Wednesday, October 17, 2007

The Basics of Eating with Diabetes

Your doctor has just told you that you have type 2 diabetes. Diabetes is a serious, common, costly, but more importantly, a controllable disease. You are one of almost 16 million Americans who have this disease, approximately 6 percent of the population. As devastating as this news is to you, you are one of the more fortunate ones because you are among the million who have been diagnosed. Nearly one-third of the people with diabetes do not know they have it. Many people are diagnosed only when they develop problems from the complications of diabetes. Though you know diabetes is serious, costly, and all too common, you might question whether it is controllable.

Most of the people who have diabetes have type 2 diabetes, and those are the people for whom this book is written. About 80 percent of people with type 2 diabetes are overweight; consequently, weight control and food choices are the major problems and barriers to controlling diabetes.

Big questions that concern everyone are: "Do I have to give up my favorite foods?" "What about ethnic foods?" and "What can I eat in a restaurant?" Unfortunately, people with diabetes are often told what they cannot eat rather than what they can eat. This book will attempt to change that paradigm and accentuate the positive. It will show you how the food you eat can affect your health, and it will give you the information you need to make informed food choices.

Your doctor told you about all the implications of the disease: complications, medications, and diet. She told you that you had to take the steps necessary to get your blood glucose under control and recommended you purchase a blood glucose meter so that you could monitor it at home. She also recommended that you lose weight. Her receptionist provided you with some written information on self-monitoring of blood glucose, what you should eat, and the importance of exercise. The doctor also told you it would be a good idea to make an appointment with a dietitian to learn what you should and should not eat. The one thing you know for sure is that people with diabetes have to be on a special diet. You may have a panicky feeling in the pit of your stomach as you wonder what you can still eat for dinner.

Everything seems so overwhelming, and all this talk about complications is so frightening. The doctor said to lose weight, which is easier said than done. When you got home you read all the information you had received at the doctor's office. One pamphlet about food said that healthy eating is the first step in taking care of your diabetes, and the same kind of food that is good for the person with diabetes is also good for the whole family. You do not need special or diet foods. It also says that you can make a difference in your blood glucose through your food choices. You are beginning to think that maybe this isn't impossible after all.

What about Dinner?

Knowing that after leaving the doctor's office you would have little time to prepare dinner, you had planned to stop and pick up fried chicken. What should you do now? Especially since your doctor told you that you needed to lose some weight?

Stop and think about that fried chicken dinner. Is it your only option tonight or do you have other alternatives? One solution may be to remove and discard the skin and eat only one or two pieces of chicken instead of three or four. Another may be to select roasted, rather than fried, chicken. Or better yet, get out of the car and go into a market where you can buy a vegetable to eat with that chicken. Many times what we eat with the chicken--like biscuits, fries, and coleslaw--adds lots of calories. The easiest way to cut down on calories is to keep it simple. Vegetables are generally low in calories. Breading and deep frying or adding cheese sauce or butter adds calories. So to get started, select the vegetables you enjoy and try them without embellishment. If you cannot eat a salad without blue cheese dressing, try eating plain sliced tomatoes instead of a salad. If you cannot eat a dinner roll without butter, substitute bread sticks. In order to figure out what to have for dinner now that you have diabetes, you need to think about three things: variety, moderation, and balance. Integrate these principles into your life to simplify making food choices.


One of the easiest ways to healthy eating is to include a wide variety of foods every day. Everyone needs well over fifty different identified (and many yet to be identified) vitamins, minerals, and other nutrients from the food they eat. The greater the variety of food we eat, the better the chance we have of getting all the nutrients we need. Try foods you have never tried before to increase the variety you eat. The modern supermarket brings foods from around the world to our doorstep. Take advantage of the many new and different foods it has to offer. Try to taste a new food every week or every month. You may discover some new favorites.

When you think of variety, think about three or four different foods and different types of foods in each meal. Let's use an example. If you eat a turkey sandwich for lunch, you are eating two different types of food: bread and meat. You might make that a deluxe sandwich by adding several slices of tomato and romaine lettuce. You have added a vegetable and now have three different types of food. Add a glass of skim milk or 1 percent milk and you have made that sandwich a whole lunch that incorporates variety. If we do the same thing for dinner you could start with spaghetti and meatballs. You have two different types of food, three if the meatballs are in a tomato sauce. Add a salad and you have created a well-balanced meal.


