For those newly diagnosed with diabetes, the recommended lifestyle changes can be intimidating. Among the first guidelines are to eat a low-fat diet to help control cholesterol levels and to watch carbohydrate intake in order to keep glucose levels in check. But how do diabetics make these changes without sacrificing the foods they truly love? It turns out that they don't have to strictly adhere to a Spartan eating regimen, experts say.
Asking diabetics to stick to rigid diets over a long period usually doesn't work, says Ann Albright, director of the Centers for Disease Control and Prevention's Division of Diabetes Translation. "Living with diabetes is a dynamic experience. It's not static," she says. But it's important that newly diagnosed diabetics know the principles behind their new eating style. A good starting point is to understand what carbohydrates, fat, and proteins are and how they affect diabetes. A diet low in saturated and trans fats, for instance, is important because it can help reduce diabetics' elevated odds of developing heart disease.
And diabetics should understand how to monitor their blood glucose levels before and after meals. The National Diabetes Information Clearinghouse suggests a glucose target of 70 to 130 before meals and of 180 one to two hours after the start of a meal. Diabetics should ask their doctors how often they should monitor blood glucose levels and request an A1C test—which provides the average blood glucose level for the past three months—at least two times per year.
There are several eating tools that diabetics can use to help manage their condition. Among them: counting carbs and the create-your-plate method, which involves drawing imaginary lines on your plate to divide it into three sections (two small, one large), then putting non-starchy vegetables onto the largest section of the plate and starchy foods and meat/protein into each of the smaller sections. Also helpful in planning meals is the glycemic index, which measures how much a carb-containing food increases blood sugar levels. These tools are best used as aids, not as a rigid rulebook that must be followed, Albright says. A person's cultural preferences, work schedule, family situation, and willingness to change his or her diet should be taken into account. "You need to start people with where they are in their walk with diabetes," Albright says. "They should still take pleasure in eating."
But patients should know that making some changes in eating habits can be beneficial, along with taking prescribed medications, lowering blood pressure and cholesterol, and keeping up an exercise routine. Some researchers are investigating whether changing diet and exercise habits can affect heart health—an important concern for people with diabetes.
Researchers are also looking into whether dietary interventions make a difference in people at high risk for diabetes but who have not yet been diagnosed with the condition. A group of 25 people with prediabetes are taking part in a study to see whether a six-month diet and exercise program produces changes the chemistry of their heart nerves, since previous research shows that these nerves don't work as well in people with prediabetes as in healthy people. (When the balance of chemical reactions in the heart is upset, the chance of irregular heart rhythm, also known as arrhythmia, increases.) The reason for focusing on people with prediabetes: Researchers want to evaluate participants to see if a rigorous diet and exercise program might affect their health risks (they'll be compared with a group of healthy people who didn't make lifestyle changes). "We will be watching to see if they do end up developing diabetes," says Rodica Pop-Busui, assistant professor in the Department of Internal Medicine in the Division of Metabolism, Endocrinology and Diabetes at the University of Michigan in Ann Arbor, who is leading the study. It's expected to be completed in the summer of 2010.