Diabetes Diet

Diet and Diabetes

One of the most effective tools you have to keep your blood glucose in the target range is your diet. What you eat, how much, and when has a big impact on your glucose levels.

Basic Guidelines for Diet Control of Blood Glucose:

1. Eat three meals a day and snacks spaced in long spans.
2. Do not skip meals.
3. Eat your meals and planned snacks about the same time every day, just as you take your medication.
4. Eat a consistent amount of carbohydrates at each meal and snack, and distribute carbohydrates evenly throughout the day.
5. It is important to be mindful of what you eat, and the effect it has on your blood glucose by testing before and after meals.

Composition of Food

Here is a mini-lesson in Nutrition 101. Food is made of three components- fat, protein and carbohydrate. Each of these has different effects on blood glucose.

Fats, oily substances like oil, mayonnaise, cream, butter and avocado, do not raise blood glucose. In fact, fats slow stomach emptying and so decrease the rate at which blood glucose rises after a mixed meal.

Protein, such as meat, poultry, fish, cheese, eggs, tofu, etc. cause the blood sugar to rise slightly, and also slows this rise because of length of digestion time.

Carbohydrates are all the sweets, starches, fruits, vegetables and milk/yogurt foods.
These foods are responsible for an increase in blood glucose, which activates insulin release. Carefully controlling your intake of certain portions of carbohydrate will keep your blood glucose on target. Your meal plan will have a defined amount of carbohydrate for you to eat each day.

What about Fiber?
Dietary fiber is a source of carbohydrate. Fiber is found in plant-based food like fruit, vegetables, legumes, peas, brown rice, whole-grain breads and cereals. Fiber is not digested or absorbed like other starches, and so has less of an effect on increasing blood sugars. The recommendation is to eat 20-35 grams of fiber a day.

There are two kinds of fiber. Insoluble fiber is roughage–bran, skins and seeds, vegetables and cereal. This kind of fiber promotes regularity by adding bulk to bowel movements, slows digestion to aid in weight loss and blood glucose control, and helps prevent intestinal disorders and reduces the risk of intestinal cancers. Soluble fiber is the part of the plant material which absorbs water and dissolves in the digestive system. Oat bran, barley, legumes and fruit are high in soluble fiber. This fiber also works to moderate blood glucose, reduce cholesterol, triglycerides and lower LDL cholesterol.

Example of Fiber on the Label

Fiber is listed on a Nutrition Facts panel in a food label under the Total Carbohydrate. The number listed is part of the total carbohydrate. A good portion of the fiber in a food goes undigested, so the impact in calories and glucose rise is minimal. Rule of thumb—if there is more than 5 grams of fiber per serving in a food item, you can subtract half the fiber from the total carbohydrate to get a more accurate representation of the available carbohydrate in the food.

 

Carbs, Fats and Protein

What are Carbohydrates?

Carbohydrates include sugars (sucrose, fructose and lactose) and starch. The body breaks down most carbohydrates into glucose. Certain carbohydrates are metabolized the same way, for example, white bread, jellybeans or saltine crackers. Regardless of whether the carbohydrate is a sugar (jellybeans) or a starch (white bread), glucose will enter the blood stream at the same rate. Nutrients that do affect the rate at which glucose enters the blood include fiber, fat and protein. All three nutrients slow down carbohydrate digestions and delay/mute the increase in blood glucose.

Carbohydrates play an important role. Not only do they provide energy in the form of glucose, but they also help your body use proteins more efficiently and metabolize fats properly.

The Truth About Carbs

Some meal plans make you think that all carbohydrates are off limits. The truth is that whether you have diabetes or not, some carbohydrates for example, 100 percent whole wheat bread – are simply better choices than others – such as a French cruller at your local donut shop.

Refined Carbs vs. Complex Carbs

Sugary foods high in refined, or processed, carbohydrates (table sugar, syrup, jelly and jam, for instance), are often lumped with carbohydrates naturally found in fresh fruits, vegetables, and whole grains. Thus, many people think all carbs can lead to weight gain. It is these refined carbohydrates in which processing removes any nutrients and fiber, and, in turn give all carbs a bad name.

You will often hear refined carbohydrates (like those found in crackers, candy, and other sweets) referred to as “empty calories” because they provide calories without other important nutrients. They also provide little or no dietary fiber, and they usually contain more calories due to added fat.

Refined foods have a high glycemic index – they cause a sudden and sharp increase in blood sugar. If the body does not use this blood sugar, it will store it as fat. Whole grains, vegetables, and fruits have a lower glycemic index.

Naturally occurring carbohydrates (like those found in whole grains, vegetables, and fruits) provide vitamins, minerals, and fiber. Also, they usually contain fewer calories than foods with added sugar.
Bread, crackers and pasta made with whole wheat flour are not the same as those made with white flour. Those made with whole wheat flour contain more nutrition and fiber and sometimes fewer calories

Count Your Carbs

By now you know that carbohydrates affect your blood glucose levels. No, you do not have to avoid all sweets and starches, and yes, you can have fruit, carrots, and even sugar (in limited amounts)! You need to have a good understanding of what foods have carbohydrates, pay attention to the amount or portion size, select the healthiest carbohydrate foods that offer some fiber, and distribute your “carbs” evenly throughout the day.

What foods have carbohydrates?

• Grains: bread, crackers, rice, cereals, pretzels, pasta
• Starchy vegetables: potatoes, peas, corn, legumes
• Fruit and fruit juices
• Milk and yogurt
• Sweets and desserts
• Non-starchy vegetables: broccoli, tomatoes, spinach, carrots etc., contain small amounts of carbohydrates and tend to not affect blood glucose unless large quantities are consumed.

The fiber and water content render the small amount of carbohydrate in these foods less available to impact blood glucose

What are the best carbohydrate choices?

Various forms of carbohydrate affect your blood sugar differently. The same amount of carbohydrate from different foods will have a different effect on your blood sugar. A slice of white bread will raise blood sugar faster than one slice of whole grain bread. In this case, the difference is the fiber content. Foods that digest slowly will release carbohydrate in the form of glucose into the blood stream more slowly.

Your goal is to eat carbohydrates in such a way that the foods cause a slow, steady release of glucose into your blood stream, so your body can effectively process it. Listed are some factors to keep in mind:

• Carbohydrate foods with fiber will slow digestion and release of glucose; soluble fiber is particularly favored, such as oat bran, dried beans and peas, fruits, vegetables.
• The more refined the food, the faster the blood sugar rises. Even though fruit juice is healthy, because it is liquid and not solid like the fruit, the quicker the blood sugar will rise. Raw foods tend to be more slowly digested.
• Concentrated sweets such as simple sugar will quickly raise blood sugar.
• Eating a carbohydrate food with fat, such as butter on the potato, will slow blood sugar rise.
• Adding protein will also slow the digestion – Have peanut butter with some crackers. This is called a combination snack (combines protein, fat and carb)

How much carbohydrate should I have?

There is no official perfect diet for diabetes. The best diet for someone with diabetes keeps blood glucose levels as close to target as possible, with the healthiest food choices. There are recommendations from low carbohydrate diets to the Mediterranean diet to vegetarian diets – you can create a personalized diet plan with your dietitian or certified diabetes educator.

Traditionally, diets best suited for people with diabetes are designed to start with this calorie distribution:

Protein: 15-25 percent

Carbohydrate: 40-55 percent

Fat: 25-35 percent

Based on your personal health, lifestyle and diet goals, you dietitian can calculate and educate you on the best diet design for you. Your dietitian will take into account your cholesterol levels, A1C, blood glucose patterns, kidney function, blood pressure, work and sleep habits, meal and snack patterns, and food likes and dislikes to create your unique meal plan.

Sample Calorie Distributions

Based on different calorie levels, you may be allowed from 120 grams to 330 grams of carbohydrate.

