Nutrition, Physical Activity, and Weight Management
Nutrition
There is no single "diabetic diet." Medical nutrition therapy delivered by a registered dietitian lowers A1c by roughly 1% in type 2 diabetes and is built around individual preference, culture, and metabolic goals. Emphasize nonstarchy vegetables, whole fruits, legumes, whole grains, and adequate fiber (about 14 g per 1000 kcal), limit added sugars and refined grains, and keep sodium under 2300 mg/day. Carbohydrate counting or consistent carbohydrate intake supports glycemic control; the total amount of carbohydrate matters more than its source. Moderate alcohol is acceptable with hypoglycemia awareness. Weight loss of 5-15% improves glycemia, lipids, and blood pressure and can drive type 2 diabetes into remission.
Physical activity
Aim for at least 150 minutes per week of moderate-to-vigorous aerobic activity spread over at least 3 days, with no more than 2 consecutive days without activity, plus resistance training 2-3 times weekly and flexibility/balance work for older adults. Activity improves insulin sensitivity for hours and reduces A1c by about 0.3-0.7%.
Safety
For people on insulin or a secretagogue, check glucose before exercise; if it is below about 90-100 mg/dL, add 15-30 g carbohydrate first. Avoid vigorous activity when ketones are present. Teach the 15-15 rule for hypoglycemia: 15 g fast carbohydrate, recheck in 15 minutes, repeat as needed, then eat a meal or snack.
Traps
Questions may suggest a rigid "forbidden food" list, skipping meals to control glucose, or advising people to stop insulin before exercise. None are correct. Also distinguish carbohydrate grams from glycemic index; low glycemic index foods are an option, not a mandate.