The Practical Aspects

Diabetes Meal Planning

A meal plan is simply a guide that helps you choose the right kinds and amounts of food to eat. The first step in meal planning is to establish a routine of eating meals and snacks at regular times every day. Some people can keep their blood sugar in good control simply by eating three regular meals a day and avoiding excessive sweets. Others need to follow a more deliberate plan, eating only the recommended number of servings from each food group every day, based on their individual calorie needs.

If you haven't been following any particular eating plan and want to develop a healthy one, start by keeping a log of everything you eat. You may be eating more than you realize or fewer fruits and vegetables than you'd like. After you've assessed your eating patterns, you and a dietitian can develop a meal plan based on your food preferences and your recommended daily calories.

When diabetes is first diagnosed, talk with both your doctor and a dietitian about meal planning. They can provide you with a variety of tools to help you prepare healthy, tasty meals. Depending on your progress, you may want to meet with your dietitian on a regular basis. You might not achieve the ideal eating plan right away, but what counts is that you continue to work toward your goal, making gradual improvements.

Working with a dietitian

Understanding what foods to eat, how much to eat and how your food choices affect your blood sugar level can be a complex task. A registered dietitian can help you make sense of all of this information and put together a meal plan that's easy for you to follow and that fits your health goals, food tastes, family or cultural traditions, and lifestyle.

When you first meet with a dietitian, he or she will ask you questions about your weight and your eating habits — what you like to eat, how much you eat, when you eat and at what time of day. The dietitian will then sit down with you and work out a meal plan, taking into account your diabetes treatment goals, eating habits, work schedule, activity level, calorie needs, whether you're trying to lose weight, your special health considerations and what medications you take.

Meal planning is often a negotiation process. Your dietitian will look at what you're doing now and what your goal is. Together, you'll figure out what is practical and achievable. For example, say you eat breakfast at a local restaurant with your buddies every Tuesday morning. You usually have two eggs, three pancakes, two pieces of bacon and coffee. Your dietitian understands that this breakfast is an important part of your social life, so he or she isn't going to ask you to give it up. But your dietitian will help you look at other food choices that may fit better into your overall plan. Maybe you'll decide you can get by with one egg, one piece of bacon, two pieces of toast and coffee. A dietitian can walk you through each meal in this way.

Every day try to eat

• At the same time
• About the same amount of food
• The same proportion of carbohydrates, protein and fats

This will help keep your blood sugar at a consistent level. It's more difficult to control your blood sugar if you eat a big lunch one day and a small one the next.

Also the more food you eat at one time, the higher your blood sugar will rise. Eating at regularly spaced intervals — meals spaced 4 to 5 hours apart — reduces large variations in blood sugar and also allows for adequate digestion and metabolism of food. If you take insulin, consistent meal times also allow you to eat when you have the greatest insulin action.

Portions

With the trend toward supersizing, megabuffets and huge portions in restaurants, many people have an inaccurate idea of what a regular portion is. Pay close attention to portion sizes. Don't just estimate.

At first, the serving sizes may seem very small. Three cups of popped popcorn would hardly make a dent in the large bucket you're used to getting at the movies. A 2- to 3-ounce piece of meat is less than the 6-ounce steak you may be used to eating. With time, you'll find that smaller servings allow you to enjoy a greater variety of foods.

The exchange system

If you're following a meal plan that you developed with your dietitian, you may be using a booklet that lists foods by food group and serving size, called an exchange list. The exchange system is one tool to help you manage your diet. Not everyone with diabetes needs to use an exchange list, but many people with diabetes find it helpful.

In the exchange system, foods are grouped into starches, vegetables, fruits, meats, milk products and fats. The foods also are portioned to measure and control calories, carbohydrates and other nutrients. An exchange is basically one portion of a food type. One starch exchange, for instance, might be one small, 3-ounce baked potato. You can exchange or trade foods within a group because they're similar in nutrient content and the manner in which they affect your blood sugar.

A dietitian can help you use an exchange list to figure out your daily meal plan. He or she will recommend a certain number of servings from each food group based on your individual needs. Say your goal is 1,400 calories a day. Your dietitian may recommend that you have six or seven starch exchanges (servings), three fruit exchanges, two milk exchanges, six meat or meat substitute exchanges and three to five vegetable exchanges.

Here are some examples of what counts as one serving under the exchange system:

Calculating exchanges for recipes

Your meal plan looks great, but there's one small problem: Where do your favorite recipes fit in? They're not on the food lists.

By following the steps below, you can figure out the exchange values for many of your favorite recipes and the number of exchanges each serving of a recipe provides.

• List all of the ingredients in a recipe and their amounts.
• For each ingredient, write down the number of exchanges it provides. You'll probably have to consult a list of exchange values of commonly used ingredients. You can find this in many diabetic cookbooks, or ask your dietitian for one.
• Total each exchange group.
• Divide the total number of exchanges for each group by the number of servings in the recipe and round off to the nearest one-half exchange. Round up for amounts greater than one-half exchange.