Sugarless Goods….or bad?

This week’s question from http://foodpicker.org is…

My doctor recently diagnosed me with type 2 diabetes.  I know it is important to watch my sugar intake.  Is sugarless candy really sugarless?

Great question! First of all, it is commonly misunderstood that regular sugar increases your blood sugar. In actuality, research has found that by itself, sucrose (table sugar) has very little effect on type 2 diabetes. It is the total CARBOHYDRATES that are the blood sugar-raising culprits!!

Before you disregard sugar entirely, it is good to know that sugar is a form of carbohydrate. You may notice that when you are reading nutrition labels, sugar is listed under “total carbohydrates.” Approximately 1 teaspoon of table sugar = 4 grams of carbohydrate. This is incorporated into that “total carbohydrate” amount. If you are using a lot of  table sugar as a sweetener, this is something to consider when you are counting carbs. (Remember 1 serving of carbohydrate = 15 grams)

So why all the fuss and worry about sugar? High sugar goods are also often high in fat, high in calories, and high in carbohydrates. This is why it is important to monitor what you are eating.  These high fat, high calorie foods in excess can cause you to gain weight, and being too heavy can put you at higher risk for diabetes or cause further complications if you have diabetes.

As far as sugarless  goods go, always read the nutrition label. It may have 0 sugar grams because it is replaced with low-calorie artificial sweeteners, but what are the carbohydrate grams?  Sometimes it’s helpful to compare labels and see if the sugarless product or the regular product has more calories or fat. This is what you want to focus on, and not be tempted just by that “sugar-free label.” If you want a piece of candy once in awhile, that’s ok. Read labels, account for it when eating your meals that day, and remember, “everything in moderation.”

Warning:   Sometimes too many sugar-free goods can cause upset stomach and diarrhea, so watch out for how they effect you. Everyone tolerates food differently, so be sure to continue to check your blood sugar routinely.

 

Diabetes Testing

This week I received the following question from http://foodpicker.org :

My fasting glucose number was 127.  Does this sound like pre-diabetes or diabetes?  What should I do to control by blood sugar?

Fasting plasma glucose is defined as getting your blood sugar tested when you have not had anything to eat in the past 8 hours.  According to national guidelines, diabetes is indicated if  fasting plasma glucose (FPG) test  reveals it as 126mg/dL or above.

FPG Test

Plasma Glucose Result (mg/dL)	Diagnosis
99 or below	Normal
100 to 125	Pre-diabetes (impaired fasting glucose)
126 or above	Diabetes*

This being said, diabetes is not officially diagnosed unless you have an impaired fasting glucose for 2 separate blood tests, preferably on separate days. Your doctor should perform these tests and confirm your results. Sometimes oral glucose tolerance tests (OGTT) will be performed, where you will fast 8 hours and then drink a very sweet, glucose-containing fluid. You will then be tested 2 hours later. In this case, 200 mg/dL or above indicates diabetes. Again, 2 separate tests will need to be performed to confirm the diagnosis.

If you do confirm that your FPG is still higher than 126 mg/dL on two different occasions, don’t panic. You must consider these important points first:

1) In your case, you have caught the disease early and you can take action now.
2) You have the awesome power to control your diabetes, and not let it control you!

Learning to control your blood sugar through diet is an excellent way to start. Even if you find you don’t have diabetes or have pre-diabetes, it is good to take action now. Diabetes education can have a lot of information packed into it, so signing up for a class might be beneficial. Your doctor can provide you with these contacts, or you can check out my post, “Newly Diagnosed…now what?” for more info on contacts in your area.

Take small steps. Watching your carbohydrate intake (starches, fruit, milk) alone will drastically improve results. Replace high carbohydrate foods with ones high in fiber, such as vegetables, fruits, and whole grains. Try to eat 3 meals a day at consistent times to keep your blood sugar from spiking and plummeting. Begin testing your blood sugar yourself each day at different times  to see how you are doing.  If you are not physically active, get moving!  Take a stroll through your neighborhood, or do something pleasant outdoors with a friend or spouse.

Don’t forget to maintain communication with your doctor. He/she may have specific recommendations for you, and may prescribe medication to help you along.

Until next time!

