by Toby Smithson, RDN, CDE, with Alan L. Rubin, MD

Diabetes Meal

Planning & Nutrition

Diabetes Meal Planning & Nutrition For Dummies®

Published by John Wiley & Sons, Inc., 111 River Street, Hoboken , NJ 07030-5774 www.wiley.comCopyright © 2014 by John Wiley & Sons, Inc., Hoboken, New JerseyPublished simultaneously in CanadaNo part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as permit-ted under Sections 107 or 108 of the 1976 United States Copyright Act, without the prior written permis-sion of the Publisher. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at http://www.wiley.com/go/permissions.Trademarks: Wiley, For Dummies, the Dummies Man logo, Dummies.com, Making Everything Easier, and related trade dress are trademarks or registered trademarks of John Wiley & Sons, Inc., and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc., is not associated with any product or vendor mentioned in this book.

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Contents at a GlanceIntroduction ................................................................ 1

Part I: Diabetes and Food: An Intimate Connection......... 7Chapter 1: Having Your Diabetes and Eating, Too ........................................................ 9Chapter 2: Understanding Diabetes .............................................................................. 21Chapter 3: Managing Diabetes and Blood Glucose ...................................................... 35Chapter 4: Doing More to Manage Diabetes ................................................................. 53

Part II: Nutrition with Purpose ................................... 61Chapter 5: Explaining Nutrition Requirements for Diabetes ...................................... 63Chapter 6: Meeting the Macronutrients — Protein, Fat, and Carbohydrates .......... 77Chapter 7: Reading the Fine Print: Micronutrients ...................................................... 91Chapter 8: Revisiting Carbohydrates .......................................................................... 115Chapter 9: Equipping Yourself For Success ............................................................... 127

Part III: Meal Planning for Better Health .................. 141Chapter 10: Exposing Barriers to Healthy Eating ...................................................... 143Chapter 11: Setting Priorities and Staying on Track ................................................. 157Chapter 12: Shopping for the Best Food Choices ...................................................... 173

Part IV: Ready, Set, Plan ......................................... 191Chapter 13: Customizing Your Meals .......................................................................... 193Chapter 14: Modifying Popular Diet Plans .................................................................. 219Chapter 15: What’s On the Menu: Having a Plan for Eating Out .............................. 239Chapter 16: Choosing Sensible Beverages and Snacks ............................................. 253

Part V: Putting It All Together: Seven Delicious Days Managing Your Diabetes .......................................... 267Chapter 17: Reviewing a Seven-Day Menu .................................................................. 269Chapter 18: Starting Your Recipe Collection ............................................................. 281

Part VI: The Part of Tens .......................................... 307Chapter 19: Ten Diabetes “Power Foods” ................................................................... 309Chapter 20: Ten Diabetes-Friendly Foods Costing Less Than $1.00........................ 315Chapter 21: Ten Healthy Food Swaps for Losing Weight .......................................... 319

Part VII: The Appendixes .......................................... 325Appendix A: Diabetes Exchange Lists ......................................................................... 327Appendix B: Ethnic Carbohydrate Foods ................................................................... 341Appendix C: Conversions.............................................................................................. 345

Index ...................................................................... 349

Table of ContentsIntroduction ................................................................. 1

About This Book .............................................................................................. 1Foolish Assumptions ....................................................................................... 3Icons Used in This Book ................................................................................. 3Beyond the Book ............................................................................................. 4Where to Go From Here .................................................................................. 5

Part I: Diabetes and Food: An Intimate Connection ......... 7

Chapter 1: Having Your Diabetes and Eating, Too . . . . . . . . . . . . . . . . . .9Accepting Your Role in Diabetes Management ......................................... 10

Losing glucose homeostasis ............................................................... 10Taking your place in glucose metabolism ........................................ 11

Understanding Your Brain ............................................................................ 12Seconding that emotion ...................................................................... 13Exposing impulsive eating .................................................................. 14

Deciding What to Eat ..................................................................................... 15Forgetting “diabetic diet” .................................................................... 15Considering carbohydrates ................................................................ 16Keeping your heart healthy ................................................................ 17

Doing It Yourself ............................................................................................ 18

Chapter 2: Understanding Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21Defining Diabetes Mellitus ............................................................................ 22

Explaining the role of glucose ............................................................ 22Simplifying insulin ............................................................................... 23

Exploring Type 1 Diabetes and LADA ......................................................... 24Losing the capacity to produce insulin............................................. 25Puzzling over the causes of type 1 ................................................... 27

Analyzing Type 2 and Gestational Diabetes ............................................... 27Following the progression of type 2 .................................................. 28Weighing the role of body mass......................................................... 29Considering ethnicity, genetics, and age .......................................... 30Developing diabetes during pregnancy ............................................ 32

Summing Up the Potential Complications of Diabetes ............................. 32

Diabetes Meal Planning & Nutrition For Dummies viChapter 3: Managing Diabetes and Blood Glucose . . . . . . . . . . . . . . . .35

Getting Glucose In and Out of Your Blood ................................................. 36Finding an escort — insulin ................................................................ 37Storing glucose for later ...................................................................... 38

Losing the Glucose Balance ......................................................................... 39Measuring Blood Glucose ............................................................................. 40

Testing blood glucose at home .......................................................... 41Getting the averages ............................................................................ 42

