Tips for Managing Diabetes

If you have been diagnosed with diabetes, then you know that controlling blood glucose is a critical part of your treatment plan. Good control requires a balance between:

  • Diet.
  • Diabetes medication.
  • Physical activity.

Although not a medical device, MyNetDiary is well suited for diabetes management since you can plan and track your dietary intake as well as physical activity — two out of the three factors listed above!

Diabetes Basics

Carbohydrates http://www.nlm.nih.gov/medlineplus/carbohydrates.html (“carbs”) are found in abundance in grains, grain products (e.g. bread), beans, starchy vegetables (e.g. potatoes), fruit, juice, milk, yogurt, sugars, syrups, and sweets. The carbs that you eat and drink directly affect your blood glucose level. All digestible carbs are eventually converted to glucose, a simple sugar. Glucose travels through the bloodstream to provide our cells with energy. Insulin, a hormone produced in the pancreas, allows glucose to enter most types of cells found in our body. Diabetes is a condition where there is not enough insulin, no insulin, or the insulin is not handled properly in the body so that levels of glucose in the blood rise and stay high. When blood glucose is high enough, glucose leaks into the urine. “Diabetes mellitus” means sweet flow or siphon. Over time, high blood glucose can cause damage to our eyes, kidneys, nerves, gums, and vascular system (e.g. heart and brain vessels).

There are four major types of diabetes: Type 1 diabetes, Type 2 diabetes, Pre-diabetes, and Gestational (pregnancy) diabetes. For detailed information about each type, please visit the American Diabetes Association’s website. http://www.diabetes.org/diabetes-basics/ What is common to all types is the fact that blood glucose is too high for health and increases the individual’s risk for poor health, disability, and early death. For all types of diabetes, it is critical that diet, exercise, and medication work in concert so that blood glucose neither rises too high nor drops too low.

The information contained in this article is mostly appropriate for Type 2 diabetes and Pre-diabetes, but has some relevance to other types of diabetes as well. If you have been diagnosed with diabetes, then I urge you to seek care from a diabetes clinic so that you get access to individualized meal plans, self-management education, and appropriate follow-up.

Tracking Carbohydrates

Having previously worked at a diabetes center, I have heard patients describe all sorts of dietary strategies to control their blood glucose. Some just avoid sugary foods while others have completely eliminated all “white foods” from their diet. Your dietary strategy for effective blood glucose control will depend partly on your diagnosis, type of diabetes medication (if any), and whether or not you exercise.

Whatever strategy you choose, it is important that you know how to control total carbs since that will have the greatest effect on your blood glucose level. Although MyNetDiary can track total carbs, sugars, fiber, and net carbs, I recommend that you use total carb content unless instructed by your diabetes educator to use a different method. I know that many people like to use net carbs, but it can underestimate the true digestible carb load. Some soluble or viscous fibers, although not digested in the small intestine, can be broken down in the large intestine, absorbed, and then converted to glucose. Also, some amount of sugar alcohols (lower calorie sweetener used in processed foods) can be broken down and converted to glucose. See Yale-New Haven Hospital’s Nutrition Advisor http://www.ynhh.org/online/nutrition/advisor/sugar_alcohol.html for more information on sugar alcohols.

Let MyNetDiary Help You!

Plan. One way to control blood glucose is to plan what you are going to eat before you eat. This is especially important for those of you who dine out or travel frequently. You can use MyNetDiary to plan your carbs instead of being unhappily surprised after finishing a meal.

iPhone - Show Meal Carbs. Did you know that you can choose to show total meal carbs just by choosing to do so in the iPhone settings in the MyNetDiary section? Take advantage of this feature to get a quick look at your meal carb totals every time you open MyNetDiary.

“Food Report” for Diabetes Care Provider. Your complete food record is a great source of information for your diabetes care provider. From “Report” section, you can print directly from MyNetDiary or you can download the report to an Excel Spreadsheet and adjust the report for printing as you wish. This will allow your diabetes care provider to view your entire diet rather than just carb intake. Having a complete dietary history will allow your clinician to better assess how well you are managing your diabetes with diet.

