The following lecture on "Eating Healthily with Diabetes" was given at the American Foundation for the Blind Center on Vision Loss in Dallas by Sabrina Marvel, RN and Diabetes Educator, employed at Blind Ambitions.
The lecture was presented as part of a series sponsored at the center by Kappa Kappa Gamma.
Well, good morning everybody. It's nice to be here with you today.
I was listening to some of the questions that you were asking the doctor and they were kinds of feeding right on into some of the things that we're going to talk about. And with my part which is more eating healthily.
What do we need to do in order to control diabetes?
Diabetes is such a self-management disease. It's one of those diseases that, of everything, it's you and your monitoring and your eating and everything that you do every day. You don't make that phone call to your doctor every morning and say, "Okay. This is what my blood sugar is."
You have to learn to make those decisions on your own. You have to have the knowledge in order to what we call self-maintenance or self-management of your diabetes. So that's what we're going to kind of talk about is self-management of your diabetes.
In self-management of your diabetes, a lot has to do with monitoring. That's one of the major big points of self-management is monitoring. And there's all kinds of meters out there for those of you who are visually impaired or totally blind or still have your sight. There's meters out there of all sizes all shapes all forms -- English speaking, Spanish speaking. All kinds of meters out there.
So monitoring is number one. Then also your daily food intake, because we know that food along with medication is a big part of managing diabetes.
So your monitoring, your food intake, and your medications and physical activity are some of the big major points of your own self-management of your diabetes. That's one of the things with making sure for what you're putting in your body, your balancing exercise with that.
So if you're one that likes to have a lot of carbohydrates in your diet, then you may be one that needs a lot of physical activity in your diet because, as you put the food into your body, you have to have a way to work it off or your body just stores it and your blood sugar goes higher. So a lot of time, physical activity, if you learn that, kind of that ratio of how much I need to exercise or how much I need to eat, then you can learn to control your diabetes, especially if you're one of those with Type 2 diabetes that are controlled by oral medication. You're not on insulin. Then that diet and exercise ratio gets to be very special for you guys because that's a good way to treat your diabetes and be able to control it with the oral medication along with the diet and exercise.
So you want to make sure that you are always doing that. Also you want to make sure that you distribute your meals throughout the day. I believe you were listening to the doctor talk about that. You don't want to have just one huge meal a day. You want to distribute your calories, your carbohydrates throughout the day. So you may have your three meals and your two snacks along with activity in between those meals to keep your blood sugar more at a normal pattern.
Then also you want to control the carbohydrates that you're eating. Many of you have probably talked to your doctor about what is a good carbohydrate count for you, or much of the carbohydrates you should be eating each day. And you want to distribute those throughout your meals in more of an equal fashion.
So for a lot of people about a fifteen day—fifteen carbohydrates in one day is about a normal, somewhere around a two thousand calorie diet.
So you want to split those up between each of your meals. You don't want to just have this huge big meal all at once with the carbohydrates.
Here are a couple of ways that you can control that carbohydrate issue. One is by some of the more people with advanced diabetes who've had a lot of training will do what is called carbohydrate counting. But then there's also what's called the "plate method" of controlling your carbohydrates. It's a very easy way to control carbohydrates.
You split your plate basically in half. In the top half of your plate you want to put all your good vegetables—the non-carbohydrate vegetables, your green beans, your broccoli, your cauliflower, things like that.
The bottom section you're going to halve again. And in one of those sections should give you a good-sized portion of your protein, of your meat, and the other half will be your carbohydrates for that meal, along with a dairy and a bread. So you may have mashed potatoes in there. You may have wild rice. You may have, you know, carrots.
Carrots do have carbohydrates with them. Corn. Carrots are not as bad. And depending on where you fall in your carbohydrate count for the day, you may count carrots as carbs or you may not. But definitely your starchy corn would fit in that category. So you'd basically have about three carbohydrates in that meal. If you didn't have milk or dairy, you could add another carbohydrate vegetable serving to that plate instead of having the dairy or the bread.
And the reason we wanted to limit the carbohydrates is that is the one thing in our diet that will raise the blood sugar the most. Your carbohydrates are going to immediately affect your blood sugar and send it quickly and at a very tall spike.