Protein	15 %	15%	20 %	20 %	25 %
Carbohydrate	50 %	55%	50 %	45 %	40 %
Fat	35 %	30%	30 %	35 %	35%
Total	100 %	100%	100 %	100%	100%

The amount of carbohydrate for each person varies with their calorie goals, exercise levels, blood glucose levels and male/female. A healthy diabetic meal plan includes:

Women: 45-60 grams of carbohydrate per meal (3-4 carb choices/meal)

Men: 60-75 grams per meal (4 to 5 carb choices/meal)

For snacks: 15-30 grams of carbohydrate per snack (1-2 carb choices/snack)

Here is a typical example:

1,500 calories – daily total carbohydrates 170 grams (45%), 40 grams (3 meals), and 15 grams (3 snacks)

What is Glycemic Load?

Glycemic Index (GI) and Glycemic Load (GL) are terms you might hear about carbohydrate foods. “Glycemic” means “sugar in the blood.” The GI and GL rank carbohydrates on a scale based on their immediate effect on the blood sugar after eating. This is called the glycemic response. Foods with a high GI/GL are rapidly digested and absorbed, raising the blood sugar quickly and high. A slower more gradual rise is preferred.

Sugar, sweets and most refined foods have high glycemic loads. Some surprises, such as cereals and potatoes, also have relatively higher GI-GL. However, when you eat these foods with milk containing protein or a potato with butter and steak and broccoli, the GI-GL changes. Also, the cooking method and food particle size can alter the values. So, GI-GL is a source of controversy because this method is not predictably consistent. It can shed light on why your blood glucose goes so high at times.

Understanding the Food Groups, or Exchange Lists

The Academy of Nutrition and Dietetics, in collaboration with other health associations, created The Exchange System. This system was designed to make meal planning easier for people with diabetes and offer health educators a common and consistent way to instruct them. Foods are categorized together into six groups that are commonly alike – like all fruits – and portions into amounts that are the same composition. For example, all the servings of fruit are 60 calories and 15 grams of carbohydrate. So, each fruit can be “exchanged” for another and the amount of calories and carbohydrate consumed remains the same.

Using Carbohydrate “Choices” to Carb Count

Carbohydrate counting is a useful tool to plan your meals, especially to balance with your diabetes medication and insulin. A carbohydrate “choice” is a portion of food that has 15 grams of carbohydrate.

The fruit group, the starch group, and the milk group all have 15 grams of carbohydrate per portion as described. So, if you are planning on having 45 grams of carbs at lunch, you could have one serving of milk, one serving of fruit and one serving of starch. Another 45 gram example for lunch – two starches (30 grams) and one fruit (15 grams).

1 carbohydrate choice=15 grams of carbohydrate

Samples of one carb choice or 15 grams of carbohydrates:

• ½ cup oatmeal
• 1 slice of bread
• ½ English muffin
• 1 6-inch tortilla
• 4-6 crackers
• ½ cup peas
• ½ cup potatoes
• 1/3 cup rice or pasta
• 1 8oz. glass skim milk
• 2 small cookies
• 1 medium apple
• ¾ cup blueberries
• 1/2 grapefruit

Using Carb Choice to Meal Plan – How This Works

Sample Meal Plan: 1,800 calories 206 grams Carb, 60 grams Fat, 112 grams Protein (45-30-25)

3 meals= 60 grams carbs; one snack 15 grams carbs

1,800 calorie food Exchange Plan

3 Milk, 4 Veg, 2 Fruit, 8 Starches, 8 Meat, 4 Fat – 13 carb choices

Distribute the 13 carb choices evenly throughout the day. A choice can be milk, a starch or a fruit. So, if you happen to not have enough fruit (15 grams) in a day, you can switch a fruit choice for a starch (15 grams) choice (hopefully it has fiber!).

Time	Meal	Carb Goal	Sample Menu
Breakfast	60 grams (4 choices)	4 Carbohydrate Group 2 Starch 1 Fruit 1 Dairy 1 Protein 1 Fats	2 slices toast ¾ cup blueberries Low sugar low fat yogurt 1 scrambled egg 1 tsp margarine
Lunch	60 grams (4 choices)	4 Carbohydrate Group 2 Starch 1 Fruit 1 Dairy 1 Non-starchy vegetable 3oz. Protein 1 Fats	2 slices bread ½ cup fruit cocktail 8 oz. milk Raw carrots ¾ cup tuna 1 tsp. mayonnaise
Dinner	60 grams (4 choices)	4 Carbohydrate Group 3+1 Starch Fruit Dairy 2 Non-starchy vegetable 4 oz. Protein 2 Fats	1 cup brown rice ½ cup peas Salad with raw veggies 4 oz. grilled chicken 1 tsp. marg, 1 tbsp. salad dressing
Snack	15 grams (1 choice)	1 Carbohydrate Group 1 Starch Fruit Dairy Non-starchy vegetable Protein Fats	1 oz. pretzels

Using the Food Label to Carb Count

Suppose you are eating a frozen dinner meal, or a combination meal of fish, pasta and vegetables. You can use the food label to find the carbohydrate content. Find the total carbohydrates (in one serving or the entire meal – see sample nutrition label below). Fiber and sugars and sugar alcohols are sub-listed there also. If there is more than 5 grams of fiber, subtract half the fiber from the total carbohydrates. This is your amount of carb grams. Divide this number by 15 grams to find the number of carb choices you are using for this food item.

Carbohydrates in Fruits

The carbohydrate in fruit, fructose and sucrose, cause your blood glucose to rise. Fruits offer the body vitamins, minerals, antioxidants, and fiber, and therefore should not be excluded from the diet of a person with diabetes. At roughly 15 grams of carbohydrate a serving, two-to-three servings a day works well in the diabetic diet. Fruit juices lack the fiber that slows the absorption of fructose in the body, and thus is to be used with caution.

What are Fats?

Fat is grouped into two categories, saturated fats and unsaturated fats. Fat provides insulation for nerve cells, imparts warmth, balances hormones, keeps skin and arteries supple, lubricates joints and is part of every cell.

Your body can make the less-desirable saturated fats but not the important unsaturated fats. You must eat unsaturated fats every day or else your body cannot function. Your body needs essential fats to:

• Maintain healthy cell walls
• Stabilize cholesterol and metabolism
• Regulate important body processes such as blood pressure and clotting
• Carry fat-soluble vitamins A, E, D, and K

Saturated vs. Unsaturated Fat

As with carbohydrates, fats come with a “good news/bad news” story. Here is the scoop on the four different types of fats:

Saturated fats (less desirable) raise LDL-C – low density lipoprotein cholesterol or “bad” cholesterol – in the blood. Saturated fats likely cause a host of problems, from heart trouble to weight gain. Keep these “fat rules of thumb” in mind to help you make healthier choices.

• Generally, the more unsaturated a fat is, the more likely it is to be a liquid at room temperature. Conversely, saturated fats remain solid at room temperature
• Foods from animal sources contain more saturated fats, and foods from vegetable sources contain more unsaturated fats.

Transaturated (Trans fats) (less desirable) also raise LDL-C. You’ll find Trans fats in vegetable shortenings, some margarines, crackers, cookies and other foods made with or fried in partially hydrogenated fats.
However, you can now look for Trans fats on food labels.

Monounsaturated fats (more desirable) can positively affect cholesterol ratios.

• Avocados and olive oil are good sources of monounsaturated fats.

Polyunsaturated fats (more desirable) are necessary for all bodily functions.

• Most nuts, vegetable oils and fish oils are good sources of polyunsaturated fats.

As the most concentrated source of calories in the foods we eat, fats enhance the taste of food and make you feel full. However, because each gram of fat yields 9 calories, the same amount of fat supplies almost twice as many calories as proteins or carbohydrates.

What is Protein?

Protein plays an all-important role in your body. It accounts for one-fifth of your total body weight, including a hefty portion of your muscles, bones, and skin.

What makes protein so important? Protein:

• Builds teeth, muscles, bones, skin and blood
• Helps with growth and helps repair your body
• Regulates body processes
• Carries nutrients and oxygen throughout the body
• Fights disease by increasing antibodies and strengthening the immune system
• Provides a source of energy

All protein contains amino acids, which include nine essential amino acids and 13 non-essential ones. Your body can manufacture the non-essential amino acids from the food you eat, but not the essential ones. You must eat proteins that supply these essential amino acids often or your body cannot function properly.

