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Eating with Prediabetes or Type 2 Diabetes

When people find out they have prediabetes or type 2 diabetes, the first thing they want to know is what they can eat, when they can eat, and how much they can eat. In fact, studies show that people with diabetes find dealing with food the hardest part of their diabetes care.

Many people think that having diabetes means they can’t eat their favorite foods. But that’s just not true. You can still eat the foods you love. By working with your dietitian and by reading this book, you will know how to include your favorite foods and still keep your blood glucose levels on track. For more information on blood glucose goals, see Chapter 8.

For most of us, food means more than just getting full. Eating meals brings us together with family and friends. It brings comfort and pleasure. That’s why, for most people with diabetes, food is the toughest part. There’s no doubt about it. Changing the way you eat or the times you eat can be really tough. But keep in mind that you’re in charge—you can do it.

When you’re first told you have prediabetes or type 2 diabetes, you may not be able to meet with a dietitian right away. So what do you do? There are many ways to take on diabetes meal planning, so let’s talk about some of those ways. The first diabetes meal planning method I’ll talk about is called Rate Your Plate.

Rate Your Plate

Life isn’t easy, and having diabetes isn’t easy. But an easy first step in meal planning is to Rate Your Plate. With prediabetes and type 2 diabetes, the amount of food you eat affects your blood glucose. Rate Your Plate is a method that helps you judge your food portions. In fact, Rate Your Plate gives you portion power. For most people with prediabetes or type 2 diabetes, eating smaller portions makes their blood glucose go down. Here’s how Rate Your Plate works. After you’ve put your food on your plate, take a look:

• Is about one-fourth of your plate filled with starchy foods, such as noodles, rice, corn, peas, or potatoes?

• Is about one-fourth of your plate filled with main dish (protein) foods, like meat, poultry, fish, or meat substitutes, such as cheese, eggs, or tofu?

• Is at least half of your plate filled with cooked or raw vegetables, such as salad, or cooked vegetables like carrots, green beans, spinach, or sliced tomatoes?

• You may also want to add one or two side foods along with your meal, such as a dinner roll and a small piece of fruit.

Check your plate against the picture shown above. How did you do? What changes do you think you need to make?

• Do you need to work on including more vegetables or fruit?

• Do you need to cut back on starches?

I’ll work on ___________________________________this week.

Now you know how to Rate Your Plate. Other members of your family who don’t have diabetes but want to lose weight might want to rate their plates along with you. Your family is a key part of your diabetes team when it comes to food and meal planning. Lean on them. Ask them for help and support. You may also become a role model for your family and friends by rating your plate and using portion power. Rate Your Plate also works great when you’re eating out. For more on eating out, see Chapter 5.

Now let’s talk about another diabetes meal planning method you can use before you see a dietitian. It’s called Carbohydrate Counting.

Carbohydrate Counting

We’ve talked about portion power when you Rate Your Plate. Now we’re going to talk about portion power with a focus on carbohydrates.

Carbohydrate counting is also called by a shorter name, Carb Counting. By counting carbohydrates, or carbs, in the foods you eat, you’ll have another way to keep your blood glucose on track. All foods contain the nutrients that your body needs: carbohydrate, protein, and fat.

• Carbohydrate. Carbohydrate foods can be put into four groups:

1. Starches, such as crackers, cereal, corn, bread, rice, and tortillas

2. Fruits, such as apples, berries, cherries, mangos, and peaches

3. Milk products, such as milk, yogurt, or buttermilk

4. Sweets and desserts, such as cookies, cake, ice cream, and pastries. Some sugar-free and fat-free foods have carbohydrate, too.

• Protein. Protein foods can be put into two groups:

1. Meats, such as beef, pork, fish, or chicken

2. Meat substitutes, such as beans, cheese, eggs, or tofu

• Fat. Fats can be divided into four groups:

1. Unsaturated fats are found in canola oil, olive oil, avocado, and nuts like almonds and walnuts. They can protect your heart by lowering your blood cholesterol.

