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11
DINING DIABETICALLY
Healthy Eating With Diabetes
Food. The diabetic’s biggest pleasure, greatest frustration, and worst temptation! Even the mere thought of food can bring on a flood of mixed emotions to a person whose entire life is a delicate balancing act—a struggle to maintain the correct balance of food, exercise, and insulin or other diabetes medicines.
Back in the days before insulin and oral medications were discovered, diabetics were put on a near-starvation diet with very little carbohydrate allowed. Without energy-giving foods, they had to stay in bed all the time because exercise without “fuel” would be dangerous!
When I was a child, the doctor told my grandmother that she had diabetes. He prescribed some pills and put her on a special diet. The diet part was horrible! Even I was unhappy because it seemed that everything Grandma had always enjoyed eating was now forbidden. When we went to visit, Grandma still took pleasure in watching me eagerly devour all the goodies she had made and the delicious fruits that she and Grandpa had grown on their farm. But it was never quite the same again because I knew that Grandma couldn’t have any.
Today the diabetic still has to live with food restrictions, but fortunately most doctors have learned a few things through the years. Now, more and more doctors, dietitians and diabetes educators try to adapt a diabetic’s diet plan to what the person was accustomed to eating before diagnosis. That way the changes in his diet may not be quite so major and traumatic as they were in Grandma’s time.
The Diabetic Diet Is a Healthy Diet
One diabetes educator commented that the diet for the diabetic is no different from that which the whole population should be eating. I know many diabetics who would wholeheartedly agree. They feel that their total lifestyle as diabetics has probably made them much healthier than they would be otherwise.
After cooking for her diabetic husband for 19 years, my friend Carole believes that the whole family has benefited from the changes in their diet. Now, she says, “We almost never have a sickness or a cold in the family.”
Eating a Balanced Diet
What do we mean when we talk about a “balanced diet”? It simply means eating proper amounts of those kinds of foods which will supply all the nutrients needed to maintain good health, or to repair the body in case of injury of illness.
Whether or not we have diabetes, our meals should provide adequate amounts of all of the major nutrients. The main difference is that the diabetic’s body is not able to metabolize the energy foods in the same way as the body of the nondiabetic. Because of this, the diabetic must make changes in his diet, and he may also need to take insulin or oral medicines to help in the metabolism of the energy foods.
The person with diabetes simply needs a modified version of a normal, nutritious diet. Each person’s diet plan will be slightly different because it must be based on his own individual need for energy, which is measured in calories. Later in this chapter we will look at how to make some of these modifications, but for now let’s see the major components of a balanced diet.
Carbohydrates
Carbohydrates provide man’s main source of energy—they give the fuel on which the human body runs.
A diabetic should get at least 55-60 percent of his calories from carbohydrate foods. (Some doctors feel that the percentage of carbohydrates should be even higher.) There are actually two main types of carbohydrates for the diabetic to consider—simple carbohydrates (or simple sugars) and complex carbohydrates.
The first group, the simple carbohydrates, includes all of the actual sugars, honey, jams and jellies. Cake, candy, pastries, cookies—most of the sweet snack or dessert foods—contain mainly simple carbohydrates. These foods raise the blood sugar to a high level quite quickly. However, they often provide very little nutrition and almost no fiber.
The second group is the complex carbohydrates, including all of the starchy and the cellulose containing foods. Here we find whole grain breads, cereals, noodles, rice and other grains. In this group we also have beans, lentils, split peas and other legumes, as well as potatoes, yams, squash and other starchy vegetables. Fruits are also an important part of this group.
The complex carbohydrates generally raise the blood sugar more gradually, which is safer for the diabetic. Also important is that these foods provide a variety of vitamins and minerals as well as a good amount of fiber. The fiber is especially important to a diabetic because it helps to control the amount of sugar and fat in the bloodstream.
Proteins
Proteins are important for body growth and repair. The bones, muscles and skin are made mostly of proteins. So are the brain, the heart, the liver, the kidneys, and the other vital organs of the body.
Protein may come from either animal or vegetable sources. Unfortunately, the animal sources—including meat, fish, poultry, eggs, milk and cheese—come naturally prepackaged with no fiber but plenty of cholesterol and extra fat, which the diabetic as well as his nondiabetic family members should avoid.
Vegetable sources of protein include grains, nuts, vegetables and the legumes—beans, lentils and split peas. The vegetarian diet, when well balanced, is actually a healthier diet with less risk of diabetes, heart attack, stroke, cancer, and many other serious diseases.
A diabetic should take about 15 percent of his daily calories in the form of protein foods. More than that may become a burden on the kidneys, which are often already overworked in diabetes.
Fats
Fats are a concentrated form of energy. Those fats not used up as energy are deposited as fat in the body, where they insulate the body against cold and prevent injury to the important organs.
Some doctors advise that 25-30 percent of the diabetic’s calories should be in the form of fats. But don’t let this fool you into thinking that you can eat all the fat you want. Remember, we said 30 percent of the calories—not 30 percent of your food. There are a lot more calories stored away in fat than there are in the same amount of other foods. While one gram of carbohydrate or protein gives only four calories of energy, the same amount of fat gives nine calories.
Furthermore, there is some disagreement over this 30 percent figure—many doctors and researchers now feel that this amount is far too much. Because of the great influence which fat has on diabetes control and complications, we will talk more about it later in this chapter.