How Many Carbohydrates per Meal or Snack?

Your carb goal per meal and snack depends upon your blood glucose response to the foods you eat, your diagnosis, your diabetes medication, and your level of physical activity.

For those of you who want some general guidelines, the American Diabetes Association suggests starting with 45 — 60 grams of carbohydrates per meal. If snacks are appropriate with your diabetes medication, then I recommend trying 15 — 30 grams of carbs per snack (this is in addition to the meal carbs, not in place of them). For both meals and snacks, add protein and/or healthy fats — they will provide other nutrients as well as help blunt the rise of blood glucose after eating.

  • If you are very short in height and/or very inactive, then try 30 — 45 grams carbs per meal.
  • If you are very tall and/or active, then try 60 — 75 grams of carbs per meal.

Carbs are necessary for all human diets. If you take medication that increases insulin production, or if you inject insulin, then make no mistake, it is dangerous to go too low in carbs. When dietary carb intake is very low or missing in the presence of circulating insulin, you risk low blood glucose (hypoglycemia http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/ ) and it’s potentially harmful effects — e.g. passing out at the wheel.

How do you know if your total carb goal for meals is appropriate? You won’t unless you measure your blood glucose. And that is another good reason to seek care from a diabetes clinic — you learn how to do it and when to do it. Your blood glucose testing schedule should be guided by a diabetes care professional. For instance:

A person with newly diagnosed Pre-diabetes may or may not be instructed to test their blood glucose levels — they might be instructed to make lifestyle changes such as lose weight, increase physical activity, and improve their diet (e.g. more fruits and vegetables, whole grains, less saturated and trans fats, less refined starches and sugary sweets and drinks). They might be instructed to return to their doctor for a follow-up HgA1C test (which measures average long-term blood glucose levels). Or, they might be instructed to go to a diabetes clinic for education and self-management training in much the same way as if they had been diagnosed with Type 2 diabetes.

A person with newly diagnosed Type 2 diabetes put on diabetes pills might be instructed to test three days a week at certain time points (e.g. fasting, before a meal, and 2-hours after a meal).

A person who is just starting insulin, or who has just been diagnosed with Gestational diabetes, might be instructed to test six times per day: fasting, before each meal, and 2-hours after each meal.

Type of Carbs — Does it Matter?

Both the type of carb as well as the total amount of carb affects our blood glucose level. In terms of type, you want to choose carbs that won’t cause a huge rise after eating, even after controlling for total carb content. Glycemic Index (GI) is the term used for how a single food affects blood glucose levels compared to a glucose solution with the same amount of digestible carbs. Sydney University’s website

http://www.glycemicindex.com/ has a good description of how GI is determined. The concept is simple — lower GI foods will cause a lower rise of blood glucose over a 2-hour period compared to foods with higher GI values. Therefore, choose more foods with a lower GI (less than 55) than foods with a higher GI (greater than 70).

What is not so simple is how to actually use the GI in meal planning for diabetes. Here are some limitations with using GI for food selection:

  • Food databases that contain GI values are not yet extensive and do not provide GI values for many brand name foods.
  • We rarely eat single foods in meals or even snacks. Other meal components will affect how high our blood glucose level rises after eating.
  • Not all low GI foods are healthy and not all high GI foods are unhealthy. You have to look at the big picture — what else is in the food? This is especially important for combination and processed foods with added fats — they will often have lower GI values. Eating a lot of high-fat foods, especially high in saturated fat, is not a good choice for people with diabetes who typically need to lose weight and control their blood cholesterol levels! Here is an example (from Sydney University’s GI database http://www.glycemicindex.com/ ):