2. Saturated fats are found in high-fat meats, such as hot dogs, sausage, and in high-fat dairy products, like cheese, cream, and whole milk. They can raise your blood cholesterol level.

3. Cholesterol is found in foods from animals, such as egg yolks, liver, and high-fat meats and high-fat dairy products. Cholesterol in foods raises your blood cholesterol level.

4. Trans fats are found in baked goods made with hydrogenated oil. Trans fats can also raise your cholesterol level.

Carbs give you calories and energy. But they also raise your blood glucose more than anything else you eat. Protein and fat give you calories and energy, too, but they don’t raise your blood glucose. If you need to lose weight, though, using portion power for protein foods and fats will help you.

Most people I know are like me—they love carb foods. And many carb foods are healthy foods. Carbs provide good taste, pleasure, energy, vitamins, minerals, and fiber. Even though carbs raise blood glucose more than other foods, it’s important for you to have some carbohydrates. For many reasons, then, “carbs count.” If you can get the right balance between the amount of carbs you eat and your insulin or diabetes pills, that will help keep your blood glucose in your target range.

The first thing many people ask me is: “How many carbs can I eat?” For many people, having:

• 3 or 4 carb choices at each meal and

• 1 or 2 carb choices at snacks

is about right. Then round out your lunch or dinner with:

• 1 serving of meat, fish, or poultry, about 3 ounces

• Plenty of colorful veggies, such as green beans, broccoli, red peppers, or cabbage

• Healthy fats, like canola or olive oil, nuts, seeds, or avocado

Here is a meal that has 4 carb choices (the carb choices are in bold print, so you can see them):

• 3 small corn tortillas (3 carb choices) with meat, salsa, lettuce, and chopped tomato

• 1/3 cup of rice (1 carb choice)

But what about portion sizes for carbs? Portion power with carbs helps keep your blood glucose in your target range. And by keeping your blood glucose levels in your target range, you can prevent or delay diabetes problems.

Take a look at the serving size guide below.

Earlier I mentioned that my mom has diabetes. A few years ago, after Thanksgiving, she was diagnosed with type 2 diabetes. Mama was having severe back problems and wasn’t able to be very active. But she and my dad were still enjoying the holidays with more food, which meant more calories. As a result, her weight went up to its highest point ever. As part of a routine checkup, her doctor checked her blood glucose level. Her blood glucose indicated she might have diabetes, so her doctor checked again a week later. Her blood glucose was still too high. Mama was scared when she was diagnosed with diabetes. She was scared because her sister had died from diabetes problems. But she was also surprised. She said she never thought she would have to worry about diabetes—even though diabetes ran in her family.

Her doctor signed her up for diabetes education classes at one of the local hospitals. While she was waiting to attend the classes and see a dietitian, she wanted me to be her dietitian! She wanted to get started right away. I told her it would be hard to be her daughter and her dietitian at the same time. She needed her own dietitian. But while she was waiting to see the dietitian, we got started. She and I talked about Rate Your Plate. After rating her own dinner plate, she decided she was eating way too many carbs. Mama loves carbs like I do—like mother like daughter, they always say. She also knew she and her doctor had agreed that she’d work on losing 15 pounds. We then talked about carb counting and trying for 3 carb choices at each meal and 1 carb choice for an evening snack.

Mama wanted her carb counting to be as simple as possible. She didn’t want to be looking things up in a book all the time. Here’s what we worked out for her to count as 1 carb choice:

1/2 cup of any starchy food, such as potatoes, cooked beans, peas, or corn

1/3 cup of cooked pasta or rice

1 small piece of fruit or 1/2 cup of fruit

1 cup of milk or yogurt

1/2 cup of low-fat ice cream or frozen yogurt

2 small cookies

1 handful (about 3/4 ounce) of pretzels, baked chips, or snack crackers

1 small dinner roll, tortilla, or muffin

1 piece of bread, 1 biscuit, 1/2 English muffin, 1/2 hamburger or hot dog bun, or 1/4 of a bakery bagel

1 cup of soup, such as chicken noodle, tomato, or split pea

1/2 cup of cooked cereal, such as oatmeal or grits

3/4 cup of dry ready-to-eat cereal, such as Cheerios

Any food that contains about 15 grams of total carbohydrate on the Nutrition Facts Label (see Steps in Using a Food Label to learn more about reading food labels).

