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Diabetes And Nutrition

By: Maudene Nelson, RD, CDE

This blood sugar business can be tricky and confusing. Do you silently cheer when your blood sugar is low when you expected it to be high? Are you mystified when the number jumps into the oh-no! range after you’ve been so “good”? The first thing you think to blame is the bun on the burger or the croutons in the soup. Let’s look closer. You may be peeling the wrong banana.

Where Should Your Blood Sugar Be?

Normally the body tightly regulates blood sugar in the range of 60 to 115 mg of glucose per deciliter (mg/dl) of blood (less than 1/25 of an ounce in less than 6 tablespoons of blood). If you have diabetes, your blood sugar regulation is not as efficient, and you try to achieve the same normal numbers with a regimen of food balancing, physical activity, and medication. It is established knowledge that the closer your blood sugar is to that range, the better your long-term health will be. The American Diabetes Association evaluated the research on blood sugar levels and advises that you try to keep your blood sugar under 126 mg/dl as much as you possibly can. Everyone with diabetes should discuss their blood sugar goals for early morning, before and two hours after meals, and at bedtime with their doctor or certified diabetes educator (CDE).

Which Foods Contribute to Your Blood Sugar Fluctuations?

The amount of carbohydrates in your diet, and the type of carbohydrates, are the most significant dietary factors that cause blood sugar fluctuations. Remember, carbohydrate includes starches and sugars. So, any food that is starchy (breads, cereals, potatoes, rice, beans, and noodles, for example) or sweet (fruits, juices, syrups, candy, soft drinks, and ice cream, for example) will contribute to your blood sugar level after they’re eaten.

Natural sugar foods
Some foods may not taste particularly sweet but contain significant amounts of natural sugar. They include milk, carrots, tomatoes, ketchup, and some tart fruit juices such as grapefruit and even lemon juice. These are very healthful foods and should be included in your diet if you wish. The goal isn’t to eliminate them, just budget them. The popularity of smoothies and juiced vegetable-fruit blends presents a challenge to managing dietary carbohydrates. I like to say, “If you can't put them down, you’ve got to tally them up.” Those carbohydrates do count. A 12 oz. smoothie with fruit pieces, milk, yogurt, or protein powder may have as much as 50 grams of carbohydrate. Also, take a close look at canned meal replacements like Slimfast. Even if it’s all you eat at a meal, build the carbohydrate into your budget. Depending on your activity level and medication regimen, you might actually need more carbohydrate to prevent hypoglycemia (low blood sugar).

Artificially sweetened foods
Artificially sweetened foods and beverages are sometimes blessings and sometimes not. Don’t be surprised if one day, after a trip to the movies, your blood sugar shoots up. It could be that the “diet” soda you bought was the real thing. This error happens more times than you'd think. It’s a delight to get a “no sugar added” yogurt or ice cream. But read carefully: there is carbohydrate (usually milk sugar, lactose) in that food. One major brand of no-sugar-added yogurt recently replaced some of the aspartame with fructose. Although it won’t spike your blood sugar, it’s best to count that fructose into your total carbohydrate (at least it still tastes yummy).

“Light” foods
Look out also for some "light" foods that have removed some of the original caloric sweetener (such as sucrose, corn syrup solids, or high fructose corn syrup) and replaced it with a very low calorie sweetener (such as aspartame or asulfame-potassium). There is usually still quite a bit of sugar in that food or beverage. Logic tells us that even if a sweet and tasty food is advertised as: “no sugar added”, it must have something going on. If “sugar” is defined only as “sucrose” (table sugar), then food producers can sweeten it with honey, apple sauce, fruit juice concentrate, rice syrup or any of a host of other carbohydrate-rich products that can still affect your blood sugar. Try to look at the label or product information before dining on those.

Sugar alcohols (sugar-like molecules such as sorbitol) will have a negligible effect on your blood sugar but they are quite high in calories. I suppose our eyes see “sugar free” and we want that to mean no sugar, no carbohydrate, no calories and scrumptious taste. Well, maybe one day it will, but not yet.

