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HEART Insight:
doi: 10.1097/01.HEARTI.0000343115.28176.17
Features: Nutrition Know-Knows

“I've Just Been Diagnosed With Type 2 Diabetes –What Can I Eat?”

Gorman, Rachael Moeller

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Our Glucose Control Primer Takes The Mystery Out Of Diabetic Diets

When Bob Cavicchi left his doctor's office last summer with a diagnosis of type 2 diabetes and a prescription for a glucose meter, he and his wife, Debbie, knew their lives were about to change. But like many in their situation, they only had a fuzzy idea just what that change meant.

Carbs, calories and weight control all seemed important — but which foods were “good” and which were “bad,” as well as how much to eat of each, was a bit murky. Aware that complications of untreated diabetes, such as eye, kidney or circulation problems, loomed in the future, the couple set out to relearn how to eat a healthy diet.

Fortunately, the basics of a sound diabetic lifestyle are relatively simple, and someone newly diagnosed with diabetes can learn how to keep blood sugar levels steady to fend off complications for years.

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Just like a car runs on gasoline, the cells in our body run on glucose that is absorbed into the bloodstream from the digestive tract when we eat. Insulin is needed to turn sugar and other food into energy. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should, or both. This causes excessive levels of sugar to build up in your blood.

When Bob became one of the 23.6 million Americans who have type 2 diabetes, his first thought was “gotta cut down on sugar.” But that's not the whole story, say experts. In fact, the most important thing Bob can do is to drop some weight.

“Type 2 diabetes is more an issue of weight rather than sugar,” says Ken Snow, M.D., Acting Chief of Adult Diabetes at Joslin Diabetes Center in Boston, MA. Research shows that fat cells pump out substances that cause insulin resistance. The heavier a person gets, the more fat cells he has, and the more severe the resistance becomes. And guess what? It works both ways: The more weight a person loses, the better his body absorbs and uses glucose.

It doesn't take much weight loss to see improvement, either. “Losing about 10 pounds can have a dramatic impact,” said Snow. Modest weight loss has been shown to improve insulin resistance, reduce blood sugar and lower blood pressure, and both the American Heart Association and the American Diabetes Association recommend weight loss of five to seven percent through lifestyle changes and increased regular physical activity.

To lose weight and protect against heart disease and other diabetes-related complications, the Joslin Diabetes Center suggests cutting 250 to 500 calories from your diet per day. A heart-healthy diet — which is really the same diet that someone who has diabetes should follow — includes all of the basic food groups: grains, vegetables, fruits, dairy, meat and beans.

▪ Carbohydrates — including whole grains, legumes, beans and fruits — should comprise about 40 percent of daily calories.

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▪ Between 20 and 30 percent of the calories you take in should come from lean protein — and make sure you eat two or more servings of fish a week.

▪ Fats, mostly in the form of unsaturated oils, like olive and canola, should be no more than 35 percent of overall daily caloric intake; saturated fats need to be limited to less than seven percent and cholesterol to less than 200mg/day. Try to eliminate trans fats, found in fast and processed foods, entirely from your diet.

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In addition to weight loss, monitoring carbohydrate intake will help regulate sugar levels. A dietitian can advise you on how many grams of carbs you can eat per meal, or can teach you how to accurately guesstimate intake using the plate method (carbs should take up about 1/3 of your plate).

Fruits, vegetables and whole grains are complex (or “good”) carbs, and your diet should emphasize them. But processed foods contain simple (or “bad” carbs), so it's a good idea to cut down on cookies, cakes, white bread and pasta.

Simple carbs are digested very quickly, which causes sharp spikes in blood sugar, and provide little more than nutrient-free calories. Since the body takes longer to digest complex carbs, the rise and fall of blood sugar levels in the body is steadier, and you also get vitamins, nutrients and fiber when you eat these foods.

“Certain foods are very high in sugar, fat and calories. They're clearly not good for folks to be eating, but it's not so much because they're high in sugar. It's because they are a high caloric food that is not going to facilitate weight loss,” says Snow. He adds, “Decreasing simple carbohydrates and increasing complex carbohydrates will help control blood sugars in the short term.” Eating high fiber foods can help, too — at least 20 to 35g a day, for the average person.

One more thing: If you were in the habit of skipping breakfast or lunch, you're now going to have to make sure that you eat three meals a day, and at roughly the same times from day to day. “You really want consistency — divide your carbohydrates up throughout the day” to keep blood sugar consistent, says Nora Saul, R.D., C.D.E., at Joslin. “It is best to divide carbs fairly evenly” to keep blood sugar consistent, says Hope Warshaw, R.D., C.D.E., author of Diabetes Meal Planning Made Easy (American Diabetes Association, 2000).

Back in the Cavicchi household, fish, chicken, whole grains and lots of vegetables now grace the table. “Ice cream every night is gone, but now I don't miss it,” says Bob. For her part, Debbie has “no problem” eating a healthier diet.

Bob has an appointment to see a dietitian for a detailed rundown of his new diet, as all newly diagnosed patients, but he has already lost about 15 pounds just by making some common-sense changes in his diet, and has seen his blood sugar drop 50 to 70 points.

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Blood Sugar Targets To Shoot For

When someone is diagnosed with type 2 diabetes, the first line of attack is changes in diet and physical activity that promote weight loss and keep blood glucose levels within the target range so as to avoid the need for daily insulin injections for as long possible.

“[While] you're trying to get glucose into the normal range, you need to monitor three to four times a day to see whether therapeutics and foods are working,” says R. Paul Robertson, M.D., President Elect, Medicine and Science, of the American Diabetes Association. Once your blood sugar is well-controlled, you can do the blood sugar checks less frequently — perhaps just once a day or a few times a week.

If you're on insulin, you will need to check blood sugar four or more times a day. Checking at various times of day — not just right before or after meals — is key to getting a sense of how specific foods and physical activity level affect your glucose control.

Whether your diabetes is being managed with lifestyle changes or with lifestyle changes plus insulin, your target fasting blood sugar level should be 90–130mg/dl; two hours after a meal, blood sugar should be 160mg/dlor lower.

© 2008 American Heart Association, Inc.