Your protein will have some effect on your blood sugar. It will send it up to some degree but nowhere near what the carbohydrates will. And it will not spike it as quickly and fall down. It will just give you more of a slight gradual increase and then level off.
Your fats also do have a bearing on your blood sugar too, but nowhere near the carbohydrates. Again, it tends to take a lot longer to get into your system and will kind of stable off instead of continuing to grow and climb to the mountain like the carbohydrates will. And talking about carbohydrate and some almost of what we've already talked about. The total carbohydrates in your diet is what you're looking at.
You do want to try to go to the more healthy carbohydrates, the starchy vegetables, the breads, the starches that way as opposed to the sugars which are the white sugar products which are going to be more of your desserts your cakes, your cookies, things like that. The more of the white sugar foods will raise blood sugar even higher than some of the just starchy vegetables.
What we've found in the most recent of times is that our serving sizes, while they haven't actually increased in the books, we have ourselves increased those serving sizes. We no longer go to MacDonald's and get a little small bag of French fries. We super-size those suckers now. So we get all, you know, a huge bag of fries and super-size that Coke. And, know we, we've increased the size of what we eat. So if we go back down to a more portion control. And looking at the amount of the carbohydrate that you're eating, and remembering that, you know, you may not need five baseball sizes of, you know, cereal in the morning.
If you use a smaller bowl that holds half a cup of dry cereal then you're going to only have that one serving of carbohydrate. Where as if you use a great big bowl and just pour the cereal in without measuring, you may end up having four servings of carbohydrates in that one bowl of cereal.
Looking at portion control, serving sizes. There are some things out there, we know, that, like one serving of bread, one carbohydrate of bread is about the size of a cigarette case. An ounce of cheese is the equivalent to a pair of dice.
Let's see, a potato. I believe I've got listed up there a small potato which is one carbohydrate would be about the size of a computer mouse.
A deck of cards is about the size of three ounces of meat or protein or your chicken. So you can look at some things in your house and know what size those are. What do those look like and know, when I look that this on my plate or I, you know, spoon it on, ,am I getting the right size or did I really put three portions of mashed potatoes on my plate and only I counted it as one when I looked at my carbohydrates? So it's really concentrating on portion sizes.
And, one thing we have found, if you use more of the correct size for things, you don't tend to load them on. If you use a huge nine ten inch plate, you're going to fill that plate up. Where, if you use a six inch plate, you're going to be a little bit smaller and more to the normal size of things.
If you put your ice cream in a four cup bowl, you may end up eating three cups of ice cream, you know. So, you want to use, if you use shovels, as I call them, the big tablespoons to eat with, you tend to put more on your plate.
If you use more of the correct size, when you go to pour your glass of milk or your glass of juice or whatever you're drinking, if you're looking that a serving of juice is four ounces. That's a carbohydrate of juice.
If you pour an eight ounce or a sixteen ounce glass full of apple juice, then you've had three carbohydrates or four in that one glass of juice. Same thing, you know, with soda or stuff like that.
So if you look at, you know, people love milk. My husband pours a twenty ounce glass of milk. I said, "Did you count all those carbs before you do your insulin?"
So if you keep the smaller size cups around, the small sized serving pieces you'll tend not to fill your plate with more than should be there.
One carbohydrate I did list up there is considered fifteen grams. Yeah, fifteen grams of carb is considered one carbohydrate if you're counting carbohydrates.
So when you're looking at things, if you look at the nutrition listing on the boxes and things like that, if you kind of keep that in mind. That fifteen grams is one carb. And you'll you know, you look at a can of Coke or Doctor Pepper. They are about the same. If you look at the serving sizes on there, it's an eight ounce serving size, which means there's more than one serving in that can. And the carbohydrates count's forty on that.
So, you've got several of your carbohydrates in that one can of Coke for the day. Most of the time, people who are on insulin take about a unit of insulin for each serving of carbohydrates that they're going to ingest.
This one (slide) gives you more on those diabetics that are a little more advanced in their training. This is a slide about individuals with diabetes that are using insulin pumps for their insulin. And those people who are really into the exact carbohydrate count, comparing it to how much insulin they should take and then putting that into their exercise program too. You can get very intense into diabetes training, into all of the things that go into trying to most normalize your blood sugar.
