Blood glucose comes from the breakdown of the food you eat. Normally, this blood glucose is turned into energy with the assistance of a substance produced by your pancreas called insulin.

What is Diabetes?

There are two types of diabetes mellitus. Type I (insulin dependent diabetes) is caused by lack of insulin. In this case, extra insulin must be taken by injection to allow sugar to be used by your body for energy. Usually this type of diabetes occurs in people under 30 years of age. Type II (non-insulin dependent diabetes) occurs for one of two reasons: ineffective insulin; a decreased supply of insulin; or by a combination of the two problems. This type of diabetes usually occurs in adults.

There isn't a cure for non-insulin dependent or insulin dependent diabetes yet. But they can be controlled through:

• A healthy diet & exercise;
• A healthy diet & exercise & pills or
• A healthy diet & exercise & insulin

The goal of diabetes control:

You should aim to prevent your blood glucose level from rising too high or dropping too low. The goal is to achieve blood glucose levels as close to normal as possible. Your doctor or diabetes educator can help you to determine what blood glucose control targets are right for you.

How?

You can maintain a stable blood glucose by balancing the kind and amount of food eaten with your physical activity and medication (pills and/or insulin).

What constitutes a healthy meal plan for diabetes?

A meal plan which:

• Recommends how much food to eat.
  
• Suggests how often and when to eat
  
• Attempts to maintain or achieve a healthy body weight for target blood glucose control.
  
• Permits you to eat regular foods in specified portions.
  

Basic eating recommendations:

• Eat three meals a day, with snacks if recommended.
  
• Eat at regular times, do not skip meals or snacks.
  
• Eat only the amounts of food listed on your meal plan.
  
• Measure or weigh your foods to be sure serving sizes are accurate.
  
• Learn the size and volume of bowls and glasses at your home so you know how much you're eating.
  
• If weight loss is your goal, a loss of 1Û2 to 1kg (1 to 2 lbs) per week is safe and healthy.
  

Canada's Guidelines for Healthy Eating suggests that a healthy diet should include each day:

• Grain products*
  
• Vegetables and Fruits
  
• Milk Products*
  
• Meat and Alternatives*

*Low fat choices are recommended.

A healthy diet for people with diabetes is the same as what is recommended for all Canadians. In addition, special attention should be paid to food groups containing carbohydrates as these easily covert into sugar. These food groups are: starch foods, milk, fruits, and sweet vegetables. The intake of these sugar producing foods should be distributed throughout the day to help maintain a steady blood glucose level.

Starch Foods
Bread, pasta, rice, potatoes, corn, etc.

Fruits and Vegetables
All fruits, carrots, peas, squash, turnips, beets, etc.

Milk
Fluid milk and yogurt

Protein
Meat, poultry, fish and cheese all belong to the Protein group. Margarine, butter and oils are in the Fats & Oils category.

While proteins and fats don't affect blood glucose directly, they can influence your weight and heart disease risk. They should, therefore, be eaten in moderate amounts.

Some vegetables are labeled as Extras. They are low in sugar, and provide you with necessary vitamins and minerals. They can be eaten in any quantity you desire, unless specified otherwise.

Foods that contain concentrated sugars like candy and soda pop can cause rapid increases in blood glucose level. Your dietitian can show you how to work these foods into your meal plan:

• Candy - 2
  
• Condensed Milk - 15ml (1 Tbsp)
  
• Corn syrup - 10ml (2 tsp)
  
• Honey - 10ml (2 tsp)
  
• Jams, jellies- 15ml (1 Tbsp)
  
• Maple syrup - 10ml (2 tsp)
  
• Marmalade - 15ml ( 1Tbsp)
  
• Molasses - 10ml (2 tsp)
  
• Regular chewing gum - 1 piece (5g)
  
• Regular gelatin desserts - 50ml (1/4 cup)
  
• Regular soft drinks - 125ml (1/2 cup)
  
• Sugar, white or brown - 10ml (2 tsp)
  
• Sweet relish - 30ml (2 Tbsp)
  

Starch Foods
One choice provides 15g carbohydrate and equals amount listed below.

Breads

• Bagel, Kaiser, English Muffin, Round Pita 20cm (8in) 1/2
  
• Bread Sticks, Ryvita, Wasa 3
  
• Chapati 15cm (6 in) Round 1
  
• Hot Dog Bun, Hamburger Bun 1/2
  
• Melba Toast Rectangles 4
  
• Rice Cakes, Rusks 2
  
• Small Dinner Roll, Bread Slice, Raisin Bread Slice 1
  
• Soda Crackers, Melba Toast Rounds 6
  
• Whole Grain Rye Bread Slice 1
  

Cereals

• All-Bran Type 75ml(1/3 cup)
  
• Flaked or Crispy Dry Cereals 150ml (2/3 cup)
  
• Hot Cereal 125ml (1/2 cup) cooked
  
• Puffed Type 250ml (1 cup)
  
• Shredded Wheat 1 biscuit
  

Grains

• Kasha Cooked 125ml (1/2 cup)
  
• Rice, Pasta, Barley, Bulgur 125ml (1/2 cup)
  

Vegetables

• Air Popped Popcorn 750ml (3 cups)
  
• Corn 125ml (1/2 cup)
  
• Corn on the Cob 1/2 medium
  
• Mashed White Potato 125 ml (1/2 cup)
  
• White Potato, Sweet Potato, Yam 1Û2 [6cm (2 1/2 in)]
  

Combinations

• Cookies ( = 1 starch + 1 fat) 2
  
• Chicken noodle soup ( = 1/2 starch + 1 fat) 1cup
  
• Cream soup ( = 1 milk + 1 fruit/vegetable + 1 fat) 1 cup
  
• Dried Beans or Peas ( = 1 starch + 1 protein) 125ml (1/2 cup)
  
• French Fries ( = 1 starch + 1 fat) 10
  
• Medium Muffin ( = 2 starch + 2 fat) 1
  
• Pea soup ( = 1 protein + 1 starch + 1 fruit/veg) 1 cup
  
• Round Waffles ( = 1 starch = 1 fat) 1
  
• Soup ( = 1 starch, usually) 1 cup
  

Fruits and Vegetables
One choice equals 10g of carbohydrate and equals amount listed below.

Fruits

• Banana, Pear, Nectarine, Grapefruit or Apple 1/2 small
  
• Blueberries 125ml (1/2 cup)
  
• Cantaloupe 1/4
  
• Grapes, Cherries 125 ml (1/2 cup)
  
• Kiwi 2
  
• Orange 1 small
  
• Peach 1
  
• Plums, Prunes 2
  
• Raisins 30 ml (2 Tbsp)
  
• Raspberries 125ml (1/2 cup)
  
• Rhubarb 250 ml (1 cup)
  
• Strawberries, Watermelon 250 ml (1 cup)
  
• Unsweetened Applesauce, Fruit Cocktail, Pineapple 125 ml (1/2 cup)
  

Juices

• Juices should be taken as part of a meal.
  
• Tomato Juice, Vegetable Juice 250ml (1 cup)
  
• Unsweetened Apple Juice 75 ml (1/3 cup)
  
• Unsweetened Grape or Prune Juice 50 ml (1/4 cup)
  
• Unsweetened Grapefruit or Orange Juice 125 ml (1/2 cup)
  
• Sweet Vegetables
  
• Canned Tomatoes 250 ml (1 cup)
  
• Peas, Beets, Parsnips, Carrots 125 ml (1/2 cup)
  
• Snow Peas 10 pods
  
• Squash, Turnip, Tomato Sauce (low fat) 125 ml (1/2 cup)
  

Milk
One choice equals 6g carbohydrate and equals amount listed below. Cheese choices are listed in the Protein Food Group.

• Evaporated 50 ml (1/4 cup)
  
• Fluid (2% MF or less) 125ml (1/2 cup)
  
• Powdered 30 ml (2 Tbsp)
  

Yogurt

• Frozen Yogurt ( = 1 milk + 1 sugar ) 125 ml (1/2 cup)
  
• Fruit Bottom ( = 1 milk + 1 fruit + 1 sugar) 125 ml (1/2 cup)
  
• Plain ( 2% MF or less) 125 ml (1/2 cup)
  

Fats and Oils

One choice equals the amount listed below.

Spreads

• Butter, Soft Margarine 5 ml (1 tsp)
  
• Light Butter or Margarine * 10ml (2 tsp)
  
• Pâté, Cheese Spread, Cream Cheese 15 ml (1 Tbsp)
  

* These choices will provide less saturated fat.

Dressings

• Light Mayonnaise*, Light cream Salad Dressing* 15 ml ( 1 Tbsp)
  
• Regular Mayonnaise, Salad Dressing 10 ml ( 2 tsp)
  

* These choices will provide less saturated fat.

Creams

• Cream (10% MF) 30 ml (2 Tbsp)
  
• Light Sour Cream 90 ml ( 6 Tbsp)
  
• Sour Cream 45 ml (3 Tbsp)
  

Miscellaneous

• Avocado 1/8
  
• Crisp Bacon Strip 1
  
• Peanuts 10
  
• Small Olives*, Walnuts, Pecans, Cashews 5
  

* These choices will provide less saturated fat.

Fruits and Vegetables

• Canola*
• Corn*
• Olive*
• Safflower*
• Sunflower* 5 ml (1 tsp)
  

* These choices will provide less saturated fat.

Protein Foods
One choice equals 30 g (1 oz) in cooked food weight and equals amount listed below. Select the lean choices more often.

Lean Choices

Cheeses

• Cottage Cheese (2% MF or less) 50 ml ( 1/4 cup)
  
• Hard Skim Milk Cheese (15% MF or less) 30 g (1 oz)
  
• Processed Cheese ( 7 % MF) 1 slice
  

Meats & Poultry

• Lean Beef, Round Steak, Tenderloin 30 g (1 oz)
  
• Lean Lamb, Veal, Pork, Skinless Poultry 30 g (1 oz)
  
• Sirloin, Flank Steak 30 g (1 oz)
  
• Pork Chops, Poultry with Skin 30 g (1 oz)
  
• Processed Meat, Cold Cuts 1 slice
  
• Regular Ground Beef, Roast, Steak 30 g (1 oz)
  
• Ribs, Corned Beef, Sausage, Chicken Wings 30 g (1 oz)
  
• Weiner 1/2

Fish & Seafood

• Canned Water Packed Fish or Seafood 50ml ( 1/4 cup)
  
• Clams, Mussels, Oysters, Shrimps, Scallops, 3 Medium
  
• Fresh Fish, Crab, Lobster 30 g (1 oz)
  

Eggs

• Poached or Boiled Egg 1 medium
  
• Higher Fat Choices = 1 Protein food + 1 Fats & Oils
  

Other

• Peanut Butter 15ml (1 Tbsp)
  
• Tofu ( 1 piece ) 6 cm x 4 cm 70 g
  

Extra Food Choices

The foods below may be eaten at any time and in any amount unless specified otherwise.

Extra Vegetables

• Artichokes Asparagus Bean Sprouts
  
• Bean, string, green or yellow Bok Choy Broccoli
  
• Brussel Sprouts, Cabbage, Cauliflower
  
• Celery, Cucumber, Eggplant
  
• Endive, Kohlrabi, Lettuce
  
• Mushrooms, Okra, Onions
  
• Parsley Peppers
  
• Radish, Rapini, Shallots
  
• Spinach, Tomato (1 small/meal), Zucchini
  

Extras

• Artificial Sweetener Lemon Juice Bouillon
  
• Broth or Consommé Clear Coffee Clear Tea
  
• Club soda Garlic Herbs and Spices
  
• Uncreamed Horseradish Lime Juice Mustard
  
• Soy Sauce Sugar-free Pop Sugarless Gum
  
• Vinegar Worcestershire Sauce
  

Measured Extras
Limit your intake of these items to 1 choice / meal

• Bar-B-Q Sauce 10 ml (2 tsp) Bran, Natural 30 ml (2 Tbsp)
  
• Coffee Whitener 5 ml (1 tsp) Cocoa Powder 5 ml (1 tsp)
  
• Diet Salad Dressing 15 ml (1Tbsp) Diet Spread (Jam Jelly) 5-10 ml (1-2 tsp)
  
• Dill Pickles, unsweetened (2) Ketchup 5 ml (1 tsp)
  
• Salsa 30 ml (2 Tbsp) Sour Mixed Pickles, unsweetened (11)
  
• Sweet Relish 5 ml (1 tsp) Whipped Topping 15 ml (1 Tbsp)
  

What about dietetic foods?

Special "dietetic foods" are expensive and are, generally, not needed by a person with diabetes. Here are a few tips to help you interpret some common label claims,

No Added Sugar or Unsweetened means that there is no added sugar but that natural sugar may be present. You should count it as you would expect that particular food to be counted in your meal plan.

• Example: Unsweetened peaches contain no added sugar, but still contain the natural sugar found in the peach and should be counted as a fruit.
  
• Example: Light pudding made with NutraSweet has no added sugar but still contains the natural sugar found in the milk and the starch. You should count it as a milk choice.
  

Sugar Free means that there is less than 0.25 grams of sugar per 100 grams and no more than 1 calorie per 100 grams. Foods with this claim can often be counted as an 'Extra'.
Example: Sugar Free Pop.

Calorie Reduced or Carbohydrate Reduced means that the product has been reduced by 50% in calories or carbohydrate compared to the original product. It is difficult to determine whether these products are good for you based on this claim. If in doubt, ask your dietitian.
Cholesterol Free or Low Cholesterol means that the product does not contain any or only small amounts of animal fat. This does not necessarily mean the product is low in fat.

• Example: A light granola cereal may only have 3g of fat per serving, but the serving size is only 1/4 cup (50 ml). This is actually a very small serving of cereal.
  

Light or Lite means that some component of the product has been reduced by 20-50%.
This claim may mean the product is a good choice.

• Example: Light mayonnaise has 1/3 of the calories found in regular mayonnaise. But read the label carefully, the term "light" may also refer to flavor, taste, or texture.
  
• Example: Light Olive oil is not light in calories or fat. It is light in taste.
  

Read Food Labels Carefully.

The Ingredient List

Ingredients on labels are listed in descending order according to weight. For instance, if you see sugar as the first ingredient on the list, the product may cause a rapid rise in your blood glucose. It should not be eaten in large quantities. Ask your dietitian how to include these foods in your meal plan.

Food with sugar listed as the second or lower ingredient on the label can be used in your meal plan. They should be counted in the appropriate food group. If you are in doubt, ask your dietitian.

Fibre

What is fibre?
Fibre is part of a plant which cannot be digested.

What does fibre do?
Moderate amounts of fibre may promote:

• A slower rise in glucose levels
  
• Normal bowel function and reduced chance of constipation
  
• A lower insulin requirement
  
• Lower cholesterol levels

How to increase your diet's fibre content:

• Eat breads and cereals which contain whole wheat, rye ,barley, oats, buckwheat or cornmeal.
  
• Eat raw or slightly cooked fruits and vegetables including skin and peel when practical.
  
• Eat brown rice, barley, lentils, dried beans, dried peas, soybeans
  
• Try meals that use beans and grains instead of meat 1-2 times weekly (example: minestrone soup and a crusty whole grain roll, vegetarian chili and rice, lentil soup)
  

Note: When increasing fibre in your diet you should drink 6-8 glasses of fluids per day

To reduce your saturated fat intake:

• Select lean meats and trim any fat before cooking. Remove skin from poultry.
  
• Drink skim, 1% or 2% milk. Choose cheese with 7-15% milk fat, choose yogurt with 2% or less
  
• Use less oil, margarine, and other fats in cooking
  
• Avoid fried foods
  
• Use soft margarine instead of butter. Select brands labeled as low in saturated fat and non-hydrogenated.

To reduce salt intake:
Limit the use of condiments such as salad dressing and processed foods such as these have high salt content. Reduce use of salt at the table and in cooking.

Diabetes and Alcohol

You should discuss the use of alcohol wit your physician and dietitian. If you need to lose weight, remember alcohol is high in calories.

• Always have food with alcohol
  
• Use only when diabetes is well controlled
  
• Drink in moderation ( defined as 2 drinks) and sip slowly
  
• Avoid sweetened mixes, sweet wines, liqueurs and wine coolers
  
• Choose sugar free pop, club soda, or water for mix. Remember unsweetened juice still has natural sugar.
  
• If you take insulin, do not substitute food with alcohol
  
• If you do not take insulin, ask your dietitian how to substitute the energy from alcohol for the energy from other foods
  
• Wear visible diabetes identification (Medic- Alert)
  
• Consuming alcohol while on oral hypoglycemic agents or insulin may cause hypoglycemia
  

Low Blood Glucose (Hypoglycemia)

Causes:
If you are on insulin or diabetes pills, you may experience low blood glucose. Low blood glucose is caused by too much insulin, too much exercise, or too little food. If your blood glucose level drops too low, the body cannot function normally. This is called hypoglycemia.

Symptoms:
It can happen quickly. The symptoms include: sweating, nervousness, fainting, hunger, mood changes, confusion, headaches, vision changes. When any of these symptoms occur, check your blood glucose immediately. This test will confirm whether your blood glucose level is too low. Urine tests are not helpful here.

Treatment:
If you can't do a blood glucose test right away, stop all activity and take some form of sugar. A half cup of fruit juice, 3-4 hard candies or 2 tsp of sugar, can bring your blood glucose level back to normal. Diet soft drinks and artificial sweeteners cannot be used to treat low blood glucose. Your diabetes educator will prepare you with a response plan so you'll know exactly what to do. If blood glucose symptoms occur frequently, tell your doctor.

Exercise

Why exercise?

• Exercise may improve blood glucose control
  
• Exercise increases blood circulation to all body parts
  
• Exercise may help weight control
  
• Exercise may lower blood pressure
  
• Exercise relieves stress and tension
  

If you use insulin and your diabetes is well controlled, exercise usually lowers blood glucose levels. To prevent blood glucose levels from becoming too low, you may require a reduction in your insulin dose and/or an increase in your carbohydrate intake.

Because each person's response to exercise varies greatly, changes in insulin dose and food intake need to be discussed with your physician and dietitian.

A typical food adjustment might include an extra starch serving for each hour of exercise or activity. Remember, when exercising, always carry a quick acting form of sugar (Dextrosol, lifesavers, sugar cubes, jelly beans). This can be taken immediately in the event of hypoglycemia.

If you use diet and pills to control your diabetes, some medication and/or food adjustments may be necessary if the exercise is strenuous or prolonged. Discuss this with your physician and dietitian.

If you use diet alone to control your diabetes, no food changes are needed

Illness & blood glucose

What to do when you're sick:

• Notify your physician
  
• Continue to take your diabetes medications
  
• Rest
  
• Test your blood glucose and urine for ketones more frequently
  
• Drink extra fluids such as water, weak tea, sugar free soft drinks. In total you should drink 8-10 cups of fluid per day
  
• If you are unable to eat your usual foods, try one of the following every hour:
  
  • 125ml (1/2 cup) fruit juice
    
  • 125ml (1/2 cup) regular ginger ale or other caffeine free soft drinks
    
  • 250ml (1 cup) milk
    
  • 250ml (1 cup) Soup
    
  • 75 ml (1/3 cup) regular Jell-O
    
  • 1/2 popsicle
    
  • 75ml ice cream
    
  • 6 soda crackers
    
• If you are unable to drink after 4 hours, or if vomiting occurs twice within four hours, phone your physician immediately
  
• If you experience extreme thirst, dry mouth, frequent urination or fatigue, these are all symptoms of high blood glucose. You should phone your physician to report these symptoms.
  
• Although blood glucose levels tend to rise with illness (even without eating) you should still watch for symptoms of low blood glucose.
  

Sources of Nutrition Information

For names of dietitians with more diet information, consult:

• Your doctor
  
• A diabetes education centre
  
• Local branches of the Canadian Diabetes Association
  
• Outpatient clinics in hospitals
  
• Provincial dietetic associations
  

Recommended Cookbooks with CDA Food Choice Values & Symbols

• Choice Cooking:
  • Canadian Diabetes Association
    
• Choice Menus:
  • Marjorie Hollands & Margaret Howard
    
• Full of Beans:
  • Violet Currie & Kay Spicer
    
• Healthy Choices:
  • Canadian Diabetes Association
    
• Kid's Choice Cookbook:
  • Colleen Bartley & John Pateman
    
• More Choice Menus:
  • Marjorie Hollands & Margaret Howard
    
• MultiCultural Cooking:
  • Kay Spicer