Vitamins and Minerals
Vitamins play a vital role in regulating many of the body functions. They are also often thought of as the protective elements in our diet. By eating a wide variety of fruits, vegetables, unrefined grains, nuts and legumes, we should be able to get all the vitamins and minerals that our bodies need.
Minerals have various important functions in the body. Calcium, magnesium and phosphorus give strength to the bones and teeth. Calcium also helps the blood to clot and the muscles to relax. Iron is important to the oxygen-carrying hemoglobin of the blood. Other minerals are necessary for the digestive juices and other body fluids.
Water
Although water is not really a nutrient, and it contains no energy or body-building materials, it is still an extremely important part of our lives. Besides helping with the regulation of various processes, water also provides the body’s internal transportation services.
For the diabetic—as well as for anyone else—pure fresh water is the best possible drink because it contains no sugar, no hidden fats, and nothing else which might be harmful to the body.
Meal Planning
When it comes to planning meals for the diabetic, there is an easy way and there is a seemingly more difficult way. The only trouble is, the easy way may turn out to be the hardest in the end.
Unfortunately some doctors advise their patients to take the easy way out. These doctors are so busy seeing patients with so many different kinds of diseases that they don’t keep up with what is really the best treatment for some of the common old diseases.
For example, Steven Lee’s general practitioner told him, “You should eat anything you want, and just take the proper insulin for it.” But Steven, who is an insulin-dependent diabetic with quite good control, strongly disagrees with that advice. To Steven, “It’s easier to eat a balanced, even diet.” He doesn’t want to be like Nancy’s many diabetic friends who “eat anything they want—no worry. Then they take their diabetes medicines and go to the doctor.”
This “easy way” idea of indulging and enjoying whatever you want whenever you want it—then trying to adjust medicine doses afterwards—just opens the way for serious diabetes complications later on! It may seem more difficult to carefully plan meals, to restrict your diet a little and leave out some of your favorite foods. In the long run, however, it is so much better to practice a little prevention and control now than to pay the penalty later in suffering and extra medical expenses.
It takes some careful planning and a bit of time to get adjusted. There are almost certain to be frustrations and feelings of being deprived at first. But most diabetics who take the time and effort to make the changes will find that proper food selection becomes a routine which is no longer difficult to live with.
Not too long after her diabetes was diagnosed, Nancy complained to a friend about not being able to eat any of the “fun stuff” that she used to eat. Her friend looked straight at her and said, “You’ve had 50 years to eat your fill of all the junk you wanted. Now just get on with the good stuff!”
Gradually Nancy has been able to make the adjustment to being a diabetic and “getting on with the good stuff”. At a recent office party, she watched as 50 or 60 of us enjoyed the yummy chocolate ice cream. Though she would have enjoyed eating some, she chose not to. “Food that was once a temptation is not any more,” Nancy said later. “Now I just feel that it’s not my food.”
Sooner or later every diabetic must decide what is appropriate for him and what is not. For Robert, living with diabetes is similar to raising a child. If you tell a child “no”—that he may not have a certain food or that he may not do something—guess what the naturally is going to want. The very thing you have denied!
In his own experience, when he is tempted to eat candy or other sweets. Robert feels that it is better to tell himself, “If you want it, you can have it. But, if you take it, you’ll have to take an injection. Do you really want an injection?” Often this little one-sided conversation with himself stops him from taking the sugar or other food. “I must think of the consequences and make choices for myself,” he says, “rather than having someone else make the choices for me.”
Good planning for your meals is important. In fact, it is so important that a good doctor will not leave you to do the planning all by yourself. He will have a qualified nurse, dietitian or health educator help you with it. More and more hospitals now have a diabetes training staff on duty to help diabetics and their families with meal planning and other problems related to diabetes.
In case you are interested in going through the whole process of working out a meal plan yourself, you will find the detailed steps in the next chapter.
But for now, let’s move on to some simpler general guidelines for meal planning. These guidelines will help the diabetic to maintain better blood glucose control and to prevent the complications of diabetes. They will also help you and me to live more healthy and hopefully diabetes-free lives.
How to plan the day’s meals depends greatly upon each individual’s needs and upon the kind of insulin or other medication he is taking. It depends on how much he weighs, and on how much he exercises.
There are some basic differences between type I and type II diabetics when it comes to diet planning. Nevertheless, there are also some rules for healthy eating that apply to all diabetics. So let’s briefly look at their dietary needs separately, and then we’ll look at some of the guidelines that apply to all diabetics—and are good advice for the nondiabetic as well.
DIET FOR THE INSULIN-DEPENDENT DIABETIC
Many type I diabetics are underweight. Therefore, one of the big considerations in planning a good diet is to give the diabetic person enough calories to stay at his ideal weight.
Another important factor in planning his diet is the amount and type (or types) of insulin he is taking. Some insulins are fast-acting, some have a medium-length of action, and others are slow-acting but last for many hours.
The diabetic must also consider how much exercise he usually gets, and what time of day he exercises. (Getting approximately the same amount of exercise at a regular time each day makes planning easier.) The diabetic has to carefully plan the timing of his insulin injections to coordinate with when he normally eats his meals and when he gets his exercise. At a diabetes conference I once attended, a dietitian gave us some “survival guidelines” for the diabetic:
“Survival Guidelines”
for the Insulin-dependent Diabetic
*Eat balanced meals and snacks.
*Do not miss or delay meals or snacks.
*Always carry a quick source of carbohydrate.
*Remember to compensate for exercise.