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December 20, 2000

Meal Planning, Food and Diet

Question from Carnegie, Oklahoma, USA:

I have diabetes which is controlled with pills, but lately my sugar has gone a little out of control. I am looking for a "Do and Don't" list of foods for a person with diabetes.

Answer:

I’m sorry you’re having difficulties controlling your diabetes, but it’s great that you want to do something about it right away. That’s the best way to stay feeling your best and protect your long-term health. As for a list of foods that everyone with diabetes should or shouldn’t eat, unfortunately, there isn’t any such thing. I’m assuming that you’re hoping a list of “do’s” would show foods that can always be eaten without raising blood sugar, and that the “don’ts” would be the foods that raise sugar a lot. The plain truth is that just about any food can raise blood sugar under certain circumstances. Portion size makes a big difference. There is literally no food that people with diabetes “can’t eat,” although portions may need to be limited by some.

The foods that have the least effect on blood sugar are protein foods (meat, fish, chicken, hard cheese), non-starchy vegetables (the kind that wilt or turn to an awful mess when you leave them in the fridge too long!), and fats (butter, margarine, sour cream and so on). A good way to use this information is to have second on these foods — more salad, vegetables, or another slice of meat — when you’re still hungry at the end of a meal. However, you can’t make a nutritionally complete, healthy, and enjoyable life eating those things alone, so you need to eat bread, cereal, fruit, and dairy products to fill out your nutritional needs. All of those foods contain carbohydrate, and carbohydrate requires insulin for its use. If your blood sugars are going up after you’re eating, it’s probably because your body is no longer making enough insulin to handle the amount of carbohydrate you’re eating.

The trick in type�2 diabetes is to figure out how much carbohydrate you can eat at a meal without having your blood sugar go too high. The most direct way to do this is to test your blood sugars before and after eating, keeping track of how much you eat. If you find that you cannot eat at least 45-60 grams of carbohydrate at a meal (3-4 carb servings) without having your blood sugars go above 160 mg/dl [8.9 mmol/L] about two hours after eating, then the problem is probably not in your food choices. You need to be able to eat that much carbohydrate in order to consume a nutritionally adequate diet. Take the information to your team and ask about possible changes in your diabetes medicines to help your struggling pancreas.

Type 2 diabetes is a “progressive disease.” It changes over time through no fault of yours. As the years go by, most people need to change or add medicines to their treatment plan in order to keep their blood sugars under control.

BB