LP WINTKA Eating Diabetes-T

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What I need to know aboutEating and Diabetes

U.S. Departmentof Health andHuman Services

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse


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ContentsEating and Diabetes ......................................................... 1

Blood Glucose Levels ....................................................... 2Your Diabetes Medicines .................................................. 5

Your Physical Activity Plan................................................ 6

The Diabetes Food Pyramid............................................. 8

Starches ......................................................................... 13

Vegetables...................................................................... 17

Fruits............................................................................... 21

Milk ................................................................................. 25

Meat and Meat Substitutes............................................. 29

Fats and Sweets ............................................................. 33Alcoholic Drinks .............................................................. 37

Your Meal Plan ............................................................... 38

Measuring Your Food...................................................... 40

When Youre Sick ............................................................ 42

Where can I get more information? ................................ 44


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Eating and DiabetesYou can take good care of yourself and your diabetesby learning

l what to eat

l how much to eat

l when to eat

Making wise food choices can help you

l feel good every day

l lose weight if you need to

l lower your risk for heart disease, stroke, and otherproblems caused by diabetes

Healthful eating helps keep your blood glucose, also calledblood sugar, in your target range. Physical activity and,if needed, diabetes medicines also help. The diabetestarget range is the blood glucose level suggested bydiabetes experts for good health. You can help preventhealth problems by keeping your blood glucose levels ontarget.

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Blood Glucose Levels

What should my blood glucose levels be?

Target Blood Glucose Levelsfor People with Diabetes

Before meals 70 to 130

1 to 2 hours after thestart of a meal less than 180

Talk with your health care provider about your bloodglucose target levels and write them here:

My Target Blood Glucose Levels

Before meals ______ to ______

1 to 2 hours after thestart of a meal less than _______

Ask your doctor how often you should check your bloodglucose on your own. Also ask your doctor for an A1Ctest at least twice a year. Your A1C number gives youraverage blood glucose for the past 3 months. The resultsfrom your blood glucose checks and your A1C test will tellyou whether your diabetes care plan is working.

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How can I keep my blood glucose levels ontarget?

You can keep your blood glucose levels on target by

l making wise food choices

l being physically active

l taking medicines if needed

For people taking certain diabetes medicines, following

a schedule for meals, snacks, and physical activity isbest. However, some diabetes medicines allow for moreflexibility. Youll work with your health care team to createa diabetes plan thats best for you.

Lunch

(Morningsnack)

(Afternoonsnack)

Breakfast

Dinner(Eveningsnack)

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Talk with your doctor or diabetes teacher about how manymeals and snacks to eat each day. Fill in the times foryour meals and snacks on these clocks.

Breakfast Morning snack

Lunch Afternoon snack

Dinner Evening snack

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Your Diabetes MedicinesWhat you eat and when you eat affect how your diabetesmedicines work. Talk with your doctor or diabetes teacherabout when to take your diabetes medicines. Fill in thenames of your diabetes medicines, when to take them,and how much to take. Draw hands on the clocks to showwhen to take your medicines.

Name of medicine: _______________

Time: ________ Meal: ____________How much: _____________________

Name of medicine: _______________Time: ________ Meal: ____________How much: _____________________



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Your Physical Activity PlanWhat you eat and when also depend on how much youexercise. Physical activity is an important part of stayinghealthy and controlling your blood glucose. Keep thesepoints in mind:

l Talk with your doctor about what types of exercise aresafe for you.

l Make sure your shoes fit well and your socks stayclean and dry. Check your feet for redness or sores

after exercising. Call your doctor if you have soresthat do not heal.

l Warm up and stretch for 5 to 10 minutes before youexercise. Then cool down for several minutes afteryou exercise. For example, walk slowly at first, stretch,and then walk faster. Finish up by walking slowlyagain.

l Ask your doctor whether you should exercise if yourblood glucose level is high.

l Ask your doctor whether you should have a snackbefore you exercise.

l Know the signs of low blood glucose, also calledhypoglycemia. Always carry food or glucose tablets

to treat low blood glucose.l Always wear your medical identification or other ID.l Find an exercise buddy. Many people find they are

more likely to do something active if a friend joinsthem.

