Diabetes: The Basics – Healthy Eating
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Diabetes Self-Management- HEALTHY EATING- based on the ADCES7 Self-Care Behaviors ™
Updated 2021 by Kim Ladd, RN, BS, CPHQ, CDCES
When you have diabetes, it’s very important to understand how food affects your blood sugar levels. Learning to prepare and eat healthy meals, read and understand food labels, and practice portion control are tools that can help you achieve your health goals.
Diabetes and Food
Eating right will help you: keep your blood sugar levels in a healthy range, manage your diabetes, and prevent diabetes complications. And you will feel healthier too!
Four (4) Steps to Healthy Eating for Controlling Diabetes
- Eat breakfast, lunch, and dinner every day
- Having a regular pattern makes diabetes easier to control. Try to eat at about the same time every day. Try to eat about the same amount of food at each meal.
- Do not skip meals
- Eating some food every 4 to 6 hours will help keep your blood sugar in range. Even if you are not hungry, eating a small amount of food will help maintain healthy blood sugar levels.
- Water is the best beverage choice, but if you must drink soda or fruit drinks, drink sugar-free or diet versions
- Regular soda pop, fruit punch, and powdered drink mixes have a lot of sugar in them. Too much sugar can make your blood sugar go too high and make your diabetes hard to control.
- Learn about carbohydrates
- Carbohydrates is the nutrient in food and beverages that affects your blood sugar levels. Not eating enough carbohydrates could lead to low blood sugar (hypoglycemia) and eating too many carbohydrates could lead to high blood sugar (hyperglycemia).
What are Carbohydrates?
Carbohydrates, or “carbs,” are sugars and starches found naturally in, or added to, some foods and beverages.
Foods and beverages containing sugar include:
Fruit, fruit juice, milk, table sugar, honey, syrups, cookies, cake, pie, candy, donuts, pastries, regular soda pop, sugar-sweetened coffee and tea, jams, jellies, ice cream, and sugar-sweetened cereals
Foods containing starches include:
Bread, unsweetened hot or cold cereal, crackers, pasta, rice, other grains, potatoes, sweet potatoes, dried beans, peas, corn, lima beans
Why are Carbohydrates Important?
When you eat carbohydrates, they turn into glucose. Glucose is also called “sugar,” and is your body’s main source of energy. Just as a car needs gas, your body needs glucose to work well.
It is important to eat some carbohydrates, but too much, or the wrong kind of carbohydrate, will make your diabetes hard to control.
Choose these carbohydrates more often: whole wheat or whole grain breads and buns, unsweetened cereals, brown rice, pasta and noodles, potatoes, fruit, sweet potatoes (without added sugar)
Choose these carbohydrates less often: jams, jellies, sugar-sweetened cereals, cake, cookies, donuts, pies, pastries, honey, sugar, syrups
Who Can Give Me More Information About Food?
A registered dietitian (die-a-tish-an) can help you learn more about diabetes and food. When you talk to the dietitian, ask these questions:
- How much carbohydrate do I need at each meal?
- Are there other things I need to pay attention to (fat, sodium, calories)?
Rate Your Plate
Planning meals when you have diabetes does not need to be difficult. Two plates with a dinner are described below. Which one sounds like your dinner plate?
Plate 1: has a large serving of spaghetti and meatballs in tomato sauce, with grated cheese sprinkled on top. The spaghetti covers the plate and is piled up to about 2-3 inches.
Plate 2: is not entirely filled. It has a chicken breast and wing covering about 1/4 of the plate, a serving of potatoes covering about 1/4 of the plate, and some broccoli and salad covering about 1/2 of the plate.
Does your plate look more like Plate 2? If not, consider making a few of the following changes:
- Plan around plants. Your meals should be mostly plant-based. Grains, vegetables, beans, and fruits should make up at least 3/4 of your plate, leaving 1/4 or less for meat or low-fat dairy.
- Cut out the extra fat. Trimming visible fat off meat and removing skin from poultry before cooking can cut the fat content of the meat in half. Eat lower-fat cuts of meat such as chicken breasts, pork loins, steak filets, turkey breasts and fish. Use creamy sauces, gravies, and dressings in moderation because they’re often loaded with fat and calories.
- Pay attention to portions. Most Americans eat much more than their bodies actually need. A portion is how much you put on your plate, but a serving is the recommended portion size. Do you know how much a serving is? Here is a simple way to estimate:
- Starches: a slice of bread the size of a CD case, or 1/2 cup of pasta or cooked cereal the size of a tennis ball, or 1 cup of unsweetened breakfast cereal.
- Vegetables: 1 cup of raw leafy vegetables like 4 large leaves of lettuce, or 1/2 cup of cooked vegetables the size of a light bulb.