Your grandmother was right when she said you should not eat dessert until you ate your dinner. The reason she said this was because if you were allowed to eat your dessert first you would have filled up on dessert and not eaten your vegetables. If, on the other hand, you select foods that are high in fiber, such as fresh fruits and vegetables, whole grains and legumes or other beans, you will fill up on nutrient-dense foods and consequently will be less likely to overeat. You really are what you eat. The foods you eat do affect both your health and the way you feel.

It is also important to choose fewer foods that have fat, sugar, and salt added to them. If you believe that apple pie belongs in the fruit group you have some changes to make! For most people, cutting back on pre-prepared, processed, and convenience foods, which are high in fat, salt, and sugar, will be a big change. The important thing is to focus on the positive. Concentrate on good food and learn to maximize the flavor and the satisfaction you get from the foods you do eat. In my admittedly biased viewpoint, ripe, delicious fresh fruit is the best dessert of all. You may not agree, but give it a try, and you may be surprised at just how much you enjoy this treat.

The best part about the concept of moderation is that it eliminates "forbidden foods." If you think about eating moderate amounts of food, you can probably fit all your favorites in occasionally. Just knowing a food isn't forbidden makes it less attractive.


The concept of balance incorporates both variety and moderation. When we think of eating a "balanced meal" most of us visualize a piece of meat or fish, some type of starch like pasta or potato, maybe a green vegetable and a salad. The thing that we have to keep in mind is that it is important not only to include all types of food, but also to eat the right amount of each of these foods. For example, we need to eat a certain amount of protein every day. Most Americans get a lot more than they need. This is because we tend to think of meat or fish as the only sources of protein and have a skewed notion of how much we need. Five or six ounces of meat or fish (each day, divided among all your meals) is more than enough for most of us. So if you look at that balanced meal, you should see a piece of meat the size of a deck of cards, and the starch and vegetable should take up most of the space on the plate. Balance means eating the right foods in the right amounts.

When you look at the recommendations given in the Food Guide Pyramid, a guide for good eating, they seem pretty simple. Incorporating those changes into your daily routine takes a little more effort. Eating meals at regular times every day may be easy for you if you follow a regular schedule. It is a good idea to space your main meals five to six hours apart. Your body will handle food better if you give it time to digest one meal before you start another. Some people do well if they eat six small meals a day. The question then becomes what do we mean by small. That depends on whether or not you are trying to lose weight. If you need 1,500 calories in a day and choose to eat six small meals, a small meal is one that contains 250 calories. One small slice of cheese pizza with a thin crust contains 400 calories and a hamburger may contain 430 calories. It is pretty easy to see that six small meals are not an option for most people, as regulating portion size is very difficult, if not impossible.

Eating Habits

Most of us have overeaten on occasion. Thanksgiving dinner is one of those times. Usually the table is covered with good food, and we want to try some of everything. Then you get up from the table and feel just like the turkey at the start of the meal, stuffed. It takes all your energy just to watch the football game on television. Compare that to how you would feel if you had eaten a meal that included a moderate-size serving of lean meat or poultry, grains, vegetables, and fruit. Most of us would have more energy after the latter meal. However, we all must cope with the tendency to overeat on festive occasions.

If the only times any of us overate were on festive occasions we would not have too big a problem. But many people eat more than they need every day. For instance, most of us can claim charter membership in the clean plate club. We have been taught since childhood not to waste food, and therefore we may be inclined to eat whatever is on our plate or on the table, even when we are not hungry.

The important thing to remember is that food that is good for a person with diabetes is good for everyone. Do not use the excuse of "I cannot deprive my family of these high-calorie goodies." I remember working with a man who had diabetes and was the family cook. When he changed his eating habits to improve his glucose control his wife was delighted not only because it improved his health but also because she finally lost the fifteen pounds that she had been trying to lose for years. She lost weight merely by being supportive. She encouraged her husband to follow his meal plan and did not bring into the house foods he was trying to avoid. If you improve your food choices, you are making better choices for your family as well.