Not All Protein Is Created Equal

Two kinds of protein exist. Complete proteins contain all essential amino acids, while incomplete proteins do not. In general, complete proteins include animal proteins such as meat, eggs, cheese, yogurt, and milk.
Incomplete proteins include vegetable proteins such as vegetables, beans (legumes), grains, fruits, and nuts.

However, you can combine two incomplete proteins so that they complement each other and provide the equivalent of a complete protein. For instance, you could eat navy bean soup and a couple of sesame crackers, which would combine legumes and seeds. Or, by combining an incomplete protein (macaroni) with a complete protein (fat-free or low-fat cheddar cheese), you can meet the need for essential amino acids while lowering your intake of animal fat and cholesterol.

COMPLETE PROTEINS

Meat, Poultry, Fish, Eggs, Cheese, Milk

INCOMPLETE PROTEINS

Vegetables, Grains, Legumes

Or

Combine two incomplete proteins to make a complete protein.

Incomplete + Incomplete = Complete

Example:
Vegetables + Grains = Complete Protein

 

Caffeine, Coffee, Tea and Diabetes

You may have been puzzled by a slight rise in blood sugar even though you just had a cup of black coffee. Researchers are beginning to uncover some insight into the relationship between our favorite drinks and diabetes.

Coffee has been associated with a reduced risk of developing diabetes. Caffeinated and decaffeinated coffee may have components other than caffeine that reduce blood glucose concentrations. But take the caffeine out of the coffee, and the caffeine will increase blood sugar up to 8 percent according to a recent study. This one study was conducted on 10 people with type 2 diabetes, using caffeine capsules. The dose was an equivalent of drinking 4 cups of coffee. How caffeine might raise blood sugar is unclear, perhaps a surge of adrenaline or cortisol elevates blood sugar, or caffeine alters the function of insulin. This small study opens up more questions, and hopefully more conclusive research will follow.

A study reported in Diabetes Care, March 2009, examined the effect of decaffeinated coffee on blood sugar levels in 15 overweight men (non-diabetics). The components in decaffeinated coffee, chlorogenic acid and trigonelline (also present in caffeinate coffee) reduced the glucose and insulin response for 15 minutes after ingestion of glucose in a standard OGTT, and then no longer effects.

So, if you are a coffee drinker and frustrated by less than desired blood sugar control, consider switching to decaffeinated coffee. This small study was done with larger amounts of caffeine, so lesser intake of coffee may have minimal effects. More is yet to be known.

Tea is a more widely used beverage than coffee, and has been used for medicinal purposes for centuries. Tea contains polyphenols – chemicals that have anti-cancer, anti-inflammatory and antioxidant effects. Tea also contains caffeine, and in a few studies, using oolong tea and green tea, have been shown to decrease blood glucose levels, improve A1C, total cholesterol and LDL cholesterol levels. Drinking green tea may lower the risk of developing type 2 diabetes.

Teas have some side effects and interfere with nutrients and drug action if consumed in large or excessive quantities. Tea may interfere with the absorption of iron from food. Tea may also interfere with certain labs tests, thallium tests, uric acid tests, and vanillylmandelic acid concentrations. Tea may also worsen glaucoma due to increase eye pressure. Excessive amounts may cause insomnia, anxiety and restlessness, and increased bleeding if used with blood thinners. Again, excessive and continuous drinking of tea may have these effects, but the intake of a few cups of tea or glasses of iced tea a day are innocuous.

Dietary Supplements for People with Diabetes

Dietary supplements are not food, and not prescribed medicine, but supplemental to your food and medicine. If you are on medicines, have a health condition, or just want to potentially improve your health, you may be currently using botanical, vitamins, minerals, and herbs.

Dietary supplements are chosen for their positive benefits, but they may also have side effects and/or interact with medicines you are taking. Your doctor and healthcare providers need to know about the entire array of over–the- counter products you take to be aware of any problems that might occur.

The U.S. Food and Drug Administration (FDA) oversee dietary supplements under a different set of regulations than over-the-counter drugs and prescriptions. These products are not approved on the basis of safety or effectiveness. The burden of safety is on the manufacturer. Contamination or lower amounts of the effective ingredients could occur, without the FDA oversight. There is a voluntary auditing agency, the U.S. Pharmacopeia Dietary Supplement Verification Program (USP), which verifies the quality, purity and potency of supplements. Products with the USP symbol have passed this test.

Research on the effectiveness of all supplements is an on-going process. Organizations such as the American Diabetes Association monitor the research carefully before making recommendations. If the proof of value is weak, or there is potential harm, recommendations are withheld. Studies need to be long-term, at multiple sites, placebo-controlled, and reproduced by other scientists to be considered evidence-based. However, the products’ marketing campaign may be making claims that are not yet tested for validity. Be careful you are not spending money on ineffective products.

You can review this reliable website to get unbiased discussions on dietary supplements:

• National Institutes of Health Office of Dietary Supplements

The following is a description of some supplements related to diabetes:

Cinnamon: Cinnamon has very mild blood sugar lowering ability, but not truly effective in treating high blood sugar. Cinnamon may have the potential of reducing post meal blood sugars. Further research is needed to confirm a positive correlation between blood glucose and cinnamon.

Alpha-Lipoic Acid (ALA): Known a lipoic acid, it is an antioxidant that protects against cell damage. ALA is being evaluated for perhaps reducing nerve damage in the feet, legs or hands. It may cause low blood sugar and nausea when taken. Also found in dark green vegetables such as broccoli and spinach and also liver and potatoes. Potential to improve insulin sensitivity and slow kidney damage.

Omega-3 Fatty Acids: Fish oil significantly reduces triglycerides in all people. It does not reduce cholesterol levels or blood sugar, but is ant-inflammatory and may protect against development of heart disease. In large doses, may interact with medications, and also act as a blood thinner.

Polyphenols-Anti-Oxidants: These are found in tea and dark chocolate may protect against cardiovascular disease. Green tea, with the ECGC, may cause anxiety and insomnia if drank in large quantities. The vitamin K content of green tea could interfere with anti-coagulant therapy.

Chromium: Chromium is an essential mineral present in small amounts in many foods – a deficiency state is rare. Chromium may improve insulin function. In addition, chromium supplementation has been researched for its effect on blood sugar in people with diabetes, but the studies have given mixed results or are poorly designed. Chromium is safe in low doses, but may cause a drop in blood sugar or kidney problems if overused.

Ginseng: This supplement is being studied, and may help to lower blood sugar in people with diabetes.

Magnesium: Eating a diet high in magnesium may lower the risk of developing type 2 diabetes. There is a strong association between low magnesium and insulin resistance. Diabetic patients with low magnesium are supplemented with 200-600 mg. magnesium a day, but higher levels can cause diarrhea.

The aforementioned National Center for Complementary and Alternative Medicine states that there is not enough scientific evidence to prove that dietary supplements have a significant benefit for type 2 diabetes.

Dining Out Tips for People with Diabetes

Living with diabetes does not mean you cannot enjoy a meal out. Restaurants strive to be more health-conscious today, offering healthy or lite menu selections. Many restaurants post their menus online so you can check them out beforehand. Some restaurants even post nutrition information.

At the restaurant, you can ask the staff for nutrition information. At some restaurants, you might even ask chefs to prepare something special. Your dietitian or health care provider can help you plan ahead, especially regarding how to adjust your insulin dose if necessary.

