive tract, Weisenberger says. One cup of cooked barley contains 6 grams of fiber and one cup of cooked oatmeal contains about 4 grams, according to the USDA.