8 Weeks to Maximizing Diabetes Control. Laura Hieronymus

bran and germ, is the requirement for creating a refined grain. This is typically done to give the grains a finer texture and improve their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Some examples of refined grains are white flour, white bread, and white rice. Many of the refined grains are enriched, which includes adding certain B vitamins (thiamin, riboflavin, niacin, folic acid) and iron back into the product after processing. Experts will usually recommend the whole grain over the refined grain since fiber is not added back into the refined product.

       Vegetables

      Any vegetable or 100% vegetable juice counts as a member of the vegetable group. Vegetables may be raw, cooked, fresh, frozen, canned, dried, or dehydrated and may be whole, cut up, or mashed. Vegetables are organized into 5 subgroups based on their nutrient content. The subgroups are dark green vegetables, orange vegetables, dry beans and peas, starchy vegetables, and other. It is important to know that the subgroups of dark green, orange, and other vegetables typically contain about 5 grams of carbohydrate for every 1 cup of raw and every 1/2 cup of cooked vegetables. These are considered “free” foods because they have very little impact on blood glucose control when eaten in reasonable serving amounts. The subgroups which contain dry beans and peas and starchy vegetables contain more total carbohydrates and must be accounted for in the meal plan. One-half cup of these two subgroups is typically about 15 grams of carbohydrates.

       Fruits

      Any fruit or 100% fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut up, pureed. While fruits are fat free and contain healthy vitamins and minerals, they also contain carbohydrates. You will want to be attentive your fruit intake and the total amount of carbohydrates in the foods that you eat. Common fruits eaten that are equivalent to 15 grams of carbohydrate include: a small apple (2 inches in diameter), a small banana (about 4 inches long), 1/2 cup (4 oz) orange juice, or 17 grapes.

       Milk

      All milk products this food group. Foods made from milk that retain their calcium content are part of the group, while foods made from milk that have little no calcium—such as cream cheese, cream, and butter—are not. The healthiest milk group choices are those that are fat free or low fat. Many the foods from the milk group contain carbohydrates, such as milk and milk-based desserts like ice cream, ice milk, pudding, and yogurt products. An 8-oz glass of milk is about 12 grams of carbohydrates. Checking the nutrition facts label is key to helping you determine total carbohydrate content, as well as maintaining your awareness of the fat content for these items. Cheese is another product that contains milk, however, it is generally lower in carbohydrates per serving.

       Meat and beans

      All foods made from meat, poultry, fish, eggs, nuts, legumes, and seeds are considered part of the meat and beans group. These foods contain very little, if any, carbohydrates. Dry beans and peas are part of the meat and beans group as well as the vegetable group because they may regularly substituted for meat (as a protein substance) by those individuals who eat very little or no meat. Dry beans and peas do contain carbohydrates and need to be counted. Most meat and poultry choices should be lean or low fat. Fish, nuts, and seeds contain healthy oils, so choose these foods frequently instead of meat or poultry.

      A key to eating healthy is to make changes you can live with. In other words, diabetes is around for life and since healthy eating is a part of your treatment plan, your goal should be to learn strategies that work best for you. Divide and conquer! Think about and move forward with the changes you want to make—keeping in mind the week by week suggestions mentioned here.

      WEEK 1

      Know Your Personal Eating Habits

      Perhaps the best place to start is figuring out what you are eating now. Successful weight-loss programs ask individuals to be accountable for what they eat. One way to accomplish this is to keep a diary foods eaten on a daily basis and then review the records to determine what, how much, and when you are eating. Sharing your food diary with your RD may be a helpful way to create problem-solving strategies to make healthier choices. To get started, include the following information as you track your food intake:

      • Date

      • Time you eat

      • Food consumed (including all food, all day long)

      • Amount of food eaten (as close as possible)

      • Reason for eating

      • Total carbohydrate content

      • Calorie intake

      Date

      Along with the date, write down the day of the week. Do you see any trends on certain days of the week? For example, does your food intake change the busier you are? If so, how does it change? As you write down the amounts of food you are eating, are you surprised? the days go by, do you see yourself changing your intake at all?

      Time you eat

      Are you taking time for breakfast? How often are you eating on a daily basis? Did you realize when and how often you were eating (or not eating)?

      Food consumed

      Be specific about the types of food you eat. For example, if you have slice of bread, what kind of bread—White? Whole wheat? Whole grain? Honey wheat? This can help you and your dietitian better evaluate how nutritious your choices are.

      Amount of food eaten

      Be as honest and specific as possible. Use a measuring cup and spoons to determine the number of servings in a packaged food to accurate as possible.

      Reason for eating

      Add comments about the reason you are eating any amount of food. Are you hungry? Is everyone else eating (one, two, or three servings) and does that influence you? Do you eat when you feel nervous? Bored? Depressed? Do you eat when you watch television?

      Total carbohydrate content

      It may be helpful for you to track the carbohydrate content in terms of the number of carbohydrate choices in a particular food (one choice 15 grams of total carbohydrates), or simply the total number of grams carbohydrate in the item consumed. Tracking carbohydrates may help you create an awareness of total carbohydrate content in foods that you typically eat, and determine if you are consistent with carbohydrates from meal to meal.

      Calorie intake

      It many cases, monitoring calories can be beneficial. You may find that some of your favorite foods are loaded with calories. While you might not be willing to totally give up these foods, perhaps you might be willing to eat them less frequently, or in smaller amounts, means making positive changes toward better health. You may find that some foods are higher in calories than you suspected, or that by taking some steps to modify a recipe you can lower the fat and calorie amounts without sacrificing the good taste. By looking at your caloric comparison from day to day, you may notice patterns to help you make decision that can improve overall calorie consumption and provide better consistency in caloric amounts on a daily basis. Also, the information can create an awareness of the nutrition content, as well as the portion sizes, of the foods you are eating.

      WEEK 2

      Carbohydrate Target Amounts

      It is a known fact that carbohydrates are the nutrients that most directly influence blood glucose levels. As a person with diabetes, you need to know the target amount of total carbohydrates as you work with your meal planning. Work together with your RD to determine the healthiest number of carbohydrate grams with each meal and snack that you eat. By considering your age, body weight, activity level, any other medical problems you might have, as well as any desire you have to lose weight, the two of you can set up a plan that you can live with.

      KEEPING CARBS CONSISTENT

      Using the table below, find the adult that best describes you. Try and stay close as possible to the number of grams of total carbohydrate listed each meal and snack. Spreading carbohydrates out through the day can help minimize the load in your body