Diabetes: Food Management

Why is food management important?

Insulin is a hormone that helps sugar enter the body's cells and controls the level of sugar in the blood. When there is not enough insulin in the body, the amount of sugar in the blood reaches very high levels and can be very dangerous. When you have type 1 diabetes, your body makes little or no insulin.

Type 1 diabetes is treated with shots of insulin, diet (food plans), and exercise. The goal of meal planning is to keep your blood sugar as close to normal throughout the day by matching your insulin with the types and amounts of food you eat. Meals are planned to fit your lifestyle, culture, likes and dislikes and goals.

What are the types of meal plans?

There are several common meal planning approaches to help manage diabetes. Your provider can refer you to a dietitian to help you find a meal plan that works for you. Most plans are based on measuring carbohydrates in food because carbohydrates have the biggest effect on your blood sugar level.

Three common types of meal plans are:

• Constant carbohydrate meal plan: You eat a similar amount of carbohydrates each day to match a consistent insulin plan.
• Carbohydrate counting meal plan: You figure out how many carbohydrates you are going to eat at a meal and match your insulin dose to your food choices. The amount of carbohydrate may vary from day to day.
• Exchange meal plan: Foods are grouped into 6 food lists. Foods on each list have a similar nutritional value, number of calories, and carbohydrate content. It is called the exchange diet because you can exchange one choice on a list for another and still get the same food value. Your dietitian helps you plan a diet that includes the number of exchanges to eat each day.

Working with a dietitian gives you a meal plan that fits your lifestyle, culture, likes and dislikes and goals. It is important to have a plan you can use on a daily basis.

What are the principles of food management?

All meal plans are based on the following principles:

• Eat a well-balanced diet. The food pyramid can help you plan a well-balanced diet. A healthy diet has 10 to 20% of calories from protein (milk, cheese, yogurt, meat, poultry, fish, egg white, nuts and seeds), 50 to 60% from carbohydrate (fruits, vegetables, and whole grains), and 25 to 30% from fat (butter, egg yolk, animal fat, etc.).
• Keep the day-to-day calories about the same. It is easier to manage your blood sugar if you eat about the same amount of calories each day. If you eat less one day, you may have too much insulin and have a low blood sugar reaction (hypoglycemia). If you eat more one day, you may have too little insulin and have a high blood sugar (hyperglycemia). Your body will need more or less insulin as you eat more or less carbohydrate or are more or less active. It also helps to eat a consistent amount of carbohydrates at the same times each day. If you are taking the same amount of insulin, the constant carbohydrate and the exchange food plans both help keep the daily amount of carbohydrate consistent.
• Eat meals at the same time each day. The insulin you inject works to lower your blood sugar whether you eat or not. Therefore, it is important not to miss meals and to eat at about the same time each day to prevent low blood sugar. Carry snacks for emergencies, such as a late bus or a schedule change.
• Use snacks to balance insulin activity. Peaks in insulin activity vary from person to person. You may need a snack before lunch, in the late afternoon, or at bedtime. The type of snack is also important. Let your dietitian and provider know if you do or do not eat snacks and when you usually have them. You can adjust your insulin dose to fit the way you like to eat.
• Manage carbohydrates. Carbohydrates make up half of the food you eat each day. Because insulin is needed for the body to use the carbohydrate, it is very important to think about how much carbohydrate you eat and when you eat it and your insulin dose. The effect carbohydrates have on blood sugar can differ, depending on what else is eaten. Testing your blood sugar 2 hours after a meal will help you learn how combinations of foods affect you.
• Reduce saturated fat in the diet. Cholesterol and triglyceride are 2 of the major fats in the blood. Eating saturated fats raise cholesterol levels. Triglyceride levels can become high if blood sugar levels are high. Your cholesterol level and triglyceride level should be checked once a year. Because people with diabetes are at high risk for heart disease, keeping your cholesterol levels in the target range is essential for your future health.
• Maintain a healthy weight. Ask your dietitian how many calories you need to maintain a healthy weight. If you are overweight, talk to your dietitian about making a plan for gradual weight loss.
• Eat more fiber. Fiber is the roughage in food that is not absorbed into the body. Adding fiber may slow down the rise in blood sugar levels. For example, your blood sugar may not be as high 2 hours after eating an apple (15 grams of carbohydrate) as it is 2 hours after drinking 1/2 cup of apple juice (also, 15 grams of carbohydrate). Raw fruits, vegetables, legumes, high-fiber cereals, and whole-wheat breads are high-fiber foods.
• Avoid foods high in salt (sodium). Eating a lot of salt may raise your blood pressure. Increased blood pressure is a risk factor for heart and blood vessel disease and eye and kidney complications of diabetes. It is recommended that people with diabetes and high blood pressure eat less than 2,400 mg (about 1 and 1/4 tsp of table salt) each day.