Food fuels our bodies, and our food choices do affect our health and our life. However, we must not ignore the fact that while we eat to live, we also eat to enjoy. Food is an important part of every social function in our lives. No one has a birthday party or anniversary party without serving food. It does not matter whether you go to a Fourth of July picnic or a fund-raiser for your favorite charity, food is central to the event.

Food has also become big business. Approximately twelve thousand "new" food products hit the market every year. Food technology has been a boon in supplying numerous varieties of foods to every area of this country, and that was unheard of just a relatively short time ago. We can eat strawberries and asparagus all year long. We can eat fresh fish in the middle of the desert, thanks to modern packaging, refrigeration, and transportation systems.

The miracles of modern food processing allow us to go to the supermarket and purchase complete pre-prepared meals; all we have to do is pop them in the microwave and eat. Unfortunately, because they are pre-prepared we are unaware of their ingredients and in many instances end up consuming too many calories, too much fat, too much sodium, and too little fiber. The frozen food industry provides a wide array of main dishes, vegetables, breads, and desserts all ready to just heat and eat. The problem for many of us is that we have become victims of this success. It is so easy to pop that frozen pie or those cookies in the oven because they are so convenient. So we tend to eat these high-calorie foods much more often than we would if we had to make them from scratch.

One of the easiest ways to make healthy eating simple is to eat as many foods as possible when they are as close to their natural state as practical. I am not suggesting we return to the hunter-gatherer era. What I do mean is that we go back to the basic food and eat it the way it grows as long as it tastes good that way. For example, a whole apple has more fiber and more satiety value (it fills you up) than a calorically equivalent amount of applesauce or apple juice (which is even more processed than the applesauce). Think about it: The apple takes virtually no preparation; all you have to do is wash and eat. If you are thinking about an orange or a glass of orange juice, try thinking about how many oranges it takes to make enough juice to fill a glass. If you drink the juice you may get more calories and carbohydrates than you should. Simply peeling and eating the orange is a much better choice.

Most of us are not going to make our own tomato sauce from scratch; however, we can make our own pasta sauce and thereby have control over the amount of fat and salt the dish contains. The same is true of many other foods. If you really want to know what you are eating, you need to do some basic cooking. Remember that even if you have never set foot in a kitchen, this isn't rocket science. If you can read and follow directions, you can cook.

Most people with diabetes will have to make some modifications in their eating habits. The most important thing to remember is that even though you have diabetes you can still eat food that tastes good and enjoy every bite. We acquire a taste for the majority of foods we eat when we are young and we can modify our likes and dislikes. If you doubt this fact, think about specific foods and beverages that you enjoy but that most kids will not touch. Conversely, kids have many favorite foods that you would never eat. Eating is a learned behavior. That fact puts you in control. If you learned to make poor choices, you can now unlearn them and relearn to make better choices. Part of the problem is attitude. It is true that you can teach an old dog new tricks. What is more important? Are you really willing to admit to yourself that you cannot change? Of course not. You are an intelligent person who is perfectly capable of accepting responsibility for and taking control of what you eat, your life, and your health.

It is very important to realize that virtually any type of food can "fit" into your new meal plan. If you cannot live without Mexican cuisine, do not panic. Italian, Greek, Mexican, Middle Eastern, and any other ethnic food are all possibilities. This book will concentrate on what you can eat rather than what you should avoid.

Some of the changes you can make in the way you eat to take care of your diabetes are straightforward. Make regular mealtimes a habit. It makes sense that if you eat breakfast you will not be "starving" by lunch. Or if you skip lunch, you are more likely to overeat at dinner. Eating regular meals and approximately the same amount of food at those meals each day can help you control your blood glucose.

If weight loss is your goal, and it is for the greatest majority of people with type 2 diabetes, food portion size and method of preparation become very important issues. You may be surprised to learn that the butter or margarine, sour cream and bacon bits, that you add to the baked potato have far more calories than the potato itself. If you have a lifetime membership in the "clean plate" club now is the time for change. It may be better to let food go to "waste" rather than to "waist." Variety, moderation, and balance are the keys to healthful eating. You will soon get "hooked" on fruits and vegetables the same way some people become "junk food junkies." The important thing is to consciously make food choices to promote your good health. Remember, good health and good glucose control are your goals, and when you achieve them weight will generally take care of itself.

