When people with diabetes are asked about the most difficult part of daily diabetes management, the answer is usually the same. People can check their blood sugar and give multiple insulin shots each day, but the greatest challenge is following a meal plan.
A person with diabetes must make food decisions quickly and accurately to maintain blood sugar control. Research has shown that those who follow a meal plan more than half the time have fewer blood sugars above the target range.
So what can people with diabetes do? Begin by setting up a daily meal plan as a guide for meals on typical days. This is beneficial in a number of ways. First, it will assure that the more than 40 different necessary nutrients your body needs are included.
Have you ever gone on a vacation and made a list of things to pack? Most times, the items forgotten are always those items which were not on the list. The same is true with a meal plan. Without a meal plan, many nutrients can easily be overlooked. A balanced meal plan should include high fiber grains, lean meats, fruit and vegetables, and low fat dairy products.
A good meal plan will provide a strategy to prevent heart disease. The risk of heart disease is a concern for all Americans because it is the leading cause of death in the United States, but it is particularly important for people with diabetes. People with diabetes are two to four times more likely to develop heart disease than people without diabetes.
The foods you eat can prevent or promote the development of atherosclerosis, a build up of plaque, a fatty-like substance, which narrows the inner walls of heart arteries. Foods to prevent heart disease are those rich in fiber, especially soluble fiber, found in legumes and soybeans, oats, brown rice, barley, fruit and vegetables. Research consistently supports the health benefits of consuming more soluble fiber. The mounting evidence has influenced the marketplace as we find many new foods manufactured with added fiber, like pastas.
Foods which promote the development of heart disease are those high in saturated fat and trans fatty acids. Most often, the fat contained in food is not obvious because you can't see it. Some of the foods high in saturated fat include cheese, hot dogs, sausage, bacon, bologna, chicken nuggets, macaroni and cheese, French fries, doughnuts, cookies, snack cakes, potato chips, cheese crackers, mayonnaise, creamy salad dressings, cream sauces, gravy, ice cream, and whole milk.
A meal plan will help establish consistency of eating habits and balance the amount of carbohydrates consumed throughout each day. This is essential in determining the amount of insulin required to keep blood glucose levels within range each day.
Studies reveal better metabolic control is directly related to regular meals. Irregular meals are the number one contributor to poor metabolic control resulting in higher glycohemoglobin A1c levels. What, when, and how much you eat directly affects blood sugar levels. Learning to balance food, insulin, and activity helps keep the blood sugar stable and within target ranges and lowers the risk for long term complications.
In general, a meal plan will include three meals and a bedtime snack. Some meals are higher in carbohydrates than others. In general, breakfast is the highest carbohydrate meal, and dinner has the least amount of carbohydrates. Carbohydrates consumed at meals provide the energy the body needs each day to be active, to grow (in children and youth), and maintain health.
Most of us need more energy to start our day, and much less energy after dinner. Eating too much at dinner will result in the body storing the energy for the future in fat cells, thus causing weight gain. It is especially important for the bedtime snack to be consistent.
Excessive snacking is eating large amounts of food frequently. This practice will directly contribute to a higher glycohemoglobin A1c. A snack should not be the same size as a meal. General guidelines for a snack is keep the portion under 30 grams carbohydrate. This would be less than 200 calories. Allow two hours between eating a snack and the next meal.
A meal plan will also serve as a map or guideline to maintain healthy weight. Over time, people with diabetes often narrow their focus of meal planning to only high carbohydrate foods. Although only some protein and very little fat turns into blood glucose following a meal, these can contribute to higher blood sugar levels.
If your regular diet includes a considerable amount of protein and fat, this may require insulin doses to be increased. The practice of focusing only on carbohydrate content of foods neglects that total caloric or energy intake is responsible for managing weight. All calories count. It is necessary for everyone to be mindful of all of the foods consumed, not only those which “count” as carbohydrate.
A personalized meal plan provides a guideline of how much food is the right amount for you so excessive weight gain can be prevented.
A person cannot succeed without a plan. Unfortunately, it is impossible to maintain blood sugars within normal ranges and prevent long term complications without a meal plan. Meal planning is the main element necessary for success. If you are striving to succeed in any area of life, you know it is a greater likelihood of achieving a goal when you have a written plan. For the person who says, “well, one day I will...” success will always be “one day” away.
Make today that “one day.” Begin to write out a meal plan and meet with a registered dietitian. Dietitians are nutrition experts and can help develop a personalized meal plan to fit individual needs. After an initial plan is developed, meeting with the dietician two or three times a year is essential to ensure the meal plan is the best plan for success.
By Jill L. Quarry, M.S.,R.D., L.D.N.,C.D.E.
Clinical Dietitian Specialist – Pediatric Diabetes Management
Penn State Milton S. Hershey Medical Center