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Low Blood Glucose (Hypoglycemia)

Low blood glucose can make you feel shaky, weak,

confused, irritable, hungry, or tired. You may sweat a lotor get a headache. If you have these symptoms, checkyour blood glucose. If it is below 70, have one of thefollowing right away:

l 3 or 4 glucose tablets

l 1 serving of glucose gelthe amount equal to 15 grams of carbohydrate

l 1/2 cup (4 ounces) of any fruit juice

l 1/2 cup (4 ounces) of a regular (not diet) soft drink

l 1 cup (8 ounces) of milk

l 5 or 6 pieces of hard candyl 1 tablespoon of sugar or honey

After 15 minutes, check your blood glucose again. If itsstill too low, have another serving. Repeat these stepsuntil your blood glucose level is 70 or higher. If it will bean hour or more before your next meal, have a snackas well.

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The Diabetes Food Pyramid

Fats and sweets

Milk

Vegetables

Starches

Meat and meatsubstitutes

Fruits

The diabetes food pyramid can help you make wise foodchoices. It divides foods into groups, based on whatthey contain. Eat more from the groups at the bottom ofthe pyramid, and less from the groups at the top. Foodsfrom the starches, fruits, vegetables, and milk groups arehighest in carbohydrate. They affect your blood glucoselevels the most. See pages 9, 10, and 11 to find out howmuch to eat from each food group.

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How much should I eat each day?

Have about 1,200 to 1,600 calories a day if you are a

l small woman who exercisesl small or medium-sized woman who wants to lose

weight

l medium-sized woman who does not exercise much

Choose this many servings from these food groupsto have 1,200 to 1,600 calories a day:

6 starches 2 milks

3 vegetables 4 to 6 ounces meat and meatsubstitutes

2 fruits up to 3 fats

Talk with your diabetes teacher about how to make a mealplan that fits the way you usually eat, your daily routine,and your diabetes medicines. Then make your own plan.

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l large woman who wants to lose weight

l small man at a healthy weightl medium-sized man who does not exercise much

l medium-sized or large man who wants to lose weight

Choose this many servings from these food groups

to have 1,600 to 2,000 calories a day:

8 starches 2 milks




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l medium-sized or large man who exercises a lot or hasa physically active job

l large man at a healthy weight

l medium-sized or large woman who exercises a lot orhas a physically active job

Choose this many servings from these food groupsto have 2,000 to 2,400 calories a day:

10 starches 2 milks




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Make Your Own Diabetes Food Pyramid

Each day, I need

_____ servings offats and sweets

_____ servings

of milk

_____ servingsof vegetables

_____ ounces of

meat and meatsubstitutes

_____ servingsof fruits

_____ servings of starches

On pages 38 and 39, you can make your own meal plan.Write down how many servings to have at your meals

and snacks.

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StarchesStarches are bread, grains, cereal, pasta, and starchyvegetables like corn and potatoes. They providecarbohydrate, vitamins, minerals, and fiber. Whole grainstarches are healthier because they have more vitamins,minerals, and fiber.

Eat some starches at each meal. Eating starches ishealthy for everyone, including people with diabetes.

Starches

Examples of starches are bread potatoes tortillas pasta rice beans corn crackers yams pretzels cereal lentils

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How much is a serving of starch?

Examples of 1 serving:

OR OR OR

1 slice of 1 small 1/2 cup cooked 1 6-inchbread potato cereal or 3/4 cup tortilla

dry cereal flakes

Examples of 2 servings:

1 smallpotato

1 small earof corn

+ OR

2 slicesof bread


1 smallpotato

1/2 cupof peas

+ OR

1 cupof rice

1 smallroll

+

If your plan includes more than one serving at a meal, youcan choose different starches or have several servings ofone starch.

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1. How many servings of grains, cereals, pasta, andstarchy vegetables (starches) do you now eateach day?

I eat _____ starch servings each day.

2. Go back to page 9, 10, or 11 to check how manyservings of starches to have each day.

I will eat _____ starch servings each day.

3. I will eat this many servings of starches at

Breakfast ___________ Snack __________

Lunch ______________ Snack __________

Dinner______________ Snack __________

A diabetes teacher can help you with your meal plan.

