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Food can be one of the most complicated parts of living with type 1 diabetes. There is the math, the insulin, the blood sugar response, and the emotional side of eating. For many people with T1D, food can start to feel surrounded by rules. What can I eat? What should I avoid? Did I make the right choice? What does this blood sugar say about how well I am managing my diabetes?
In a recent Blue Circle Health podcast conversation, Scott spoke with Mary Ellen Phipps, a registered dietitian who has lived with type 1 diabetes since childhood and the founder of Milk & Honey Nutrition, about rethinking the way we approach food and nutrition with T1D. Her message was simple: there are many tools that can help with food and blood sugar management, and the more you have in your toolkit, the better. But it’s important to remember that they do not all need to be used at the same time and you can adapt them to what works for your lifestyle.
Moving beyond rigid food rules
Mary Ellen was diagnosed with type 1 diabetes at age five in 1991. At the time, diabetes management looked very different than it does today. With older insulin regimens, meals often had to be carefully scheduled and consistent. Eating the same foods at the same times was often the recommendation. When rapid-acting insulin became available, that changed what was possible. But, according to Mary Ellen, diabetes nutrition education eventually swung toward the other extreme: eat whatever you want and simply take insulin for it. Her own experience has led her toward something in between.
People with type 1 diabetes can enjoy the foods they know and love. At the same time, there are strategies that may make it more likely that blood sugars stay steadier. For some people, that might mean adding protein or fiber to a meal. For others, a lower-carbohydrate approach may be a useful tool in certain situations. The important part is recognizing that different approaches can work for different people.
Think of nutrition as a toolbox
Mary Ellen uses the idea of a toolbox to describe diabetes management. When you build a house, you need certain tools, but you do not use every tool for every job. Diabetes management can work in a similar way.
Insulin and food are essential parts of managing type 1 diabetes. Physical activity and stress can also affect blood sugar. Beyond those basics, there are other strategies people can choose to use depending on their needs, preferences, goals, and circumstances. For example, a very low-carbohydrate diet may be useful for one person and not appealing or helpful for another. Non-nutritive sweeteners may be useful to one person without being necessary for someone else. Importantly, even the same person may use different tools at different times.
Mary Ellen shared that she personally does not normally follow a very low-carbohydrate diet, but she may intentionally eat lower-carbohydrate foods when she is sick or traveling because she knows those situations can affect her blood sugar. The goal is to know what tools are available and understand how they might help, rather than feeling like every tool has to be used at every meal.
Adding support instead of eliminating foods
One practical way to use this approach is to think about what you can add to a meal. Take bread as an example. Someone newly diagnosed with type 1 diabetes might hear that bread is something they should avoid. Instead, Mary Ellen suggests considering what could be added to make the meal more balanced.
That could mean adding eggs, avocado, peanut butter, or another source of protein, fiber, or healthy fats to slow down carbohydrate absorption. Another option could be choosing a whole grain bread with nuts or seeds. The same idea applies to pasta. There are bean-based and whole grain pasta options that some people may find useful. But if you prefer traditional pasta, you can still think about portion size and what you can add to the meal, such as protein and vegetables. Scott shared an example from his own experience, combining regular pasta with an edamame-based pasta rather than replacing his favorite pasta entirely. The point is to have options.
What is resistant starch?
Another nutrition tool discussed in the conversation was resistant starch. Mary Ellen explained that resistant starch is a type of starch that the body does not digest in the same way as traditional starch. It can be found in foods such as potatoes, pasta, bread, rice, and beans.
One example she discussed was cooked potatoes. When cooked potatoes are cooled in the refrigerator for several hours, some of the starch can convert back into resistant starch. She noted that some resistant starch may remain even after the food is reheated. For some people, this may result in a more gradual blood sugar response. For others, they may not notice a difference.
You do not need every tool at every meal
Having more tools available can be helpful, but it can also become overwhelming if every meal starts to feel like a project. Mary Ellen discussed another strategy, food order. Eating non-starchy vegetables or protein before the carbohydrate portion of a meal may help slow carbohydrate absorption. With that said, you absolutely do not need to dissect every meal to follow a particular strategy.
If you are eating tacos or a stir-fry, for example, picking apart the meal to follow a specific food order may not make sense. If you are eating freshly cooked potatoes that evening, refrigerating them overnight is not an option. That is where the toolbox concept comes back in. Remain flexible, and choose the tool that fits the situation.
Be careful with diabetes advice online
Nutrition information is everywhere, especially on social media. Mary Ellen encourages people with T1D to pay attention to how that information is presented. One red flag is absolute, black-and-white language: good or bad, yes or no, always or never. Nutrition and diabetes management often require nuance because people are individuals. What works for one person may not work for another.
Mary Ellen also cautioned against comparing your diabetes management to someone else’s online. A social media post only shows a small part of someone’s life. One person’s blood sugar patterns, insulin doses, or meals do not provide a template for everyone else.
She shared another important idea from her childhood: blood sugars are data. A blood sugar result does not have a moral value attached to it. It can provide information that helps you understand what happened and consider what you might change next time.
Start with what you want to eat
One of the most practical takeaways from the conversation was Mary Ellen’s advice to decide what you want to eat first. Next, think about your toolbox.
If it is pizza night, start with the fact that you want pizza. From there, consider which strategies might help you manage the meal based on what you already know about your body and diabetes. This approach gives food a place in your life beyond diabetes management. It also leaves room for individual preferences and real life.
General nutrition advice can give you ideas, but your experience with food and type 1 diabetes is your own. If there is a food you love, you can look for information about ways to enjoy it rather than automatically accepting someone else’s rule that you should never eat it. The goal is to build a toolbox that works for your life, one useful tool at a time.
This article is based on a Blue Circle Health podcast conversation with Mary Ellen Phipps. It is for educational purposes and does not provide medical advice. Talk with your healthcare team about nutrition and diabetes management strategies that are appropriate for you. For more practical support, explore the ADA Food Hub and Blue Circle Health’s cooking classes for additional tools and ideas to help make food and diabetes management work for you.