Mama thought the serving sizes seemed awfully small, especially that 1/4 bagel. Then we talked about having 3 carb choices at breakfast. Three carbs could be a 1/2 bagel (2 carb choices) and a 1/2 cup orange juice (1 carb choice) to drink with her medicine. That seemed more like something she could do. Today Mama skips the orange juice and drinks low-sodium vegetable juice to take her medicines. She likes saving that carb for fresh fruit or jam.

Next we did some meal planning for lunch and dinner. She decided on a sandwich on whole wheat bread (2 carb choices) and some baked chips (1 carb choice) for lunch. For dinner she wanted all 3 of her carb choices as spaghetti (about 1 cup, cooked).

For her bedtime snack, Mama said she would have a piece of fruit (1 carb choice), like a peach, apple, or orange. Or she might choose a glass of 1% milk for 1 carb. Or she might have a cup of light yogurt, like lemon or blackberry, for 1 carb. Or a couple of small cookies would be 1 carb.

“This isn’t so hard,” Mama said. “It’s like I have a bank account of carbs for my meals and my evening snack. Then I spend the carbs in my bank account for the foods I love.”

Then she thought about the rest of her meals. “But what about the rest of my meal?” Mama asked. “What about the meat and my salad with dressing?” I suggested she try for about 3 ounces of lean meat, poultry, or fish.

“I don’t love meat the way I love carbs, but I’m not sure how much 3 ounces would be,” Mama said. “And I need this to be simple. I don’t have all day to be weighing and measuring my food. Besides, I thought you said carbs were what would raise my blood glucose.”

“That’s right, carbs are what raise blood glucose, but because you want to lose weight, you’ll want to watch your portions of meats, too,” I said.

“So portion power is coming into play with meats, too,” Mama said. “How can I keep this simple?” We decided to look at a serving of 3 ounces of fish, poultry, or meat this way:

• a meat patty or serving the size of a mayonnaise jar lid

• a serving the size of the palm of your hand

• a serving the size of a deck of cards

• a serving the size of a checkbook

• a serving of three meatballs the size of ping pong balls or golf balls

“Those would all fill about one-fourth of my plate, just like when I rate my plate,” Mama said. “That makes sense to me. But what about tuna fish or cottage cheese—how do you count them?” she asked. We decided to count half of a 5- or 6-ounce can of water-packed tuna or 3/4 cup of low-fat cottage cheese the same as 3 ounces of meat.

“But what about regular cheese—how do I count it?” Mama asked.

“Mama,” I said, “1 slice of cheese would be equal to

1 ounce of meat. Or a 1-inch cube of cheese, say, the size of 4 dice, would be equal to 1 ounce of meat. You know that a lot of cheeses are high in fat and cholesterol. Think about choosing fat-free or low-fat cheeses when you can. This will be good for your heart and blood cholesterol level.”

“That reminds me that we haven’t talked about fats yet, like margarine and oils,” Mama said. “I know they say to eat less fat to lose weight.”

“That’s right, Mama,” I said. “Fats have twice as many calories as carbs or protein. So choosing one or two fats at a meal or snack would be about the right amount.”

“So how much is a fat?” Mama asked. “And keep it simple.”

“A fat serving is about 5 grams of fat and about 45 calories, but that’s not simple, is it?” I said. Mama and I decided about 4 fats a day would be right for her and that she’d count these as 1 fat:

• 1 teaspoon margarine, butter, mayonnaise, or oil. That’s about the size of the tip of your thumb.

