When we talk about type 2 diabetes, carbohydrates tend to get all the attention.

Bread. Pasta. Potatoes. Fruit. Sugar.

And somewhere in the middle of all that carbohydrate counting, we can forget to ask a fairly important question.

Are you actually eating enough protein?

For some people living with type 2 diabetes, particularly older adults, maintaining muscle, strength and adequate nutrition can be just as important as what happens to the number on the scales.

Diabetes doesn't automatically mean you need to lose weight

Weight loss can improve blood glucose management for some people with type 2 diabetes, particularly when someone is living above their healthiest weight.

But that doesn't mean weight loss is appropriate for everyone.

If you're already a lighter person, have a small appetite, have recently been unwell, are unintentionally losing weight or are getting older, continually cutting food from your diet can potentially create another problem. You may simply not be eating enough.

And one of the things we particularly want to protect as we age is muscle.

Muscle isn't just about looking strong. It helps us get out of a chair, carry the groceries, climb stairs, maintain our balance and remain independent.

It also plays an important role in glucose metabolism.

So where does protein come in?

Protein provides the amino acids our bodies use to maintain and repair muscle and other tissues.

Good sources of protein include eggs, Greek yoghurt, cottage cheese, milk, fish, chicken, lean beef and other meats, tofu, tempeh, lentils, chickpeas, beans, nuts and seeds.

You certainly don't need an enormous steak at dinner to get enough protein.

In fact, one of the first things I look at is where protein appears across the entire day.

Breakfast is often where things go missing

Think about a fairly typical breakfast.

Toast with jam.

Cereal with a splash of milk.

A piece of fruit.

There is nothing inherently wrong with these foods, but depending on the portions, breakfast may contain relatively little protein.

Compare that with adding Greek yoghurt to your cereal, having eggs on wholegrain toast, adding milk and yoghurt to a smoothie, or having cottage cheese with fruit.

Suddenly we have a meal containing a meaningful source of protein without dramatically increasing its size.

That's particularly useful for someone with a small appetite.

What about carbohydrates?

Having diabetes does not mean carbohydrates need to disappear from your plate.

Carbohydrate foods provide energy, fibre, vitamins and minerals and, frankly, make eating considerably more enjoyable.

The type and amount of carbohydrate matters, but so does what we eat alongside it.

Rather than looking at a potato and thinking, I have diabetes, therefore potato is bad, we can look at the whole meal.

Perhaps it's potato alongside grilled fish, plenty of vegetables and extra virgin olive oil.

Or wholegrain pasta with beef, lentils, tomato and vegetables.

Or oats with Greek yoghurt, berries, nuts and seeds.

That's a very different nutritional picture from looking at one food in isolation.

But I have diabetes. Aren't I supposed to lose weight?

Not necessarily.

Nutrition advice should be based on you, not simply your diagnosis.

An active 45 year old living in a larger body may have completely different nutritional goals from an 80 year old who has lost five kilograms without trying and is struggling to finish meals.

Both may have type 2 diabetes.

They don't necessarily need the same diet.

For an older adult who is losing weight unintentionally or struggling to eat enough, preserving weight and muscle may become an important part of their diabetes care.

This is also why I'm cautious about automatically describing every lower calorie option as the "healthier" option.

Sometimes we actually need more nutrition, not less.

Five easy ways to add protein without enormous meals

1. Add Greek yoghurt to breakfast.

It works with cereal, oats, fruit or muesli and is an easy way to increase protein.

2. Keep eggs simple.

Boiled, scrambled, poached or made into an omelette. They don't need to become a complicated recipe.

3. Use legumes as an addition rather than a replacement.

Lentils can disappear surprisingly well into bolognese, soups and casseroles while adding protein and fibre.

4. Make snacks count.

Try yoghurt, cottage cheese, a small handful of nuts, milk or another protein containing option rather than relying exclusively on biscuits or crackers.

5. Look at the whole day.

If dinner contains nearly all your protein while breakfast and lunch contain very little, there may be an opportunity to spread it more evenly.

What could a day of eating actually look like?

Talking about protein is one thing. Putting it on the plate is another.

Here is an example of a simple day that includes protein across meals, plenty of plant foods and carbohydrates rather than avoiding them altogether.

Breakfast

Oats, yoghurt and berries

½ cup rolled oats cooked with milk

½ cup Greek yoghurt

Fresh or frozen berries

1 tablespoon chopped nuts or seeds

A sprinkle of cinnamon

The oats and fruit provide carbohydrate and fibre, while the milk, yoghurt, nuts and seeds bring protein into breakfast.

Morning tea

Fruit and cheese

One piece of fruit, such as an apple, pear or mandarin, with a small piece of cheese.

If you don't feel particularly hungry, a small Greek yoghurt can be an easy alternative.

Lunch

Chicken and Mediterranean grain bowl

Grilled or leftover chicken

½ to 1 cup cooked wholegrain pasta, brown rice or quinoa

Tomato, cucumber, capsicum and leafy greens

A spoonful of chickpeas

Extra virgin olive oil and lemon juice

This is a good example of why we don't need to fear carbohydrate foods. Instead, we're combining them with protein, vegetables, legumes and healthy fats to create a balanced meal.

Afternoon tea

Cottage cheese and fruit

Cottage cheese with sliced peach, pear or berries.

If you prefer something savoury, try cottage cheese on wholegrain crackers with tomato and cracked pepper.

Dinner

Fish, potato and vegetables

Grilled or baked fish

A small to moderate serve of potato or sweet potato

A generous serve of colourful vegetables

Extra virgin olive oil and herbs

Potato hasn't disappeared simply because we're talking about diabetes. It is part of the meal rather than the entire meal.

Something later?

If you're hungry, particularly if you're trying to maintain your weight, a small protein containing supper can be useful.

Try Greek yoghurt with fruit, a glass of milk, or a small bowl of natural muesli with milk.

A note about portions

There isn't one correct portion size for everyone with diabetes.

Your energy and protein requirements will vary depending on your age, body size, activity level, medications, appetite, health conditions and whether your weight is stable, increasing or decreasing.

Someone trying to prevent further unintentional weight loss may need quite a different meal plan from someone working towards intentional weight loss.

That's why I'd rather use this as an example of how to build a day than call it the perfect diabetes diet.

There isn't one.

The bottom line

Managing diabetes isn't about creating an increasingly long list of foods you're no longer allowed to eat.

It's about building a way of eating that supports blood glucose management while also providing enough energy, protein, fibre, vitamins and minerals to keep your body functioning well.

And sometimes the most important nutrition question isn't:

“What should I cut out?”

It's:

“Am I eating enough of what my body actually needs?”

If you're living with type 2 diabetes and you're unsure whether you're eating enough protein, losing weight without intending to, struggling with appetite or simply confused by conflicting nutrition advice, an Accredited Practising Dietitian can help develop an approach that fits your health, your appetite and the foods you actually enjoy eating.

The Cooroy Dietitian

Practical, evidence based nutrition advice for real life.