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What are healthy ways to eat starches?

l Buy whole grain breads and cereals.

l Eat fewer fried and high-fat starches such as regulartortilla chips and potato chips, french fries, pastries, orbiscuits. Try pretzels, fat-free popcorn, baked tortillachips or potato chips, baked potatoes, or low-fatmuffins.

l Use low-fat or fat-free plain yogurt or fat-free sour

cream instead of regular sour cream on a baked potato.

l Use mustard instead of mayonnaise on a sandwich.

l Use low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.

l Eat cereal with fat-free (skim) or low-fat (1%) milk.

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VegetablesVegetables provide vitamins, minerals, and fiber. They arelow in carbohydrate.

Vegetables

Examples of vegetables are lettuce peppers celery broccoli carrots chilies vegetable juice green beans greens spinach tomatoes cabbage

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How much is a serving of vegetables?Examples of 1 serving:

OR OR


1/2 cupvegetable

juice

1/2 cupcooked

green beans

+

1/2 cupbroccoli

1 cuptomatosauce

+

OR

1/2 cupcookedcarrots

1 cupsalad

+

1/2 cup 1/2 cup 1 cup saladcooked carrots cooked

green beans


1/2 cupcookedgreens

1/2 cup cookedgreen beansand 1 small

tomato

+ OR

If your plan includes more than one serving at a meal,you can choose several types of vegetables or have twoor three servings of one vegetable.

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1. How many servings of vegetables do you now eateach day?

I eat _____ vegetable servings each day.

2. Go back to page 9, 10, or 11 to check how manyservings of vegetables to have each day.

I will eat___________vegetable servings each day.

3. I will eat this many servings of vegetables at

Breakfast ___________ Snack __________

Lunch ______________ Snack __________

Dinner______________ Snack __________


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What are healthy ways to eat vegetables?

l Eat raw and cooked vegetables with little or no fat,sauces, or dressings.

l Try low-fat or fat-free salad dressing on raw vegetables or salads.

l Steam vegetables using water or low-fat broth.

l Mix in some chopped onion or garlic.

l Use a little vinegar or some lemon or lime juice.l Add a small piece of lean ham or smoked turkey

instead of fat to vegetables when cooking.

l Sprinkle with herbs and spices.

l If you do use a small amount of fat, use canola oil,

olive oil, or soft margarines (liquid or tub types)instead of fat from meat, butter, or shortening.

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FruitsFruits provide carbohydrate, vitamins, minerals, and fiber.

Fruits

Examples of fruits include apples bananas mango fruit juice raisins guava strawberries oranges papaya dried fruit watermelon berries grapefruit peaches canned fruit

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How much is a serving of fruit?Examples of 1 serving:

OR OR

1 small 1/2 cup juice 1/2 grapefruitapple


OR

1 banana 1/2 cuporange juice

11 4 cups wholestrawberries

+

If your plan includes more than one serving at a meal, youcan choose different types of fruit or have several servings

of one fruit.

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1. How many servings of fruit do you now eat eachday?

I eat _____ fruit servings each day.

2. Go back to page 9, 10, or 11 to check how manyservings of fruit to have each day.

I will eat _____ fruit servings each day.

3. I will eat this many servings of fruit at

Breakfast ___________ Snack___________

Lunch ______________ Snack___________

Dinner______________ Snack___________


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What are healthy ways to eat fruits?

l Eat fruits raw or cooked, as juice with no sugar added,canned in their own juice, or dried.

l Buy smaller pieces of fruit.

l Choose pieces of fruit more often than fruit juice.Whole fruit is more filling and has more fiber.

l Save high-sugar and high-fat fruit desserts such aspeach cobbler or cherry pie for special occasions.

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MilkMilk provides carbohydrate, protein, calcium, vitamins, andminerals.

Milk

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How much is a serving of milk?Examples of 1 serving:

OR

1 cup fat-free or 1 cup fat-free (skim) orlow-fat yogurt low-fat (1%) milk

Note: If you are pregnant or breastfeeding, have four tofive servings of milk each day.

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1. How many servings of milk do you now have eachday?

I have _____ milk servings each day.

2. Go back to page 9, 10, or 11 to check how manyservings of milk to have each day.

I will have ___________ milk servings each day.

