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Diabetes Voice Online - November 2015
DIABETES VOICES
Healthy eating challenges for diabetes
self-management
Elizabeth Snouffer
What is healthy eating? A healthy lifestyle involves many choices and for all people in our modern
world today choosing balanced nutrition is a priority to live a long healthy life. Generally, it is
recognized that a healthy eating strategy emphasizes vegetables, fruit, whole grains, lean meat and
foods low in salt and added sugar.
For people living with all types of diabetes, a healthy eating plan is extremely important to meet blood
glucose targets and avoid complications related to untreated or poorly managed diabetes. When a
person is first diagnosed with diabetes, this is one of the most significant self-care messages from
healthcare providers worldwide, and much of what is said in the healthcare setting about nutrition
and diabetes is delivered as common sense. However, it is also commonly appreciated that it can
be a challenge to put healthy eating, which sounds so simple - even easy, into practice. Add insulin
therapy into the mix, required for people living with type 1 diabetes, and matters become much more
complex. Careful coordination of carbohydrate intake with medication, physical activity, and other
variables including stress must be prioritized to manage blood glucose levels, and for many, survival.
In support of the International Diabetes Federation’s (IDF) World Diabetes Day 2015 campaign, which
recognizes healthy eating as an important part of the effective management of all types of diabetes,
we asked individuals living with diabetes to discuss their greatest challenges related to making the
right food choices and sticking to a strategy. In the following contributions, we hear from people who
are making a total effort to self-manage diabetes successfully, which for so many millions requires
24/7 vigilance and discipline.
CHARLES MATTOCKS (USA)
Celebrity chef, film maker and global diabetes advocate, diagnosed with type 2 diabetes in 2011
I was recently at the doctor for a follow up visit.
We discovered that my HbA1c was higher than it
normally would be and that I had protein in my
urine which can be an early sign of kidney disease.
Needless to say, I was worried.
don’t need.
As much as I help and share other people’s
stories about living with diabetes, I am now
becoming a story of my own. Let’s be honest
here, I know what I should be doing for my type
2 diabetes and at times, like many other people
with diabetes, we just don’t do what’s right for
our condition. It’s time to get back on course!
My first step is to lose the extra 15 pounds that I
© Charles Mattocks
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Diabetes Voice Online - November 2015
don’t need. I should be at my ideal weight and
that’s that. So I need to start with a plan that allows
me to lose 15 pounds and then maybe I can shed
more. What works for me is a low carbohydrate,
low sugar, and low starch meal plan. A few months
back I recently lost 12 pounds and it was primarily
from lots of walking! In order to achieve that,
I was walking about three times a day for about
forty minutes per walk. I drank nothing but water
and was eating lean meat and vegetables. As a
celebrity chef, it can be hard staying away from
the food - heck it can be hard for anyone to stay
away from the table. Food is truly a drug that
can be used for good and for bad. When society
accepts that healthy eating and an active lifestyle
can make a positive change then we will be in a
much better place.
I always go back to what a healthy food choice is
for me and my type 2 diabetes. I start with what
God gave us and go from there. We can’t go wrong
with loads of vegetables and water. We can’t go
wrong with small portions of lean meat and limit
our total intake. Let’s face it, when I am back in my
home country of Jamaica, I go crazy at times. I love
curried goat and ackee and salt-fish, the national
Jamaican dish! I know some Jamaican foods are the
cause for many people suffering in the Caribbean
islands with high cases of type 2 diabetes. But in
reality, when I get there I actually slim down a
bit because I go on a fresh food diet. If I need to
eat on the go, I will make a small meal, like some
egg whites or some curried chicken. Now that’s
mostly protein and vegetables, low in calories,
but these choices still have that great taste.
When I am out with friends or family, that can
also be an issue that haunts us. I always suggest
sticking to quality vegetables and protein. I
suggest that people with diabetes grab a steak
or some lean chicken, because these options
can be tasty but still healthy. Also, grab some
steamed veggies instead of the rice, and always
make sure your portions are small. Don’t forget
if you live with diabetes, you need to make sure
what you do today, won’t hurt you tomorrow.
Fortunately, I got back to my healthy ways again
with a smile on my face and I’m down a few
pounds in only a few days and counting. I also
got my medical tests back and it’s all clear. I
must admit I was very nervous and I know those
test results were a wake-up call for me. I don’t
miss some of the bad choices I make from time
to time and with the holidays coming up, I want
to make sure I am heading in the right direction.
HÉLÈNE COLON-RAPHAEL (USA)
Grandmother, diagnosed with type 1 diabetes at 23 years
There are many challenges in having diabetes, but
I faced one big hurdle when it comes to healthy
eating and being social. I declined invitations to
friends’ homes because I was afraid of what I was
going to be challenged to eat and how it was going
to affect my blood glucose. Now, I accept social
invitations, with the caveat that I am allowed to
bring a dish or a beverage.