Dining Out Tips:

• The National Diabetes Education Program and the American Diabetes Association offer these tips:
  • If possible, pick a restaurant that offers a variety of choices.
  • At fast food restaurants, choose one of the healthier selections. Try grilled chicken (usually skinless white meat), and choose a salad instead of French fries.
  • If you are not sure about the ingredients in a dish, ask.
  • Eat the same amount you eat at home. Eat slowly, and do not feel you must clean your plate just because you paid for it. If you get a large serving:
• Take home a doggy bag. (Divide your meal in half before eating.)
• Ask if you can order a smaller portion for a lesser charge.
• Split an entree with a friend or family member.
• Order fish or meat broiled, baked, poached, or grilled.
• Request accompaniments (such as sour cream, butter, gravies, sauces and salad dressing) on the side.
• Ask for low-calorie condiments and selections that might not appear on the menu.
• If you are watching your salt intake, ask that the chef adds no salt, or very little, to your selection.
• Send breaded selections back if you ordered items without breading, or remove the coating.
• Consider substitutions, such as low-fat cottage cheese or a double portion of vegetables, instead of something less healthy.
• Mix things up on the menu. For instance, order fruit cup or melon from the breakfast section for dessert.
• Many restaurant chains now offer nutrition information about their menu items. Check the menu listing on the restaurants’ website and find the calorie and carbohydrate content of the menu items you plan to order. You will be more likely to stick to your carbohydrate goal by pre-planning your selections.

Everything You Need to Know About Diabetes and Portion Control

Type 2 Diabetes and Food Portion Distortion

The expanded size of our food portions is directly related to the expanded waistlines of Americans. We want more food for our money, such as all you can eat buffets, even if we leave feeling horribly overstuffed. We get more for our money when we buy the larger size packages, and when we buy in quantity at the big box stores. Our restaurants serve heaping plates of food, and we finish it all. The average fast food burger was 330 calories, and now is 690 calories, and up to 1,420 calories for monster burgers.

In our homes, our glasses hold 20 oz. of liquid, not the old standard of 8 oz. Four ounce juice glasses are rare. Plates and bowls are bigger, and of course we fill them to the brim.

The growth in diabetes diagnoses seems to have kept pace with the expansion of our portions. Might there be a connection? Certainly larger portions mean extra calories and carbohydrates, which leads to weight gain. Extra weight is a precursor to type 2 diabetes, and two of the primary treatments of type 2 diabetes is weight loss and carbohydrate control. Carbohydrate control can only be accomplished with portion management.

Portions and Diabetes

Portions sizes are part of the problem, and most of the cure. The increased calorie intake of the copious portions leads to obesity, which predisposes us to type 2 diabetes.

Part of the treatment for diabetes is weight loss, and carbohydrate control – and both improve blood glucose levels. In order to count and manage carbohydrate intake, measuring portions is essential.

Re-teaching your eyes and stomach about reasonable portions starts with measuring. Your meal plan defines a certain amount of food. Are you able to guess what a cup of cereal looks like? Get out the measuring cups, spoons and scale, and check the serving sizes of the food you eat. You will learn the amounts you should eat, according to your meal plan. As you improve with portion control, you need only measure certain foods that are less healthy or you are more likely to overeat.

Your meal plan is planned to balance the amount of carbohydrate to your blood sugar. Twenty years ago, bagels were three inches in diameter, about 140 calories and 30 grams carbohydrate. Today, the average bagel is six inches in diameter and 350 calories, and almost 60 grams carbohydrate. The larger bagel will cause a much greater rise in blood glucose – that’s if you’re only eating one bagel.

Carbohydrate Counting

Your treatment plan may define the amount of carbohydrate you should consume at each meal and snack. This can only be effective if you are accurate about the portions of the foods you consume with carbohydrate. The diet exchange system is designed to define portions in 15 gram units for fruit, dairy and starches, so planning and implementing carb counting is easy. A Registered Dietitian can help you master this skill.

Portion Control Pointers

1. Develop an eye for accurate portions by measuring key foods at home – a teaspoon of oil, a table spoon of salad dressing, ½ cup of corn, 1/3 cup of rice (and then a cup of rice), a 3 oz. serving of chicken, 8 oz. of milk in your glass, etc. By using your home plate and glasses, you will eventually be able to estimate portions accurately. This training will come in handy when guessing portions in restaurants.
2. Use this list of known objects for comparisons when out:
   1. One deck of cards equals 3 oz. of meat, poultry or fish. Four dice, one lipstick, or one domino equals 1 oz. of cheese or meat
   2. One die equals 1 tsp. of margarine, oil
   3. Tip of thumb equals 1 tbsp. of mayo, salad dressing
   4. Rounded handful equals 1/2 cup potato, corn, 1 oz. of pretzels
   5. Baseball or fist of a woman equals 1 cup of ice cream, cereal
   6. One golf ball equals 1 oz. meatball, egg
3. Use smaller plates and bowls to serve yourself – you will naturally eat less.
4. Avoid eating family style, you will not measure at the table and you can be tempted to go back for seconds if the food is right in front of you.
5. Make your own single serving packs, rather than pay for the individual portions. Count out a carbohydrate serving of crackers and put in a baggie. Do this for the whole box and put the bags back in the box. You will have the appropriate snack serving when you are ready to eat.
6. Try the plate diet. Divide your plate in half; fill one half with low carb/calorie vegetables. Divide the other half into half, with a serving of starch in one section and a serving of protein in the other.
7. When you eat out, avoid all-you-can-eat buffets.
8. Split, share and take home half the meal if the restaurant portions are large. Glimpse at the plates on diners tables to see how generous the serving sizes are before you order.
9. Check the menu for a “light and healthy” section. Some restaurants offer half portions of entrees.
10. Mind the classic eating behavior rules: Eat slowly, sitting at a table (not on the couch in front of the TV), chew your food well, stop eating when your hunger is satisfied, and do not eat to very full.

How Do You Measure Up?

With diabetes, you need to develop a skill for estimating portions. Try this checklist to see if you are measuring up:

• Do you own measuring cups?
• Do you have measuring spoons?
• Do you own a food scale?
• Have you measured the amount of liquid your favorite drinking glass, juice glass, and coffee cup hold?
• How much cereal does your cereal bowl hold?
• How big is the plate you use for dinner?
• Have you measured 1 cup of cooked pasta and put it on your plate?
• Is your tortilla 6 inches across?
• About how many green beans in ½ cup?
• How many blueberries in ¾ cup?
• How many almonds in one ounce?
• Have you measured the amount of salad dressing you use on your salad?
• How many ounces is the protein portion on your plate?
• How many ounces of protein do you put in a sandwich?
• How much fiber is in a slice of the bread you buy?
• How many level tablespoons of peanut butter do you put on your bread?

Do you feel like you are in a food lab? Your kitchen is your preparation for success with diabetes in the outside world. Some people with diabetes have been comfortable with cooking for years, so these questions are not too challenging. However, if you have never measured your cereal, or salad dressing, spend some time getting familiar with common portions. You cannot accurately control carbohydrates, and calories, without a basic working knowledge of portions.

Portions to Carbs

So, now you can give an educated guess as to the amount of spaghetti in the restaurant portion on your plate. (Actually, even the best of us have trouble with a mound of pasta on an oversized restaurant plate!) So, how many carbohydrates in that plate of pasta? If you are on insulin, how much medicine do you need to cover that food? Are there any other carbohydrates lurking in that meal? (Bread, croutons, drinks, deserts?) Do you see why you need to pay attention?

Good Old Exchange List

Yes, it comes back to that lesson on the Diabetic Exchange Lists that you promptly forgot. Let’s make it simple, and therefore workable.

The three main food groups that contain mostly carbohydrates are starches, fruit and milk. Each serving, as defined on “the lists” is about 15 grams of carbohydrate. If you eat 2 servings, you have 30 grams of carbohydrates, 3 servings, 45 grams, etc.

All you have to memorize is the serving size on “the list,” not on the box label.

Here is a simplified start – Servings that equal 15 grams of carbs (or one carb choice):

Food Group	One serving
Milk Group	8 oz. milk
(90 calories, no-fat)	1 cup plain yogurt
Fruit	1 whole medium fresh fruit
(60 calories, no added sugar)	1/2 banana
½ cup no sugar added canned fruit
1 cup berries, melons
2 Tbsp dried fruit
Starch	1 slice bread
(80 calories, no added fat or sugar)	¾ c dried cereal
½ cup cooked cereal

Your meal plan, as developed for you by your dietitian, will define how many servings of milk, fruit and starch you should have at each meal and snack, and the total for the day. This can be different for each person with diabetes, but generally, we recommend 45-60 grams carbs per meal, and 15-30 grams carbs per snack.

