Volume 16, No.4, Fall 2008
By Debra Gibbons, R.D.
November is designated Diabetes month. There are now 24 million Americans with diabetes and more than double that with pre diabetes. So chances are you know someone with this condition or may be at risk yourself.
Years ago people would say they had “sugar” diabetes or a touch of sugar or perhaps old age diabetes, but nothing serious like those people taking “shots.” They would eat a regular diet, but avoid table sugar. Only limited education on what to eat, or whether to exercise or awareness of potential problems was offered. There were no glucometers to check blood sugar at home. Instead you would check the sugar in your urine, or just wait for your next doctor’s appointment.
Now we know a lot more about diabetes and patients are given more information regarding their diet and physical activity, plus how this affects other aspects of their health.
The view has changed, from the physician solely managing the diabetes to empowering patients to learn how to control their condition—with, of course, the help of their doctors and other health care professionals. This allows the people to go home alone to handle the everyday task of caring for their diabetes with confidence in their daily decisions.
Most people with diabetes call meal planning the most challenging aspect of their care.
This means controlling blood sugars while meeting nutritional needs and striving to obtain a healthy weight. For most, eating modest amounts 4-5 times a day and not skipping meals is a first step.
The diabetic food exchange lists have been around for a long time and are still in use. But now there’s another approach in meal planning. Learning how to count the amount of carbohydrate in particular foods increases the flexibility of one’s choices and improves the management of blood sugars. Controlling the carbohydrates and distributing them through the day will help control blood sugars.
Carbohydrates have the greatest influence on the blood sugar and consist of all starches, sugars and fiber, of which 90-100 percent turns to sugar.
The carbohydrate content of packaged foods is listed at the top of the Nutrition Facts label as Total Carbohydrate per serving as listed on the label. Ignore the sugar amount since it is already included in the total carbohydrate. Remember to check the serving size listed and see if that is the amount you plan to eat. If not, adjust the carbohydrate content to your serving size. The carbohydrate content of foods without packages such as fresh fruits, vegetables, meats and fish can be found in reference books in most bookstores and on websites.
People with diabetes who take insulin before meals are now able to learn how to adjust their insulin according to the amount of carbohydrates they are eating rather than always being forced to limit their intake of food according to a fixed dose of insulin. Since appetites may vary at different meals, a person can be taught how to make insulin adjustment to prevent their blood sugar from being too high or too low after eating.
There are a variety of approaches to use in meal planning and each person has to see which one works for them. Healthcare providers specializing in diabetes such as Certified Diabetes Educators provide reliable education to help people learn about diabetes and the meal planning options. Then it is up to the patient to put them into practice to discover which approach is best for them.
Regardless of the type of diabetes, the goals are the same—maintaining a heart-healthy diet that controls blood sugars and weight. This formula will help decrease the risks of complications and improve your quality of life.
(Ms. Gibbons, a Registered Dietician and Certified Diabetes Educator, provides outpatient nutrition medical therapy at Cape Cod Hospital.)