Source: National Diabetes Information Clearinghouse: http://diabetes.niddk.nih.gov/dm/pubs/diagnosis/#diagnosis

Fruits and Veggies

This week I received the following question from http://foodpicker.org:

I have pre-diabetes and am trying to lose weight.  How many servings of fruit and veggies should I have each day?

Losing weight is one of the primary recommendations your doctor will give you when you are diagnosed with pre-diabetes.  Excess fat, particularly in the abdominal region puts you at high risk for developing type 2 diabetes. Lifestyle changes to reduce your weight and to live an overall healthier lifestyle can prevent disease  progression. Replacing unhealthy, high calorie food choices with fruits and vegetables is an excellent way to start this process. 

To answer your question, aim for 3-5 servings of vegetables and 2-4 servings of fruit a day.  A serving size of vegetables is considered 1 cup raw or 1/2 cup cooked, and a  fruit serving  is considered a small piece of fresh or 1/2 cup of canned. Fruit and starchy vegetables such as potatoes, corn, peas, or lima beans are considered carbohydrates, but if eaten in moderation they are fine (see my post on carb counting for more information). Non-starchy vegetables, however, I often tell patients that if they’re still hungry they should go for these.  They contain minimal amounts of carbohydrate and are good for you.

Fruits and vegetables have less calories yet more vitamins and minerals that can improve your overall health, and fiber for lower cholesterol and improved heart health. I mention this because those at risk for diabetes are also at a higher risk for heart disease. 

Give it a try, and go for variety to keep your meals interesting. Frozen and fresh produce are the best, as canned can be high in sodium/sugar. Shoot for the most colorful fruits and vegetables, they tend to be the most nutrient packed and beneficial. The CDC has a great website for recipe ideas, more information regarding serving sizes, and budget tips:
http://www.fruitsandveggiesmatter.gov/

Last but not least, if you find yourself discouraged along your path towards a healthy weight, don’t give up. Losing just 5-10% of your body weight greatly increases insulin sensitivity and further reduces your risk for developing diabetes.

Source: http://www.diabetes.org/food-and-fitness/food/planning-meals/diabetes-food-pyramid.html

Counting Carbs..

This week’s question from http://foodpicker.org:

I was diagnosed with type 2 diabetes last month.  I’m having difficulty understanding how many carbs and sugar I can have each day.  I’m finding that nearly everything contains carbs and sugar!  Can you help me with this?

Certainly we can help you! There is an abundance of information out there on this very topic. Although trying to figure out carbohydrates can be overwhelming, understanding a few vital points will help you on your way.

First of all, it is important to understand what a carbohydrate actually is. Carbohydrates are our main form of energy in the diet, and are made up of starches, fiber, and as you’ve already mentioned, sugar. In the body, we break down these various types of carbohydrates into the form of  glucose, which our blood stream absorbs to provide the body with energy. As you may already know, type 2 diabetes is where the body does not sufficiently absorb glucose into the cells, resulting in high levels of circulating blood glucose. Because of the damage this can cause our bodies, people with type 2 diabetes must be especially careful to eat a limited about of carbohydrates daily. The foods that contain carbohydrates are mainly

-fruits
-starches (grains, starchy vegetables, beans)
-dairy 

Non-starchy vegetables have negligible amounts of carbohydrates, protein (such as meats, eggs, nuts) and fat sources have none. These 2 groups are good to keep in moderation as well due to their fat content. Excess can put you at greater risk for heart disease.

So what is a ”limited” amount of carbohydrates? It is recommended that men can consume 4-5 carbohydrate servings per meal, while women can have 2-3 servings per meal. What is a serving? Just remember 15 grams. One serving of carbohydrate is 15 grams. 