3. I will have this many servings of milk at

Breakfast ___________ Snack __________

Lunch ______________ Snack __________

Dinner______________ Snack __________


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What are healthy ways to have milk?

l Drink fat-free (skim) or low-fat (1%) milk.

l Eat low-fat or fat-free fruit yogurt sweetened with alow-calorie sweetener.

l Use low-fat plain yogurt as a substitute for sour cream.

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Meat and Meat SubstitutesThe meat and meat substitutes group includes meat,poultry, eggs, cheese, fish, and tofu. Eat small amounts ofsome of these foods each day.

Meat and meat substitutes provide protein, vitamins, andminerals.

Meat and MeatSubstitutes

Examples of meat and meat substitutes include chicken eggs cheese beef peanut butter pork fish tofu lamb canned tuna or

other fish cottage cheese turkey

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1. How many ounces of meat and meat substitutes doyou now eat each day?

I eat _____ ounces of meat and meat substituteseach day.

2. Go back to page 9, 10, or 11 to check how manyounces of meat and meat substitutes to haveeach day.

I will eat _____ ounces of meat and meatsubstitutes each day.

3. I will eat this many ounces of meat and meatsubstitutes at

Breakfast ___________ Snack___________

Lunch ______________ Snack___________

Dinner______________ Snack___________


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What are healthy ways to eat meat and meatsubstitutes?

l Buy cuts of beef, pork, ham, and lamb that have onlya little fat on them. Trim off the extra fat.

l Eat chicken or turkey without the skin.

l Cook meat and meat substitutes in low-fat ways: broil

grill

stir-fry roast

steam

microwave

l To add more flavor, use vinegars, lemon juice, soysauce, salsa, ketchup, barbecue sauce, herbs, andspices.

l Cook eggs using cooking spray or a non-stick pan.

l Limit the amount of nuts, peanut butter, and fried foods you eat. They are high in fat.

l Check food labels. Choose low-fat or fat-free cheese.

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Fats and SweetsLimit the amount of fats and sweets you eat. Fats andsweets are not as nutritious as other foods. Fats have a lotof calories. Sweets can be high in carbohydrate and fat.Some contain saturated fats, trans fats, and cholesterolthat increase your risk of heart disease. Limiting thesefoods will help you lose weight and keep your bloodglucose and blood fats under control.

Fats and Sweets

Examples of fats include salad dressing butter avocado oil margarine olives

cream cheese

mayonnaise

bacon

Examples of sweets include cake pie cookies ice cream syrup doughnuts

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How much is a serving of sweets?Examples of 1 serving:

OR OR

1 3-inch 1 plain cake 1 tablespoon

cookie doughnut maple syrup

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How much is a serving of fat?Examples of 1 serving:

OR

1 strip of bacon 1 teaspoon oil


OR

1 tablespoonregular salad

dressing

2 tablespoonsreduced-fat

salad dressing

1 tablespoonreduced-fatmayonnaise

+

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How can I satisfy my sweet tooth?

Try having sugar-free popsicles, diet soda, fat-freeice cream or frozen yogurt, or sugar-free hot cocoa mix.

Other tips:

l Share desserts in restaurants.

l Order small or child-size servings of ice cream or frozen yogurt.

l Divide homemade desserts into small servings andwrap each individually. Freeze extra servings.

Remember, fat-free and low-sugar foods still have calories.Talk with your diabetes teacher about how to fit sweets intoyour meal plan.

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Alcoholic DrinksAlcoholic drinks have calories but no nutrients. If you havealcoholic drinks on an empty stomach, they can make yourblood glucose level go too low. Alcoholic drinks also canraise your blood fats. If you want to have alcoholic drinks,talk with your doctor or diabetes teacher about how muchto have.

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Your Meal PlanPlan your meals and snacks for one day. Work with yourdiabetes teacher if you need help.

B

r e a

k f a s

t

Food Group___________________________________________________________________________

____________________________________________________________

Food Group______________________________

_______________

Food Group___________________________________________________________________________

____________________________________________________________

Food____________________________________________________________

________________________________________________

How Much___________________________________________________________________________

____________________________________________________________

Food________________________

____________ S n a c

kHow Much

__________________________

_____________

Food____________________________________________________________

________________________________________________

How Much___________________________________________________________________________

____________________________________________________________

L u n c

h

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Food Group_____________________________________________

Food Group_______________________________________________________________________________________________________________________________________

Food Group_____________________________________________

S n a c

k

D i n n e r

S n a c

k

Food____________________________________

How Much_______________________________________

Food____________________________________________________________________________________________________________

How Much_______________________________________________________________________________________________________________________________________

Food____________________________________

How Much_______________________________________

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Measuring Your FoodTo make sure your food servings are the right size, youcan use

l measuring cupsl measuring spoonsl a food scale

Or you can use the guide below. Also, the Nutrition Factslabel on food packages tells you how much of that food isin one serving.

