9) CONTROLLING BLOOD SUGAR WITH DIET
c) What a Diary Tells a Person with Diabetes
The diary of anyone with type 2 diabetes should consist of recording each meal (food, total calories, and total carbohydrates), recording blood sugar before the meal and one hour after the meal, and recording amount of exercise. Also record the weight each day. Doing this will allow patterns to start to emerge which are very useful. The calorie and carbohydrate numbers should be totaled as they are incurred and a maximum level set for each day, at which point a person should stop eating for the day. Some might ask why not total protein and fat amounts as well. The amount of calories and amount of carbohydrates will control the fat and the protein levels. If a person sets reasonably low calorie and carbohydrate levels, say 1500 calories and 60 grams carbohydrate per day total, they will soon learn that only low carbohydrate, high protein, low fat meals will work.
If an accurate and complete diary is kept an individual can really be surprised by the numbers. Take a bowl of blueberries and high fiber cereal with artifical sweetener. That shouldn't cause any problem, right? At first glance for at least some people it was probably too much carbohydrate for one meal:
Net Carbs calories Fiber Protein Fat Blueberries 15 gms 80 4 gms 1 gm 0 gm High Fiber Cereal 22 gms 120 14 gms 4 gms 2 gms 1% fat Milk 12 gms 90 0 gms 8 gms 1 gm Total 49 gms 290 18 gms 13 gms 3 gms BUT the numbers are misleading. Fiber is indigestible yet it is included in both the Net Carbs and in the Calories. If the amount of fiber is backed out the Net Carbs drops to 31, acceptable for some plans, and the total calories drops to 200, very acceptable. It is too bad that the Federal Government decided to include undigestable fiber in the calculations for both total carbohydrates and for calories. This is not how the rest of the world does their labeling. The rest of the world subtracts out the fiber so as not to mislead people. The Federal Government has made it necessary for individual watching their carbohydrates and calories to do some math to arrive at the truth. One gram of fiber equates to one gram of carbohydrate and four calories.
How about a healthy but small 4 oz piece of salmon:
Net Carbs calories Fiber Protein Fat Salmon 0 gm 100 0 gm 19 gms 2.5 gms Considering the amount of omega 3's in salmon this is an excellent meal.
How about a 4 oz piece of white meat chicken breast:
Net Carbs calories Fiber Protein Fat One Chicken breast 0 gm 120 0 gm 22 gm 3 gms Again, an excellent meal.
How about a candy bar treat? One small 1.55 ounce Hershey's Chocolate bar:
Net Carbs calories Fiber Protein Fat One Candy Bar 27 gms 220 0 gm 0 gm 11 gms Seven of the eleven grams of fat is saturated! This is not a good snack for anyone, especially someone with type 2 diabetes.
What about a small 5 oz can of tuna fish with a teaspoon of both Smart Balance Omega Plus mayonaise and Sugarless sweet pickle relish:
Net Carbs calories Fiber Protein Fat Sweet Pickle Relish 0 gms 0 0 gms 0 gm 0 gm Mayonaise 1 gms 22 0 gms 0 gms 2 gms Tuna Fish 0 gms 120 0 gms 24 gms 2 gm Total 1 gms 142 0 gms 24 gms 4 gms This is a very healthy meal since most of the fat is omega 3 oils and the amount of carbohydrates and calories is very low. This is a meal that should be eaten as often as possible.
How about some "Men's Bread™" (one brand of high fiber bread) with some "Benecol™" butter substitute.
Net Carbs calories Fiber Protein Fat 2 slices of bread 10 gms 178 8 gms 12 gms 3 gms One Tablespoon Benecol 0 gms 80 0 gms 0 gms 10 gms Total 10 gms 258 8 gms 12 gms 13 gms This has only 10 grams of low glycemic carbohydrates (since fiber is included in the carbohydrate count that actually becomes just 2 grams of digestible carbohydrates 146 actual digestible calories for the bread) and about one third of the 90 calories of fat in the Benecol™ was very beneficial and indigestible plant sterols, this is a very good meal, two slices of high fiber bread!
What about a whole can of turkey chili?
Net Carbs calories Fiber Protein Fat Can of turkey chili 56 gms 420 12 gms 34 gms 6 gms Correction for Fiber - 12 gms - 48 Total 44 gms 372 12 gms 34 gms 6 gms The problem with this meal is that the third and fourth ingredients found on the label are corn starch and sugar. These two ingredients drive the amount of carbohydrates up a little too high for a single meal. A half a can makes a much better meal. But the amount of protein and the amount of fiber are excellent, so some might try a whole can, then measure their blood sugar an hour later and see what has happened.
What about a can of lima beans?
Net Carbs Calories Fiber Protein Fat Can of Lima Beans 60 gms 300 14 gms 14 gm 1.8 gm Correction for Fiber - 14 gms - 42 Total 46 gms 258 14 gms 14 gms 1.8 gms Much like Chili, this is a meal which pushes the boundaries and will require testing the blood sugar levels to determine whether or not it works for any given individual. Whole 15 oz cans of just about anything are just too much of a portion unless they are the sole ingredient in a meal. It is much better to put half the can into a small container and put it in the refrigerator. Don't leave any in the can unless you want a bad metallic taste to the second portion.
