There are two types of Diabetes Mellitus: types 1 and 2. The pathology of each of the two diseases is completely different and, from a nutrition and exercise viewpoint, each should be treated differently.

Blood glucose levels are controlled by the hormone insulin produced by the pancreas. Glucose comes from our food from starchy foods, like rice, potatoes, bread, etc and from sugar. It is also manufactured in the liver from where it is passed into the blood. In diabetes glucose cannot be used effectively as a fuel by the body so levels rise in the blood and excess passes into urine. This is why diabetics, before diagnosis, pee more and feel excessively thirsty. There may also be other symptoms like lethargy, blurred vision, lack of concentration and fatigue.

In type 1 diabetes there is no insulin produced from the pancreas at all, so the patient has to be treated with injections of insulin a number of times a day, as well as following a suitable diet. There are a number of different types of insulin regimens advised by doctors, and which regimen an individual follows may have implications for the diet. Fortunately, newer insulin regimens encourage patients to take more control over their own nutrition themselves.

In type 2 diabetes insulin is produced from the pancreas but is unable to act properly in the body. This is as a consequence of a metabolic state of the body called insulin resistance and, because the insulin is not having its desired effect, this leads to more and more insulin being released; high blood glucose levels are associated with high blood insulin levels. Type 2 diabetes is often, but not always, associated with being overweight and it usually occurs in people over 40 years old, with the main exceptions being younger people who are morbidly obese.

Regular meals and snacks are vital for optimum diabetes control, especially in respect of carbohydrate foods. Diabetics should aim to consume slow-released low glycaemic carbohydrate foods as the basis of each meal and snack. This ties in well with the goals of bodybuilders, who require regular nutrition for optimum energy levels.

The plan below has been compiled to suit a diabetic bodybuilder and is suitable for someone treated with insulin and who's looking to increase their strength and muscle size. If the insulin regimen is not so flexible, then the individual should review the meal and snack times, but the principles remain the same. If the insulin regimen involves super-fast acting varieties, then adjust the dose appropriately. If you do not control your own insulin regimen, then speak to your doctor or diabetes specialist nurse.

Often diabetics feel they cannot make good muscle and strength gains due to their condition, but there is absolutely no reason why a diabetic, whether insulin-treated or not, cannot make just as good gains as a non diabetic. Indeed, there is nothing radical in a diet for type 1 diabetics; the principles are simply based on the healthy eating guidelines which everyone should be following: simply incorporate concepts applicable to muscle growth, and the size and strength results will come.

Some foods are marketed especially for diabetics such as special chocolates, cakes, biscuits, etc, but these are actually not recommended. Eating a range of low fat, low sugar, high fibre 'ordinary' foods is far better. Many of these 'diabetic products' are no lower in fat or calories and are normally more expensive. Some contain the sweetener sorbitol which can cause wind, stomach upsets and diarrhoea. Normal 'low sugar'/'sugar-free' products, like low calorie and 'diet' soft drinks, are fine to consume.

Your goal is to gain muscle and strength without the concurrent addition of body fat. To do this, you need to ensure that you have a good understanding of your insulin regimen and that you are well controlled. The key to quality weight gain is to eat plenty of quality food spread over six or seven smaller meals / snacks. Include plenty of high protein food choices like lean meat, chicken, fish, eggs and milk; low glycaemic starchy carbs; fruit and vegetables (nuts and pulses are also good sources of protein). Also include some sources of the essential fatty acids, like oily fish or flaxseeds/linseeds.

Spread meals and snacks regularly through the day and try to adhere to a schedule like the one below. In respect of protein supplements, always look at the label. Whey protein can be a useful addition in your quest for making gains, but the quality of product varies hugely from brand to brand. Ensure you have a product which is over 75g protein per 100g, otherwise it will contain too many simple carbohydrates and this could adversely affect your blood sugar control. Weight gain supplement formulas should be avoided by diabetics as many contain too high levels of high glycaemic carbs. Remember supplements are there to supplement and are not meant to replace good wholesome food.

The following meal plan is an example plan of a healthy diet which is suitable for a diabetic on insulin to follow in bodybuilding. Use it as a base and to help you learn what are healthy nutritious foods to include. Vary food choices and drink plenty of water through the day. Check with your doctor or diabetes specialist nurse before following this plan, and if you do not control your own insulin regimen, levels may need adjusting in line with the increased food intake.

Wake 7.30 am
Breakfast
Large bowl porridge made with 250ml skimmed milk + tbsp ground linseeds (+ sweetener, if desired)
2 slices granary bread toasted
4 egg whites + 1 yolk (scrambled/boiled)
200ml orange juice
10.30am
Sandwich: 2 slices granary bread + tuna or sliced chicken breast or lean off-bone ham + salad
Banana
12.30pm
Large chicken breast or mackerel fillet
4-5 rye crispbread or oatcakes
Tbsp seeds (e.g. sunflower seeds)
Large varied salad
Low fat, no added sugar yoghurt
3.00pm
6 oatcakes
200g cottage cheese or quark
Large handful mixed nuts
Apple
45 mins pre-workout
Shake: 30g whey protein powder + 30g oats in water / skimmed milk

TRAIN – 45-60minutes
Immediately post workout
2 scoops whey protein
2 oatcakes
7.30pm
Lean red meat
70g (dry weight) basmati rice or 5-6 small boiled new potatoes or large dry roasted sweet potato
Large serving of vegetables
Low fat, no added sugar yoghurt
10.00pm
Large bowl unsweetened muesli + 250ml skimmed milk
Bedtime
1 scoop whey protein in 150ml skimmed milk

Weight training should be performed three or four times per week with intense sessions for around 45-60 minutes. It would also be an idea to incorporate 45 minutes low intensity steady cardiovascular training two or three times a week to help with heart health, to help keep body fat levels down and for general fitness.

Eat a variety of different meats, fish, alternatives, complex carbohydrates, fruit and vegetables every day, and drink plenty of water. Adapt the plan to suit your own needs, daily routine and insulin protocol and vary portions and food choices from day to day.

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Type 2 diabetes is a terrible disease that will eventually cause irreversible damage. Medication only treats the symptoms, not the cause.

A low carb, high fat ketogenic diet if done properly will almost certainly reverse and will definitely prevent any worsening of the condition.

While a ketogenic diet might not be optimal for bodybuilding, careful and controlled use of carbs intake pre and post workout would be a good balance.

We all have a choice and sometimes getting huge and forsaking our health isn't the best idea.

Good write CC for those who choose to get huge btw. Just wanted to offer an alternative view.