8 Weeks to Maximizing Diabetes Control. Laura Hieronymus

prevent hunger from meal to meal. This information does not replace expert advice. The best plan is one developed by you and your RD.

      (Carbs counted in grams.) Adapted from A Field Guide to Type 2 Diabetes. American Diabetes Association, 2004.

      To get started until you see the RD, set a target to maintain as consistent of a carbohydrate intake as possible. As you begin to have questions about your meal planning, keep notes so your RD can help you better understand your meal planning effort. Keep in mind that meal planning is an important part of your treatment plan, so don’t look upon it lightly. Just as you would follow up with your physician if he prescribed a medication for you, be sure you do the same with the RD. Follow-up visits with the RD can help you get your carbohydrate and nutrition needs adjusted to help you get the best possible glucose control.

      WEEK 3

      Know Your Nutrition Facts

      Nutrition labeling of foods is required by the Food and Drug Administration (FDA), under the Nutrition Labeling and Education Act of 1990—which identifies the nutrients that must be listed on food labels, other ingredients that may be listed, health claims, and standard portion sizes. The Act also defines terminology commonly used on labels such as light, low fat, and sodium free. The nutrition information on food labels can be found in several locations—the nutrition facts panel, the ingredients list, and other areas of the label where health claims may be displayed. As a consumer with diabetes, skill at reading food labels and recognizing the nutrient content of foods may benefit your blood glucose control.

      BASIC NUTRITION LABEL

      Your best source of information is the nutrition facts panel, where manufacturers provide serving size information, quantities of specific nutrients, and percent Daily Values (%DV). Nutrient information required on all food labels includes total calories, calories from fat, total fat, saturated fat, trans fat, cholesterol, sodium, total carbohydrate, dietary fiber, sugars, protein, vitamin A, vitamin C, calcium, and iron.

      Check the serving size

      All of the information on the nutrition facts panel reflects the serving size listed in the print.

      Calories

      The calorie information tells you the number of calories in the serving size (serving size listed on the nutrition facts panel). If the serving size increased, then the calorie amount is increased; likewise, if the serving size is cut in half, then the calorie amount is 50% less.

      Limit the fat

      The American Diabetes Association recommends that people limit their saturated fat intake to less than 7% of total calories, along with minimal intake of trans fat, on a daily basis. Saturated fat is a fat or oil—from either animal or vegetable sources—that is typically solid room temperature. Eating foods high in saturated fat is thought to contribute to higher levels of cholesterol in the blood. Trans fats are partially saturated and may increase your risk of heart disease. Your dietary cholesterol intake should be < 200 mg on a daily basis and your overall daily fat intake should be determined based on your individual need. Expert counseling with an RD is important to learn more about the various types of fat, as well as a recommended total daily intake of that is right for you.

      Check the total carbohydrate

      Focus on total carbohydrate (sugar is only part of the total carbohydrates) to determine the amount of carbohydrates in a serving. The total carbohydrates listed on the nutrition facts label are 31 grams each 1 cup serving that you eat. If the serving size is changed, you should calculate the total carbohydrate to match the change. For example, if you eat 1/2 cup, then the total carbohydrate is 15 1/2 grams; likewise, for 2 cups, the total carbohydrate is 62 grams.

      Note your protein

      The amount of protein you need is based on your size, calorie needs, and stage of life. The ADA recommends that most adults get between 15 to 20% of their daily calorie requirement from protein. In general, men need about 60 grams of protein per day and women need about 45–50 grams of protein.

      What about sodium?

      Keep in mind that the ADA recommends that adults get about 2,400 mg of sodium on a daily basis. Use this as a guide when keeping track of daily sodium intake. In some cases, a restriction of sodium recommended by your physician or RD. Adjust accordingly as you track the amount of sodium you eat.

      While this information can help you get started, keep in mind that visits with an RD can help you further analyze the nutrition information on the foods you are eating and help you make healthy food choices to keep your blood glucose control optimal.

      WEEK 4

      Portion Size Matters

      Whether it was in your early childhood years, any previous experience monitoring your eating habits, or any consults you have had in the past with a nutrition expert, somewhere down the line you have probably been exposed to portion sizes. These days, portion sizes are often blurred in a food service industry where smalls have become talls, mediums have become grandes, and larges are now super supremes. True, you may justify this by thinking you get more for your money, but in reality, increased portion sizes mean higher calories and more carbohydrates and fat, which can subsequently affect your blood glucose control and weight. Since weight is a concern of many with type 2 diabetes, sizing up your servings makes sense.

      While portion sizes in the marketplace have increased, standard serving sizes found on food labels and used by RDs when designing diabetes meal plans have not. When working toward keeping your portions in check, the following tips may be helpful.

      Measure your foods

      If you want to be sure of how much you are eating, use measuring tools—such as measuring cups, spoons, or a food scale that measures food in grams. Start by putting your usual serving on a plate, in a bowl, or in a cup, and then measure it. Next, measure out the standard serving or the portion specific to your meal plan and compare. What the difference? Are these changes you are willing to make? Keep in mind that YOU have to make the effort to scale down portion sizes.

      Estimate food portions

      While measuring food is by far the most accurate, there will be times when carting around measuring cups and spoons is not practical. In those instances, it may be helpful to use a measuring tool always available to you in any situation—your hands. Another way to help you estimate your portions is by using common, standard size items, when keeping your portions in check when measuring tools aren’t option. Examples include:

      • 2 Tbsp peanut butter (ping-pong ball)

      • 3 oz meat or poultry (deck of cards)

      • 1 medium fruit (a tennis ball)

      • 1/2 cup of fresh fruit (1/2 baseball)

      • 1 1/2 oz of low-fat or fat-free cheese (4 stacked dice)

      WONDERING HOW MUCH TO EAT? DO THE “HAND JIVE”!

      Hand Jive is based on a method used in Zimbabwe where teaching without any written materials is a common approach. The hand teaching method is very useful for anyone when estimating portion sizes.

      Adapted from Wondering How Much to Eat? Do the Hand Jive! American Diabetes Association, Diabetes Spectrum, Volume 12, Number 3, 1999.

      Pre-portioned foods

      Taking time in advance to package your foods in single portion sizes may be helpful. For example, measuring snack type foods and putting them in snack-size bags in 15 gram (carbohydrate) serving portions may be helpful in preventing the tendency to overeat, as well as keeping serving sizes in check. On pre-packaged foods, take time to review the nutrition facts label or ask your RD to help you figure out how to pre-portioned foods, such as frozen meals,