The most important thing about a good eating plan or healthy diet is make it something that you can stick too. You can talk to a diabetes educator. You can talk to a nutritionist. You can do all of those things. you can come up with this elaborate plan that's got everything that you should have the most perfect blood sugar that you've ever had. But if it's not a plan you can stick too, it's not something that's going to help you.
So, I always say with the people I'm working with, I do a lot of diabetes education through contracting with the Division for Blind Services; when I go out and speak to my clients, we're going to make this something you can do.
So think about what you're doing now. What's a step we can take in the right direction for you to either lose weight or improve your blood sugar or whatever it is we're trying to work on? Let's make a step that you can go from where you're at to something that you think you can do because you can make all the plans in the world. You can have the best-looking diet plan. But if not something you can stick to it's not something that'll help you.
So you definitely want to make things that you are able to stick to.
The last slide I've put on there—Make sure that you reward yourself. If you find that you've done a good job, give yourself a reward. I put the people up here dancing. Go to the movies. I don't know. Depending on your financial situation, now. But (laughter). I can't afford the movies any more but ...
You know give yourself that that goal. And when you reach your goal, reward yourself, you know. Say when I'm going to get to this point, I'm going to buy a new pair of jeans. You know, when you get to that point go buy those jeans, you know. Set that money aside. Reward yourself for your good job.
Depending on your family, you can let them know where you're at in your plan. My husband and I work very hard together on, he's an insulin dependent diabetic. I'm an insulin dependent diabetic. So we kind of have little games in our house. So we struggle over who has the lowest blood sugar in the morning. So.
We can play game like that, you know, at home because we're both in the same boat. But if you've got family support, if you've got someone that you can share what you're trying to do with, that's not going to overly hover you to make sure that it's done, that that can celebrate with you when you reach those goals, then that's great.
If not, you know, celebrate with your kitty or your dog or do something that's going to be fun for you. Tell yourself "Good job." Don't forget that when you're succeeding in your plan, give yourself that pat on the back. You know, you're doing a great job today.
Do you guys have questions?
Audience Question: What about the protein bars and shakes and stuff, how would you incorporate those into a diabetic diet and are they healthy or should you just stick to real foods?
Marvel: You can incorporate those. You have to, look, I would not make those that's all I eat all day long. But you can take the health bars, maybe that's a snack. Look at what kind of carbohydrate count those have on them. And maybe that's something that you don't normally, are able to stop in the middle of the afternoon and get a snack. Maybe you're like me and you're on the go. I keep granola bars in my bag for my afternoon snack because sometimes I'm not home to have, you know, a piece of fruit, a piece of protein or whatever. So I do grab one of those bars so that I keep my carbohydrates level throughout the day.
So you can incorporate those but just watch some of those and what the carbohydrate count is. Because they can call things healthy for you and then when you really start looking at what's in them and the nutrition labels, you'll see that they're just laden with either fat or sodium or, you know, things like that. So you just have to watch which one it is that you're using.
But as to supplement that for a meal or a snack then I think that's okay. You don't want to supplement that for all three meals of the day though. It's going to be better for you to eat one of those or drink one of the shakes as opposed to totally skipping a meal.
Audience Question: Basically how much time should pass between the last meal and you're going to bed?
Marvel: That's going to really vary with everybody. But you want at least a couple of hours because your blood sugar should, after about two hours, start to stabilize. So within the first two hours of eating your meal, your blood sugar is going to be climbing up. At about two hours it's going to stabilize and then will start to kind of come back down or curve back out into your, to a straight line.
So you definitely don't want to eat a meal and then just go lay down because that will not give you any activity in order to bring your blood sugar back to a normal level within those first few hours.
Audience Question: How about fish?
Marvel: Well, fish will be just covered in your protein. Now fish are a good protein or is a good protein depending on how you cook it and things like that. So you know, fish as far as using it as your protein is excellent because you have a lot less fat normally in your fish. You don't have some of the processing if you've got fresh fish. So fish can be a good source of protein for you without adding other things to it depending on how you cook it.