Change Is Possible

I am going to introduce you to three people who are all patients of mine, all of whom, when diagnosed with type 2 diabetes, had the same question you have: "What Do I Eat Now?!?" See if you identify with any of them and their dilemmas.

Pete is the executive chef at a large hotel and casino in Las Vegas. He recently gained thirty pounds. Part of his responsibilities include making sure the all-you-can-eat buffet with its wide array of soups, salads, main dishes, and desserts looks and tastes great. How can he possibly change his way of eating? After all, he has to taste everything to make sure it is acceptable for his patrons. Can you imagine a worse scenario? Pete's problem is similar to that of many people who enjoy cooking and do so regularly. First of all he needs to become aware of what he is doing. "Tasting" does count and can add up to a considerable number of calories every day. In Pete's case he may want to use a smaller spoon for tasting so that he tastes, critiques, and moves on rather than eating a whole portion of something during preparation. The most important thing Pete can do is set realistic goals he can keep. It may be as simple as having a bowl of cereal in the morning so that he isn't starving when he arrives at work. That way he can taste what he needs to, rather than make a meal of "tastes" because he is hungry. Pete may also plan to take time to sit down and eat lunch. If he plans lunch he can have better control of what he eats than if he skips lunch and just "tastes."

Pete reminds me of many family cooks who sample so much in the kitchen that they have lost their appetite by the time they get to the table. One problem these "tasters" have is that tasting isn't satisfying. When you sit down to the table and eat, you know you have eaten a meal. When you pick in the kitchen it is easy to delude yourself into thinking that you really haven't had anything to eat. In the meantime you have consumed 300 or 400 calories as "tastes." If you are a "taster" your primary change may simply be to eat only at the table.

Molly is a working woman whose family was raised on carryout and convenience foods. She has struggled with her weight since the birth of her last child, 18 years ago. She gave up cooking when she started working full-time. For the past 20 years she has depended on carryout and convenience foods, which typically are high in calories, salt, and fat, to balance her schedule as a wife and mother. Molly is devastated with her diabetes diagnosis. Now she feels she will have to starve herself, because the doctor said she had to lose 75 pounds. Even if she had any desire to take up cooking again it was shattered by the thought of having to diet!

The first thing Molly needs to think about is how she can adopt some more healthful lifestyle habits that can be maintained long-term, rather than making weight loss a goal in itself. If Molly concentrates on healthy habits that will help her control her blood glucose, weight loss may end up being just one benefit that can last a lifetime. Molly's cooking skills may be rusty, but cooking is just like riding a bike: you really do not forget how to do it. She may be pleasantly surprised to find that over the last 20 years there have been lots of advances in cookware and cooking appliances that will make her new challenges easier and maybe even enjoyable.

Sam is a 73-year-old retired gentleman who has never had a weight problem and has just been diagnosed with diabetes. He just lost his wife. He never set foot in the kitchen except to talk to his wife. Sam is overwhelmed. His wife had always done all the food shopping and meal preparation in their home. Now that she is gone he has no idea of what to do. His doctor had recommended he make an appointment to see the dietitian, and Sam heeded that advice.

At his first appointment with the dietitian, she explained that the most important thing for Sam to do is to think logically. She had Sam sit down with paper and pencil and make a list of the things he enjoys eating for breakfast, lunch, and dinner. Sam thought about the way he has eaten all his life and listed the foods he commonly eats. He discovered there really are not that many foods on his list. The dietitian explained that most people repeat their food choices with regularity. She said that if you are suddenly faced with having to shop and cook for yourself, then breaking these new tasks down into parts will help you see that what seemed monumental has become manageable.

