Diabetes and Diet: What Do I Eat?

WebMD Live Events Transcript

This class is sponsored by Hershey's Sugar-Free chocolates.

The good news: You have the power to influence your blood sugar levels with what you eat. The bad news: The path to eating right is not always easy to follow. On April 20, 2004 diabetes educator Karmeen Kulkarni joined us with tips and guidelines for controlling your blood sugar levels.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MEMBER QUESTION:
I was just diagnosed with diabetes and I'm unsure what kind of food I am able to eat. Can you help me?

KULKARNI:
I'm glad you're seeking out information right away and that you're participating in our program today. If you're newly diagnosed, I would recommend that you check in your area for a diabetes program that has American Diabetes Association recognition and make an appointment with the registered dietician that is part of that staff. He or she will help you individualize your food choices

In the meantime I would encourage you to eat three meals a day and keep your carbohydrate foods consistent at each meal. Carbohydrate food sources are starches and sugars -- starches like pasta, rice, bread, and cereals, and sugars like fruit, juice, milk, desserts.

Be conservative in your portion sizes. If you have a blood glucose meter, I would encourage you to do a fasting blood glucose in the morning; that is, when you wake up and you haven't eaten anything or taken any medication, do a blood glucose and that would be your blood glucose for the day. Then I would encourage you to also do a before lunch and two hours after lunch, a before dinner, and two hours after dinner blood glucose, and take that information into your appointment. Best wishes to stay healthy.

MEMBER QUESTION:
I am prone to high triglycerides, causing pancreatitis five times and now type 2 diabetes. This means sugar and fat are excluded off my eating list. The problem is, what is left to eat besides rabbit food?

KULKARNI:
We certainly want you to go to the land of bunnies. There are many food options and again, I would encourage you to set up an appointment with a registered dietician so she can evaluate what you are currently eating and give you recommendations on how to fine tune your food choices.

In the interim, the recommendation is not no sugar and no fat ever again, it's just reduced-sugar foods and more of a focus on low-fat choices. There are many options and many choices with some rabbit food but not all rabbit food.

MEMBER QUESTION:
Do you suggest a 40%, 50%, or 60% carb diet? What does a typical 40% carb menu looks like?

KULKARNI:
At this time the American Diabetes Association nutrition recommendations for carbohydrates do not have a specific percentage of carbohydrates from the total calories from the day. There is also no percentage of fat from the total calories from the day. Only protein has a recommendation of 10% to 20% of the total calories for the day. To translate this, it means that the carbohydrate content of a person's total calories for the day should be individualized based on the person's preferences, ethnic cultural background, and eating pattern.

Therefore, I will not recommend a specific percentage of carbohydrate for the day from the total calories. So to provide a menu based on 40% of the total calories will depend on the total calories a person plans to consume and how they want the carbohydrate distributed between the three meals and a snack.

MEMBER QUESTION:
Please give a breakdown of a 2,000 calorie-a-day plan in grams of protein, fat, and carbohydrates.

KULKARNI:
Two-thousand calories for the day can be broken down in different ways for grams of carb, protein, and fat. It will depend on what percentage of carbohydrate, protein, and fat a person with diabetes and the registered dietician mutually agree upon. And therefore, it cannot be calculated generically.

MEMBER QUESTION:
Why is totally avoiding carbs not good for diabetics?

KULKARNI:
Whether you have diabetes or don't have diabetes, we all need some calories from carbs, protein, and fat. So avoiding any one of those is not recommended, because we have nutrient benefits from all three sources. By totally avoiding carbs, we eliminate important vitamins, minerals, phytochemicals, and fiber from our daily food intake. A person can then respond by saying, well, I can get vitamins, minerals, and fiber from supplements. Absorption of nutrients from food is always higher and more efficient by the body than from supplements. So from an overall health standpoint, it is not recommended to avoid either carbs, protein, or fat.

MEMBER QUESTION:
Since I went through diabetes nutritional training almost two years ago, the low-carb craze has hit the food industry. How do these new foods play into nutrition for people with diabetes?

KULKARNI:
The low-carb craze is not a new concept. It was very fashionable and popular in the late 1970s. And like fashion statements in clothes, it's been revived again. The low-carb foods are on the market because of popularity and sales. For a person with or without diabetes they would need to check the food label. Check the label for total calories per serving, grams of carbohydrate, grams of fat, and make the decision as to if it's an appropriate food choice for them.

MODERATOR:
But since there is no legal definition of "low carb" can consumers really trust the "low-carb" label?

KULKARNI:
Currently there is no recommendation from the FDA of what is a low-carb food. A low-carb diet is defined as 60 grams of carbohydrate or less a day. If there is no FDA definition for a nutrition claim on a label then the person has to make a judgment call as to whether they use that product or not.

