People taking insulin should be counseled on the importance of balancing food and beverage intake with timing and dosing of insulin. This is especially important for individuals with varied or hectic schedules such as shift workers, people that travel frequently, or anyone who has a schedule in which timing of meals and access to food is irregular. (2) Numerous materials and resources are available that can be provided to PWD to help them consider portion control, consistency in food intake and medication dosing, as well as planning to allow some flexibility in their daily self-care regimen. (46) The health care provider should provide individualized guidelines for a target blood glucose range, considering safety and health. For motivated people, teaching an insulin to CHO ratio, and blood glucose correction factor may assist them with achieving blood glucose targets and achieving better glycemic control. (2,47)
Carbohydrate (CHO) from any food affects blood glucose levels. Monitoring carbohydrate, whether by carbohydrate counting, using the exchange method, or experienced-based estimation, remain an important strategy used in timing of medication administration and improving glycemic control. (7) CHO counting methodology is based on the concept that each serving of CHO equals approximately 15 gms of CHO. Generally, blood glucose response to carbohydrate is similar for most foods, however PWD should be educated on more healthful carbohydrate sources including legumes, whole grain or multi-grain foods and whole fruits rather than highly processed foods, fruit juices, and sweetened beverages. The average woman needs about 3 to 4 choices (45-60 gms), while men may need 4-5 choices (60-75 grams) of CHO at each meal. (46) This number could vary more or less depending on individual calorie needs (i.e., pregnant/nursing, ill, etc.), medication, and level of physical activity.
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The glycemic load (GL) combines the GI and the total CHO content of an average serving of a food. It is defined as the GI multiplied by the amount of carbohydrate per serving of food in grams and dividing the total by 100. It was introduced as a measure of the overall effect of a food on blood glucose and insulin levels. Lowering the GL of the diet may be an effective method to improve glycemic control in individuals with type 2 diabetes. This approach is not currently included in the overall strategy of diabetes management in the US. (51)
A 2011 review article on GI and GL in the diabetes diet by Marsh, et al concludes that both the amount and type of carbohydrate are important in predicting glycemic response to a meal. Diets based on low GI carbohydrate containing foods have been associated with a reduced risk of type 2 and CVD, and intervention studies have shown improvements in insulin sensitivity and A1C in those with diabetes. Low GI diets may also assist with weight management through effects on satiety and fuel partitioning. Since no demonstrated negative effects of a low GI diet have been demonstrated, the GI can be an important consideration in the dietary management of diabetes. (52)
What Do I Eat Now? A book primarily used for the initial stage of type 2 diabetes meal planning. It includes an overview of diabetes nutritional management within the framework of basic eating guidelines. Other resources may be added to this tool, as appropriate, to move the PWD toward more in-depth management. (83)
The other side of the Diabetes Place Mat illustrates the "Plate Method" of managing a diet for proper nutrition and control of blood sugar and weight. It shows the proportions of each food category that are appropriate for a healthy, balanced diet. The food groups shown on the top half of the Plate Method side are carbohydrates, which affect blood sugar the most - fruit, milk, and starch & bread. These are colored in yellow to distinguish them from the other food groups that don't significantly affect blood sugar (meat, vegetables, fat and free foods). The food categories are shown in proportion to how much of each might be eaten in a healthy, balanced diet. The plate method is a great plan for PWD who have poor math or reading skills, or are non-English speaking. (84)
Jenny Craig offers two programs: its standard program and Jenny Craig for Type 2, which is designed for people with Type 2 diabetes by including a lower-carb menu, reinforcement of self-monitoring of blood sugar levels, consistent meals and snacks, and other self-management strategies for weight loss and support for diabetes control. This plan was voted #6 for best diabetes diet (42) and is good for those that need support from a group and ready-made meals. Because you buy foods, this program can be more expensive, but convenient. For more information see: (90)
The diet is low in fat, refined carbohydrates and animal protein. It also emphasizes exercise, stress management and relationships. On nutrition, for instance, Ornish categorizes food into five groups from most (group one) to least (group five) healthful. It tied for #6 for best diabetes diet. (42) The plan has been shown to reverse heart disease. For more information see: -program/nutrition (91)
Its WW Freestyle program, launched in late 2017, builds on its SmartPoints system, which assigns every food and beverage a point value, based on nutritional content. The newest program expands dietary options that are 0 points from only fruits and vegetables to more than 200 foods. A backbone of the plan is multi-model access (via in-person meetings, online chat or phone) to support from people who lost weight using Weight Watchers, kept it off and have been trained in behavioral weight management techniques. It ranked #6 as well for best diet for diabetes. (42) Also good for those that need support group-based approach to losing and maintaining weight loss. For more information see: -diet/weight-watchers-diet (93) 2ff7e9595c
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