Take a Guess!

Here is a cup of white rice, no added fat. It has about 220 calories. How many grams of carbohydrates?

45 grams! If 1/3 cup has 15 grams, 3 times that is 45 grams.

In comparison, the low calorie vegetables not listed in the starch group, such as broccoli, zucchini, green beans, tomatoes, have about 5 grams of carbohydrate for ½ cup cooked or 1 cup raw. We recommend lots of vegetables on your plate, to take up space on your plate and in your tummy, in addition to all the health benefits. And, you do not get a concentrated source of carbohydrates.

Here is 10 cups of cooked cauliflower, 220 calories—guess how many carbohydrates?

About 45 grams! Same amount of carbs as one cup of rice.

10 Portion Control Tips For People with Diabetes:

1. Keep a set of measuring cups on your counter to quickly measure your starches such as rice, potato, cereal , corn, etc. Starches are dense in carbohydrates, so it is easy to underestimate the amount you are about to eat.
2. Measure the 8 oz. mark on your glasses and cups, and take note. Also measure 4 oz. on the glass you drink juice from.
3. Use a tablespoon to put salad dressing on your individual salad, peanut butter on your sandwich, and mayo (3 fat servings!) in your tuna. Although these fats do not add carbohydrate to your intake, they do add twice the calories!
4. Consider getting a food scale, to weigh your protein. Or, for a while, purchase your meat, chicken and fish in pre-portioned servings or you can learn what 3, 4, or 5 oz. looks like. Protein will not add carbohydrates to your intake, but calories do count.
5. Use the plate method—fill half your plate with low carb vegetables, so there is less room to oversize your starch and meat.
6. Use a smaller plate for your dinner—or even buy plates with portioned sections to guide you.
7. When you buy snacks, measure out 15 grams worth of crackers in a snack size plastic bag (do the whole box) and put them all back in. When you grab a snack, you know how many carbs you are getting. you can purchase 100 calorie snack foods (about 15-20 grams carbs) already measured and packaged.
8. Consider buying your ice cream confection in Dixie cups or popsicles so you have a measured portion rather than hearty scoops from the carton into a dish.
9. Keep serving dishes off the table. It is too easy to scoop more food on your plate. More salad or low calorie vegetables could sit on the table.
10. If all else fails, only have 1 cup, a baseball size, of the starch on your plate. Leave the rest, or even over-pepper it so you do not nibble it. A cup of starch is about 45 grams of carbs at the most, so this will suffice.

What is the difference between a portion and a serving?

A “portion” is how much food you choose to eat at one time, whether on your plate, in a restaurant or from a package. A “serving” size is a defined amount of food with nutrition information, such as a serving size on a Nutrition Fact Label. Take note, the serving sizes of food on the food label are not the same as the serving sizes defining carbohydrates in the exchange lists.

You can still use this information to watch your carbohydrate intake. So, if you decide to eat Cheerios, you can see from the label below that if you have 1 cup, you will eat 22 grams of carbohydrates (and 120 calories). Oh yes, if you add ½ cup of skim milk, add 6 more grams of carbs. The trick is to measure and know how much you have—and eat that much!

Healthy Supermarket Shopping Guide for People with Diabetes

Choices, decisions – confusion? Eating healthy at home starts with a plan – how to navigate the supermarket and buy the best healthy food you can afford. Use this guide on your next shopping trip.

Vegetables and Fruit

Choose a variety of fruits and vegetables – they are more nutrient-rich, higher in fiber, and lower in calories than most prepared snack foods. Fresh, in season, is a great choice, but frozen versions are always handy.

Vegetables

Canned vegetables have more sodium. Prepare vegetables raw, lightly steamed, roasted or grilled. Avoid adding lots of added butter, salt, cheese or sauce. Except for the starchy vegetables, most have less calories and carbohydrates than fruit:

• Broccoli (and other cruciferous vegetables-cauliflower, Brussels sprouts, cabbage)
• Onions
• Carrots
• Spinach
• Celery
• Sweet potatoes
• Potatoes (baked, not French fries or tater tots!)
• Asparagus
• Mushrooms
• Peppers
• Tomatoes
• Cucumbers
• Green beans
• Greens
• Beets
• Garlic
• Fresh lettuce mixes – dark greens

Fruit

Fruits contains carbohydrates, fiber, vitamins, minerals, and anti-oxidants. The portions of fruit are important to a diabetic meal plan. Fresh fruit is best, but frozen or canned without sugar added is convenient and economical. If using fruit juices, be sure they are 100% juice, not fruit drinks, punches or sweetened soda. A 4 oz. serving of juice is equal to a medium piece of fruit, or 15 grams of carbohydrates:

• Oranges, all citrus
• Banana
• Grapes
• Berries
• Apples
• Peaches
• Pineapple
• Melons
• Dried fruit – raisins, apricots (2 tbsp. is one serving)

Grains and Starches

These foods are generally considered “complex carbohydrates,” which are turned into glucose to give your body energy. Because of the complex chemical structure, as well as the benefit of fiber, these non-sweet carbohydrates are absorbed more slowly and are an important nutritional contribution to the diabetic diet:

• Whole grain flours
• Whole grain breads (>3 grams of fiber per slice)
• Brown rice (more fiber than white rice)
• Whole grain flour tortillas (whole wheat low fat wraps)
• Corn tortillas
• Whole grain couscous, nice change from rice
• Whole wheat pasta (Dreamfields or Barilla Plus)
• Cereals with whole grains and very little added sugar (< 3 grams of fat, < 6 grams of sugar, > 5 grams of fiber per serving)
• Whole grain first ingredient
• High fiber, low sugar cereal bars
• Oatmeal, preferably 1-minute cooking, not instant (high in sodium)

Legumes

Legumes are very high in fiber, protein and carbohydrate and low in fat. Dried beans need to be soaked before cooking, and canned need to be rinsed of sodium before use. Blood glucose will rise slowly when consuming legumes.

• Black beans
• Garbanzo or chick peas
• Cananelli, navy, pinto beans
• Lima beans
• Lentils
• Soy beans and edamame

Dairy

Dairy foods are the best source of calcium and Vitamin D. Select the lowest fat versions to reduce intake of saturated fat:

• Low fat or fat free yogurt without added sugar
• Nonfat sour cream
• Low sugar and low fat frozen desserts
• Low fat cottage cheese, ricotta cheese
• Low fat cheeses – processed cheese will have more sodium
• Nonfat half and half

Meat, Meat Substitute and other Protein

The primary contribution of these foods is protein essential for growth and repair of our bodies, and insures a healthy immune system. Protein food slows digestion of meals and has a moderate and delayed effect on blood glucose. Select lean cuts of meat, such as top sirloin, loin, or less than 10 grams of fat per 3 oz., serving. Non-animal sources will provide less fat. Cooking methods should not include the skin on the poultry, or be breaded and fried, or added gravy or sauces on all meats. Bake, broil, grill, or steam meats, fish and poultry. Sauté or cook tofu for soups.