MEMBER QUESTION:
I am on Lantus and Humalog. I take my Lantus at 10:30 p.m. and if my sugar level is not 200 or above then I bottom out around 2:00 a.m. So I am eating candy at night to keep my sugar level up. What is the best thing to eat at night to keep my sugar level somewhat normal so I won't bottom out? And can you explain why this is happening? I shouldn't have to keep my sugar level so high. Can you please help me? I have even cut my Lantus in half. I'm still having lots of problems.

KULKARNI:
Thank you for your question. I'm sorry you're having so many problems. I would recommend that you keep one week's worth of records. These records would include:

• A blood glucose check before each meal and two hours after each meal
• What you eat at each meal, including food choices and quantity
• How many units of Humalog you were taking prior to each meal
• How much Lantus you were taking at bedtime

This will give you data. I would recommend you take it in to your health care provider and review it together. See where the changes need to occur. Your fasting and before-meal blood glucose would be adjusted by changing the Lantus dose. You would do one at a time.

The second phase would be to look at your blood glucoses after the meal and what you have eaten and make an adjustment in the food choices, and/or the Humalog dose before the meal. To keep your blood glucose in the optimal range so you don't get hypoglycemic, a bedtime snack of a turkey sandwich, which would include two slices of wheat bread, 2 ounces of lean turkey, and mayo or margarine, based on your choice, may help.

But looking at your blood glucose before bedtime and how much Lantus you're taking also needs to be part of the equation. That is why I recommended the record keeping, to see what the pattern is like for a week before making adjustments.

MEMBER QUESTION:
What are the blood glucose normal ranges -- from what to what?

KULKARNI:
The normal range that we recommend for fasting in the morning or before meals is 80 to 100 mg/dl. Two hours after a meal, 140 to 160 mg/dl.

MEMBER QUESTION:
I just can't get my head around the relationship between grams of protein, fat, and carbohydrates and total calories. Is there a simple formula/relationship/rule of thumb I can use?

KULKARNI:
Carbs, protein, and fat all provide calories. We get them from the food we eat. Carbohydrate foods provide four calories per gram; protein provides four calories per gram; fat provides nine calories per gram.

• Carbohydrate foods are starches, sugars; Starches are pasta, breads, rice, and cereals.
• Sugars are fruit juice, fruit, milk, and desserts.
• Protein foods are beef, lamb, and pork, chicken, turkey, fish.
• Fats are two categories: animal and vegetable.
• Animal fat examples are butter, bacon, and sour cream.
• Vegetable fats are olive oil, canola oil, nuts, and avocadoes

It depends on a person's total calories that they plan to eat for the day. If it is, for example, 2,000 calories and if they're planning 50% of those calories from carbohydrates, that means 1,000 of those calories are coming from carbohydrate foods. Those 1,000 calories would be divided by four, because we get four calories per gram from carbohydrates. So there would be 250 grams of carbohydrate for that day or 50% of the calories or 1,000 calories from carbs. The same way protein and fat can also be figured out based on the calculation and what the person wants to eat.

MEMBER QUESTION:
Is there really a true measure of net carbs? I see several new products for weight loss touting a low net carb number for their product and indicating that even though their product actually has a larger number of carbohydrates in it, that they (i.e. fiber, sugar alcohols etc.) don't affect blood sugar. I thought a carb was carb but maybe that is only for calorie counting. I find this claim of net carb confusing.

MEMBER QUESTION:
When counting carbs, why are we not allowed to do the "net carbs" count like Atkins (subtracting ingredients like fiber which fall under the carb label but do not affect glucose levels)?

KULKARNI:
I can understand your confusion. Currently there is no FDA definition for net carbs; hopefully it should be forthcoming. An example of calculating net carbs, for example, if you have a slice of bread which lists total carbs as being 15 grams and fiber grams being 5, and sugar alcohol grams being 5. Examples of sugar alcohols are sorbitol, zyletol, and mannitol. They do not have alcohol in them, they have sugar alcohols have the same number of calories as carbohydrates, but affect the blood glucose 50%t less than other carbs.

So going back to the bread example, food manufacturers are subtracting the fiber grams and the sugar alcohol grams from the total carbs, and the answer they are labeling as net carbs. So if the slice of bread had 15 grams of total carb, fiber grams were 5, sugar alcohol grams 5, 5 plus 5 = 10, subtracted from the total carbs of 15 grams, the answer would be 5 grams of net carbs.