    • Sara Lee High Fat French Vanilla Ice Cream, 1 ⁄ 3 cup, GI = 38 (low)
    • Fresh dark cherries, pitted, about 18 cherries, GI = 61 (moderately high)
    • If you just used GI to select your foods, then you could find yourself choosing foods higher in fat and calories over healthier choices. In this case, I would pick the cherries over the ice cream despite the higher GI value. With cherries, I get dietary fiber, anti-oxidants, and a serving size three times as large as the ice cream for half the calories.
  • How much of a food you eat also affects your blood glucose response. Glycemic Load (GL) is probably a better tool than the GI since it accounts for portion size eaten. GL = grams of digestible carbs in the portion size eaten x GI ⁄ 100. Lower GL foods should be chosen over higher GL foods. In the example above, if you ate 1 cup of ice cream instead of 1 ⁄ 3 cup, the GL would nearly triple and so it would look like a less desirable choice than the 1 cup of fresh cherries.
  • Research has mixed results on use of GI to control blood glucose — some studies show improvement and some do not.

If you like GI as a tool to help you make food choices, and then use it with common sense. Do not simply choose foods based on GI alone, remember to look at the big picture — what else does that food provide? Given that the majority of people with diabetes die from heart disease, it is critical that your food intake is heart healthy and supports your effort to achieve a healthier weight.

Sugars, Syrups, and Honey

Do you have to cut out all sugars, syrups, and honey from your diet if you have diabetes? Not necessarily, but you do have to account for the carbs. Some items are so high in carbs for commonly consumed portion sizes that I recommend that people either severely restrict their portion size or try artificially sweetened versions. For example, maple syrup is typically consumed in a ¼ cup serving (4 tablespoons), which contains 54 grams of total carbs. That is a huge carb load, and we haven’t even accounted for the pancakes! The same amount of diet syrup, on average, will have 30 grams of total carbs. Although still high in carbs, it has a lot less than real maple syrup. Even better would be to use either 1 tablespoon of real maple syrup (if you can make yourself do that), or use 2 tablespoons of diet syrup. That limits the carbs from syrup to about 15 grams — about 25% of the total carbs if your goal is 60 grams per meal.

Should you avoid all foods with high fructose corn syrup (HFCS)? Well, it depends. If the food contains small amounts and has nutritional benefit, then I would eat it. However, many sweetened soda, teas, and energy drinks have a high HFCS content and just based on their total carb content alone makes them a poor choice for anyone, whether or not they have diabetes. Same goes for many brands of milk shakes and smoothies. Read the label. How many total carbs are you getting for a typical portion size? The danger is using your meal and snack carbs on junk foods that provide little or no nutritional value and that are likely to spike your post-meal blood glucose level sky high.

Artificial Sweeteners

Are artificial sweeteners safe? I recommend that you read the FDA consumer flyer for more detail so that you can decide for yourself. http://vm.cfsan.fda.gov/~dms/fdsugar.html The National Cancer Institute’s website also provides information on this topic. http://www.cancer.gov/cancertopics/factsheet/Risk/artificial-sweeteners I think moderation is wise. For instance, are you drinking one can of diet pop a day, or a liter or more? I personally do not see risk in using small amounts of artificial sweeteners on a regular basis.

If you like sweet foods but do not want to consume artificial sweeteners, then exercise portion control and modify recipes to help control total carbs. I highly recommend “Betty Crocker’s Diabetes Cookbook” http://www.amazon.com/Betty-Crockers-Diabetes-Cookbook-Everyday/dp/0764567047# for tasty, lower carb treats as well as for other modified recipes. The book also contains excellent chapters on diabetes self-management since two out of the three authors work with the International Diabetes Center at Park Nicollet Clinic.

Important Diet and Lifestyle Factors

  • Lose weight if you are overweight or obese.
  • Control blood pressure.
  • Control blood lipid (cholesterol) levels.
  • Eat a healthful diet that helps you achieve all of the above.
  • Exercise.

Resources for Diabetes

Good luck. Please remember that you can ask questions about this topic in Community Forum.

Katherine Isacks, MPS, RD

Disclaimer: Please note that we cannot provide personalized advice and that the information provided does not constitute medical advice. If you are seeking medical advice, please visit a medical professional.