Читать книгу Practical Carbohydrate Counting - Hope S. Warshaw - Страница 16

The number of meals and snacks a person eats should be based on two factors: current food habits and daily schedule. Understanding a person’s food habits and general daily schedule casts light on blood glucose results and control. Find out if the person is a three-meal-a-day eater, a person who finds it helpful to snack between meals, or a three-meal-a day eater and nighttime snacker. Learn about how and why a person divides his or her food between the number of meals and snacks he or she eats each day. Perhaps the person barely eats breakfast and eats a large evening meal. This might be why blood glucose levels after the evening meal are higher than at other times of the day. If the person eats snacks, find out why.

In addition, review the types and doses of blood glucose—lowering medications he or she has been prescribed. Overlay this information with their food intake and daily schedule. Then think about how well this routine works for them or whether a change in his or her medication and/or medication schedule may improve glycemic control. Keep in mind that it is easier for someone to change a medication or medication regimen than to change lifelong food habits.

After exploring and considering the above factors, divide the total amount of carbohydrate into meals and possibly one or more snacks. Strive for a balance of carbohydrate throughout the day and a similar amount of carbohydrate at meals and snacks from day to day. However, keep the person’s food habits in mind. Recognize that the average American eats a light breakfast, slightly heavier lunch, and the biggest meal at the evening meal.

Note that an eating plan for people with diabetes should no longer automatically include snacks. The rationale in years past for including snacks was to prevent hypoglycemia, a common risk from the then limited array of oral blood glucose—lowering medications and insulins (Polonsky and Jackson 2004). If hypoglycemia is occurring regularly, work with the person to determine the common reasons for their hypoglycemia and develop solutions that involve changes or timing adjustments with blood glucose—lowering medications and/or food intake. Include or eliminate snacks with the goal of achieving a balance between food habits and hypoglycemia prevention (if they take a medication that can cause hypoglycemia). If someone doesn’t want to include snacks and is not on blood glucose—lowering medication that can cause hypoglycemia, then snacks are unnecessary. If a person doesn’t want to include snacks and is on a multiple daily injection (MDI) insulin regimen or a continuous subcutaneous insulin infusion (CSII) pump, then snacks are unnecessary. An exception comes with young children. If a child has a small appetite at meals or difficult-to-control nighttime hypoglycemia, then snacks (generally three a day) are probably necessary to meet nutrition needs.

Table 3-2 provides a sample handout to help people learn how much carbohydrate to eat, how to divide the carbohydrate into meals and snacks, and space to work out or provide two sample meals.