• 1 tablespoon reduced-fat margarine, reduced-fat mayonnaise, cream cheese, or half-and-half cream, the size of the pad of your thumb.

• 2 tablespoons reduced-fat salad dressing, reduced-fat cream cheese, or reduced-fat sour cream. Two tablespoons would be about half a ladle of dressing at a salad bar.

“How would you like some good news, Mama?” I asked.

“What’s good about having diabetes?” she asked.

“The good news is that sometimes finding out you have diabetes is a wake-up call,” I said. “People eat better, lose weight, get more active, start feeling better, and just enjoy life more. But the best news about diabetes is that you can prevent or delay diabetes problems like the problems Aunt Carla had.”

“That is the best news I’ve had in a long time!” Mama said. “Is that all there is to eating with diabetes?”

“That’s a good start, Mama,” I said. “Plus just keep on making healthy food choices.”

Then the time arrived for Mama’s diabetes education classes. I told Mama that she needed to tell her dietitian the way she likes to eat and then work together to design her own meal plan.

Your meal plan needs to fit your schedule, your likes and dislikes in foods, how active you are, when you like to eat, and where you go when you eat out. You and your dietitian will then design a meal plan that will fit the way you live and will include the foods you and your family like.

Luckily, a diabetes meal plan is good for the whole family. Making one dinner is hard, but making two—one for you and one for your family—just won’t work. The foods you choose for taking care of your diabetes are the same foods that we all need to eat to stay healthy, whether we have prediabetes or diabetes or not. It’s been great that Dad has been part of Mama’s diabetes team. He’s helping her count carbs. In fact, he’s lost about 10 pounds by rating his plate and counting his carbs, too. And he’s starting to walk some. Mama has been a good role model for him.

The first day of Mama’s classes, a nurse educator talked to the group about diabetes in general, about checking blood glucose, and about things that affect blood glucose. Many family members, like me, were there to learn about diabetes care. They asked lots of questions and learned from each other.

Mama then worked with Marion, a dietitian and CDE. Marion started by talking about Carb Counting with Mama. Marion was pleased to learn that Mama had already started counting her carbs. Marion agreed that 3 carb choices at meals and 1 carb choice for a bedtime snack was a good starting point for her. Marion told Mama the next step was to start checking her blood glucose to see how this plan was working for her. For more on checking your blood glucose, see Chapter 7.

Next, Marion had Mama look at a food label. The Nutrition Facts label can help with meal planning. It can also help you make better food choices when you’re shopping.

In the food label shown below, let’s go through the steps together to see how it can help you.

Steps in Using a Food Label

Step 1—Serving size.

Look first at the serving size. All of the numbers in the Nutrition Facts box are based on this serving size. Is this the serving size you will be eating? How many servings are in the container or bag? In the sample label, one serving of macaroni and cheese equals 1 cup. If you ate the whole package, you would

eat 2 cups. That doubles the calories and other nutrients.

Step 2—Calories.

Now look at the calorie section of the label. It can help you with your weight. On this label, one serving of macaroni and cheese is 1 cup and 250 calories. If you eat 2 cups, it will be 500 calories. Eating too many calories will lead to weight gain.

Step 3—Total fat, saturated fat, trans fat, cholesterol, and sodium.

Look at the grams of total fat, saturated fat, trans fat, and cholesterol. Eating too much of these fats may increase your risk of heart disease, some cancers, or high blood pressure. The same is true for sodium (salt). Experts suggest eating as little saturated fat, trans fat, cholesterol, and sodium as you can.

Step 4—Total carbohydrates.

How many grams of carbohydrate are there in one serving? Mama said 31 grams, and she was right! If you eat two servings, it would be 62 grams, which is too high for most meals. Divide total grams of carbohydrate by 15 to find out the number of carb choices. One serving of the macaroni and cheese would be 2 carb choices because 31 grams divided by 15 equals 2.