Following Doctor’s Orders ........................................................................... 43Choosing a “which” doctor ................................................................. 44Minding your medications .................................................................. 45Explaining insulin therapy .................................................................. 47

Seeing a Registered Dietitian ........................................................................ 48Losing body weight.............................................................................. 49Reducing risk for heart disease ......................................................... 49Getting to know carbohydrates ......................................................... 50

Starting Your New Management Job ........................................................... 50

Chapter 4: Doing More to Manage Diabetes . . . . . . . . . . . . . . . . . . . . . .53Adopting a Healthy Diabetes Lifestyle ........................................................ 53

Getting physical activity ..................................................................... 54Extinguishing the smokes ................................................................... 56Shedding stress .................................................................................... 56

Prioritizing Your Health ................................................................................ 57Making the commitment ..................................................................... 58Learning new tricks ............................................................................. 59Valuing prevention .............................................................................. 59

Part II: Nutrition with Purpose .................................... 61

Chapter 5: Explaining Nutrition Requirements for Diabetes . . . . . . . .63Targeting Blood Glucose Control ................................................................ 64

Matching medication and food .......................................................... 64Keeping A1C in range .......................................................................... 65

Losing to Win — Weight Loss ...................................................................... 67Monitoring Cardiovascular Risks ................................................................ 68

Normalizing high blood pressure ...................................................... 69Lowering LDL cholesterol ................................................................... 70

Considering Some Special Circumstances ................................................. 72Children ................................................................................................. 72Elderly ................................................................................................... 73Athletes ................................................................................................. 74Celiac and gluten sensitivity............................................................... 75Gastroparesis ....................................................................................... 75Kidney failure ....................................................................................... 75

vii Table of Contents

Chapter 6: Meeting the Macronutrients — Protein, Fat, and Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Building with Protein for Diabetes Management ....................................... 78Recycling amino acids from food ...................................................... 79Finding animal sources of protein ..................................................... 80Harvesting plant sources of protein .................................................. 81Leaning toward lean — a diabetes priority ...................................... 81

Figuring Out Fats for Heart Health .............................................................. 82Going beyond insulation ..................................................................... 83Highlighting unsaturated fat ............................................................... 83Watching out for saturated fat and cholesterol ............................... 84

Energizing with Carbohydrates — The Foundation of a Diabetes Diet..... 86Sugar and diabetes — sweet or sour? ............................................... 87Making a chain — complex carbohydrates ...................................... 88Fantastic fiber ....................................................................................... 90

Chapter 7: Reading the Fine Print: Micronutrients . . . . . . . . . . . . . . . . .91Introducing Versatile Vitamins .................................................................... 92

Give me a “B” (vitamin or two) .......................................................... 93A sunny day with vitamin D ................................................................ 95

Finding Marvelous Minerals ......................................................................... 97Calcium — more than strong bones .................................................. 97Chromium — from the Emerald City ................................................. 99Magnesium matters ............................................................................. 99Potassium — too much, or too little ............................................... 100Sodium — a little goes a long way ................................................... 101Insulin and zinc — two peas in a pancreas .................................... 103

Analyzing Some Antioxidants and Herbal Remedies .............................. 104Alpha lipoic acid and neuropathy ................................................... 104Fenugreek for better blood glucose control ................................... 105Cinnamon, minus the bun ................................................................. 105Garlic — just a breath enhancer? .................................................... 106

Considering Phytonutrients ....................................................................... 107Colorful carotenoids .......................................................................... 107Chocolate covered flavonoids .......................................................... 109Resveratrol — fruit of the vine ......................................................... 110

Sorting Out Supplements ............................................................................ 111

Chapter 8: Revisiting Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . .115Deciphering Carbs ....................................................................................... 115

Finding carbohydrates ...................................................................... 116Deciding to “carb” or not to “carb” ................................................. 117Evaluating glycemic index/glycemic load ....................................... 118

Counting Carbs ............................................................................................ 120Counting to 15 grams ........................................................................ 120Comparing carb choices ................................................................... 121Insulin bolus dosing........................................................................... 123

Diabetes Meal Planning & Nutrition For Dummies viiiPutting Carbs on Your Plate ....................................................................... 124

Managing staple carbs ...................................................................... 125Following your meal plan .................................................................. 126

Chapter 9: Equipping Yourself For Success . . . . . . . . . . . . . . . . . . . . .127Stocking Your Diabetes Kitchen ................................................................ 127

Gathering tools and gadgets ............................................................. 128Planning the pantry ........................................................................... 130

Understanding Nutrition Facts Labels ...................................................... 132Calories ............................................................................................... 134Grams and milligrams ....................................................................... 135Serving sizes ....................................................................................... 135

Calculating Food Choices ........................................................................... 136Sizing up your food — portion sizes ............................................... 136Estimating tricks ................................................................................ 138

Referencing the Right Resources .............................................................. 138Searching websites and apps ........................................................... 138Collecting recipes .............................................................................. 139Converting recipes............................................................................. 139

Considering Exchanges ............................................................................... 140

Part III: Meal Planning for Better Health ................... 141

Chapter 10: Exposing Barriers to Healthy Eating . . . . . . . . . . . . . . . . .143Tracing Changes in the Food Environment .............................................. 144

Surviving scarcity .............................................................................. 144Being overwhelmed by food ............................................................. 146

Recognizing Our Emotional Attachment to Food .................................... 147Identifying with our culture .............................................................. 147Making the social connection........................................................... 148

Deferring To Our Inner “Caveman” ........................................................... 149Seeking the pleasure response......................................................... 149Losing logic to impulse from stress ................................................ 150Uncovering the mindless subconscious ......................................... 152

Beating the Odds — Eating Healthier Forever ......................................... 153Creating the right environment ....................................................... 153Planning: Using your incredible brain ............................................. 155

Chapter 11: Setting Priorities and Staying on Track . . . . . . . . . . . . . .157Committing to Your Future ........................................................................ 158

Making time for healthy eating ........................................................ 158Accepting inconvenience .................................................................. 159Learning new things — Old dog, new tricks ................................... 160Standing your ground ........................................................................ 161

ix Table of Contents

Adopting Better Habits ............................................................................... 161Eating at home more often ............................................................... 162Timing is everything .......................................................................... 163

Staying On Track ......................................................................................... 164Declining deprivation — insisting on delicious ............................. 165Embracing imperfection.................................................................... 165Ignoring quick fixes ............................................................................ 166

Achieving Your Goals .................................................................................. 168Writing it all down ............................................................................. 168Using blood glucose readings .......................................................... 169Asking for directions ......................................................................... 170Rewarding small successes .............................................................. 172

Chapter 12: Shopping for the Best Food Choices . . . . . . . . . . . . . . . . .173Starting Healthy Meal Planning .................................................................. 173Heading For the Grocery Store .................................................................. 174

Making your list.................................................................................. 175Stretching your dollars ..................................................................... 176Avoiding temptation .......................................................................... 177

Unraveling Food Terminology ................................................................... 177Picking prepackaged ......................................................................... 178Defining processed foods ................................................................. 179Analyzing organic foods .................................................................... 180

Shopping Smart Aisle to Aisle .................................................................... 180Picking produce ................................................................................ 181Bread, cereal, crackers — grain in disguise ................................... 182Choosing meats, poultry, and fish ................................................... 183Ovo and lacto — eggs and dairy ...................................................... 184Deli counter — no place for a novice .............................................. 185Long-term storage — canned and frozen foods ............................. 186Carb loading — pasta, rice, and legumes ....................................... 187Oils and condiments .......................................................................... 189Chipping away at snack foods .......................................................... 189Surprises in the “health foods” aisle ............................................... 190

Part IV: Ready, Set, Plan .......................................... 191

Chapter 13: Customizing Your Meals . . . . . . . . . . . . . . . . . . . . . . . . . . .193Laying the Foundation ................................................................................ 194

Knowing your personal meal plan ................................................... 194Making MyPlate into YourPlate ........................................................ 197Coming to grips with carb portions ................................................ 199Starting simple ................................................................................... 201Picking a perfect protein ................................................................... 201

Diabetes Meal Planning & Nutrition For Dummies xIsolating carbohydrates .................................................................... 202Filling up on vegetables .................................................................... 204Mix and match meals for you ........................................................... 205

Moving Beyond Simple ............................................................................... 207Knowing the sneaky foods ................................................................ 207Trying mixed dishes and casseroles ............................................... 208Remembering breakfast and lunch .................................................. 210Adding in the add ons ....................................................................... 211

Gobbling Around the Globe ....................................................................... 213Satisfying Southern and “soul” ......................................................... 213Loving Latino ...................................................................................... 215Assessing Asian .................................................................................. 216Incorporating Italian .......................................................................... 216

Chapter 14: Modifying Popular Diet Plans . . . . . . . . . . . . . . . . . . . . . . .219Basking in the Mediterranean .................................................................... 220

Balancing grains, legumes, and fruit ............................................... 221Swapping meat for fish and olive oil ............................................... 222Having wine with dinner ................................................................... 224

Dining With DASH ........................................................................................ 224Controlling high blood pressure with diet ..................................... 225Considering grains, fruit, and dairy ................................................. 225Finding Potassium, Magnesium, and Calcium ................................ 227Losing sodium is even better ........................................................... 228

Preferring Plants .......................................................................................... 228Adopting the ovo-lacto view ............................................................. 229Being vegan ......................................................................................... 230

Counting Points — Weight Watchers ........................................................ 231Food By Mail ................................................................................................. 232

Nutrisystem ........................................................................................ 232Jenny Craig ......................................................................................... 233

Saying Farewell to Carbs ............................................................................ 234Resisting Fads .............................................................................................. 234

Promising the quick fix...................................................................... 235Trumpeting miracle foods ................................................................ 235

Salvaging Your Heirloom Recipes ............................................................. 236Calculating nutrition facts ................................................................ 236Modifying ingredients ....................................................................... 237

Chapter 15: What’s On the Menu: Having a Plan for Eating Out . . . .239Making Decisions First ................................................................................ 240

Remembering your meal plan .......................................................... 240Checking ahead .................................................................................. 242Sticking to a plan ................................................................................ 242

Dining Out ..................................................................................................... 242Analyzing the menu ........................................................................... 243Asking the right people ..................................................................... 244

xi Table of Contents

Bringing your own ............................................................................. 245Taking some home ............................................................................. 245

Keeping it Honest ........................................................................................ 246Drinks and bar snacks ....................................................................... 246Hors d’oeuvres, appetizers, bread, and dessert ............................ 247Salad bar foolers ................................................................................ 248Wanting it all — buffets ..................................................................... 251

Chapter 16: Choosing Sensible Beverages and Snacks . . . . . . . . . . .253Mixing with Alcohol ..................................................................................... 254

Finding the calories and carbohydrates ......................................... 254Caution about hypoglycemia ........................................................... 255

Coffee and Tea ............................................................................................. 256Soft Drinks and Flavored Waters ............................................................... 257Sports and Energy Drinks ........................................................................... 258Nuts and Seeds ............................................................................................. 259Chocolate and Candy .................................................................................. 260Low-Carb Healthy Snacks ........................................................................... 262

Low-carb snacks................................................................................. 26315-gram snacks ................................................................................... 26330-gram snacks ................................................................................... 264

Alternative Sweeteners ............................................................................... 264Treating Hypoglycemia ............................................................................... 265

Part V: Putting It All Together: Seven Delicious Days Managing Your Diabetes ................................... 267

Chapter 17: Reviewing a Seven-Day Menu . . . . . . . . . . . . . . . . . . . . . .269Day 1 .............................................................................................................. 270Day 2 .............................................................................................................. 271Day 3 .............................................................................................................. 272Day 4 .............................................................................................................. 274Day 5 .............................................................................................................. 275Day 6 .............................................................................................................. 276Day 7 .............................................................................................................. 278Snacks ........................................................................................................... 279

Chapter 18: Starting Your Recipe Collection . . . . . . . . . . . . . . . . . . . . .281Enticing Entrées ........................................................................................... 282

Spiced pork tenderloin with gala apples ....................................... 282Panko chicken tenders ...................................................................... 282Chipotle beef tacos ........................................................................... 282Chicken with lemon .......................................................................... 282Teriyaki salmon with ginger and orange juice ............................... 282

Diabetes Meal Planning & Nutrition For Dummies xiiGreat Grains ................................................................................................. 288

Flatbread pizza ................................................................................... 288Rice pilaf with currants ..................................................................... 288Shrimp salad rolls .............................................................................. 288Baked polenta with turkey sausage ragu ........................................ 288Lindsey’s quinoa salad ...................................................................... 288

Running it Through the Garden ................................................................. 294Tuna Niçoise ....................................................................................... 294Meal in a potato ................................................................................. 294Mushroom lasagna with zucchini noodles ..................................... 294Quick soy stir fry ................................................................................ 294

Starters and Sidekicks ................................................................................. 299Egg muffin ........................................................................................... 299Cheese Danish .................................................................................... 299Spaghetti squash ................................................................................ 299Roasted Brussels sprouts ................................................................. 299

Fun with Fruit ............................................................................................... 303Baked apples ...................................................................................... 303Fancy fruit salad ................................................................................. 303Whole-wheat French toast with red berry sauce ........................... 303Banana pudding ................................................................................. 303

Part VI: The Part of Tens ........................................... 307

Chapter 19: Ten Diabetes “Power Foods” . . . . . . . . . . . . . . . . . . . . . . .309Oats ............................................................................................................... 309Beans ............................................................................................................. 310Salmon ........................................................................................................... 311Nuts ............................................................................................................... 311Oranges ......................................................................................................... 312Kale ................................................................................................................ 312Dark Chocolate ............................................................................................ 312Soy ................................................................................................................. 313Dairy .............................................................................................................. 314Barley ............................................................................................................ 314

Chapter 20: Ten Diabetes-Friendly Foods Costing Less Than $1 .00 . . . .315Black Beans .................................................................................................. 315Apples ........................................................................................................... 316Yogurt ........................................................................................................... 316Potato ............................................................................................................ 316Banana .......................................................................................................... 317Carrots .......................................................................................................... 317Lentils ............................................................................................................ 317

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Eggs ............................................................................................................... 317Beets .............................................................................................................. 318Peanut Butter ............................................................................................... 318

Chapter 21: Ten Healthy Food Swaps for Losing Weight . . . . . . . . . .319Lighten Up Your Mayo ................................................................................ 320Try Bacon of Canadian Descent ................................................................. 321Baked Potato, Meet Greek Yogurt ............................................................. 321Freshen Your Salads with Lime ................................................................. 322Moooooove to Lower-Fat Dairy Products ................................................ 322Chipping and Dipping ................................................................................. 323Spice it Up ..................................................................................................... 323A Healthier Chocolate Fix ........................................................................... 323Roasted Garlic Spread ................................................................................. 324Keeping Your Fish in Water ........................................................................ 324

Part VII: The Appendixes ........................................... 325

Appendix A: Diabetes Exchange Lists . . . . . . . . . . . . . . . . . . . . . . . . . .327Carbohydrate Exchanges ........................................................................... 328

Starches............................................................................................... 328Fruits.................................................................................................... 330Milk ...................................................................................................... 331

Meat and Meat Substitutes ......................................................................... 332Lean and very lean meat, and meat substitutes ............................ 333Medium-fat meat and meat substitutes .......................................... 334High-fat meat and meat substitutes ................................................. 334

Fats ................................................................................................................ 335Free Foods .................................................................................................... 337Sweets and Desserts .................................................................................... 339

Appendix B: Ethnic Carbohydrate Foods . . . . . . . . . . . . . . . . . . . . . . . .341

Appendix C: Conversions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .345Blood Glucose and Blood Lipid (fat) Measures ....................................... 345Hemoglobin A1C (A1C) to Average Blood Glucose ................................. 346International Units (IUs) ............................................................................. 346Dry verses Cooked Measures for 15 grams of Carbohydrate ............... 347Non-nutritive Sweeteners ........................................................................... 348

Index ....................................................................... 349

Diabetes Meal Planning & Nutrition For Dummies xiv

Foreword

P roper nutrition is one of the foundations of good diabetes care, along with exercise and medication, if necessary. In type 1 diabetes, proper

nutrition serves to balance the effect of the insulin that must be administered as well as exercise, so that the blood glucose remains as close to normal as possible. In type 2 diabetes, proper nutrition helps to reduce weight if over-weight, thus preventing complications like heart, eye, kidney, and nerve dis-ease and providing energy for the tasks of daily living.

For too long, people with diabetes have thought that proper nutrition means loss of freedom to eat the things they enjoy. As this book shows, such an idea is a myth. You can enjoy almost all the foods you grew up with, but if they raise the blood sugar or the cholesterol or the blood pressure, you must eat them in moderation. It is very important that proper nutrition be based on your needs. If it is not, you will be reluctant to follow the recommendations of your doctor or dietitian. Proper nutrition can never be found on a pad of paper called a “diabetic diet.”

No one is more qualified to teach you about proper nutrition than Toby Smithson. Toby has lived with type 1 diabetes since she was a young girl. She is a professional dietitian who has been recognized by her peers for her excellent work and is a certified diabetes educator. She is a spokesperson for the Academy of Nutrition and Dietetics, has received the Outstanding Dietitian in Illinois Award in 2009 from the Academy of Nutrition and Dietetics, and she recently served as president of the Illinois Dietetic Association. Toby’s website, www.Diabeteseveryday.com, is a treasure chest of information about nutrition as well as many other aspects of diabetes.

This book, Diabetes Meal Planning & Nutrition For Dummies, distills decades of knowledge in an easily readable form. It starts by providing a basic under-standing of diabetes. It proceeds by teaching you about nutrients like carbo-hydrates, proteins, and fats and the best way to prepare them. It continues with meal planning and ends with a menu of seven delicious days of food.

Studies have shown that proper nutrition can have a significant effect toward lowering the hemoglobin A1c, a measure of diabetic control that correlates with diabetic complications. You are taking a major step in that direction by reading this book and applying its concepts to your diabetes.

Alan L. Rubin, M. D.

Introduction

T he most recent semi-official estimate of the number of people with dia-betes in the United States was released in January 2011, and the tally

was 25.8 million — 8.3 percent of the entire population. But, with more than 150,000 new cases each month, that number is outdated even before it’s released. You can add 1.9 million for 2011, 1.9 million for 2012 (and so on) if you enjoy playing with big numbers, but it’s more likely the number you’re most concerned about is 1 — yourself, or a loved one. Coincidentally, this book has exactly the same concern.

You can see by the title that the main subject is food — the words meal and nutrition are the giveaway. But, food and diabetes health can’t be separated, and with the exception of essential insulin for people with type 1 diabetes, the food you eat every day is as important — maybe even more important — than your diabetes medicine. Food is the simplest, least expensive, most available, and most immediate treatment option for diabetes health. Not spe-cial food — plain old food you walk past every time you’re in a grocery. Yet, most people with diabetes struggle to adopt healthier eating habits, many to the point of giving up. There is a simple solution that can end the struggle.

If the word planning in the title seems like the least important (even least interesting) subject in the pages ahead, you are in for an amazing surprise — maybe even an epiphany. See, the struggle with healthy eating doesn’t come from your stomach, your pancreas, or an uncontrollable hand that sneaks unhealthy food into your mouth when you’re not looking. Your struggle with healthy eating is a struggle between your incredible brain, and your primitive survival chemistry, and when it comes to food, chemistry often wins. You’re about to learn how planning can tip the balance, and make healthier eating your newest accomplishment.

About This BookDiabetes Meal Planning & Nutrition for Dummies zeros in on the important relationship between diabetes and food, and helps you make choices that benefit your long-term health and satisfy your eating preferences. The book’s focus is on which foods you can, and should, eat to improve your health with diabetes, and not on what you shouldn’t eat. There is no doubt, by the way, that how you choose to eat when you have diabetes can have a remarkable effect on your health — this book helps ensure that effect is a positive one.

2 Diabetes Meal Planning & Nutrition For Dummies

The book acknowledges and explains some of the barriers you may have experienced to adopting healthier eating habits, and how your best inten-tions can be sabotaged. And, you see how the power of making eating deci-sions in advance — planning — can get you beyond those barriers and keep you there. More than 80 percent of people with type 2 diabetes are over-weight or obese, and many have made attempts to change eating habits with-out success. This discussion on planning may be just the advice you need.

The target audience is people already diagnosed with type 1 or type 2 dia-betes, but the concepts and practical advice for managing diabetes with diet apply to gestational diabetes, and to those with prediabetes. This book doesn’t substitute for medical nutrition therapy from a registered dietitian, but should help you put your personalized diabetes meal plan into action.

Diabetes Meal Planning & Nutrition for Dummies does discuss diabetes as a disease, but if you’re new to diabetes you may want to grab one of Dr. Rubin’s other books, Diabetes for Dummies or Type 1 Diabetes for Dummies, for a more detailed discussion. Food is an important part of managing diabe-tes over the long term, but there’s a lot more you need to know.

Diabetes often occurs with medical conditions, like celiac disease or lactose intolerance, that limit food choices. And, diabetes can promote health con-ditions, like kidney failure, that trigger very specific dietary requirements which are significantly different than general recommendations for a diabetes meal plan. Your doctor and a registered dietitian can advise you in these cases, but advice in this book may not always apply.

You should know that you don’t have to read this book from front to back. All Dummies books are written so that each chapter will make sense on its own. It’s not necessary that you remember anything either — a detailed table of contents helps you find what you need whenever you need it. This book is meant to be a reference; there will be no final exam to test your memorization skills.

Here are a few other tidbits that may answer your questions before you have to ask:

✓ Blood glucose is often casually called blood sugar. Blood glucose is the correct terminology and is used exclusively in the book. In common usage, the terms mean the same.

✓ Blood glucose is measured in milligrams per deciliter (mg/dl) in the United States, but many countries use the International System of Units measure of millimoles per liter (mmol/l). The same is true for choles-terol and triglycerides. Where this book only gives U.S. units, refer to Appendix C for conversion factors.

✓ Nutritional information is given in metric measures — grams, milligrams, and micrograms. Appendix C provides conversion factors to U.S. mea-sures, but frankly there’s no need to convert these. The number of car-bohydrate grams in a particular food is unrelated to the total weight of the food, so converting to U.S. measures doesn’t really clarify anything.

3 Introduction

✓ The recipes in Chapter 18 are offered with common U.S. measures and Fahrenheit cooking temperatures. The exchange list in Appendix A also gives food portions in U.S. measures. Appendix C provides conversions for U.S. food measures and cooking temperatures to metric and imperial units. Note that U.S. measures of dry ingredients don’t necessarily cor-respond well with metric measures of dry ingredients by weight.

✓ Healthy eating is no less important for people with type 1 diabetes, but insulin does provide a more direct way to control blood glucose. Some discussion about managing food amount and timing may be less relevant to people with type 1 diabetes when rapid acting insulin is used.

✓ The term diabetic is not used to refer to a person with diabetes. Diabetes is not who you are; it’s a condition you have.

✓ This book does not spend much time addressing the particulars of insu-lin dosing, insulin-carbohydrate ratios, or insulin correction factors. These are very individualized and must be worked out with your doctor or diabetes educator.

Foolish AssumptionsYour authors have some preconceived notions about you, and thought you might be interested in knowing what those are. This book assumes the following:

✓ You have diabetes, or have an interest in someone who has diabetes. It’s OK if neither is true, by the way.

✓ You realize that effectively managing diabetes for better health includes managing what and how you eat. Maybe you’ve been advised about the importance of diet, or maybe you learned from previous experience with diabetes.

✓ You are not expecting a miracle answer that requires no further thinking or effort from you.

✓ Even though you are not expecting a miracle, you appreciate advice that makes healthy eating for diabetes easier.

Icons Used in This BookThroughout For Dummies books you find icons that call your attention to something especially important, or something technical. This book includes the following icons:

4 Diabetes Meal Planning & Nutrition For Dummies

A tip often suggests you try something or check something out. A tip usually leads to something surprising about food or nutrition.

A warning is exactly what it sounds like. It’s often a caution to avoid jumping to conclusions, or to make unwarranted assumptions.

The Remember icon might re-emphasize something discussed earlier in the section, or it may be a reminder to follow specific advice when you put what you’ve learning in practice.

Technical stuff is beyond what’s key to the book’s message, but something some curious readers might find interesting. You may skip over technical stuff.

In some places Dr. Rubin has added special insight from his expertise and experience.

Beyond the BookThere is much more information available from your authors, and from the For Dummies brand, for your learning pleasure. Check out these resources to learn more about diabetes, diabetes self-management nutrition, nutrition, or to find some great recipes:

✓ Find the For Dummies Cheat Sheet for this book at www.dummies.com/cheatsheet/diabetesmealplanningandnutrition. The cheat sheet gives you a quick reference for 15 gram portions of carbohydrate foods you’ll eat often, as well as a list of nutrients that are extra special for diabetes, and the foods you can eat to get them.

✓ For Dummies online articles are available at http://www.dummies.com/WileyCDA/redirect/extras/diabetesmealplanningand nutrition, and these short articles offer a little more detail on some very important concepts.

✓ You can meet your authors face to face, literally, on their respective websites. You can find Dr. Rubin at www.drrubin.com and Toby Smithson at www.DiabetesEveryDay.com, both on video so you can get an idea of who’s giving you the wonderful advice in the book.

5 Introduction

✓ And, although this book includes 22 diabetes-friendly recipes, you can use what you learn about choosing diabetes friendly dishes from other resources. Some excellent places to start would be Diabetes Cookbook For Dummies, Glycemic Index Cookbook For Dummies, Mediterranean Diet Cookbook For Dummies, and Hypertension Cookbook For Dummies, all published by John Wiley and Sons.

Where to Go From HereYou can start anywhere with For Dummies books, but there’s a logic to begin-ning at the beginning. If that’s not in your personality, consider starting on Chapter 10 to see why healthy eating, diabetes or not, is so difficult in this society. Chapter 14 reviews how some popular diet plans will fit with effec-tive diabetes self-management, and if you’re not sure what diabetes self- management means, try Chapter 3.

Chapter 11 addresses how you can stay motivated, and offers some simple tricks that usually bring big rewards. If you’re heading straight to the buffet or bar, check Chapter 15; the grocery can be found in Chapter 12.

Some final advice is don’t get in such a rush. Diabetes will still be there, and changes often come slowly. Take your time, try different approaches to eating healthier, and be patient about seeing real improvements in your lab work. Most importantly, follow the advice that Sir Winston Churchill gave the gradu-ating class of Harrow School in 1941, when all he said in his commencement address was, “Never give up, never give up, never give up.”

The nine word Churchill commencement address is an excellent example of an urban legend. His speech was short, but considerably longer than nine words. However, the advice is so incredibly appropriate to anyone living with diabetes, it’s possible to imagine that’s exactly what Churchill would have said were he addressing the subject.

6 Diabetes Meal Planning & Nutrition For Dummies

Part IDiabetes and Food:

An Intimate Connection

Visit www.dummies.com for great Dummies content online.

In this part… ✓ Learn that it’s important to watch every bite of food you put in

your mouth, and how each bite contributes to a healthy glucose level.

✓ Become an active partner in your body’s metabolism. The bet-ter the helper you are, the less damage you experience from the diabetes.

✓ Understand what diabetes is, and know the difference between type 1 and type 2.

✓ Know how to test your blood glucose levels at home, especially with type 1 diabetes. With so many different ways to test, you no longer have to guess your blood glucose level.

✓ Learn about the different types of healthcare professionals that you might want to see . . . from your family physician to an endocrinologist, from a registered dietician to a certified diabe-tes educator.

✓ Read up on the different kinds of medication currently offered for diabetes type 1 and type 2. Some are oral meds; some are injectable meds. These medications can be used in combina-tion, and it’s important that you take them according to your doctor’s instructions.

Chapter 1

Having Your Diabetes and Eating, Too

In This Chapter▶ Realizing that food is effective medicine for diabetes▶ Considering your essential role in preserving your health▶ Keeping your brain working for you▶ Impacting your health by how you choose to eat

H ippocrates, sometimes called the father of modern medicine, once said “let food be thy medicine, and medicine be thy food.” When it comes

to diabetes, Hippocrates was absolutely correct. It would be difficult to think of another serious medical condition that’s so intimately and immediately connected to food. Yes, there are drugs for diabetes — eight different classes of diabetes drugs, numerous formulations of insulin, drugs that help other drugs work better, and a few drugs that seem to benefit diabetes by accident — and diabetes drugs are extremely important. Without insulin, people with type 1 diabetes could not live. Putting your confidence in drugs alone is insufficient to keep diabetes from affecting your long-term health, and you don’t have to rely on advice that’s more than 2,300 years old to believe that.

The definitive 800-page resource book for diabetes-specialized healthcare pro-fessionals in the 21st century, The Art and Science of Diabetes Self-Management Education (American Association of Diabetes Educators) begins its chapter on diabetes drugs by reminding professionals and patients that, “any pharma-cologic treatment for type 2 diabetes is only a supplement to lifestyle changes.” Lifestyle is more important than drugs when it comes to type 2 diabetes. How you choose to eat is the most important, and perhaps the most challeng-ing, lifestyle issue that people with diabetes face, and is just as important for people with type 1 diabetes as for those with type 2. With diabetes, food really is medicine.

Chances are you already have a least a vague idea that what you eat is impor-tant to diabetes, and this book will give you the whole story on just how the food choices you make can work to preserve your long-term health. But knowing and doing are two different things, and it’s doing that really counts.

10 Part I: Diabetes and Food: An Intimate Connection

In this chapter you learn about your key role in your own health care, see how overcoming emotion and impulse can help you actually do what you know is best for your health, and get a five-point plan for adding healthy and active years to your life.

Accepting Your Role in Diabetes Management

Whether you have type 1 diabetes or type 2 diabetes, you share one crucial responsibility from your diagnosis going forward — doing your part. In simple terms, you must now become an active helper in your body’s metabolism, and the better helper you become, the less likely you are to experience the damage that diabetes can do to your body.

Type 1 diabetes results when your capacity to produce insulin is lost. Type 2 diabetes is related more to your natural insulin being unable to do its job effectively. If you were a car and insulin was gasoline, type 1 diabetes is having an empty tank, and type 2 diabetes is more like lost efficiency from clogged fuel injectors. Managing type 1 diabetes requires constantly adding gasoline; type 2 diabetes requires that you get your fuel injectors to work better. The real story is a little more complicated.

Losing glucose homeostasisYour body needs to keep a certain concentration of glucose circulating in your blood — a normal blood glucose level. Glucose is the favorite fuel of your trillions of cells, and some really important cells — your brain cells — can’t get their energy from anything else. Glucose in your bloodstream is all about energy — it’s delivered right to the doorstep of every cell that needs it.

Because glucose enters your blood after you eat carbohydrate foods, causing your blood glucose levels to rise, your body has a way to return those levels back to normal by storing the excess for later. The stored glucose can be released back into the blood when glucose levels drop between meals, keep-ing a constant supply available for your brain. This kind of balance in a biological system is called homeostasis.

The hormone responsible for escorting glucose into storage is insulin, and insulin is automatically released from special cells on your pancreas when blood glucose levels are going higher after eating. If insulin isn’t available or isn’t working properly, blood glucose can’t be stored, and blood glucose levels remain high. High blood glucose levels not only upset glucose homeo-stasis, but begin to damage cells and tissue.

11 Chapter 1: Having Your Diabetes and Eating, Too

Chronic high blood glucose levels is diabetes — literally. It’s important that you understand diabetes, and Chapters 2 and 3 include a more in-depth explanation. In the simplest terms, having diabetes means your blood glu-cose levels go up after eating and don’t come down to normal levels in a normal amount of time.

Type 1 diabetes results when insulin production capacity is destroyed, and no insulin is available to facilitate glucose homeostasis. Type 2 diabetes begins when the cells that normally store excess glucose stop responding to insulin. So, even though insulin may be available, blood glucose levels remain high. The long-term damage caused by high blood glucose, in either case, can progress to very serious consequences like heart attack, stroke, vision loss, nerve damage, kidney failure, and more. These secondary conditions are called complications of diabetes, and avoiding these outcomes is one reason that lowering blood glucose levels is so important.

High glucose levels not only mean that excess glucose can’t get into cells to be stockpiled, but glucose can’t get into cells to properly fuel energy needs. That means your microscopic cells, like the muscle cells you need to move, don’t have access to their favored fuel, and must turn to plan B or plan C for generating energy. Plan B and plan C are ordinarily temporary plans for times of shortage — generating energy without glucose is inefficient, and even pro-duces toxic waste products. Diabetes upsets your entire energy balance.

Taking your place in glucose metabolismTreating diabetes is not like treating an infected cut, where the problem goes away after a week or two. In fact, diabetes treatment is called diabetes management, hinting at a responsibility that requires continuous oversight. And, that’s exactly what diabetes management is — continuous oversight. Managing diabetes is like managing a company, or a sports team, or a lawn, or anything else where the goal is to achieve and sustain a certain level of performance. The manager works to provide the best environment and materials for success, looks at performance indicators, sets priorities, makes adjustments to improve efficiency, tries to avoid disruptions, and always keeps a focus on surviving and prospering over the long term.

Effective management is a key to success in business, sports, lawn care, and diabetes. But, while the management responsibilities for businesses, sports teams, and even lawn care can be delegated to professional experts, the extraordinarily important job of managing your diabetes has suddenly fallen on you — diabetes self-management. Not only that, you’ve inherited respon-sibility for the equivalent of a business that’s failing, a sports team with all its stars on injured reserve, and a lawn that’s been overcome by weeds — and the stake is your long-term health.

Fortunately, if you’re willing to take this responsibility seriously, there is a proven plan that can turn you into a successful manager of your body’s

12 Part I: Diabetes and Food: An Intimate Connection

metabolism. And, as daunting as this might sound, with some dedication and practice you’ll be managing your metabolism like a pro, and enjoying the rest of your life’s activities even more than before. How’s that? Well, like any good manager, success is a little bit of participating, but a whole lot of setting up a system where success is possible.

You can’t actually fix your glucose metabolism. You can, however, provide the best environment and materials for success, look at performance indica-tors, set priorities, make adjustments to improve efficiency, try to avoid dis-ruptions, and always keep a focus on surviving and prospering over the long term. That sort of management strategy lets your natural metabolism work as well as it possibly can, and that’s effective diabetes self-management at its best. And, you can do it.

Eating a healthy diet and managing your carbohydrate consumption is essential to your long- term health with diabetes. Taking your medication as directed, exercising regularly, getting adequate rest, reducing stress, and not smoking also have important, sometimes critical, roles in your long- term health, but there’s no separating diabetes health from food. Although you may think this challenging part of managing diabetes effectively mostly involves your pancreas, your stomach, or some other food related organ, you might be surprised.

Understanding Your BrainRight between your ears is your incredible and mysterious brain, and your brain plays essential roles in managing diabetes. But, the different roles your brain plays in diabetes management aren’t always in your best interests, and more often than you might imagine messages from your brain make managing diabetes more difficult.

On the surface, literally and anatomically, it’s obvious that your brain helps you to understand diabetes, to remember what your healthcare team has advised you to do, to schedule your time, to decide what you’re going to eat, and to comprehend what you read in this book. The part of your brain doing your thinking, the outer cerebral cortex layer, is an amazing problem solver that has never been duplicated biologically or electronically. Your thinking brain can evaluate hundreds of variables, look at issues from every direction, factor in previous experience, apply concepts that are only abstract, project future out-comes, and come to solidly logical conclusions. When your thinking brain is in charge, it’s hard to go wrong. And, if things do go wrong, your thinking brain will figure out exactly why, and make sure the same thing doesn’t go wrong again.

But, guess what? Your thinking brain isn’t always in charge. At times, the well thought recommendations from your marvelous thinking brain get outvoted. At other times, your thinking brain takes too long to make decisions, allowing another part of your brain to beat it to the punch. There’s nothing abnormal about this — in fact some completely illogical behaviors, like risking personal