Diet Management and Meal Planning for the Type 2 Diabetic

When my husband was diagnosed with Type 2 diabetes, it required both of us to receive an education on what that diagnosis meant and what changes we would need to make in our lives. This is as it should be. Families need to work together in change, particularly when it can mean life or death for one of its members.

Type 2 Diabetes was formerly called Adult-Onset Diabetes.

Though normally diagnosed when an individual is in their 40s, Type 2 Diabetes got a name change when, much like obesity, it started showing up in younger and younger individuals. There have now been cases of children as young as eleven years of age with Type 2 diabetes. This also gives you a good hint as to many of the issues a Type 2 Diabetic faces.

Discovering an individual's care requires careful monitoring.

For Type 2 Diabetes, particularly for the newly diagnosed, a combination of both medications and changes in diet and exercise regimes may be needed to control the condition. Though some individuals may be able to avoid medications if they commit themselves to an immediate diet/lifestyle change, many others find medications are still needed while addressing the dietary and exercise needs.

When my husband was diagnosed it was clear that both medication and lifestyle changes were necessary. His blood sugar levels were dangerously high and if not brought quickly under control he would most certainly need insulin injections at some point in his life. He not only needed medication, but in order for the medication to be effective, we discovered this pizza, pasta, potato-chip and fast-food loving family would need to undergo some major diet changes.

My husband discovered just how effective this change could be when, for the first three months after the diagnosis, he kept an extensive record of his blood sugar levels. Only by monitoring blood sugar levels can someone discover what times and foods cause spikes in the blood sugar.

Setting up a spreadsheet assists in discussing treatments with your doctor.

The first thing he did was to set up two Microsoft Excel spreadsheets, one to track his blood sugar levels and the other to track his food intake. By keeping this dual record, if his blood pressure spiked, he had good running data as to what his meal records were for that day and whether he had exercised or not.

The first worksheet listed:

Date// Before Breakfast// After//Before Lunch// After// Snack//Before Dinner// After// Snack// Comments// BP// Avg.

This allowed him to record six blood sugar readings including a daily average. He also logged the times of snacks, if any, and recorded his blood pressure once a week. In the Comments cell he would log any exercise he did.

The second spreadsheet kept a matching meal record for the same days as his blood sugar tracking.

This spreadsheet included:

Date// Breakfast// Lunch// Snack// Dinner// Snack.

In these cells he would jot down a basic meal description, for example: eggsmuff=45// 1 sandwich =45// none// steakveg=45// Ice cream 30

The goal for blood sugar levels is 90-120 before meals and 140-170 after meals.

Eating a meal should cause a jump of 50 between the before meal reading and the after meal reading. What causes the rise and fall in blood sugar is the body's metabolism of glucose, generally caused by the metabolism of carbohydrates and a rise of 50 is normal. During sleep, the liver also outputs glucose and this can often be the reason for high before breakfast readings. By keeping a record like this, it helps the doctor determine what medication is best for the diabetic's individual needs.

Using the CHO method is an easy way to plan meals.

In the training class we attended, given by our local Evergreen Medical Center we discussed food control by the CHO method (Carbohydrate Choices). A CHO (Carbohydrate Choice) is an amount of food providing 15g of carbohydrates.

For a woman, we were given an ideal CHO for each meal as 3 CHO, or 45-55g/carbohydrates per meal. For man, it was 4 CHO or 60-70g/meal. This part of the diet monitoring only covers carbohydrate intake and not calorie counting. Both may be needed for some diabetics depending on how much their weight is a factor in their condition.

How can someone know how much CHO a food provides? Read labels and look at the Total Carbohydrates. You will find some diet plans, particularly those on working with a Glycemic Index, recommending you deduct the fiber from that figure. In the hospital training program we were taught not to deduct fiber on this plan but to always go by the Total Carbohydrates shown on the label, per serving.

Though it may sound confusing and a colossal pain to keep up with, this method can actually end up easier to manage than counting calories for every bite put in your mouth. By doing this in tandem with blood sugar monitoring, we soon learned which foods my husband could eat without a blood sugar spike and which ones he needed to avoid completely.

A person's body is their biggest advisor.

An individual should listen to what their blood sugar levels are telling them, no matter how many carbohydrates are on the label. For example, though according to carbohydrate charts, my husband should be able to eat half a potato, a portion of broccoli and perhaps a portion of green beans and still be within his CHO range for a meal. However, we found that potatoes will cause an immediate and high blood sugar spike in his next reading, whereas if we substitute corn (another starch) for that same potato, he will not get the same blood sugar spike. The same thing occurred with white or wild rice and even worse with Bulgur wheat. I thought Bulgur wheat would be a good rice substitute, high enough in fiber to counterbalance the carbohydrates. Not so. The Bulgur Wheat was actually worse than the white rice! Yet, to be even more contrary, his blood sugar is actually better in the mornings when he eats Chef Boyardee Mini-Bites instead of Cheerios with Splenda and almonds. What this tells us is the process is going to be a combination of recording what is eaten, along with careful monitoring of blood sugar levels, in order to find the ideal diet plan for an individual.

The ADA (American Diabetics Association) does have their own variation of the old Food Pyramid, giving you the number of servings you should look at each day and from which group. This can be very helpful, as well as learning how much food constitutes one portion. Again, remember to read labels. If the individual serving size says 3 cookies, then an entire box of cookies is not one serving size.

Eating out is possible but it can definitely be a challenge.

When we start talking about serving size, we have to mention the worst of the serving size culprits: Restaurants. One of the reasons Americans have lost touch with what constitutes a decent serving size is the frequency Americans eat outside of their home. Restaurants want happy customers and serving larger than life portions makes customers happy. Yet, if you eat those portions, you definitely exceed your serving size for a meal.

Our diabetic trainer recommended several solutions to this:

1) Ask for a To-Go box to be delivered with your meal. As soon as your meal arrives, take half of it and place it in the To-Go box. You will be less tempted to eat more than you need.

2) Ask the restaurant to serve you half portions. Now, if you object to this from an economical standpoint, go back to the first solution. The nice part about this is you don't waste the food and you don't have to be tempted at all.

3) Ask restaurants to put all gravies, sauces and dressings on the side. This allows you to control the portion here. These additions to the meal can add numerous carbohydrates.

4) If there is a choice between sides, forego the potatoes or rice and ask for the vegetables or to substitute a small salad. If that is not possible, ask them to leave it off your plate and find a new restaurant more congenial toward diabetics next time.

5) Eat slowly. The slower you eat your food, the less you food you will need. Your body will have time to inform you that you are full.

Another important requirement in diabetes management is exercise.

So far, this article has only discussed the diet changes but in the beginning of the article both diet and exercise was mentioned. Nothing lowers my husband's blood sugar levels like a short bike ride. Stress is a major factor in our blood sugar levels and exercise can counteract this killer. The exercise does not have to be strenuous and does not have to take a great deal of time. Thirty minutes of exercise, three times a week can lower blood sugar levels. Does this sound like a lot of time? Does it sound hard to manage? We were delighted to discover the thirty minutes does not have to be in one chunk of time.

Exercise can be broken down into separate 10 minute intervals and include things like vacuuming, gardening, mowing the lawn, walking the dog or even walking at the mall. It is the movement and the activity which makes the difference. Of course, before pursuing any increase in activity levels, you should consult with your physician.

Realistic is better than giving up

Sometimes after a month of watching what we eat, a good game will be on television and you want that pizza to go with the game. Of course, this should not become a habit or you are not treating yourself...you are slacking off. But, if you decide to have a pizza with that ball game, try to reduce your carbohydrate choices in the rest of your meal. Did you splurge one time with French fries at the restaurant? Eat salad instead of a side of corn. Balance your diet so that you can make this change to your lifestyle without being so miserable you give up on your management. Diabetes kills. Your realistic attempts at management are worth your intelligent efforts.

Make it a family affair.

At the beginning of this article, I made the statement, "Diabetes does not solely affect the diabetic individual." If a member of your family is diagnosed with diabetes, there is a better chance of management success if the entire family participates in various changes required for management.

When a parent gets Type-2 Diabetes, it is not uncommon to find the children following suit at a later date. What better way to prevent that situation than to have the family start on a healthy eating and exercise path before there is further damage to the pancreas, the organ that must put forth insulin in order to counteract high sugar diets? What better ways to help a spouse with their meal planning than to have both partners avoid the candy bars and fast food hamburgers?

Resources Used:

"Diabetes Class Workbook for people living with diabetes", Evergreen Hospital Medical Center, Kirkland WA, 2007
http://www.diabetes.org/nutrition-and-recipes/nutrition/foodpyramid.jsp
http://www.diabetes.org/home.jsp