Guide to Sensible Serving Sizes

This much is the same as

3 ounces1 serving of meat, chicken,turkey, or fish

1 cup1 serving of

cooked vegetables

salads casseroles or stews, such as

chili with beans milk

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This much is the same as

1 2 cup1 serving of

fruit or fruit juice starchy vegetables, such as

potatoes or corn pinto beans and other dried

beans rice or noodles cereal

1 ounce1 serving of

snack food cheese (1 slice)

1 tablespoon1 serving of salad dressing cream cheese

1 teaspoon1 serving of

margarine or butter oil mayonnaise

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When Youre Sick Take care of yourself when youre sick. Being sick canmake your blood glucose go too high. Tips on what to doinclude the following:

l Check your blood glucose level every 4 hours. Writedown the results.

l Keep taking your diabetes medicines. You need themeven if you cant keep food down.

l Drink at least one cup (8 ounces) of water or othercalorie-free, caffeine-free liquid every hour whileyoure awake.

l If you cant eat your usual food, try drinking juice oreating crackers, popsicles, or soup.

l

If you cant eat at all, drink clear liquids such as gingerale. Eat or drink something with sugar in it if you havetrouble keeping food down, because you still needcalories. If you cant eat enough, you increase yourrisk of low blood glucose, also called hypoglycemia.

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l In people with type 1 diabetes, when blood glucose ishigh, the body produces ketones. Ketones can makeyou sick. Test your urine or blood for ketones if

your blood glucose is above 240

you cant keep food or liquids down

l Call your health care provider right away if

your blood glucose has been above 240 for longer

than a day you have ketones

you feel sleepier than usual

you have trouble breathing

you cant think clearly

you throw up more than once

youve had diarrhea for more than 6 hours

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Where can I get more information?Diabetes Teachers (nurses, dietitians, pharmacists, andother health professionals)

To find a diabetes teacher near you, call the American Association of Diabetes Educators toll-free at 1800TEAMUP4 (8326874) or see www.diabeteseducator.org and click on Find an Educator.

Recognized Diabetes Education Programs (teachingprograms approved by the American Diabetes Association)

To find a program near you, call the American DiabetesAssociation toll-free at 1800DIABETES (3422383)or see www.diabetes.org/education/edustate2.asp on theInternet.

Dietitians

To find a dietitian near you, contact the American DieteticAssociation at www.eatright.org and click on Find aNutrition Professional.

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National DiabetesInformation Clearinghouse

1 Information WayBethesda, MD 208923560Phone: 18008608747TTY: 18665691162Fax: 7037384929Email: [email protected]: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is a serviceof the National Institute of Diabetes and Digestive and Kidney Diseases(NIDDK). The NIDDK is part of the National Institutes of Health of theU.S. Department of Health and Human Services. Established in 1978, theClearinghouse provides information about diabetes to people with diabetesand to their families, health care professionals, and the public. The NDICanswers inquiries, develops and distributes publications, and works closelywith professional and patient organizations and Government agencies tocoordinate resources about diabetes.

Publications produced by the Clearinghouse are carefully reviewed by bothNIDDK scientists and outside experts. This booklet was originally reviewedby Marion J. Franz, M.S., R.D., L.D., C.D.E., Minneapolis, and CarolynLeontos, M.S., R.D., C.D.E., University of Nevada.

This publication is not copyrighted. The Clearinghouse encourages usersof this booklet to duplicate and distribute as many copies as desired.

This booklet is also available at www.diabetes.niddk.nih.gov .

This publication may contain information about medications. Whenprepared, this publication included the most current information available.For updates or for questions about any medications, contact the U.S. Foodand Drug Administration toll-free at 1888INFOFDA (4636332) or visitwww.fda.gov. Consult your doctor for more information.


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U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of Health

LP WINTKA Eating Diabetes-T

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