So now that we know the serving  size is 15 grams, what exactly does that look like?? It is hard to visualize a specific measurement like that, much less when you are trying to prepare a meal. Examples of carbohydrate servings, also known as ”exchanges” include:

1 small piece of fresh fruit (4 oz)
1/2 cup of canned or frozen fruit
1 slice of bread (1 oz) or 1 (6 inch) tortilla
1/2 cup of oatmeal
1/3 cup of pasta or rice
4-6 crackers
1/2 English muffin or hamburger bun
1/2 cup of black beans or starchy vegetable
1/4 of a large baked potato (3 oz)
2/3 cup of plain fat-free yogurt or sweetened with sugar substitutes
2 small cookies
2 inch square brownie or cake without frosting
1/2 cup ice cream or sherbet
1 Tbsp syrup, jam, jelly, sugar or honey
2 Tbsp light syrup
6 chicken nuggets
1/2 cup of casserole
1 cup of soup
1/4 serving of a medium french fry

You can find information on just about any food item, using a diabetes exchange lists. One of my favorites sites to use is http://www.mayoclinic.com/health/diabetes-diet/DA00077 . You can print these out and put them on your fridge for easy reference.

 Counting carbohydrates is also easier when food nutrition labels are available. When reading labels, looking the number of total carbohydrates per serving will give you a good idea of how much you can have of that product. It will also give you an idea of the amount of fiber it has out of those total carbohydrates (the more the better), and how much sugar it may have.

Learning about carbohydrates can easily be too much information in one sitting, but practicing identifying carbohydrate serving sizes is a great way to start. You may notice that a lot of serving sizes are in specific measurements. It may be helpful to measure them out with cups, teaspoons, etc., then make a mental note of what that looks like so you don’t have the hassle of measuring portions on your plate every meal. Once you get the hang of it, it will become a habit and won’t take as much thought each time.

Not only is this way of eating good for you, but it is the way we should all be eating, diabetic or not. Once you have the hang of carbohydrate counting, think of your plate as a whole like this:

Source: http://www.envisionnm.org

Newly diagnosed…now what?

This week I received this question from http://foodpicker.org:

I am trying to find a class for our grandson.  He is 19 and has a part-time job but no insurance.  He just found out last week that he has type 1 diabetes after losing a lot of weight and his blood sugar was 523.  He is on insulin but needs to go to a class to manage his diabetes without going hungry.  Where do we start?  Any suggestions would help us a lot.

Finding out you have diabetes can be a scary time, and can leave you wondering what to do first. To a lot of people it can be overwhelming, learning to take new medications, insulin, and for many, having to alter their lifestyle. Fortunately, there is hope! People with diabetes can live full, long, happy lives, just like anyone else. The secret to their success is being educated on the disease, how to manage it, and in making life-long healthy habits.

Bravo to you and your grandson for seeking out education right away. To get started, I recommend taking a look at the National Diabetes Education website developed by the CDC. It has a wealth of information to browse through:  http://ndep.nih.gov/index.aspx. There are many other useful internet sites out there on diabetes education, but be careful of their credibility. Government run websites, or national programs such as the American Diabetes Association are among the best.

Many cities offer local, free, community diabetes education classes. These classes will educate you on the disease itself,  introduce you to diet management, how to use a glucometer, how to administer insulin, how to treat various symptoms such as hypoglycemia (low blood sugar), and may even provide cooking classes. State health departments are a great way to locate these programs, and can refer you to local sources  for more information. Check out
http://www.cdc.gov/diabetes/states/index.htm to find the contact information for your state.
Hospitals often offer free classes as well, by a certified diabetes educator. You might be  really surprised how much your community has to offer!

It may be beneficial to consider a health insurance option, as the cost of doctor visits, medications,  and test strips  can become burdensome. The American Diabetes Association has some options you may want to check out:
http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/

This site also provides  a consumer guide to state insurance mandated coverage, Medicaid coverage, and state-sponsored diabetes programs:
 http://www.ncsl.org/IssuesResearch/Health/DiabetesHealthCoverageStateLawsandPrograms/tabid/14504/Default.aspx http://www.ncsl.org/IssuesResearch/Health/DiabetesHealthCoverageStateLawsandPrograms/tabid/14504/Default.aspx

You are not alone. The prevalence of diabetes in our country has led to the development of a ton of resources and free education programs. Your community is there to help.  The important thing to remember is that the more knowledge you seek about diabetes, the better off you are. As a soon-to-be dietitian, I am quite the believer that educating yourself, and developing healthy eating habits now will set you up wonderfully for the rest of your life. You can be your own diabetes expert, and can spread the wealth of knowledge to someone else you may encounter in need.

If you have any questions, please feel free to comment or email me at erbasham@gmail.com. Until next time!