Consult a dietitian.
Your doctor can refer you to a registered dietitian, who will evaluate your current diet and make suggestions based on what, when, and how much you like to eat. Don’t worry that a dietitian will only give you a list of rules and no-no’s-a common fear. You may find instead that she actually provides you with more flexibility than you thought possible. For example, if you eat an ethnic diet that includes a lot of beans and rice-foods that raise blood-glucose levels-your dietitian can help make sure those staples remain a major part of your diet by, say, limiting per-meal portions or spreading your consumption out over the course of the day.
Many health-insurance and managed-care plans won’t pay for ongoing consultations with a dietitian, but a diagnosis of diabetes will often allow you to schedule up to three visits. That’s enough to establish a workable plan, which you, your doctor, and-perhaps occasionally-your dietitian can fine-tune as you go.
Keep a food diary.
Before you see your dietitian for the first time, keep a log of each morsel-no matter how small-that you eat every day for at least a week. Don’t just simply note what you put in your mouth. Also write down where you ate a particular food and what you were doing at the time. Doing this will help your dietitian find patterns that may reveal the other “w”-why you eat. If, for example, you often go out with colleagues after work, your dietitian won’t want to eliminate this important social and business noshing, but she may suggest that you nibble on pretzels instead of beer nuts. Keeping a food diary doesn’t help only your dietitian: Writing down what you eat will heighten your awareness of your eating habits, and this can help you recognize ways you can change.
For your diary, keep a small notebook handy throughout the day so you can jot down what you eat right away. Some people make notes in their BlackBerry devices. If taking notes at every sitting is inconvenient, you can try to reconstruct your food consumption at the end of the day; the record will be valuable even if you forget an item here and there.
Factor in your blood sugar.
Also show your dietitian your log of daily blood-sugar readings so she can compare your glucose levels to your eating patterns. Comparing the two will indicate how much your blood sugar tends to swing in response to food and will help determine when and how much you should eat. Some people with diabetes can manage simply by eating three balanced meals a day and cutting back on the empty calories in sweets; others need to follow a more detailed plan specifying calories, grams of carbohydrate, or number of servings from different food groups.
Put it all together.
Once you and your dietitian have a grasp of your eating and blood-sugar patterns, it’s time to hammer out recommendations for specific foods you can eat at each meal or snack. This process is part negotiation and part analysis, and it involves other variables that have to be factored in:
- Your weight. The more excess pounds you carry, the more careful you’ll need to be about what you eat.
- Exercise habits. Exercising typically makes blood sugar go down, so how much you do-and when-will affect the number of calories you should take in at each meal.
- Insulin use. If you’re type 1, the content and timing of your meals should consistently balance the amount of insulin circulating in your blood from injections. If you’re type 2 and using insulin, you’ll need to factor this in on top of variables (such as weight and exercise) that affect insulin resistance.
- Medication use. Which medication you take, how much, and when its action peaks may affect your dietary choices. If you have type 2 diabetes, getting off medication may be a realistic goal for your meal plan.
- Special considerations. Be sure to inform your dietitian of results of tests for lipids (such as cholesterol), blood pressure, and microalbumin (for kidney function). If you already suffer such complications as poor cholesterol ratios, high blood pressure, and kidney damage, you may need to follow guidelines that specifically deal with those conditions, such as eating even less saturated fat, cutting back on salt, or avoiding excessive amounts of protein.
Consistency is key.
Once you’ve developed a plan, you’ll keep your blood sugar more stable if you eat about the same amount of food with the same balance of nutrients at about the same times each day. Don’t figure you can be “bad” on some days as long as you’re “good” on others: Eating in erratic patterns only causes blood sugar to seesaw. Instead, try to come up with a meal plan you can live with all the time.
How’s it working?
Self-monitoring your blood sugar will give you and your doctor a sense of how well you’re able to control it with diet. From there, you can fine-tune your plan of attack by tinkering with your meal plan or changing your activity level, insulin dosage, or other variables. If you’re type 2 and you’re having trouble keeping your blood sugar in line through diet and exercise, that may mean you’re a candidate for drug intervention. On the other hand, if you’ve succeeded at losing weight and controlling your blood sugar through diet and exercise, you may be able to stop taking insulin or medication.