Find turkey sausage and bacon, instead of pork, generally lower in fat. Or these:

• Tuna, fresh or canned, or bags (high in omega -3 fatty acids)
• Salmon
• White fish such as flounder, tilapia, cod
• Crab, shrimp, scallops
• Turkey breast or chicken, no skin
• Ground turkey breast or chicken, white meat only
• Pork tenderloin
• Lean ham
• Venison
• Veal chop, loin
• Beef top round, flank steak, London broil
• Low sodium lean deli meats and hot dogs (Boars Head, Healthy Choice)
• Eggs ( egg whites as egg substitutes have no fat or cholesterol)
• Tofu
• Soy-based vegetable protein products (veggies burgers, etc. – sodium could be high)

Fats and Oils

This group of food is over twice the calories of other foods. The plant-based oils and fats are heart healthy, but use all sparingly when watching calories. Avoid “partially hydrogenated vegetable oils” as an ingredient:

• Olive oil: High in monounsaturated, use in salad dressings and cooking
• Canola oil: Heart heat monounsaturated, mild in taste and good for cooking and baking
• Soft-tub margarines: Select “no trans fats”, and may have added sterols or omega-3 to make more heart healthy
• Nuts: almonds, peanuts, walnuts, pecans, sunflower seeds, cashews – heart healthy benefits
• Avocado
• Mayonnaise
• Salad dressings
• Cream cheese (select low fat)
• Butter, lard and bacon: high in harmful saturated fats

Miscellaneous Choices

• Tomato sauce: No sugar added, contains cancer-fighting lycopene
• Vinegar: It has little or no calories (rice vinegar is sugared), and may have properties to control blood sugar
• Broth: Low sodium. Chicken, beef or vegetable, use to start soups or in place of water to flavor rice
• Soy and teriyaki sauce: Low sodium. Adds flavor to dishes without the calories
• Salsa: A great way to easily add vegetables to a snack (low fat tortilla chips) or use as a condiment for foods
• Hummus: Healthy, high fiber, protein, heart healthy snack – use with veggies or whole wheat pita crackers
• Flaxseed/ground: Adds fiber and is heart healthy fat, anti-inflammatory
• Mustard, hot sauce, ketchup: good flavor, little calories
• Baked snacks: Baked potato chips, corn chips, rice cakes instead of fried chips
• Cinnamon: May help control blood sugar, add to cereal, applesauce, tea and coffee
• Fresh herbs and spices: Add wonderful flavor without calories, use less salt and fat to make dishes tasty
• Unsweetened beverages: Check label for calories on flavored waters, tea and power drinks. Could be detrimental on blood glucose if sweetened.
• Sports drinks: These have calories and added sodium and potassium. Useful if very active, not meant as a meal beverage.

How to Be a Mindful Eater

Are you always in a hurry when it comes to food? Do you eat too fast – trouble making your meal last? Do you multi-task while you eat – driving, reading or computer surfing? Is your dinner consumed on the couch, while catching your favorite TV show? Do you think you are really tasting and enjoying your food?

Research by Brian Wasink Ph.D., at Cornell University, author of “Mindless Eating,” indicates that we consume up to 500 calories a day, mindlessly. We would not need to diet if we re-engineered our approach to eating, and saved those calories by learning to enjoy every bite of food, and therefore be satisfied with less.

The Center for Mindful Eating offers the concept that mindfulness is deliberately paying attention to food, non-judgmentally. With practice, you can learn to be aware of your physical hunger, differentiate it from emotional or stress hunger, and eat until you are satisfied having allowed your senses to enjoy the eating experience.

How to be a “Mindful Eater”

1. Slow down, you eat too fast – you’ve got to make the mealtime last! Eating quickly does not let you really taste each bite, nor does it give your digestive system time to process the food and make you feel satisfied. So, you go back for seconds, or learn that you need larger portions to start with. Here are some ideas to slow down your speed of eating:
   1. Eat at a table for meals and snacks. Make eating an enjoyable special event. Put down a tablemat, eat off a plate, and eat with others. Make the plate attractive – good looking and enjoyable food.
   2. Sit down when you eat. Do you walk around the kitchen nibbling while you fix a meal? Do you eat lying down? (Yes, people do this!)
   3. When eating, only eat. Watching television, driving, and working only distract you from the chance to really enjoy the food and feel satisfied.
   4. Choose foods that you eat with utensils. Hand-held foods, like sandwiches and pizza, go down fast.
   5. Put the fork, or the food, down between each bite. Use “slow down foods” – take a sip of water between bites, add a side salad to dinner, and add sliced fruit or carrots when eating a sandwich. Put the sandwich down to grab a carrot.
   6. Cut the food into smaller pieces – makes your meal seem like more.
   7. Watch the clock. Have you ever timed how fast you eat a meal? Check the clock and work to extend the time to 20 minutes.
   8. Here is a fun trick – eat with your non-dominant hand. The act of eating feels different and you just aren’t as adept at eating fast.
   9. Slow your eating speed to match the others at the table (if you can find someone else slower).
   10. Be aware of how you look while you eat.
   11. If you are served a heaping amount of food, divide each item on the plate in half and slowly enjoy the first half. You might find this was enough, and the rest can be saved for a later meal.
2. Be in touch with your hunger. Do you eat “by the clock,” or automatically finish all the food on your plate? Does the food in television commercials trigger a trip to the kitchen? Does a big bowl of ice cream soothe you after a stressful day? Are you an unconscious eater? By slowing down, you can sense your hunger being satisfied, and stop eating before you feel too full. But what about before you eat? When you think about eating, or are triggered to grab a bite, stop to check in with your body – “Am I really hungry?” If you are not very hungry (you just ate a meal an hour ago), why do you want food now?

Develop an “Intuitive Eating” style.

We eat for four reasons: hunger (stomach), appetite or pleasure (mouth), habits, and emotions. If you could confine eating for only hunger, and not because you are bored, or you saw that luscious burger commercial on television, or you like the candy the receptionist keeps on their desk, perhaps your food intake will be closer to your calorie needs and your weight would be normal.

Do you really know what it feels like to be hungry? Think about it – does your stomach growl, do you feel irritable, have a headache? Do you notice your hunger before you reach for food? Do you notice your fullness as you come to the end of the plate?

On a scale of 0 to 10, with 0 being ravenous and 10 being stuffed like on Thanksgiving, think of 5 as neutral – not hungry or full. As your stomach digests food and empties, your hunger level will move down from 5, to 4, and then 3 means “I am ready to eat now!” If you do not eat, you might find you are a 2 or a 1 in a short while. If you are overly hungry – you will over eat. If you withhold food and cause yourself to be too hungry, you will eventually make up for it by overeating.

Once you do eat, you move up the scale through 4, 5, 6, and then 7 – which means satisfied and the hunger has gone. If you are eating slowly and tasting and enjoying the food, you will notice this fullness happening. At this point, you probably should stop eating, even if there is more food on the plate. Finishing the plate will cause you to feel 8 or even 9, which becomes uncomfortable.

Ever notice that a little while after you stop eating you feel even fuller? Digestives juices pour into your stomach and expand your stomach even more. Ugh! If you manage your hunger by being conscious of your hunger level, you more likely will be successful in managing your weight.

Do not set yourself up to starve and binge. When you want to eat, check your hunger level. If you are not really hungry and you are thinking about food, there may be other non-hunger reasons. Smelling a favorite food, watching a food commercial, or having a bad day, can all trigger reaching for food. If you can pause and check your hunger, you can be more aware of the non-hunger issues that drive you to eat when you know you are not hungry. This technique of hunger awareness has a profound influence on how and why you eat. Add this to your weight loss and exercise program, and you will eventually change your relationship with food.

Snack Ideas for People with Diabetes

Snack is not a “four-letter” word. Snacks are important in the daily life of a person with diabetes, particularly those with type 1 diabetes and insulin-requiring type 2 diabetes. If there are more than four or five hours between meals, the person runs the risk of low blood sugar, and getting so hungry that he overeats at the next meal. Between-meal and bedtime snacks are essential, as well as keeping glucose tablets accessible, wherever you go, particularly when driving or exercising.

The best snacks are healthy, convenient and carbohydrate-controlled. Healthy foods are higher in fiber, low in fat, low-sodium, very little or no sugar content. Convenient snacks do not have to be refrigerated, like snack bars and packaged snacks. Most important is the amount of carbohydrate the snack offers – a serving or choice is about 15 grams of carbohydrates. Your meal plan may designate the amount of carbohydrate for snacks. To slow the rise of blood sugar, and keep you full longer, you can include some healthy protein with your snack.

