Food Is Not the Enemy

You can manage your diabetes and eat your cake, too

You’ve got diabetes. Your next thought may be: there goes any hope of enjoying an ice cream cone or Aunt Sadie’s famous apple pie. Not so!

It’s true that years ago people with diabetes were told to completely avoid sugar. This is no longer the case. Today, we know more about how all kinds of foods, not just sugar, affect blood glucose levels. We know more about how diet and exercise can help manage blood glucose levels. More precise insulin dosing lets you correct for glucose highs and lows before and after meals. And improved food labeling makes it easier to track your intake of carbohydrates and other nutrients. All of these advances now make it possible to fit occasional treats into any meal plan.

“There’s no food you can’t have because you have diabetes,” says Christine McKinney, M.S., a diabetes educator at Johns Hopkins Bayview Medical Center. Here’s how to make room for those special treats and still manage your diabetes.

Stop deprivation thinking

To most people, the word “diet” sounds like deprivation. Instead of thinking you’re following a “diabetic diet,” think of it as a “meal plan” or “food plan.” You are simply choosing to eat healthier.

Your chances of long-term success are better if you can modify your eating without feeling deprived. “Depriving yourself of foods you really crave can actually lead to overeating or binge eating,” says McKinney. “That could raise your blood glucose more than if you had just had that piece of candy to start with.”

Know how foods affect glucose levels

Blood glucose levels are affected by the total amount of carbohydrates you consume, which includes fiber and starch as well as sugar. For example, sugar-free cookies still contain carbs and increase glucose levels because they are made with flour (starch).

There’s no such thing as good and bad carbs, either. Some foods are just healthier sources of carbs than others. Consider this: two small chocolate chip cookies and a small apple may raise your blood glucose levels by the same amount because they have about the same amount of carbs. The difference is in their nutritional value—obviously the apple is a healthier choice. And the choice is yours.

“The good news is you can have a donut, slice of cake or any other treat you want—as long as you plan accordingly,” says McKinney.

Treat yourself, but only occasionally

The key to successful indulgences is to make it an occasional deviation from your regular meal plan, not an everyday habit. Sticking to a diabetes-friendly meal plan most of the time will help you enjoy special treats like cake and ice cream without derailing your diabetes management.

There’s no one perfect meal plan for everyone with diabetes. The American Diabetes Association (ADA) suggests a good meal plan is one that helps you control blood glucose, blood pressure and cholesterol, and also keeps your weight on track. A dietitian or diabetes educator can work with you to fit in your favorite foods and make recommendations based on what you like to eat.

Count your carbs

One way to stick to a meal plan but still be flexible is by counting carbohydrates. Once you know your carbohydrate goal at meals, you can include whatever carbohydrates you want. Food labels are a great resource because they tell you the amount of carbohydrates per serving size.

Here’s another strategy: Say it’s your birthday and you want to indulge in your favorite cake. Plan ahead. For the meal before cake, eat lower-carb choices like meat and non-starchy vegetables and “save” your carbs for the cake. Again, this is not something to do often but it’s fine to enjoy treats that were once forbidden foods for people with diabetes.

Don’t despair, be prepared

If you do overeat—you ate a big dinner and dessert and now your blood glucose has skyrocketed to 284 mg/dL—don’t despair. Make it a learning experience. Record what happened in your logbook, and why.

One effective way to lower your glucose level when it is elevated from overeating is exercise. Take an after-dinner walk or play catch with the kids in the yard instead of watching TV. If you take insulin and your doctor has taught you how to correct for glucose highs, then take extra insulin. If you take insulin and haven’t talked with your doctor about this, now is the time to do it.

Choose the lesser of two evils

Compare similar items when grocery shopping. If you check the nutrition labels on cracker boxes, for example, you’ll find there’s a big difference in the calories in 16 Wheat Thins™ (equivalent to one serving and 150 calories) and 16 Ritz™ crackers (equivalent to more than 3 servings and 240 calories). Ice creams vary widely in the calories per serving, too. Would a low-fat version of your favorite flavor still satisfy your craving?

Use available tools

Even if your meal plan is flexible enough to include occasional treats, it’s important to know how eating affects your blood glucose. Use these tools to stay on track:

• Blood glucose meter. Your doctor may recommend that you test your blood glucose before and 1-2 hours after a meal. In addition to helping you monitor your glucose levels, these measurements will help you learn how much certain foods raise your numbers.
• Logbook. Record meter readings along with when and what you eat and your activity level in a logbook. According to the ADA, testing regularly and keeping good records will give you and your health care team the most accurate picture of diabetes control.
• Insulin pump. The pump delivers more precise doses of insulin than is possible with injections. For example, instead of rounding to 10 units of insulin, you could give yourself 9.4 units. The pump also calculates the correct bolus amount (but you still have to count your carbohydrates!). The pump’s smaller and more frequent insulin doses are absorbed more consistently by the body than a single injection of a larger dose. Talk with your doctor or diabetes educator to learn if a pump is right for you.
• Insulin pen. Pre-dosed insulin pens are available for many different types of insulin. Since pens don’t need to be kept in a cool place like insulin, you can carry them with you and make quick adjustments before or after eating without disrupting your daily routine. And with a pen you just dial up the dose instead of using a syringe to draw the correct amount of insulin from a vial.

Food should be an enjoyable source of fuel, not your enemy!

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