- Fruit: 1 piece of fresh fruit the size of a tennis ball, or 1/2 cup of fruit salad or canned fruit.
- Meat or other protein: 2-3 ounces of cooked meat the size of a deck of playing cards, or 2-3 slices of lowfat cheese, or 1/2 cup cooked dry beans the size of a light bulb.
- Milk: 1 cup milk or yogurt
- Fat: 1 teaspoon, about the size of the tip of your thumb.
- Sweets: 1 cookie 2 inches across.
- Think about what you drink. Water is the best choice, but if you want variety choose sparkling water, diet soda, or unsweetened or diet iced tea. If you drink fruit juice limit your daily intake to 1/2 cup of 100% juice. Avoid regular soda pop, fruit drinks, punch and powdered drink mixes that are sweetened with sugar.
How Much Should I Eat?
The amount of food you should eat each day depends on many things: your sex, your age, your weight and how physically active you are. A visit with a registered dietitian (RD) is the best way to find out how much and what kind of foods you should be eating. A dietitian can work with you to develop meal plans that meet your diabetes needs and include your personal and cultural likes and dislikes. You can ask your doctor for a referral to a dietician and if you have diabetes, Medicare and most health insurance plans pay for the service.
How Do I Get Started Eating Healthy with Diabetes?
Until you can make an appointment with a dietitian, use these guidelines to get you started:
First, you need to know how much food is in a serving size for each food group.
- For grains, beans, and starchy vegetables, 1 serving is about ½ cup which is the size of a tennis ball. For bread, one slice the size of a CD case is a serving.
- For fruit, 1 serving is 1 small piece of fresh fruit the size of a light bulb, or about 1/2 cup.
- For milk, 1 serving is 1 measuring cup of low-fat milk, plain yogurt, or diet-flavored yogurt.
- For meat or other protein, 1 serving is 2-3 ounce of lean meat, fish, or cheese. One ounce is the size of a slice of lunchmeat or cheese, or 1 egg. Three (3) ounces of meat is about the size of a deck of cards. Two ounces of hard cheese is about the size of 2 dice.
- For oil, 1 serving is 1 teaspoon of oil.
- For low-calorie vegetables like green beans, celery, spinach, or broccoli, 1 serving is 1 cup of raw vegetables or 1/2 cup of cooked vegetables. Although these do contain some calories, they are so low in calories that many people can treat them as “free foods.” If you need to fill up on something, choose low-calories vegetables.
The Diabetes Plate Method
An easy way to ensure you are eating a variety of foods at each meal, and controlling portion size, is to use the Diabetes Plate Method.
Explanation: Using a 9-inch diameter plate, fill ½ of your plate with non-starchy vegetables, ¼ of the plate with protein foods, and the last ¼ of the plate with carbohydrate foods like potato, rice or pasta. Top it off with a glass of water or another zero-calorie drink and you’ve got yourself a well-balanced plate! This helps take the guess work out of meal planning so you can spend more time doing the things you love.
Non-starchy vegetables: artichoke, artichoke hearts, asparagus, baby corn, bamboo shoots, beans (green, wax, Italian), bean sprouts, beets, brussels sprouts, broccoli, cabbage, carrots, cauliflower, celery, chayote, cucumber, daikon, eggplant, greens (collard, kale, mustard, turnip), jicama, kohlrabi, leeks, mushrooms, okra, onions, peppers, radishes, rutabaga, salad greens (chicory, endive, escarole, lettuce, romaine, spinach, arugula, radicchio, watercress), sprouts, squash (cushaw, summer, crookneck, spaghetti, zucchini), sugar snap peas, Swiss chard, tomato, turnips, water chestnuts, yard-long beans.
These vegetables are high in vitamins and fiber and lower in calories and carbohydrates. Try to eat 3-5 servings per day and more is even better!
Good protein choices:
- Plant-based proteins: beans (black, kidney, pinto), bean products (baked beans, refried beans), hummus, falafel, lentils (brown, green, yellow), black-eyed peas, split peas, edamame, soy nuts, nuts, almond butter, cashew butter, peanut butter, tempeh, tofu.
- Seafood: fish high in omega-3 fatty acids (albacore tuna, herring, mackerel, rainbow trout, sardines, salmon), catfish, cod, flounder, haddock, halibut, orange roughy, tilapia, shellfish (clams, crab, imitation shellfish, lobster, scallops, shrimp, oysters)
- Poultry: chicken, turkey, Cornish hen
- Game meat: buffalo, ostrich, rabbit or venison, dove, duck, goose, or pheasant (no skin)
- Beef: Select or Choice grades of beef trimmed of fat including chuck, rib, rump roast, round, sirloin, cubed, flank, porterhouse, T-bone steak or tenderloin
- Lamb: chop, leg, or roast
- Veal: loin chop or roast
- Pork: Canadian bacon, center loin chop, ham, or tenderloin
Plant-based proteins have less cholesterol and more heart-healthy fats and fiber. But they are higher in carbohydrates which may raise your blood sugar more. Read food labels to learn serving sizes for other proteins. It is best to limit red meat and processed meats, which are high in saturated fats.