What about a whole bag (12 Oz) of "steamable" mixed vegetables?
Net Carbs calories Fiber Protein Fat Mixed Vegetables 48 gms 240 8 gms 8 gms 0 gm One Tablespoon Benecol 0 gms 80 0 gms 0 gms 10 gms Correction for Fiber - 8 - 32 Total 40 gms 288 8 gms 8 gms 10 gms This is actually a decent meal as long as one avoids the temptation to go overboard on the Benecol. The meal of vegetables is very filling, the carbohydrates are very slowly digested, the fiber is high, the protein is high and the fat has phytosterols in it. It makes a good evening meal (the phytosterols work best at night). This does contain kernel corn. Some individuals with type 2 diabetes experience a blood sugar spike after ingestion of kernel corn and some don't. Try the food, then do a blood sugar test one hour later to see if it affects you.
What about a whole bag (12 Oz) of "steamable" peas?
Net Carbs calories Fiber Protein Fat Peas 48 gms 280 16 gms 8 gm 0 gm One Tablespoon Benecol 0 gms 80 0 gms 0 gms 10 gms Correction for fiber - 8 gms - 32 Total 40 gms 288 8 gms 8 gms 10 gms This is actually a good meal, again as long as one avoids the temptation to go overboard on the Benecol. The fiber has to be subtracted from the calories and the carbohydrates, making this a much better meal than one might suspect. It is very filling,the carbohydrates are very slowly digested, the fiber is very high, the protein is high and the fat has phytosterols in it. It makes a good evening meal (the phytosterols work best at night).
What about a whole bag (12 Oz) of "steamable" green beans?
Net Carbs calories Fiber Protein Fat Green Beans 20 gms 120 8 gms 4 gm 0 gm One Tablespoon Benecol 0 gms 80 0 gms 0 gms 10 gms Correction for Fiber - 8 gms - 32 Total 12 gms 168 8 gms 4 gms 10 gms This is a great meal, again as long as one avoids the temptation to go overboard on the Benecol. The meal is very filling,the carbohydrates are very slowly digested, the fiber is high, the protein is moderate and the fat has phytosterols in it. It makes a good evening meal (the phytosterols work best at night).
Now for the best meal. What about a whole bag (16 Oz) of frozen spinach?
Net Carbs calories Fiber Protein Fat Spinach 18 gms 180 6 gms 12 gm 0 gm One Tablespoon Benecol 0 gms 80 0 gms 0 gms 10 gms Correction for fiber - 6gms - 24 Total 12 gms 236 6 gms 12 gms 10 gms Since spinach is the best food by far for anyone, this meal leads the list for anyone. Eat this as often as you can. It is enough food to make an evening meal out of. Twelve ounces is a lot of spinach (six "normal" servings). Collard greens, turnip greens, and kale have similar values.
Also be aware that the tables for most exchange programs seem to be very outdated. The tables don't seem to have been updated to reflect the accurate food product nutritional analyses now required by federal law. So we recommend using the analysis on the food package and a calorie based plan or a gram based plan rather than an "exchange", "serving" or "point" plan. Another concept that is not very practical is "meal planning" where a plan calls for a person to eat two carbohydrate "exchanges", two protein "exchanges", one fat "exchange" etc. at a given meal. Sounds great, but the quantity of food can be huge and the calorie intake way too high. If a person with type 2 diabetes tries to drop the quantities to compensate, they end up with "two and a half tablespoons of sweet potato", hardly practical. Some prefer to just try to balance everything out over several days time. Some people find calorie counting much simpler than exchanges or points, others prefer exchanges or points. Flexibility is the key as every individual is different. One such system gives one point for 75 calories of carbohydrate (roughly 20 grams) and one point for 150 calories of protein (roughly 40 grams). For purposes of insulin calculations fats are "free". The "point system", "serving" and the "exchange" system all rely on extensive tables which give the number of points, servings or exchanges for a given amount of food, for instance one ounce of meat and two slices of bread are both one point. I just find it easier to calculate the data from the food package and put most of the meals I generally eat in my own personal table, much as above.
What a honest diary will rapidly show anyone is that the normal concept of a "meal" is just far too much food, especially for someone who has type 2 diabetes and is trying to lose weight. Small amounts of food and putting up with hunger cravings are the key to successful diet control. Note that anyone taking insulin should be much more concerned with food intake timing and amounts. If a dietician recommends an "exchange" or a "point" system with the insulin injections, find out how many grams of carbohydrate each "exchange" or "point" actually represents and do some calculations before each meal and before taking insulin. Read the labels and test the blood sugar one hour after every meal. If taking insulin it is important to remember that protein is actually composed of about 50% very slow acting carbohydrate.
Current Chapter: 9) CONTROLLING BLOOD SUGAR WITH DIET
a) Blood Sugar Control
b) Individualized Reactions
c) What a Diary Tells a Person with Diabetes
d) Protein Poisoning by Fruit Sugar
e) What are "Acceptable Fruits
f) Other Sugars
g) Best Mix of Protein, Carbohydrates, and Fats
h) Low Carbohydrate Diets
i) Fitting the Diet to the Individual
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