| Despite all the publicity surrounding new research and new nutrition guidelines, many people with diabetes still believe that there is something called a "diabetic diet." Many people with diabetes who are receiving inadequate information about how to manage their condition imagine that this so-called "diabetic diet" means they have to "avoid sugar."
"That just simply isn't how meal planning works today with patients with diabetes," says Karen Chalmers, R.D., M.S., C.D.E., a nutritionist at Joslin in Boston and author of 16 Myths of a Diabetic Diet.
"Simply stated, with proper education and within the context of healthy eating, a person with diabetes can eat anything a non-diabetic eats," says Chalmers.
In response to this gap in knowledge about what people believe about eating with diabetes, Joslin Diabetes Center has undertaken a campaign to educate people with diabetes - and the general public -- about what the nutrition issues are for people with diabetes.
Unfortunately, for many people with diabetes - both those who have had the disease for a while, and for newly diagnosed patients - the new concepts around eating and diabetes are still not widely known, says Chalmers.
What's the Truth About Diabetes and Diet?
We know now that it is okay for people with diabetes to substitute sugar-containing food for other carbohydrates as part of a balanced meal plan. Prevailing beliefs up to the mid-1990s were that people with diabetes should avoid foods that contain so-called "simple" sugars and replace them with "complex" carbohydrates, such as those found in potatoes and cereals. A review of the research at that time revealed that there was relatively little scientific evidence to support the theory that simple sugars are more rapidly digested and absorbed than starches, and therefore more apt to produce high blood glucose levels.
Now many patients are being taught to focus on how many total grams of carbohydrate they can eat throughout the day at each meal and snack, and still keep their blood glucose under good control.
Well-controlled blood glucose is a top priority because other research studies have shown conclusively that all people with diabetes can cut their risk of developing diabetes complications such as heart disease, stroke, kidney and eye disease, nerve damage, and more, by keeping their blood glucose as closely controlled as possible.
What does this mean for people with diabetes?
This means that a person who has worked with a dietitian and a diabetes treatment team to figure out how many grams of carbohydrate they can eat throughout the day can decide at any given meal what they will eat. Those with diabetes who are not on insulin need to focus on keeping the amount of carbohydrate they eat consistent throughout the day. Those on insulin can decide both what and how much to eat at given meal (as long as it doesn't exceed their daily allotment), and can then adjust their insulin accordingly. "There aren't any foods that are 'off-limits,'" says Chalmers. "Rather , one just needs to learn how to spend his or her grams of carbohydrate wisely over the course of the day."
Regular home blood glucose monitoring is then used to keep track of the effects of meals and activity levels on their blood glucose. They work with their healthcare team to make adjustments in their food intake, physical activity, and medication to keep their blood glucose as close to normal as possible.
How does carbohydrate counting work?
Most all foods (except meat and fat) contain some carbohydrate, and carbohydrate has the fastest effect on increasing blood glucose. The number of grams of carbohydrate that a person can eat each day or at each meal is determined by such things as their weight; whether or not weight loss is a goal (which it frequently is in people with type 2 diabetes); when and how much physical activity is done (because physical activity will lower their blood glucose); what diabetes medication or insulin they are taking, and when; and other factors such as age and medical issues such as the presence of high blood fats.
For example, a 6' 2" tall man with diabetes who weighs 180 pounds and wants to maintain his current weight might be told he could eat 350 grams of carbohydrate spread out over the day. His goal would be to spread those grams out over the course of the day so that he doesn't send his blood glucose too high at any one time. If he is taking insulin or oral diabetes medication, he might also have to manage when he eats his carbohydrate in such a way that there is enough sugar from his meals in his bloodstream when his medication is working its hardest.
"We now know that in general, a sugar-containing food like a piece of angel food cake may have 30 grams of carbohydrate in it, but that piece of cake will have the same effect on your blood glucose as 2/3 cup of rice or one cup of applesauce, both of which have 30 grams of carbohydrate in them," says Chalmers. "So, if this man's meal plan that he's developed with a dietitian states that he can eat 60 grams of carbohydrate at a meal, it's his choice where he 'spends' those 60 grams. One time he may have 2/3 cup of rice and one cup of applesauce, because that's what he feels like eating. Another time he may decide to eat a cup of applesauce, a cup of milk (12 grams of carbohydrate) skip the rice, and have the small piece of angel food cake for dessert."
People who develop diabetes when they are over 40 frequently develop diabetes in part because they are overweight. Being overweight makes it more difficult for their bodies to use insulin to convert food into energy. For this reason, many patients with diabetes also have weight loss as a goal. Because each gram of fat contains 9 calories (while a gram of protein or carbohydrate contains only 4 calories), fat gram counting as a means of losing weight becomes an additional nutritional tool for many patients.
Frequently people with diabetes also have problems with high blood fats and/or cholesterol levels, and will be prescribed a meal plan that is low in fat as well. So even if they aren't overweight, some patients may be counting grams of fat eaten at each meal or over the course of the day, as well as how many grams of carbohydrate.
There are many food lists available that show how many grams of carbohydrate and fat are in most foods. Also, most any food you purchase in a grocery story lists carbohydrate and fat content as part of the food label requirements mandated by the federal government.
Not a do-it-yourself project
"Obviously using nutrition as part of an overall diabetes treatment plan is not an entirely do-it-yourself project," notes Chalmers. "That's why we can't just send people preprinted diets. You need to work with a dietitian to determine whether carbohydrate counting, fat gram counting, a combination of both, or the older exchange meal planning system will work best for you. And you have to work with a dietitian to develop what your meal planning parameters are -- how many grams of carbohydrate, how many grams of fat, etc. you can eat each day.
"But then the rest of it is pretty much up to you," she adds. "You get your meal plan 'budget', and then you decide how to spend it at each meal. Just as a person without diabetes can't eat cookies and cakes all day long and expect to be healthy, if you have diabetes you have to eat a balanced diet to remain healthy. But within limits, and with proper education, if you have diabetes you can eat whatever anybody else does."
Learn more about carbohydrate counting, click here.
Joslin's newest nutrition book, Staying Healthy with Diabetes -- Nutrition & Meal Planning is available at the Joslin Store. | 