Carbohydrate or starchy foods: potato, sweet potato, rice, pasta, quinoa, wheat bulgur, farro, oats, corn, barley, tortillas, breads, and hot and cold cereals.
Healthy fats and oils: Choose heart-healthy oils that are liquid at room temperature like olive, canola, safflower, soybean, sunflower, and cottonseed. Other healthy fats include avocado, walnuts, flaxseed and chia seeds, oily fish, eggs and peanut butter. Eat less saturated fats (found in foods from animal sources) and trans fats (found in baked goods and packaged snack foods) which increase blood cholesterol and in turn, increases your risk of heart disease.
What About Fruits?
Fruit naturally contains sugar, in the form of fructose. However, fruit is full of healthy vitamins and minerals, so they are ok to eat if you have diabetes and can be a great way to satisfy your sweet tooth! You will want to be smart about portion size and choose fruit that is higher in fiber. Fresh fruit is best. Frozen or canned fruits with no added sugars are good too. Dried fruit and fruit juices can contain higher amounts of sugar.
Good fruit choices: apples, apricots, avocado, banana, blackberries, blueberries, cantaloupe, cherries, grapefruit, grapes, honeydew melon, kiwi, mango, nectarine, orange, papaya, peaches, pears, pineapple, plums, raspberries, strawberries, tangerines, watermelon, dried fruit (cherries, cranberries, dates, figs, prunes, raisins)
General Guidelines for Choosing Healthier Foods
- Eat a variety of foods from each food group every day. Choose colorful fruits and vegetables. This ensures you will get the macro and micronutrients you need.
- Choose low-fat or nonfat dairy and lean proteins to reduce the amount of saturated fats and cholesterol in your diet.
- Choose whole grains and other high-fiber foods most often.
- Limit processed and fast foods which are high in calories, fats, and sodium. Instead eat foods as close to their natural state as possible.
- Limit foods high in added sugars, sodium, and fats like snack foods and baked goods. They are full of “empty calories” without much in the way of healthy nutrients.
Reading Food Labels
Understanding how to read nutrition facts labels can help you make healthier food choices. Food labels contain information on serving size and the number of calories, carbs, fat, fiber, protein, sodium, and vitamins and minerals in each serving of the food or beverage. There will also be a list of ingredients on the label. This information makes it easier to compare the nutrition of similar products and brands so you can make the healthiest choice. The Center for Disease Control recommends these steps to read a food label:
- Check the Serving size first. All the numbers on this label are for a 2/3-cup serving.
- This package has 8 servings. If you eat the whole thing, you are eating 8 times the amount of calories, carbs, fat, etc., shown on the label.
- Total Carbohydrate shows you types of carbs in the food, including sugar and fiber.
- Choose foods with more fiber, vitamins, and minerals.
- Choose foods with lower calories, saturated fat, sodium, and added sugars. Avoid trans fat.
Accessible Resources for Reading Food Labels
Seeing AI app for iPhone
Lookout by Google app for Android phone
Be My Eyes app on android and iPhone
CalorieKing.com website and app for android and iPhone
If you have type 1 diabetes or take insulin, you may need to adjust your insulin dose based on the amount of carbohydrates you eat at each meal. Some people with diabetes also use carbohydrate counting to keep tighter control of their blood sugar levels. Learning how to “count carbs” is not very difficult, but it does take research and practice.
You need to be familiar with the amount of carbs in a serving size of the food and beverages you consume plus how many servings your portion size is. You can figure out the number of carbs per serving by reading food labels or researching the nutrition facts online, in a book, or on an app. Add up the number of grams of carbohydrates or “count the carbs” for each item you ate and drank to determine the total number of carbohydrates you consumed. You then use the carb to insulin ratio that your doctor prescribed for you to determine how much insulin you need to inject for that meal or snack. You can also use the result to determine how many carbohydrates you consumed each day and use the data to better control your blood sugar levels.
For more information on carb counting, visit these websites:
Carb Counting from the CDC
Carb Counting and Diabetes from the American Diabetes Association
Healthy Eating with Diabetes Resources
Diabetes Meal Planning from the American Diabetes Association
Diabetes Superfoods from the American Diabetes Association
Reading Food Labels from the American Diabetes Association
Eat Well from the Centers for Disease Control (CDC)
FDA Changes to the Nutrition Facts Label
USDA Food Data Central
USDA What’s In Food?