Step 5—Fiber, vitamins A and C, calcium, and iron.

Most of us don’t have enough dietary fiber, vitamins A and C, calcium, or iron in our meal plans. They are identified in the food label. Eating enough of these nutrients can improve your health and help reduce your risk of some diseases. For example, getting enough calcium may reduce the risk of brittle bones as we get older. That condition is called osteoporosis. Eating plenty of dietary fiber promotes healthy bowel function. Make an effort to choose fruits, vegetables, and grain products that contain dietary fiber.

You can use the Nutrition Facts label to compare products. Let’s say you’re shopping for canned soup. By looking at the Nutrition Facts label, you will be able to tell which brand is lower in calories, total fat, trans fat, cholesterol, and sodium.

You may be thinking that using the Nutrition Facts label will take more shopping time. That’s true the first few times you use the label. But over time, you will find that it is a great tool to use for healthier shopping and eating.

Making Healthy Food Choices

Marion, the dietitian, and Mama then talked about making healthy food choices when planning meals. Marion suggested eating a wide variety of foods daily. Marion said this meant:

• Eating some fruit each day.

• Eating lots of vegetables that aren’t starchy, such as tomatoes, cabbage, asparagus, cauliflower, green beans, broccoli, carrots, mushrooms, okra, leafy greens, and turnips.

• Trying to eat different colored fruits and vegetables, such as dark green (collards or broccoli), orange (cantaloupe, apricots, or carrots), red (watermelon or tomatoes), blue (blueberries), and white (banana, cauliflower, or turnips). Some people call this “eating the rainbow.” Research shows that eating colorful fruits and veggies also helps prevent cancer and heart disease.

• Choosing different kinds of starches, such as corn tortillas, black or pinto beans, hominy, whole-grain breakfast cereals and breads, and sweet potatoes.

• Eating high-fiber foods, like beans, whole-grain breads and cereals, and fruits and vegetables.

• Checking food labels for breakfast cereals that have at least 4 grams of fiber per serving.

• Looking for breads that have 2 to 3 grams of fiber per slice.

• Choosing dairy products that are low in fat. Nonfat (or skim) milk and 1% milk are the good choices. Light yogurts are also great when you want something sweet. Check the Nutrition Facts label for yogurts that are sweetened with a calorie-free sweetener.

Mama and Marion decided to choose only one or two changes for Mama to work on. Mama decided she wanted to eat more colorful fruits and vegetables. She thought it sounded like fun to eat the rainbow.

You may want to think about doing some of these things—one at a time—along with Rate Your Plate or Carb Counting. Read through the list of ideas above, and pick one action item you want to work on.

This week, I’ll work on ____________________________________________________________________.

The following week, I’ll work on _____________________________________________________________.

Marion gave Mama a longer list of carb choices. That list is at the end of this book in Chapter 21, Diabetes Tools. If you decide to count your carbs, this longer list may come in handy later on.

Glycemic Index

Mama heard about the glycemic (gly-SEE-mik) index on TV. The glycemic index is a number that tells you how much a carb food will raise blood glucose. A carb food may raise blood glucose a lot, a little, or somewhere in between.

Mama called and said, “I’m confused by this glycemic index. I thought all carbs raised blood glucose.”

“You’re right,” I said. “All carbs do raise blood glucose, but some carbs raise blood glucose levels more than others. For example, corn flakes raise blood glucose more than oatmeal. For some people, using the glycemic index can help them keep their blood glucose on target.”

“Well, what carbs raise blood glucose less?” Mama asked.

“The glycemic index for a food is not the same for everyone. The glycemic index of a food is also not the same for every meal. It depends on what else is in the meal, such as foods containing fiber or protein. It also depends on how well a food is cooked, like how long you cook your pasta. Research shows that you may have lower blood glucose levels after eating a meal if you choose low glycemic index foods, such as: