Diabetic Diets Are Not What They Used to Be

by Jeanne Hutson, RN

Teresa D. Johnson, BS

 

Diabetes is among the many diseases that have been diagnosed for thousands of persons being served in adult day centers daily.  Years ago, the diet of the diabetic was rigid and unappealing.  Today, it may be varied and is much more satisfying.  People with diabetes can even eat foods containing sugar! A meal plan such as one with no concentrated sweets, no sugar added, low sugar or a liberal diabetic diet is generally no longer appropriate—given some basic assumptions!

 

While it is true that guidelines for diabetic diets have been liberalized recently, the meal plan changes are based on some important assumptions:

ü Close monitoring of blood glucose values

ü An individualized nutrition prescription based on the blood glucose values.

 

Maintaining a balanced diet is vital in every type of diabetes.  In the diabetic, it is important to know the insulin response of a food in order to predict blood sugar response.  By eating consistent amounts of carbohydrates daily, blood sugar levels will remain in better control.

             Carbohydrates, in any form, are the food substances that influence blood glucose levels.  Protein and fat (the other two macronutrients) have very little immediate affect on blood glucose levels and are therefore not as strictly controlled.  So, we can take carbohydrates—in the form of milk, fruit, vegetables, grains and sweets—and spread them throughout the day in order to avoid peaks and valleys in blood glucose.  Insulin elevated by a food is calculated by a clinical rating system called the Glycemic Index.

             In order to avoid peaks and valleys in blood glucose (insulin), we must know how many grams of carbohydrates are in the food—the Glycemic Index.  For example, all of the following have 15 grams of carbohydrates:  1/2 bagel, 1 slice bread, 1/2 c oats, 2/3 c limas, 1/2 c applesauce, 2 fat-free cookies, 1/2 c fat free frozen yogurt.  All of those foods raise blood sugar the same.

             Foods and drinks that carry a high glycemic index trigger an undesirable insulin response.  This reaction results in an excess of insulin in the blood stream.  Controlling the glycemic index of food and drinks allows for control over food-driven stimulation and reactive hypoglycemia.  Foods that elicit a low glycemic response are licensed to use the Seal of Approval from the Glycemic Research Institute which may be displayed on the label.  It is a FTC violation to state a product is “Low Glycemic” on labels, brochures, advertisements and product materials if it is not.  The Glycemic Research Institute strictly adheres to FDA and FTC guidelines.

             Usually doctors recommend three small meals and three to four snacks every day to maintain the proper balance between glucose and insulin in the blood.  Carbohydrates—especially some starches and other complex carbohydrates, which release glucose relatively slowly into the bloodstream—should make up 50 to 60 percent of total caloric intake; proteins should compose from 20 to 25 percent; and fats, from 20 to 30 percent.

 

The Truth about Sugar

Meal plans such as no concentrated sweets, no sugar added, low sugar and liberal diabetic diets are no longer appropriate.  These diets do not reflect the latest diabetes nutrition recommendations and unnecessarily restrict sucrose.  Such meal plans may perpetuate the false notion that simply restricting sucrose-sweetened foods will improve blood glucose control.  After all, dessert foods labeled as “sugar free” may contain as much carbohydrate and fat as regular desserts.

             Eating a piece of cake made with sugar will raise the body’s blood glucose level.  So will eating corn on the cob, a tomato sandwich, or lima beans.  People with diabetes can and do eat sugar.  In the body, it becomes glucose, but so many health foods.  Including sweets in a diabetic’s diet translates to substituting food with poor nutritional quality.  Dieticians recommend serving a very small amount of sweets if they must be served at all.  According to the American Diabetes Association, the rule with sugary foods is moderation.  Eat too much, and 1) you’ll send your blood glucose level up higher than you expected; 2) you’ll fill up but without the nutrients that come with vegetables and grains; and 3) you’ll gain weight.  So, most diabetics needn’t pass up a slice of birthday cake.  Instead, at the next meal, they should eat less bread or potato and be sure to take a brisk walk to burn some calories.

 

Fat

Monosaturated fats are the healthiest for your body.  Nuts—like almonds, cashews, hazelnuts and peanuts—and avocados contain this type of fat.  Choose olive or canola oil for cooking.  Polyunsaturated fat is the next healthiest fat.  This is found in margarine, corn oil, safflower oil, soybean oil and mayonnaise.  Avoid saturated fats like butter, lard and meat fat, bacon and shortening.  There are lower-fat versions of saturated fats like sour cream and cream cheese.  A healthy diet includes less than 30 percent of calories from fat, with less than 10 percent of these from saturated fat.

 

Treatment Through Exercise

Another crucial element in a treatment program for diabetes is exercise.  With any type of diabetes, check with your doctor before starting an exercise program.  In laboratory tests, exercise has been shown to increase the tissue levels of chromium, which the body uses to regulate blood glucose and cholesterol levels.  For people requiring insulin injections, exercise has also been found to increase the body’s ability to use available insulin so that fewer insulin injections are needed.

             It is also a good idea for diabetics to wear a Medic Alert bracelet or tag indicating that they have diabetes.  Identifying oneself as having diabetes is important because hypoglycemic attacks can be mistaken for drunkenness, and victims often aren’t able to care for themselves.  Without prompt treatment, hypoglycemia can result in a coma or seizures.  And, since the body is under increased stress when a person is ill or injured, the glucose levels will need to be monitored by medical personnel who give emergency care.

             There is no cure for diabetes at present.  No two cases of diabetes are exactly alike, so treatment must be prescribed on an individual basis by a physician.  Persons with diabetes should also consult a dietician and/or nutritionist to determine their most appropriate meal plans.  The Nutrition Facts panel required on all packaged foods is the best way to get carbohydrate information to help plan healthy diets.  Most local bookstores and libraries have books that also list the carbohydrate in restaurant foods, fast foods, convenience foods and fresh foods.  The books will tell how much carbohydrate is in what is considered a serving.  Measuring the proper amount to be eaten and then figuring the total grams of carbohydrate in the portion are also necessary. 

 

References

The recommendations in this article are based on the information published by the following:

 

· American Diabetes Association, The American Dietetic Association:  The First Step in Diabetes Meal Planning.  American Diabetes Association, Alexandria, VA 1995

· Diabetic Facts and Figures, American Diabetes Association, 1997.

· Translation of the diabetes nutrition recommendations for health care institutions (Technical Review).  Diabetes Care 20:96-105, 1997.

· Ullrich, Lisa, RD, CDE (Bayer Diagnostics). Counting carbohydrate and reading the food label for diabetes management.

 

Reprinted from The Information Source for Adult Day Centers®, October 1999.