I mean if you're going to fry it, it's going to be like eating a piece of fried chicken. But if you bake it, tilapia, something like that, then you're going to have a better source of protein with a leaner meat.
Audience: It's also good for people who have macular degeneration.
Marvel: Do we have another question?
Audience Question: Do you find as a diabetic that you're always hungry?
Marvel: No. A lot of times diabetics will have the hunger when your blood sugar is staying higher because your body is not able to process the foods that you've given it. So when your body's not feeling like it has the, um, glucose that it needs, then it's going make you feel hungry because that's what it thinks you need. And if you don't have the insulin in your body, whether it's made by your natural body, whether your injecting it, or what you're using to break down your food, if you can't break down your food, your body's going to constantly be hungry because it's not able to use the food that you're putting in.
So it doesn't realize that you tried to feed it. It's just going to keep telling you, "I need to eat again."
Same thing goes with low blood sugar. If your blood sugar's too low, you will be hungry then too because your body's trying to say to you, "I need sugar. I need the glucose. I don't have the energy source -- because your brain needs the glucose to run your body. So it'll tell you, "I'm hungry. I need to eat."
Audience Question: What is the best to eat? More proteins?
Marvel: Ah, depending on why you're hungry. It would depend on whether your blood sugar's low or high. You know? Obviously if your blood sugar is low, you need some kind of carbohydrate. If your blood sugar's high, then actually um, ingesting water. Sometimes you'll be hungry or your blood sugar will be high because you may be a little dehydrated. And that may make your blood sugar a little bit high. So, you know, getting a couple of eight ounce glasses of water in. Or if you're on the insulin, you may need some insulin to bring that blood sugar down. And once your blood sugar's down, your body is happy. It's breaking down the food that you put in your body. Then you won't feel that hunger much any more. You'll go back into, you know, just a normal hunger.
So far as the monitoring, I kind of said this in the beginning, but monitoring is such a crucial point in diabetes. You don't know what's happening in your body if you're not monitoring your blood sugar. So monitoring your blood sugar is the biggest number one thing to do. I know sometimes we don't feel like we have the time or we can't get to it or it's so complicated and it doesn't have to be complicated. But that may be the reasoning behind not wanting to do it. But monitoring your blood sugar is the only way you'll know how your body reacts to what you're doing. So if you're eating and you're eating a certain food, you're wondering how it's reacting. Is it good? Is it not? Monitor before, and two hours after you've eaten it.
There are all kinds of monitoring devices out there, if you're sighted or can read meters. There are all kinds. The Advocates are very close with Prodigy. I don't know about the new advocate. The state sends me a lot of Prodigy materials. I know more about their meters. But, ah, there are all kinds of meters out there that can be affordable even if you don't have insurance. So don't let that stand in your way. They speak. They do everything for you. Tell you when to put the blood on the strip, do all of that. So there are definitely ways to do that.
Audience Question: The one thing that I have difficulty with is when I do three meals a day and then get some snack in there too, I need more ideas on different kinds of snacks. Because, you know, I'm tired of apple or, you know, cheese and crackers. And you said that you have granola bars. What kind of granola bars do you normally have?
Marvel: If you check out the carbohydrate count and look at what you're getting, you know. If you're taking two carbs for a snack which would give you around 30 grams of carbohydrates, you just want to check out the box and see if you've got a shopping assistant helping you or something. Ask them to read you the total carbohydrate on there when you're shopping and see what it gives for each bar. and then just kind of start comparing it because you can almost make anything a snack. You make, you know, a little bit of spaghetti, a leftover from the night before, a snack if you want to just by controlling the portion size. We have one more question.
Audience Question: I know that you monitor your blood sugar two hours after you eat. How long after you exercise do you monitor your blood sugar?
Marvel: I would exercise from the time you start from the time you finish. About ten or fifteen minutes into exercising, you are going to notice that your blood sugar will start to go down. So you can check your blood sugar immediately after you're through exercising. Because if you exercise for twenty minutes, you are already going to start to see the difference. Now you may still have another thirty minutes or so, that you still have the blood sugar falling. So. But you can monitor immediately and probably see a difference. But after about thirty minutes, your exercise probably isn't going to have affected on your blood sugar after that.
[End of lecture]