The high-carbohydrate diet in diabetes management.

In summary, the best diet for an insulin-requiring diabetic person is a diet that can be best integrated into the person's lifestyle, one that is best matched to an insulin regimen acceptable to that person, and one that leads to the best control of the 24-hour integrated blood glucose concentration. Should future research indicate that a very high-CHO, low-fat diet is of additional benefit to the patient, then the dietary recommendations to the patient should be altered accordingly. It should be understood that diabetes is a chronic disease that requires intensive effort by the patient if reasonable management is to be attained. We should not complicate this management unnecessarily by dietary intervention unless clear benefits can be observed. For the type II, noninsulin-requiring diabetic person, dietary recommendations are even less certain. Obese patients should be encouraged to lose weight and to maintain a more ideal body weight, but one should not be disappointed if the patient is unable to accomplish this. Medical indications for weight loss rarely have been sufficient motivation for patients to remain on a semistarvation diet. Should safe, effective anorexigenic drugs become available, they clearly would be the treatment of choice for these patients. The best weight-maintenance diet for type II diabetic persons remains to be determined. A high-CHO, low-fat diet would appear to be best, provided it results in a more normal average level of blood glucose. An increase in dietary soluble fiber also may be useful in reducing the serum cholesterol concentration. In such a diet, those CHO foods that raise the postprandial glucose concentration the least should be emphasized.