When you have diabetes, and you're checking the label, for total carbohydrate, you can subtract the fiber grams from the total carbs if the fiber grams are 5 grams or higher per serving. Lower than 5 grams of fiber does not make much of a difference. The sugar alcohol grams of carb subtract 50% of them from the total carb. That would help you get the actual carb in the food product

MEMBER QUESTION:
While all proteins are converted in the end to glucose, why do many experts recommend high-protein diets for diabetics?

KULKARNI:
Diabetes experts are not recommending high protein-low carbohydrate meal plans for people with diabetes, since there is inadequate research to support them. What we eat and the amount, whether it's carbohydrates, proteins, or fat, all will impact the blood glucose after a meal. Carbohydrate foods impact the blood glucose after a meal much more than protein or fat. But a person with diabetes also has to pay attention to the amount of protein and fat eaten.

MEMBER QUESTION:
What is the most accurate procedure to measure the precise effect that a particular food has on my glucose levels?

KULKARNI:
I'm going to refer you to the recommendations I made to some other questions I made earlier. I would encourage you to do a before and two hours after the meal blood glucose to see the effect of the food or food items on your blood glucose level.

MEMBER QUESTION:
Is there a chart depicting how long it takes foods to be converted into glucose? I assume an orange is converted almost immediately and that a cup of rice would take considerably longer.

KULKARNI:
Research has shown us that the source of the carbohydrate is not as important as the total amount of carbohydrate and its impact on blood glucose. So if today you ate a bowl of rice giving you 60 grams of carbohydrate, you would know you ate carbs from rice, but your body would not know where the carbs came from; all it knows is that 60 grams of carb needed to be processed. Compared to tomorrow, if you ate 60 grams of carbs from gourmet jellybeans, you would know you ate 60 grams of carbs from a sugar source, but your body would not know that. All it would know is that 60 grams of carbs need to be processed.

MEMBER QUESTION:
Doesn't it make a difference if the carbs are simple or complex? Aren't whole grains better than processed sugar carbs?

KULKARNI:
All whole grain and unprocessed carbs are overall healthier than the refined carbs due to the fiber and nutrients, like vitamins and minerals, that are not processed out. But the grams of carbs are the same in a slice of white bread versus a slice of wheat bread. From a health standpoint we would encourage you to eat the wheat bread. But the effect on blood glucose would be the same whether the bread was white or wheat.

MEMBER QUESTION:
But what about net carbs differences between wheat and white bread?

KULKARNI:
Again, it goes back to the previous calculations I provided. If it's 5 grams of fiber or higher per serving, you would subtract the fiber grams from the total grams of carb. The answer is the actual grams of carb.

MEMBER QUESTION:
During the time I was sick with a viral infection for three days, my fasting blood glucose was 160-180. I am taking metformin 500 milligrams 2 times per day. How should I have changed my diet for these days? My doctor hasn't given me any advice on what to do on these days and I can't afford to go to a diabetes education program because I don't have health insurance to cover it.

KULKARNI:
It sounded like you had a few days of being ill. Recommendations for sick days are to do frequent blood glucose checks, keep yourself well hydrated with water, and try and eat your usual amount of carbohydrates at each meal. If your blood glucoses are over 200 or 250, you may temporarily need insulin after you've consulted with your physician. And always call your physician and let him know you're feeling ill.

The American Diabetes Association web site, www.diabetes.org, has accurate, up-to-date information on diabetes. They have applications and books at very reasonable costs that can be ordered to be a source of accurate information.

MEMBER QUESTION:
The doctor has recommended a 1,400-calorie diet for people with diabetes. Said to find it online. Any suggestions?

KULKARNI:
Well, you can do a Google search, but I would encourage you to find a registered dietician in your area specializing in diabetes, which would be more effective (personal) than online information.

MEMBER QUESTION:
Where can I find a free carbohydrate counts? I do not have much money to buy books.

KULKARNI:
I would encourage you to go to your local library. There is a book published by the American Diabetes Association, The Diabetes Carbohydrate and Fat Gram Guide that would be helpful.

MODERATOR:
We are almost out of time. Karmeen, do you have any final words for us?

KULKARNI:
There is a lot of confusion currently on food information, specifically carbohydrate and protein and diabetes. Evaluate all the claims a diet makes or a food product promises. Have that evaluated by a diabetes expert, either a certified diabetes educator or an endocrinologist prior to implementing or using that information. With the current information we have about the disease, from the American Diabetes Association, available from their web site, publications, and call center, people with diabetes, have access to accurate information to stay healthy.

MODERATOR:
We are out of time. Our thanks to Karmeen Kulkarni, MS, RD, BC-ADM, CDE, for being our instructor today. For more information diabetes and diet, pick up a copy of The ADA Complete Guide to Carb Counting . Thanks to all of you for being here today and for participating in our WebMD University course. Please be sure to visit the WebMD message boards to talk with others about living with diabetes.

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