By: Susan Watkins, RDN, CDE
It can be extremely overwhelming when you receive a new medical diagnosis of any kind, especially diabetes. You often get conflicting advice from family, friends, your doctor, specialists (such as endocrinologist), and even the news.
Everyone seems to have an opinion on the best diet for diabetes and it is hard to know what to believe. Many patients have told me over the years that they were so confused about all of the conflicting information out there that they simply decided to do nothing.
I can hardly blame them, but also worry that they will end up with preventable complications from diabetes. Hopefully, the following guide can help you with some simple tips to get started gradually.
First of all, it’s important to realize that having diabetes is not all your fault. Yes, extra weight and poor eating can bring on the diagnosis sooner, but genetics plays a role in who is predisposed to developing diabetes.
Also, many other factors besides what you eat will play a role in your blood sugar control. The quicker you can get and keep your blood sugar in an optimal range the less risk of developing any side effects or complications from your high blood sugar numbers.
Visit a Registered Dietitian
Ask your doctor for a referral to a registered dietitian or diabetes program through your medical group or in your area. This is a very important step, if your doctor doesn’t have someone, don’t give up. Look online for a diabetes program.
Many free and low-cost programs are also available. This will help you create a specific plan directly towards your needs and break-down how to get started in simple and easy steps. You also will meet others in the same boat as you, which can help with your support network along this journey.
Patients often tell me that they did not want to attend our diabetes program at St. Joseph Health, but they are so happy they did. They often mention that they feel more confident in making their own day-to-day decisions regarding their diabetes care and love having a support network of diabetes professionals to lean on with questions (especially after hearing all of the conflicting information out there).
If you are prescribed new medications for diabetes be sure you understand when and how you are supposed to take it. You can ask your doctor, pharmacist and/or Certified Diabetes Educator (CDE).
Good questions you can ask:
- Should you take the medicine with or without food?
- What time of the day should you take the medication?
- What if I forget a dose?
- Should I still take it if I plan to skip a meal?
- Can this medication drop my blood sugar too low, if so how can I both treat and prevent low blood sugar? (you will also learn the answer to this question in most diabetes programs).
Some patients no longer need the medication once they lose weight, but it can take a long time to lose weight and you want to keep your levels in control until then.
Also, some of the diabetes medication out there can even help you with your weight loss (GLP-1’s – you can ask your doctor about these).
It is important to remember that if your body is not making enough insulin, these medications will be important lifelong.
Blood Sugar Goals for People with Diabetes
The goal levels vary somewhat based on your age and other medical conditions. So it is important to ask your doctor, endocrinologist or CDE in your medical group what the ideal goals are for you.
General Recommendations from the American Diabetes Association are:
- Fasting or Before Meals: 80-130
- 2 hours after a meal: Under 180
- A1C – under 7 (AACE guidelines are under 6.5)
Keep in mind that if your numbers are very high at diagnosis it can take a while to get them in range, the key is that they are moving in the right direction! The normal ranges for those without diabetes are lower.
Diet Doesn’t Have to be Complicated
This does not have to be super complicated. You can start out with just controlling the number of carbs you eat at one meal. The first step is to learn what foods are considered carbohydrate foods (starches, fruit, milk, and yogurt) and which are not (chicken, turkey, fish, nuts, eggs, tofu).
Then start by decreasing the amount of these foods at each meal to about 1/4th of your plate or about 1 cup or less.
Also combine carbohydrate foods with fiber, protein, and healthy fats. If you want to take it a step further you can count the total carbs you are eating at each meal, the general recommendation (that often helps lower the blood sugar) is 30-45 grams total carbohydrate per meal for women and 45-60 grams of total carbohydrate per meal for men (but be sure to talk to your RD, CDE or MD about what is right for you).
This may mean you decide not to have both rice and tortillas at the same meal to allow you a larger portion of the one you choose, but it is ultimately up to you.
The amount you can tolerate varies depending on your activity level. But most people feel this plan still allows them to eat the foods they love while helping them to lose weight and control their blood sugar. This is a great place to start.
Get Out There and Exercise
Exercise is a natural way to lower and control your blood sugar. The effects of exercising last for about 24 hours after you do it. So try to get some activity every day, such as simply walking. Exercising 30 minutes or more is ideal but you can start with less and build up if this is too much.
Also, if you do overeat, exercise can help prevent your blood sugar from going up or bring it down quicker. So if you overeat, be sure to go for an extra walk after the meal.
Keep Checking Blood Sugar
A meter and strips to check your blood sugar are typically covered by insurance with a diagnosis of diabetes. They are very simple and easy to use and your doctor’s office, dietitian, CDE or diabetes educator can teach you how to use it. You can also use online videos from reputable sources.
Keeping an eye on your blood sugar can help you see how different foods, activity levels, stress or pain are affecting your blood sugar.
Knowing this information can help you adjust your lifestyle to help your blood sugar control. For example, if you see a pattern that your blood sugar is always higher after eating oatmeal versus an English muffin, you can make positive changes based on this information.
You can decide to eat the English muffin more, walk after eating oatmeal or you can cut down the portion of oatmeal and add a protein to it like nuts to see if that helps the reading. Sharing these numbers with your doctor can also help determine if you need medication, and which ones are right for you. Most people find that by checking their blood sugar (even if it’s only every other day), they can make better decisions about their care.
Manage Your Stress
You might not have heard of this one, but stress can negatively impact your blood sugar numbers. When you are stressed you release stress hormones that can negatively impact your diabetes.
So stress management is important for diabetes care. Sometimes talking to a therapist can be helpful with your new diagnosis, as well as looking for mindfulness-based stress therapy programs in your area.
There are also great meditation apps out there that can also assist in distressing (such as Headspace). Remember to take some time every day to do something you enjoy that also relaxes you, believe it or not, it is important to your diabetes care!
Find a Support Network
Try to develop a positive support network. Friends, family or an online community that encourages you in a positive way. Even a walking group can be a fun way to stay in shape and socialize with those that have similar goals.
Remember to take it one step at a time. Everything does not have to happen at once.
I often hear patients saying that their diabetes diagnosis pushed them to make positive changes and now they feel better than they have in years.
Susan Watkins is a Registered Dietitian and Certified Diabetes Educator at the Center for Health Promotion at St. Joseph Health in Orange County, Calif. She is the coordinator for St. Joseph’s American Diabetes Association-recognized diabetes program, and also manages the HMR weight program, which has been nationally recognized by U.S. World News and Report as the best, fast weight loss diet in the country for five years in a row. In addition to her focus on diabetes, she creates programs and educates patients on a variety of conditions such as IBS, heart disease, kidney disease, and liver conditions. In her free time, she loves paddleboarding in the ocean, riding her bike and listening to music.