Here are some tips in selecting your snacks:

• Do not eat right out of the container – count out your designated serving, put the food items on a plate, and enjoy. There are single serving raisins, pretzels and other snack foods to help you with portion control.
• Look for fresh snacks in the produce department – baby carrots, fresh fruit.
• All crackers, bread and English muffins should be whole grain.
• Watch the calories while you control the carbs. A snack should be about 150-200 calories.
• Select nutrition bars carefully. Granola type bars are high in sugar and low in protein. Find bars that are more balanced – with 7 or more grams of protein. There are handy nutrition bars designed for diabetes that slow the rise of blood sugar with special formulations. (Extend Bars, Glucerna Bars, and Choice Bars).
• You can also drink your snack – a glass of milk, or lower calorie meal replacement drink.
• Satisfy your sweet tooth with label reading – 6 grams of sugar per serving is manageable in a diabetic diet. Find chocolate low sugar popsicles, or low fat puddings as treats.
• All cheeses should be low fat or reduced fat; cottage cheese should be skim or 1 percent fat.
• Milk should be 1 percent fat or skim.
• Popcorn should be light microwavable or air-popped.
• Sugar-free cookies and candy are neither particularly calorie-saving nor cost saving. Sugar alcohols are used to make the products “sugar-free.” Sugar alcohols are listed on the label – and sometimes too much causes gas and bloating. Watch your portion here.
• If the fiber content is more than 5 grams per serving, you can subtract half of the fiber carbs from the total carbs. So, the total effect of the carbohydrate in the items is less on your blood sugar.

Here is a list of snack ideas:

Less than 10 grams of carbohydrate

• 2 stalks celery, 4 bell pepper rings, cucumber slices with 2 tbsp. onion dip
• String cheese (1 oz.)

10-15 grams of carbohydrate

• Almonds or peanuts (½ cup)
• ½ cup Cheerios and ¼ cup milk
• 1 Graham cracker, 2 tsp peanut butter and 3 oz. milk
• Popcorn (3 cups)
• 7 Wheat Thins and 1 oz. cheese
• 4 oz. Light Yogurt
• ½ cup applesauce no sugar added
• ½ cup sugar free pudding

15-20 grams of carbohydrate

• 1 small Apple and 1 tbsp. peanut butter
• 6-8 animal crackers
• ½ large Banana and 1 tbsp. peanut butter
• 2/3 cup Cheerios and ½ cup milk
• ½ cup Cottage cheese, ¼ cup pineapple chunks and 5 Wheat Thins
• 5 caramel corn mini rice cakes with 2 tbsp. peanut butter
• 1 slice toast and 1 oz. low-fat cheese
• 5 Triscuits and 1 oz. low-fat cheese
• Sun chips-10

25 grams of carbohydrate

• 1½ graham crackers, 2 tsp. peanut butter and ½ small banana
• 1 slice cheese melted on ½ English muffin and 6 oz. milk
• 1 packet plain instant Oatmeal prepared with 4 oz. milk, cinnamon & Splenda
• baked potato chips

30-35 grams of carbohydrate

• 1 cup Cheerios, 8 oz. milk and 1 tbsp. chopped walnuts
• 2 Graham crackers, 1 tbsp. peanut butter and 8 oz. milk
• 3 cups Popcorn, 1 small piece of fruit and 1 oz. cheese
• 3 RyKrisp crackers, 1 apple and 1 oz. low-fat cheese
• 1 cup strawberries & ½ cup vanilla yogurt mixed w/½ cup cottage cheese
• 1 oz. string cheese, 5 Triscuits and 1 piece of fruit
• 1 oz baked tortilla chips and ¼ cup salsa
• 2 fig cookies and ½ cup skim milk

And for some more great diabetes-friendly snack ideas, visit the “Snack” section of the DiabetesCare.net Recipe Center.

The Facts About Sugar & Sugar Substitutes

Contrary to what you may have heard, people with diabetes can have some sugar in their diet. That is, if their diabetes is controlled and their diet well balanced, a small amount of carbohydrates in their diet can be exchanged out for sugar.

The food industry also offers those with diabetes, and those trying to save calories, reduced-sugar and sugar-free foods. These foods are not necessarily calorie-free, but the calories and carbohydrates have been reduced with the use of artificial sweeteners.

Sugar

All sugar contains 4 calories per gram, and is all carbohydrate. Every teaspoon of sugar has 16 calories. You will find sugars listed under total carbohydrates on a food label, but you will need to check the ingredient list to know where the sugar in the food item comes from. Naturally occurring sugar is found in fruit (fructose) and milk and yogurt (lactose). Added sugars are added in the food processing or recipes to sweeten the food, such as sugar, dextrose, honey, high fructose corn syrup, and other sweeteners.

Sugar Substitutes

Sugar substitutes contain almost no calories and no carbohydrates, and do not raise blood sugar. The FDA approves these food additives after rigorous testing. The additives provide a sweet taste to foods without the calories. There are five no-calorie sweeteners:

Aspartame (NutraSweet, Equal): Digested as a protein, this sweetener is 180% sweeter than sugar. It loses its sweet effect if heated to high temperature for a prolonged time – not useful for baking. Because it contains phenylalanine, there is a warning label for people with Phenylketonuria (PKU)

Sucralose (Splenda): 600 times sweeter than sugar and can withstand high temperatures. It is suitable for baking, dessert products, beverages, and as a tabletop sugar substitute.

Saccharin (Sweet’n Low, Sugar Twin): This is used in many foods and drinks to reduce calories. It can also be used in cooking

Acesulfame potassium (Sunette, Sweet One) – (Ace-K): Used in soft drinks, baked foods, oral hygiene and pharmaceuticals. It is 200 percent sweeter than sugar.

Neotame: 8,000 times sweeter than sugar. A tiny amount of this non-nutritive sweetener can be used for sweetness and flavor enhancement. It was developed to improve upon the drawbacks of aspartame. Neotame can be heated to high temperatures and is safe for PKU. It is used as a tabletop sweetener, in gum candy, frozen desserts, cereal and baked goods

Dietary Supplement – Stevia: In Dec. 2008, the FDA cleared the dietary supplement, Stevia, a non-nutritive sweetener from an herb, in its pure form – rebaudiosideA – as safe for use in food and beverages. Pepsi (Purevia) and Coke (Truvia) are bringing it to market in beverages. It is 30 times as sweet as sugar and can be found as a tabletop sweetener in packets, tablets and powders

Reduced-Calorie Sweeteners – Sugar Alcohols

This group of ingredients saves calories and carbohydrates – by half of the normal amount. Polyols, or sugar alcohols, have 2 calories per gram, because they are not fully digested. Because of this property, large amounts of these ingredients can have a laxative effect. This might be gas, cramping and diarrhea. Mostly used in gums, candies, cookies and ice cream, the sugar alcohol reduces the calorie and carbohydrate effect of the food somewhat, but the food items themselves still provide carbohydrates and calories. Do not consider these “free” foods.

Names of sugar alcohols are: sorbitol, maltitol, xylitol, isomalt, mannitol, and hydrogenated starch hydrolysates.

You can identify sugar alcohols in a food under the Total Carbohydrate on the food label (see label example below). If more than 5 grams of sugar alcohol is in a serving, you can subtract half that number from the total carbs.

Sweetener Safety

Using sugar substitutes is a personal choice, since you can still have small amounts of sugar in your diabetic diet. The above non-nutritive sweeteners have passed extensive testing and review by the FDA to be safe for use, even by pregnant women and children over four years of age. Sugar substitutes can be helpful with weight loss and reducing your intake of carbohydrates. Remember, a food labeled as “sugar free” can still have considerable carbohydrate and calories. Acceptable Daily Intakes (ADI) have been defined for the non-nutritive sweeteners. The levels have been set so that you can consume 100 times more than the ADI and still be safe.

Sugar Substitute	Acceptable Daily Intake	Product Amount
Aspartame	50 mg/kg body weight	97 packets or 17 cans diet soda
Sucralose	5mg/kg body weight	20 packets or 5 cans of soda
Saccharin	Child—500 mg/day Adult 1000 mg/day	13 packets Sweet’n Low 25 packets Sweet’n Low
Acesulfame K	15 mg/kg body weight	20 packets Sweet One
Neotame	18 mg per day	18 mg = 20 packets
Stevia	Not determined	GRAS list

For additional information, the Academy of Nutrition and Dietetics Evidence Library features a paper called “The Truth About Artificial Sweeteners and Sugar Substitutes.”

