Meal planning for people who happen to have diabetes has changed drastically over the last several years. It used to be that sweets were forbidden, but this premise no longer holds true. The key to success both in weight management and glycemic control is to learn as much as you can about developing a meal plan which incorporates your treatment goals (e.g. weight, blood glucose levels, cholesterol, etc.), your lifestyle, as well as your likes and dislikes. As a starting point to any meal planning approach, the MyPyramid food guidance system translates nutritional recommendations into the kinds and amounts of food to eat each day. Ideally, your individual meal plan should be developed with the assistance of a Registered Dietitian (RD) who also has the credential of Certified Diabetes Educator (CDE). Most insurers (including Medicare) typically pay for this consultation.

Carb Counting When Meal Planning

One of the newer approaches to meal planning is called Carbohydrate Counting, or "carb counting." Since carbohydrates alter blood glucose levels the most of any food group, this approach is based on the total amount of carbohydrate consumed rather than the its source. In this way, it is possible for people who have diabetes to "work in" a piece of pie or an ice cream cone into their overall meal plan.

If we look at the pyramid, the food groups which contain carbohydrates are Grains, Fruits, and Milk. Some starchy vegetables contain carbohydrate as well. One serving of carbohydrate is equivalent to 15 grams. So, learning to determine portion sizes is also of great importance. For example, 1/2 cup of ice cream usually contains the same amount of carb as 1 slice of bread, 4 ounces of fruit juice, or 1 cup of skim milk. Another very useful tool to help learn about correct amounts is the food label you find on the majority of products today. It contains the information you need to determine the correct portion size for that food (See
The Nutrition Facts Label--An Overview) for more information about reading food labels). At the beginning, it is traditionally important to use measuring cups and spoons to figure out the right portion size. Later on, you may be able to train your eyes to judge correct portion sizes.

Moving On to Healthy Eating

Once you feel comfortable with carb counting basics, you may wish to move on to a more advanced system. Advanced Carb Counting is targeted for those who use either an insulin infusion pump or a flexible insulin regimen. Again, employ the assistance of your dietitian to learn these concepts. You may need to gain an understanding of appropriate target blood glucose along how your insulin and food intake interact to maintain target levels. The key to success here may be frequent blood glucose monitoring (before meals and two hours afterwards) and assessing blood glucose results over time.

In using this approach, it is also important to recognize that other nutrients do also have an impact on blood glucose levels. For example, a serving of ice cream may result in a different blood glucose level than four ounces of juice. This is because the fat in the ice cream causes the carb to be more slowly absorbed. Through frequent monitoring and trial and error, you can learn how to make appropriate adjustments to your insulin dose and/or timing of delivery.

Healthy Eating: In Summary

Is carbohydrate counting a panacea? Certainly not. As any system, it has advantages and disadvantages. There is a lot to learn in order to use it properly, and of course, the flexibility it affords can lead to weight gain and increased cholesterol levels if one is not careful. However, it is fairly simple to learn and excellent glucose control is possible without not giving in to those occasional cravings you might have. The key (as has been emphasized before) is to eat a well-balanced meal plan that incorporates all food groups. There are a multitude of articles on the web and books that can also be of assistance as you embark on this learning process; some are listed below.

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Also see:

MyPyramid.gov
From the USDA
http://www.mypyramid.gov/

The Nutrition Facts Label: An Overview
From the FDA
http://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm078889.htm#twoparts

Nutrition Recommendations and Interventions for Diabetes
A position statement of the American Diabetes Association, January, 2008
http://care.diabetesjournals.org/content/31/Supplement_1/S61.full.pdf

Carb Counting
at the American Diabetes Association website
http://www.diabetes.org/for-parents-and-kids/diabetes-care/carb-count.jsp

Carb Counting
at the Diabetes Mall
http://www.diabetesnet.com/diabetes_food_diet/carb_counting.php

Carb Counting
at Diabetes Self-Management
http://www.diabetesselfmanagement.com/Blog/Amy-Campbell/carb_counting/

Making Carbs Count: Advanced Carbohydrate Counting for Intensive Diabetes Management References
at the Canadian Diabetes Association Web site
http://www.diabetes.ca/files/Advanced%20Carb%20Counting%20References%20final.pdf