So, What Can I Eat?
Meal planning is central to managing diabetes. Here's how to get started
For most people who are new to diabetes, the one thing that seems clear is that sugar is off limits, right? Think again: It turns out that a diabetes diagnosis doesn't mean your sweet tooth has to go cold turkey. In fact, you can eat many of the foods you love—yes, even desserts—as long as they're part of an overall healthy diet. The key, as you will soon figure out, is moderation. A diabetes meal plan, developed in collaboration with your doctor, nurse, diabetes educator, or dietitian, will guide you in choosing how many calories you should shoot for in a day, how much carbohydrate you can eat per meal, the types of foods you should eat, and how to make it all work with your medical profile, lifestyle, and eating habits. As with all diabetes management, what makes sense for a coworker or friend with diabetes won't necessarily work for you—although those folks can be a great source of tips and encouragement.
More good news: The foods that are best for someone with diabetes are the same ones that are healthiest for people without diabetes. Look for a mix of carbohydrates, protein, and fat, with an emphasis on whole foods that are minimally processed and nutrient rich. That means whole grains, nuts, fruits, vegetables, beans, low-fat or nonfat dairy products, lean meats, and fish. Cut down on foods and drinks that are high in sugar or fat, like soda, sweets, fried foods, and lunch meats.
Since people with diabetes are at an increased risk for heart disease, it's also important to limit the bad-for-you fats that lurk in full-fat milk products, meats, and processed foods. Both saturated fat and trans fat up your risk for heart disease and stroke, so begin replacing foods like whole milk, regular cheese, butter, shortening, bacon, and bologna with low-fat versions, such as skim milk, low-fat cheese, olive oil, and lean meats or fish. It can sometimes be hard to tell how much fat is in the foods you eat, but reading packaged foods' nutritional labels, which list total fat, saturated fat, and trans fat, can help. Aim to get less than 7 percent of your calories from saturated fat, and to eliminate trans fat altogether.
For starters, experts recommend reevaluating how you put together a meal. Half of your plate should be filled with vegetables, such as a salad, broccoli, or green beans; a quarter of your plate should contain carbohydrates, preferably whole grains, starchy vegetables, or fruit; and the last quarter of your plate should be protein from lean meat, fish, or soy products like tofu. (Avoid eating too much by following these portion size cues.) To get food and recipe ideas, you can check out the American Diabetes Association's My Food Advisor, which provides a database of 5,000 foods searchable by meal type and carbohydrate, sodium, fat, or fiber content, as well as recipes and a create-a-dish feature. You'll also find recipes here.
Many people with diabetes find counting carbs a useful approach to meal planning. Carbohydrates are your body's main source of energy, but they also have the biggest effect on your glucose levels. Counting the number of carbs you get at each meal can help you stabilize your blood glucose and, in turn, better control your diabetes. The number of carbohydrates you can eat at a sitting depends on the type of medication you're taking and your activity level, weight, and age, so discuss your carb intake with your health care provider. In the meantime, a good place to start is between 45 and 60 grams of carbohydrate per meal.
Carbohydrates can be found in foods like bread, cereal, rice, and crackers as well as in fruits, milk, juice, beans, potatoes, corn, snack foods, and sweets. Meat, fish, eggs, cheese, oils, and butter contain few or no carbs; nonstarchy vegetables like carrots, broccoli, peppers, and asparagus, which have few carbs and plenty of vitamins and minerals, can be eaten often. And yet other foods—think pizza, ice cream, and many snack products—contain a lot of carbohydrates plus a lot of fat. Though two foods—say, a half-dozen jelly beans and an apple—may contain the same amount of carbohydrates, you shouldn't trade nutritionally rich foods for junk. Jelly beans are void of any nutrients while apples are packed with vitamins and fiber. Still, if you're craving a piece of chocolate cake for dessert, you can occasionally sacrifice carbs elsewhere in your meal—for example, by eating a salad instead of pasta—to make up for it.
