The Diabetes Diet
Story by Mary Jo Plutt, Illustrations by Dave Granlund
Here are four steps to losing weight, feeling great and having a healthier heart
Healthful eating and weight management
are important for everyone, but they are of special concern to people who live with diabetes. Even if you’re carrying just a little extra weight — let’s say 10 to 15 pounds — and have type 2 diabetes, losing it may help lower your blood sugar, reduce your risk of cardiovascular disease by improving blood cholesterol levels, and lighten the stress on your hips, ankles, knees and feet. In some cases, losing those extra pounds may reduce or eliminate your need for diabetes medication.
“For some, weight gain can be a side effect when they begin taking insulin. This is because glucose calories are no longer being excreted in the urine,” explains Beth Anderson, a registered dietitian and certified diabetes educator at Liberty Medical. As a result, extra calories may be converted to fat that is stored in cells. If you gain excess weight, your body becomes more resistant to the insulin action — which means you may need to take more insulin.
“The best way to avoid this paradox is to maintain a healthy weight,” says Anderson. “Most of all, it’s important not to stop taking your insulin or reduce its level without first consulting your doctor.”
Steps to a successful diabetes diet plan
Before starting any weight-loss plan, be sure to check with your doctor, then work with a diabetes educator or registered dietitian to determine the program that’s right for your physical well-being — as well as one that will fit into your lifestyle for achieving long-lasting results. Anderson recommends working with a diabetes educator or registered dietitian on a weekly or biweekly basis.
Prior to discussing a weight-loss plan with your health care professionals, consider the following steps.
Step 1: Write down what you eat for a week
To design a diet plan that’s best for you, you first need to understand your current eating habits — what you eat, when and why. The best way to do this is by keeping a daily log or diary of everything you eat and drink for a week. “The more detailed your diary is, the better,” says Anderson. “On paper you will be able to see exactly what you’ve eaten and what triggers your thoughts behind your food choices.” To create a food diary, you may want to keep several sheets in a loose-leaf binder or have a small notebook that you can carry with you. Anderson recommends including the following columns for recording your information:
- Time of day
- Food
- Amount
- Mood
- Location
- Who you’re with
- Hunger level (ranging from 0 for “stuffed” to 5 for “famished”)
You may also want to record the amount and type of exercise you do each day. After keeping a diary for a week, you and your health care professional or registered dietitian will be able to evaluate your habits to identify possible problem areas that are keeping you from losing weight.
Step 2: Make Your Goals Realistic
Setting the proper goals is important. Your “ideal weight” may allow you to fit into your high-school prom dress or suit, but getting to that weight may be an unrealistic expectation, setting you up for failure and discouragement. Effective goals are specific, achievable and even a little forgiving when you have a small setback.
Your food diary will allow you to tally how many calories you are now taking in and how many calories you’ll need to reduce to reach your target or “healthy” weight. A healthy weight should be one that will lower your risk for increasing blood sugar and for developing heart disease, high blood pressure and other weightrelated conditions.
To determine a patient’s healthy weight, many health care professionals use body mass index (BMI) and waist circumference. BMI is a measure of weight relative to height. It is calculated by multiplying your weight in pounds by 703, then dividing by your height in inches and dividing again by your height in inches. A BMI score above 30.0 is considered to be obese, a score between 25.0 and 29.0 is considered overweight, and below 18.5 is underweight.
Step 3: Make a Meal Plan That Works for You
To lose weight — and keep it off — you will need a meal plan that you can follow every day. You’ll also need to know how to alter your insulin and other medications based on what you’re eating and how much you’re exercising. This is why it is important to consult with your health care professionals on a regular basis.
Most plans aim for a small but consistent weight loss. “For women, this is one-half to one pound per week; for men, one to two pounds per week,” says Anderson. By slowly reducing weight, your body can adjust more easily — and keep additional weight off without losing muscle mass — than if you were losing weight rapidly. As a rough rule of thumb, one pound of fat equals about 3,500 calories. So by just cutting back by 500 calories each day, you could lose a pound a week. One of the healthiest ways to cut back is to consume 250 fewer calories, then burn off 250 more calories through exercise.