Proteins
About half of the protein molecules in your food can be turned into glucose in your liver. This means that a 12 oz. portion of chicken or fish at dinner containing about 84 grams of protein (remember the exchange list? 1 oz. of meat has 7 grams of protein) will turn into about 42 grams of glucose by morning. My advice is to cut the protein serving in half (6 oz.) and enjoy 2-3 carbohydrate exchanges. Your kidneys may thank you someday.

The glycemic index
Thanks to studies on the “glycemic index” (the power of a food to raise your blood sugar) of foods, it is now known that some high carbohydrate foods, even pure table sugar (sucrose), have surprisingly little effect on blood sugars. Fortunately these are also filling and nutrient-rich foods. Enjoy an occasional splurge on these: all beans and peas, most vegetables, and nuts. Just remember that these are still carbohydrates, and need to be balanced with exercise or insulin.

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Which Foods Don’t Contribute to Your Blood Sugar?

Fat, such as oil, butter, margarine, or mayonnaise (or any fat exchange) will not goose your blood sugar. Yet, many people suspect that the butter on a buttered bagel raises their glucose when one slice of toast with jelly doesn’t. Logic leads you to the conclusion that the toast and bagel are bread so what’s the difference?...you guessed it. The bagel weighs in at the equivalent of 4 to 5 slices of bread. This is significantly more carbohydrate than one slice of bread, even with a bit of jelly. Similarly, people sometimes think that the fat of fried plantain or potato must have been the culprit and raised their glucose, because the boiled version behaved itself. Look again. Fried stuff tastes better so we usually eat more of it! There is potato in both meals, but the larger portion of fried potato results in more carbohydrate in that meal. The underlying message to this is that portions count – larger portions mean more carbohydrate and higher blood sugar.

Hidden sugars
Watch out for “hidden” sugar in foods. In cooking, sugar helps with browning. Added sugar also enhances flavors, especially in fast foods. And when a muffin or goodie shouts “fat free” on the label, it’s usually loaded with sugar. These are all examples of where sugar can hide in food. Watch out and steer clear.

The right fats
You don’t need to aim for a very low-fat diet. You can keep your calories under control and still enjoy dressings and spreads. Just remember to select fats that are low in saturated fat, low in hydrogenated oils, and rich in mono-unsaturated fat. Olive and canola oils are the champions, here. Select soft margarines in the tub, not the stick. These choices will help you to keep your “bad” blood cholesterol down and your “good” blood cholesterol up. Check the “Nutrition Facts” labels for fat content.

Artificial sweeteners
Sugar-free soft drinks will not raise your blood sugar. However, some research has shown that when carbohydrate cravings are not satisfied with a real carbohydrate, artificial sweeteners may increase the desire for starchy or sweet foods leading a person to overindulge on carbohydrate-rich foods. My advice is to be sure to include some real carbohydrates that you can indulge in: popcorn, flavored rice cakes, or cubed fresh fruit!

If you’ve read this far and realize that your starches and sugars are a wee bit too much, but you can’t imagine eating less of them … then introduce yourself to walking. (I would always rather walk it off than to give it up). Start with a call to your doc or CDE for the “OK” and make your walk 5 to 7 days a week for 15 minutes the first week. Add 5 minutes every week until you meet yourself coming and going.

Sweet Without Sweeteners

Our sweet taste buds can be fooled ... some of the time. Cinnamon and nutmeg always seem to “sweeten” foods and beverages without adding carbohydrate. Some work at the US Department of Agriculture even suggests that about ½ tsp of cinnamon may help to lower blood sugars.

To get the best blood sugar control whether you have Type 1 or Type 2 diabetes, start with a convenient blood glucose meter to measure your blood sugars, and a daily carbohydrate goal from your doc or CDE. Once you have developed a routine amount of carbohydrate at each meal, you will soon see how to take the mystery out of controlling blood sugar.

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