A crucial tool in controlling diabetes is being vigilant about what you put in your mouth. But, some experts say, you don't have to be a slave to the glycemic index or banish cake and ice cream forever.
The primary goal for diabetics is to regulate their blood glucose (sugar) levels because they can't rely on their bodies to naturally produce enough insulin, the hormone that shuttles glucose from the bloodstream into cells. With Type 1 diabetes, the pancreas stops making insulin, while with Type 2, the pancreas progressively makes less and less insulin or the body has difficulty using it (known as insulin resistance).
Anyone with diabetes should meet with a dietitian to formulate a meal plan tailored to their particular needs, experts say. But there are some general best practices.
Carbohydrate-rich foods, which break down into glucose during digestion, are of principal concern in a diabetic's diet. Those who use mealtime insulin injections — usually Type 1 diabetics and some Type 2 diabetics — typically have to count the grams of carbohydrates they eat at each meal so that they can give themselves the appropriate insulin dose.
But carbs are not the enemy or the only factor.
"What matters most is how much people eat," said certified diabetes educator Marion Franz, a Minneapolis-based nutrition and health consultant. If people cut back on total daily calories, regardless of the food source, generally their blood glucose levels decrease, and some people lose weight, which also helps significantly, Franz said. Eating anything in excess, even healthy foods, can be harmful, she said.
It's generally recommended for people to eat less than 2,000 calories daily, though that depends on body size and level of physical activity, Franz said.
Diabetics shouldn't eliminate carbs completely, though they should limit them and choose nutritionally rich carbs (veggies, whole grains) over empty ones (sugars, refined grains), said Amy Campbell, manager of the clinical education programs at Joslin Diabetes Center, a research organization affiliated with Harvard Medical School.
Typically diabetics should aim to eat 30 to 60 grams of carbohydrates per meal, and 15 to 30 grams per snack, so that they spread their carb intake throughout the day, she said. Sometimes men and avid exercisers can handle more.
Counting carbs can be tricky, so Campbell recommends following the American Diabetes Association's plate method for devising a meal: Fill half your plate with nonstarchy vegetables (carrots, broccoli, spinach), a quarter with lean protein (fish, chicken) and a quarter with high-fiber starches (brown rice, quinoa, beans). Add a piece of whole fruit (not fruit juice, which isn't as filling and sometimes contains added sugar) and an 8-ounce glass of nonfat or low-fat milk. Foods like cheese can be eaten in small amounts.
Avoiding saturated fats, such as fried foods and high-fat meats, is as important as watching carbs, as people with diabetes are more than two times more likely to suffer heart disease than people without, Campbell said.
Diabetics can eat sweets on occasion — no need to deny yourself a slice of cake on your birthday — as long as they swap out another carb and stay under their total carb goal, said Catherine Brown, senior diabetes education coordinator at the University of Maryland Center for Diabetes and Endocrinology. So, nix the rice during dinner if you plan to eat pie for dessert.
There is controversy about whether to take into account a food's glycemic index, which is a measure of how fast a food causes a person's blood glucose levels to rise within two hours. Research has been mixed on whether it makes a difference, and multiple variables can affect a food's impact on glucose levels, including how it's prepared and what it's eaten with.
Once overall carb intake is under control, Brown said, it could be worth it to pick foods with a lower glycemic index.
While eating healthfully is important, diabetics can still fit favorite foods — including sugar — into their meal plans as long as they eat them in serving sizes that don't significantly affect blood glucose levels, said Janis Roszler, a Miami-based registered dietitian and certified diabetes educator who has written several books on the topic, including "Diabetes on Your Own Terms."
To determine a safe serving size, she suggests people check their blood glucose level two hours after their first bite of a meal. If it's less than 180 milligrams per deciliter — or, for tighter control, less than 140 — the amount consumed was OK, Roszler said. If not, they should cut back.
The only food Roszler suggests diabetics avoid at all costs are nondiet soft drinks, which contain "way too much" sugar, she said.
Exercise is another way to make room for more favorite foods, Roszler said, as it can bring down blood sugar levels for up to 24 hours.
She said she's also excited about preliminary research showing the potential of a Mediterranean diet to help prevent sexual complications for people with Type 2 diabetes.