Your doctor may give you a list of foods with their carbohydrate amounts to help you count the carbs in fruit, vegetables, meats, and cheeses (check out our list, here). If you're eating packaged foods, you can count carbs by checking the label's Nutrition Facts. To find out how many carbohydrates you'll be getting for a particular food, look first to the serving size. All of the information on the label is for one serving—and there may be several servings in a single package—so if you plan to eat, say, twice that amount, you'll have to double the nutrition information on the label. After you determine the serving size, scan the carbohydrate content, listed in grams per serving. If you'll be eating multiple foods to make up a meal (like a turkey sandwich with a side of baby carrots), you'll need to add all of the foods' carb contents together for a meal total. Fiber is not digested like other carbohydrates, so it may affect your blood glucose differently; talk with your registered dietitian about ways to account for fiber when counting carbohydrates.
It may seem easier to swear off carbohydrates for good, and some people with diabetes find success in low- or no-carb diets. But be warned: A diet low in carbs and high in protein and fat (such as the well-known Atkins diet, which limits carbs but permits free grazing on foods like red meat and eggs) is highly restrictive, hard to follow for an extended period of time, and may not be healthy in the long run. Since carbohydrates raise your blood glucose levels, restricting your intake while on insulin or certain type 2 medications could set you up for low blood glucose. What's more, the diet is high in saturated fat, which can raise your risk of heart disease.
Others find success in eating five or six small meals during the day instead of three larger ones. The key to losing weight or gaining better blood glucose control while "grazing" throughout the day is to make sure your portion sizes have been trimmed. Because reducing the amount of food you get at each meal and adding more snacks can affect your blood glucose levels, test often when starting out.
You may hear about another dieting tool, the glycemic index, which ranks foods based on how quickly they raise your blood glucose. High-glycemic-index foods (white bread, white rice, corn flakes) raise glucose faster than do low-glycemic-index foods (whole-wheat bread, beans, fruits). Since a number of factors can change the glycemic index of a food—including its ripeness, how it was cooked, and the time of day it's consumed—the plan is fairly complicated and may require help from a dietitian.
Learn the Lingo
Along with carb counting and glycemic index, you may also hear about exchanges. The Exchange Lists for Meal Planning (available from your doctor's office or through ADA) groups foods with similar carb and nutrient content. All of the foods on a list can be swapped—or exchanged—for one another, making meal planning easier. Even if you don't follow an exchange diet, knowing food exchanges can aid your carbohydrate counting.
If you can't stomach any more food restrictions, take heart: Your diet will also include "free foods" (and drinks) that don't need to be counted when calculating your meal plan as long as you limit them to three servings spread throughout the day. Free foods contain fewer than 20 calories or fewer than 5 grams of carbs per serving and include items such as a quarter cup of salsa, a tablespoon of fat-free cream cheese, two teaspoons of powdered nondairy creamer, and as much as you'd like of sugar-free gelatin, sugar substitutes, coffee (but not sugary coffee drinks), tea, and herbs and spices.
Free foods are not the same as sugar-free foods, which you should treat warily. Sugar-free foods sound like a godsend for people with diabetes, but there's a catch: Many no-sugar foods still have calories, fat, and carbs in the form of starches. If you eat a handful of sugar-free cookies, for instance, you'll still have to count the carbs you've ingested. In the same way, low-fat or no-fat foods may contain ingredients that can raise your blood glucose.
Planning meals for diabetes isn't easy, at least not at first. And yes, you probably won't be able to eat with abandon again. But in the end you may find your new meal plan helps you become healthier than you were before your diagnosis. With practice, you can tackle hurdles like cooking for weight loss, whipping up low-sodium dishes, or baking with sugar substitutes like Splenda. Once you get going, you'll be able to successfully create healthy (and delicious) diabetes-friendly meals.
For More Information
Have a meal you love that doesn't jibe with your diabetes diet? Submit a recipe to be "diabetized" by our food editor, and view new-and-improved versions of other readers' dishes. You can request a free copy of ADA's booklet "What Can I Eat?" by calling 1-800-DIABETES (1-800-342-2383).