How to Decode Food Labels

The Nutrition Facts Label: An Overview

Food labels provide a wealth of nutritional information about the food you purchase so you can make healthy choices.

Looking at the sample food label below, you will see the serving size and servings per container listed at the top. Remember that if the package contains multiple servings, you must multiply the amounts listed for calories, fat, cholesterol, etc., since food labels list the amount per serving.

Example: The label below lists a 1 ounce serving size, but the package contains 4 servings. That means if you eat the entire container, you have eaten 620 calories (155 calories x 4).

List of Nutrients

The label lists calories, calories from fat, total fat, saturated fat, cholesterol, sodium, total carbohydrate, fiber, sugars and protein. The label might also contain calories from saturated fat, polyunsaturated fat, and monounsaturated fat. The number following each listing identifies the amount of the nutrient in grams (g) or milligrams (mg) contained in one serving.

Calories

Calories count when it comes to trying to lose or just maintain your weight. A dietitian can help you determine the proper number of calories you should eat daily. (You may need to eat fewer calories than your body burns.) By reading food labels to compare similar products, you can find similar items that contain a surprisingly wide range of calories.

Total Fat

Total fat indicates how much fat per serving a food contains. Fats that are beneficial for health include monounsaturated and polyunsaturated fats, while fats that negatively influence health include saturated and Trans fats. Monounsaturated and polyunsaturated fats can help to lower your blood cholesterol and protect your heart. Saturated and Trans fat can raise your blood cholesterol and increase your risk of heart disease. The cholesterol in food might also increase your blood cholesterol.

Fat contains more than twice the calories of carbohydrate or protein. Although monounsaturated and polyunsaturated fats make healthier choices, you still need to remain vigilant about the total number of calories you eat if you want to maintain a healthy weight. To lose weight, you must limit the amount of total calories, including fat that you eat.

Sodium

The terms “sodium” and “table salt” are used interchangeably. Table salt contains sodium. While sodium does not affect blood glucose levels, it might affect blood pressure. Many people eat much more sodium than they need. In fact, a healthy adult should eat less than 2,400 mg per day. To flavor your food, you can substitute herbs and spices for salt in cooking.

Total Carbohydrate

Both sugar and fiber make up the grams of total carbohydrates. The American Diabetes Association warns that if you look only at the sugar number, you might end up excluding nutritious foods such as fruits and milk, mistakenly believing they contain too much sugar. You might also over eat foods such as cereals and grains that contain no natural or added sugar, but do contain a lot of carbohydrate.

In general, adults should eat 25-30 grams of fiber per day. People with diabetes should consume at least the same amount, and some research has shown benefit in consuming more, up to 50 grams per day. Good sources of fiber include dried beans (such as kidney or pinto beans), fruits, vegetables, and grains.

When and What to Eat Advice for People with Diabetes

What you eat and when you eat play important roles in diabetes management. Both affect your glucose level and both affect how well diabetes medicines work.

Timing is Important

Your blood glucose will rise after you eat. Before a meal, average blood glucose levels range between 90 – 130 mg/dl. After a meal, the average level should be less than 180 mg/dl. Doctors recommend maintaining a relatively balanced blood glucose level. For instance, if you eat a big lunch one day and a small lunch the next day, your blood glucose levels will change significantly. Eating around the same time every day will help stabilize your glucose levels. How much you exercise also affects what you should eat and when.

Eating Time Tips

• Do not skip meals or snacks
• Carry some nutritious snacks with you (ex. protein bar, vegetables, fruit, light popcorn)
• If you are eating with other people, ask if you can eat at your usual time
• Visit a restaurant during its off-peak hours so you will not wait long
• If you want something special, ask if it will take longer to prepare
• If you must wait, eat something at the time you would normally eat, such as a cracker or some fruit
• If you must wait a long time, eat your usual bedtime snack before you eat dinner

What to Eat

According to the American Diabetes Association (ADA), a healthy eating plan is low in saturated fat and cholesterol, moderate in protein, high in starches and fiber, and moderate in sodium and sugars. The National Diabetes Information Clearinghouse (NDIC) advises that the food pyramid can help you make wise food choices.

How Much to Eat

Consume about 1,200 to 1,600 calories a day if you are a

• small woman who exercises
• small or medium-sized woman who wants to lose weight
• medium-sized woman who does not exercise much

Choose this many servings from these food groups to consume 1,200 to 1,600 calories a day:

• 6 starches, 2 milks
• 3 vegetables, 4 to 6 ounces meat and meat substitutes
• 3 fruits, up to 3 fats

Consume about 1,600 to 2,000 calories a day if you are a

• large woman who wants to lose weight
• small man at a healthy weight
• medium-sized man who does not exercise much
• medium-sized or large man who wants to lose weight

Choose this many servings from these food groups to consume 1,600 to 2,000 calories a day:

• 8 starches, 2 milks
• 4 vegetables, 5 to 7 ounces meat and meat substitutes
• 3 fruits, up to 4 fats

Consume about 1,200 to 1,600 calories a day if you are a

• small woman who exercises
• small or medium-sized woman who wants to lose weight
• medium-sized woman who does not exercise much

Choose this many servings from these food groups to consume 1,200 to 1,600 calories a day:

• 6 starches, 2 milks
• 3 vegetables, 4 to 6 ounces meat and meat substitutes
• 3 fruits, up to 3 fats

Consume about 1,600 to 2,000 calories a day if you are a

• large woman who wants to lose weight
• small man at a healthy weight
• medium-sized man who does not exercise much
• medium-sized or large man who wants to lose weight

Choose this many servings from these food groups to consume 1,600 to 2,000 calories a day:

• 8 starches, 2 milks
• 4 vegetables, 5 to 7 ounces meat and meat substitutes
• 3 fruits, up to 4 fats

Snacks

Besides eating a snack if you must wait for dinner, you might also need a snack if you participate in a long, vigorous exercise session. Snack ideas include a small roll, a piece of fruit, or a small glass of juice or milk. A dietitian can tell you about other healthy snacks as well as other times you might need them.

The ADA recommends eating a snack before exercising if your blood glucose level measures less than 100 mg/dl and eating one every 30 minutes if it measures between 100 and 250 mg/dl and you’ll be exercising for more than an hour. You probably do not need a snack if you are exercising for less than an hour and your level measures between 100 and 250 mg/dl.

However, you might not need snacks when you exercise if you take insulin. Your diabetes care provider can advise you.

Children and Their Diabetes Diet

Eating a structured meal plan can be a difficult adjustment for a child, but it is critical to maintaining healthy blood sugar. Living with diabetes no longer means cutting out sweets completely; instead, it means eating a healthy, balanced diet that every growing child needs. A balanced diet features foods from the three major groups -protein, carbohydrates and fats – in the appropriate amounts.

With a little extra effort and planning, children with diabetes can live a normal life. When your child eats out at restaurants, choose the lower fat options and healthier desserts, such as frozen yogurt. Also, do not overdo the bread. When your child goes to a party, call ahead of time to check what foods will be served. You might want to pack some healthy snacks. Check the blood glucose of your child beforehand; giving some extra insulin might also be a good idea. And being a person with diabetes does not mean your child must forgo birthday cake – as long as you prepare for it.

Low Blood Glucose (Hypoglycemia)

If you feel shaky, confused, irritable, hungry, weak, or tired, and if your blood glucose level measures 70 or lower, consume one of the following:

• 1/2 cup (4 ounces) of any fruit juice
• 1/2 cup of a regular (not diet) soft drink
• 1 cup (8 ounces) of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey
• 3 or 4 glucose tablets
• 1 serving of glucose gel (check the label – you will want the amount equal to 15 grams of carbohydrate)

After 15 minutes, check your blood glucose again. If it is still too low, eat or drink another serving. Repeat until your blood glucose level measures 70 or higher. If it will be an hour or more before your next meal, eat a snack.