From resistance to diabetes
People who develop type 2 diabetes have usually had insulin resistance for many years. The turning point is not the resistance itself. It is the pancreas. Beta cells, the cells that make insulin, can work overtime for a long stretch. Eventually they tire, and some are lost. Insulin output falls short of what the body needs and blood glucose stays high.
The liver plays a bigger part than most people think
Between meals the liver releases glucose to keep your blood sugar steady. Insulin is the signal that tells it to stop. When the liver is resistant, especially when it is full of fat, it keeps releasing glucose even when blood sugar is already high. That is why fasting glucose can be raised first. The muscles add to the problem by taking up less glucose after a meal. If you want the liver side of the story, read insulin resistance and fatty liver.
Can type 2 diabetes go into remission?
For some people, yes. In the UK's DiRECT trial, adults who had been diagnosed with type 2 diabetes in the previous six years followed a structured program of low-calorie meal replacement and then food reintroduction. After one year, 46 percent were in remission, meaning HbA1c below 6.5 percent without diabetes medication. The more weight they lost, the higher the chance. Of those who lost 15 kg (33 lb) or more, 86 percent reached remission. At two years, 36 percent were still in remission.
Remission is not a cure, and glucose can climb again if weight returns. It does show that the condition is more flexible than people are often told.
What fiber does for diabetes control
In a classic crossover study published in the New England Journal of Medicine, adults with type 2 diabetes ate either a moderate-fiber diet (about 24 g a day) or a high-fiber diet (about 50 g a day, half of it soluble) for six weeks. On the high-fiber diet their glucose control improved, their insulin levels fell, and their triglycerides dropped. That level of fiber is high and not for everyone, but it shows the direction.
A gentler, realistic aim is 30 to 40 g a day, reached slowly. Our fiber guide gives amounts for common foods.
Cooking habits that help day to day
- Build plates around vegetables and protein, and treat starch as a side.
- Use chickpea flour, lentils and beans in place of some wheat flour. Try the chickpea flour pancakes.
- Eat fatty fish like salmon or sardines twice a week. See the sheet-pan salmon with lemon tahini lentils.
- Try psyllium husk in baking. Trials in type 2 diabetes show modest drops in fasting glucose and HbA1c. The psyllium flatbreads make it easy.
- Keep a short walk after dinner as a standing habit.
If you use insulin or a sulfonylurea, a big shift to high-fiber, lower-sugar meals can bring glucose down further than your doses expect. Check your levels more often at first and tell your care team before you start. If you have gastroparesis, ask about fiber first, because it can slow stomach emptying further.
Do not skip the heart
People with type 2 diabetes have roughly twice the risk of cardiovascular disease. Blood pressure, cholesterol and not smoking matter as much as glucose. See insulin resistance and heart disease.
Savory Chickpea Flour Pancakes
Chickpea flour is used in India, the south of France and Italy for the same reason: it makes a sturdy, savory pancake from a single ingredient.
Sheet-Pan Salmon with Lemon Tahini Lentils
Fish, legumes and vegetables on one tray, with a sauce that makes it taste like a restaurant dish.
Psyllium Husk Flatbreads
Psyllium husk is among the best-studied fibers for blood sugar and cholesterol, and most people have never used it in the kitchen.
For the numbers behind low-GI eating, read our guide to glycemic index and glycemic load.
Quick recipes for type 2 diabetes
Every recipe below takes 30 minutes or less and is built around fiber, protein and slow carbohydrate. Browse the full recipe collection for more.
- Salmon with Lemon Tahini Lentils (25 Minutes) (25 min): Fatty fish plus legumes is one of the most useful pairings for type 2 diabetes.
- Psyllium Husk Flatbread (20 Minutes) (20 min): Psyllium husk is a soluble fiber that forms a gel with water.
- Quick Turkey and Bean Chili (25 Minutes) (25 min): Most chili takes an hour of simmering because of the meat and dried beans.
- Shrimp White Bean and Broccoli Soup (20 Minutes) (20 min): Shrimp cooks in three minutes and is almost pure protein, which makes it perfect for a fast dinner.
- Cauliflower Fried Rice with Egg (15 Minutes) (15 min): A takeout portion of fried rice can contain over 80 g of carbohydrate.
- Savory Chickpea Flour Pancakes (25 min): A savory pancake made from chickpea flour, with yogurt and raw vegetables.
References
- Chandalia M, et al. Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. N Engl J Med 2000;342:1392-1398.
- Lean MEJ, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT). Lancet 2018;391:541-551.
- Lean MEJ, et al. 2-year follow-up of the DiRECT trial. Lancet Diabetes Endocrinol 2019;7:344-355.
- Davies MJ, et al. Management of hyperglycemia in type 2 diabetes, 2022. ADA/EASD consensus report. Diabetes Care 2022;45:2753-2786.
Please note. This page is for education and is not medical advice. If you take insulin or medication that can cause low blood sugar, such as a sulfonylurea, talk to your care team before making large changes to what you eat. Read our medical disclaimer.