Both the American Diabetic Association and the American Heart Association recommend reducing calories from across the board — protein, fat and carbohydrates. Ideally, your daily diet should be made up of the following:
- 10 to 15 percent protein
- 30 percent fat (less than 10 percent from saturated fatty acids, up to 10 percent from polyunsaturated fatty acids, and the remainder from monounsaturated fatty acids)
- 50 percent to 55 percent carbohydrates (rich in complex carbohydrates and fiber)
- At least 11⁄2 to 2 quarts of fluid, preferably water, each day
Begin creating a healthful meal plan by paying attention to what you are eating. By keeping your food diary up to date, you can see exactly what and how much you’re eating. Be aware of those “hidden” calories that you consume when snacking or tasting while you’re cooking. You may want to consider switching to a smaller dinner plate and bowl, and use a teaspoon rather than a soup spoon when eating soup, stew or cereal. “It’s also a good idea to measure your portions until you learn portion sizes,” says Anderson.
Also, remember to read labels carefully. A product labeled “lowfat” may actually be high in calories and carbohydrate. Don’t forget to include high-fiber foods, such as whole grains and fresh fruits and vegetables, in your diet. They’ll help you feel fuller longer.
Step 4: Enjoy Being More Active
There's more to weight loss than just eating less. Physical activity is important for not only taking off weight but also for keeping your heart healthy. Other bonuses include an increase in energy, a better ability to keep excess weight off and a positive sense of well-being.
For best results, most programs recommend at least 30 to 60 minutes of physical activity five to seven times per week. At first, this may sound like a lot of exercise, and so the whole idea falls at the bottom of your “to do” list. But it doesn’t have to be if you look forward to it.
“There is actually a one-two approach to physical activity,” says Anderson. “The first approach is a ‘work-out,’ the second is a ‘work-in.’”
For the “work-out” approach, choose activities that you enjoy. Perhaps it’s getting together with a friend or your spouse for a quick stroll though the park or around the inside of a mall, then enjoying a cup of coffee afterward. Or maybe your local gym offers a class in water aerobics, ballroom dancing or some other low-impact exercise.
For the “work-in” approach, simply work physical activity into your daily routine. For example, park the car at the end of the parking lot, or take the stairs instead of the elevator. You can even “workin” household chores, such as gardening or washing the car.
When starting any exercise program, check with your doctor about the type of activities that are best for you. Sometimes, a stress test is used to determine the intensity of activity that a person with diabetes can tolerate, especially if there is a history of heart conditions.
The success of your weight-loss program truly depends on you and your level of confidence. “So many people think that they can’t lose weight, and so they don’t,” says Anderson. “But if you are really cutting back on what you’re eating, exercising more and confident that you can lose the weight, then you will lose it.” HM
DIET STRATEGIES THAT DON'T WORK
“Be leery of diets that make quick-fix promises such as ‘lose 15 pounds fast — without ever feeling hungry,’ or claims that attach a certain number of days to weight loss,” cautions registered dietitian Beth Anderson.
In addition to fad or quick-loss diets, many people develop unhealthy eating habits. Two strategies in particular are harmful to people living with diabetes.
Low-carb diets:
One common dieting strategy is to cut out carbohydrates. But when your body doesn’t have carbohydrates to burn as fuel, it burns fat instead. This metabolic change is known as diet-induced ketosis. Some health care professionals believe that diet-induced ketosis can have numerous damaging effects on the body over time.
Skipping meals:
Another oftenused approach for losing weight is to skip meals, breakfast in particular. But it’s true what they say: Breakfast is the most important meal of the day. So try to eat something, even if it is just a piece of whole-grain toast or a half of a bagel with low-fat cream cheese. For a person living with diabetes, it is important that your blood glucose not drop to dangerous levels due to a missed meal. — M.J.P.