“My husband has type 2 diabetes. The doctor told him to eat 6 meals a day but didn't give any guidelines as to what foods to eat at each meal. I would like to fix healthy meals for him but I don't know where to start.”   I have a feeling that a lot of people out there are wondering how to eat properly when diagnosed with diabetes. Type 2 Diabetes is becoming more and more common and in many cases can be managed with simple changes in diet and exercise. First of all, it’s important to learn a few things about digestion and the different types of diabetes. I’m sure that you’ve heard some of the key terms such as “insulin” and “glucose”…here’s how they fit in!   When we eat, much of the food is broken down into a form of sugar called glucose. Glucose is absorbed from the stomach and intestines during digestion into the blood and used for energy. Our bodies use glucose for all sorts of activities such as running, walking, thinking and talking. It’s a vital part of our metabolism and we cannot live without it.   So, how does insulin fit in? Insulin is a hormone produced by the pancreas. Basically insulin is like a “key” to the “door” of the cell.  It is needed to allow glucose to pass into the cells so the body can utilize it. If there is not enough insulin to bring the glucose into the cells, the glucose accumulates resulting in high blood glucose. This is what occurs in people with diabetes. Over time, high blood glucose can cause many health problems, some of them very serious.   There are two main types of diabetes. In Type 1 Diabetes, the pancreas is unable to make insulin, so the individual must actually inject insulin in addition to an exercise and meal plan to maintain blood glucose levels. Type 2 Diabetes is the more common version. The pancreas still makes some insulin, but it is either not enough or the body is not able to use it properly. Someone with Type 2 Diabetes may be able to control blood glucose with only an exercise and meal plan, while others may still need to take medications or inject insulin to maintain normal levels.   It used to be that patients diagnosed with any type of diabetes were told to avoid all carbohydrates (also called starches or sugars). Thankfully, that is absolutely not the case anymore. Carbohydrates are an important part of a well-balanced meal plan, but people with diabetes just need to pay special attention to their carbohydrate intake since it turns into glucose when digested. There are three main types of food groups: carbohydrates, proteins and fats. It is important to ensure that each meal/snack be well-balanced and include foods from each group. Please see the food guide pyramid for additional information (http://www.mypyramid.gov/).   In order to start monitoring carbohydrate intake, you obviously need to be able to recognize which foods are starches. So, which foods contribute carbohydrate to the diet?   -Grains, breads, cereals, pastas, rice, pretzels, chips, crackers, etc. -Starchy vegetables such as corn, potatoes, peas, winter squash. -Beans and legumes. -Fruits and fruit juices. -Milk, yogurt. -Sugar, jam, syrup, cookies, cakes, ice cream.   When planning meals for yourself, your husband or someone with diabetes, you have to consider the whole day’s food intake. Each person will have slightly different numbers of carbohydrates they should eat at each meal or snack. But, in general, 3-4 carbohydrates should be eaten at meals and 1-2 carbohydrates at snacks. One of the main ways to split this up is to have 3 meals (breakfast, lunch and dinner) and 2-3 snacks. So, taking 5-6 meals/snacks a day is a good approach to managing blood glucose!   Each meal or snack should include carbohydrates, protein and/or healthy fat. This “food pairing” of the carbohydrate with a healthy fat and/or protein makes the meal or snack more complex and slows the digestion of the food down resulting in a slow steady move of glucose into the blood. When choosing protein, always try and pick low-fat options such as lean meats, chicken (without the skin!), fish, low-fat cheese, dried beans and meat alternatives such as soy and tofu products. Remember that milk and yogurt are sources of both carbohydrate and protein. When it comes to choosing fats, it is important to limit animal fats and emphasize plant fats to keep your heart healthy. Heart healthy fat choices include canola and olive oils as well as nuts and seeds.   So now you know about how many carbohydrates to have at each meal/snack, but how do you quantify them? When it comes to counting servings of carbohydrates, it is important to understand portion sizes and what makes up one “serving” of carbohydrate. This can also be referred to as “one carb” or 15 grams of carbohydrates. You may be shocked to find out how small some of these servings are. We are so used to eating out and seeing those gigantic portions that these may seem absolutely tiny!! When you are choosing breads or grain products, it is always better to choose whole grain or whole wheat versions. The fiber in these products actually slow down the digestion of the carbohydrate helping prevent a quicker rise in blood glucose while keeping us satisfied longer.   Here are some examples of portion sizes…I recommend measuring out some of the surprisingly small portions such as pasta and rice to help visualize how much we should actually be eating! When I recommend 3-4 carb choices at a meal, you may think that’s a lot, but once you measure it out, you’ll find that it really is probably a smaller portion than you are used to.   Starches/Breads ½ cup cooked pasta ½ cup cooked starchy vegetable 1 tortilla (6 inch size) ½ English muffin or small bagel or bulkie roll 1 slice bread or small, dinner roll 6 saltines 1/3 cup cooked beans or lentils 1/3 cup cooked rice 3/4 cup dry cereal ½ cup cooked cereal 3 cups popcorn (plain) ¾ oz potato chips or pretzels (about 15-20)   Fruit 1 medium fruit such as apple, peach (think baseball sized) ½ cup fruit juice ½ cup canned fruit 1 cup berries 10-15 grapes 1 small banana or ½ large 2 tbsp raisins ¼ cup dried fruit   Milk 1 cup skim or low-fat milk 8 oz. low fat, light yogurt   Sweets (to be enjoyed in moderation!) ½ cup low-fat ice cream or frozen yogurt ¼ cup sherbet 2 small cookies 1 tbsp jam, sugar or honey   A good, well-balanced meal plan is not the only important part of diabetes management. It is also imperative to exercise regularly, lose weight if necessary, take your medications as prescribed by your doctor and check your blood glucose regularly. This is a very quick overview of the dietary management of diabetes. You may also want to consider an outpatient visit with a Registered Dietitian for more extensive information. Most insurance companies will cover a visit when referred from your primary care physician. A Registered Dietitian will be able to design a food plan specifically for your husband using his likes/dislikes as well as his calorie needs based on his height and weight.   So to wrap it up, here’s some basic guidelines you should keep in mind when planning meals and snacks: -Eat meals and snacks at regular times, try not to skip meals. -Eat about the same amounts of carbohydrates foods each day. Try to spread them out throughout all your meals and snacks. Again, a general suggestion is 3-4 carbohydrates at meals and 1-2 carbohydrates at snacks. -Remember to eat a variety of the following foods:             *low fat milk and dairy products             *lean cuts of meat, chicken and fish             *fresh fruits and vegetables             *whole grain breads, cereals, rice and pasta *And remember, these suggestions aren’t just for people with diabetes! Anyone would benefit from following these healthy guidelines. There are many resources available about diabetes, visit them for any additional educational material and again, please consider visiting your local dietitian for more intensive counseling!   -Lori   References: http://www.diabetes.org/uedocuments/10-CarbCounting.pdf http://www.diabetes.org/home.jsp http://www.cdc.gov/diabetes/ http://diabetes.niddk.nih.gov/index.htm http://www.ndep.nih.gov/