Sam looks at his list and sees that pretty much his whole life he has eaten cereal, juice, and toast for breakfast five days a week. Pancakes, waffles, bacon, and eggs were foods he only ate occasionally, on weekends and vacations. He has always eaten shredded wheat, GrapeNuts or frosted flakes for breakfast. The dietitian asked Sam if he is happy with these cereals or does he want to try something new. He is happy with these, so now all that they have to do is determine if he is eating an appropriate serving size of each cereal because it is important to try to eat the same amount of food at the same time each day. When she showed Sam how to check the Nutrition Facts on the cereal boxes he finds that the manufacturer says two shredded wheat biscuits are a serving and they contain 160 calories. Sam says he never eats more than one biscuit. One biscuit will provide 80 calories. If Sam wants to eat about the same number of calories from cereal each day he needs to find out what the serving size will be for Grape-Nuts and frosted flakes. The label says a serving of Grape-Nuts is cup and contains 200 calories. Sam could cut that in half and eat cup. He could look around the kitchen, find his wife's measuring cups, and use the one marked cup to scoop out the serving of Grape-Nuts. When he does the same thing for frosted flakes he also discovers he can have cup of frosted flakes for 80 calories. Sam puts about cup of milk on his cereal. He always drinks orange juice with his breakfast. He needs to measure out his-cup portion and use the same size glass every day. He also has one slice of toast with fruit spread and black coffee with Sweet'n Low. If Sam eats this same breakfast most days, his shopping and preparation for this meal become very simple.

Sam and his dietitian have figured out that this meal contains about 60 grams of carbohydrate. He learns that he can substitute two small waffles with cup of reduced calorie syrup for the cereal, milk, toast, and fruit spread. He can still have his small cup of orange juice. He can buy frozen waffles, the kind you can put in the toaster. By adding only two items to his shopping list that need virtually no preparation skills, he has added a new breakfast. Once in a while he goes to a restaurant and eats a poached egg and two slices of toast instead of the cereal and milk. He always eats pretty much the same amount of food each morning. That is important because if he eats too large a breakfast his blood glucose will go up and will be higher than it should be before lunch.

Sam isn't much of a lunch eater. Especially now that he has to prepare his own meals and eat alone. When he ate alone before he usually had a salami sandwich because he didn't have to cook that. The dietitian spoke with him about how it is important to space his meals throughout the day for better glucose control. She told Sam that if he ate his largest meal or dinner in the middle of the day he could plan "leftovers" for supper or his evening meal. She suggested that Sam might be more motivated to cook for himself if he could prepare two meals at once. For example, he could prepare chicken breast, rice, and vegetables for lunch. If he cooked two chicken breasts he could slice the second one for a sandwich for supper. She suggested he learn to use his leftover meat for sandwich meals. This is a far better choice than buying salami or other high-fat luncheon meats.

She told Sam that it was very easy to steam fresh vegetables in the microwave. All he had to do was wash the vegetables well under running water, trim the waste, cut, and cook. Use microwave-safe cookware for all cooking and reheating. She explained to him that it is not safe to use plastics not designed for the microwave in a microwave oven because the high temperatures may cause chemicals in the container to leach out into the food. Cookware specifically designed for the microwave oven also allows steam to escape and not build up pressure in the container. It is very simple to steam vegetables in the microwave without adding any fat during the preparation. Sam left the dietitian's office feeling much better about his ability to cope with the changes he realized he must make. Sam's regular eating patterns will help him to control his blood glucose.

Basic Menu

All three of these patients of mine were interested in controlling their blood glucose through healthful eating, and wanted help in planning meals. The menu I am suggesting here will demonstrate how easy it is to prepare a delicious and satisfying meal at home. It is one that I think Pete, our professional chef, would enjoy yet is also low enough in calories to please Molly's physician and simple enough for Sam to fix. It can be prepared for one as easily as for a group.


Mixed green salad with balsamic vinaigrette
Poached or broiled salmon
Steamed spinach
Baked potato
Fresh fruit

This menu incorporates variety and balance. The moderation is up to you, and moderation is crucial if weight loss is your goal. Chapter 2 talks about weight loss strategies and a different approach to measuring progress.

Excerpted from

What to Eat when You Get Diabetes: Easy and Appetizing Ways to Make Healthful Changes in Your Diet
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Healthy menus for Diabetes at