Bringing something for myself to eat is reassuring
knowing that there is something I will feel
comfortable eating or drinking. It is important
for me to know how certain food or drink will
impact my blood glucose and when I do know the
number of carbohydrates in my food, I am able to
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properly dose my insulin. Sometimes I will bring
an appetizer, side dish or a beverage, and I make
sure I know how many carbohydrates are in each.
Otherwise, it is very difficult. I will have to guess,
or ask the host what exactly is in each dish which
can lead me to take either too much insulin or too
little insulin. When deciding on an item to bring to
a host’s party, I typically bring homemade hummus,
shrimp cocktail, white bean stew or low calorie/no
sugar added margaritas. With my strategy, going
out socially means I have lower stress, and I can
enjoy visiting friends and family at their home.
Diabetes Voice Online - November 2015
KATE CORNELL (USA)
Writer, diagnosed with type 2 diabetes at 50 years
My diagnosis of type 2 diabetes changed a lot
of things for me, but the biggest change related
to food. Everything revolves around food in our
society, which makes eating with type 2 diabetes
more challenging. Challenging, but not impossible.
The way I eat now is dramatically different than the
way I ate ten years ago but those changes didn’t
happen overnight. Type 2 diabetes is a progressive
condition and, therefore, I have made progressive
changes to the way I eat. One change at a time.
As luck would have it, most of my favourite foods
became difficult for me. I couldn’t keep my blood
glucose levels where they needed to be if I ate
bread, pasta, cereals and potatoes. Some fruits
also became off-limits. It was necessary for me to
remove those things from my food plan because I
do not use insulin to manage my diabetes. Finding
alternatives made living with these food changes
much more bearable. Alternative flours, such as
almond and coconut, allowed me to make breads,
cookies and cakes that didn’t spike my blood
glucose. Replacing pasta with spaghetti squash or
zucchini made a huge difference! Some might say
that I am now following a low carb diet, but I prefer
to call it a “no processed carb” diet. I’m choosing
to eat whole foods that I (mostly) cook myself as
opposed to processed meals or foods that contain
too much of what isn’t good for me.
I’m fairly successful at home, but eating out,
travelling or attending social functions add a layer
of difficulty to my food choices. I choose to eat a
sandwich with a fork and knife, avoiding the bread.
I order cottage cheese or sliced tomatoes instead
of potatoes. I travel with my own snacks so that I
can avoid fast and convenient foods. Attending a
celebration means loading up on salad and having
only a taste of that birthday cake.
These may seem like sacrifices but I no longer feel
deprived. I’m happy to be eating in a way that has
made me healthier and will hopefully help prevent
complications down the road. I’m lucky to live
where I have choices.
Visit Kate’s blog on living with diabetes.
JOÃO VALENTE NABAIS (PORTUGAL)
President of IDF Europe, diagnosed with type 1 diabetes at 12 years
I have been living with diabetes for 35 years. On
my journey, I have witnessed several changes in
the way food was taught to be managed for insulin
therapy. Back to the beginning of my diabetes,
treatment was based on one insulin shot of slowacting insulin, and the advice was to base the
“diet” (yes it was a “diet”!) on vegetables, meat
and fish with only a small portion of carbohydrates.
Sweets and similar food were the devil and to be
used only for hypoglycaemia episodes (low blood
glucose events).
With the evolution of diabetes treatment options,
including new insulin and monitoring devices, a
new world opened up to me. This evolution was
extremely positive in all aspects and the freedom
to choose a variety of foods is only one of them.
But new challenges came along! How can I choose
© João Nabais
healthy food with all opportunities available?
Carbohydrate counting is like a game, in particular
when I am travelling abroad and the food is
unfamiliar. Adjusting the insulin dose correctly to
exercise and food can sometimes feel like a horror
movie.
There are apps for smart phones, devices to
evaluate the food content and a panoply of tools
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Diabetes Voice Online - November 2015
to help people with all types of diabetes. I use a
few of those to base my decisions, but most of the
time I use my experience and what I have learned
from other people with diabetes and healthcare
providers. Sometimes you make good choices,
sometimes not. But, this doesn’t make you a bad
person, only human!
I try to plan my meals as carefully as possible in
order to include healthy ingredients for both food
and drinks (water is the first choice along with red
wine or beer) but all have to be tasty and enjoyable.
When I travel I like to experience the local food,
which can be tricky because most of the time
you don’t know the fat or carbohydrate content.
For me, this is not a problem as I can always readjust my insulin dose afterwards or eat a sugary
supplement (that we must carry all the time) to
ensure my blood glucose doesn’t go too low.
SCOTT JOHNSON (USA)
Diabetes advocate, diagnosed with type 1 diabetes at 5 years
I believe that learning more about healthy eating
would be good for me. It would give me an
additional set of tools to manage my blood sugar,
and my overall health. Essentially, I’ve allowed
myself to look the other way when I eat something
unhealthy, especially if I can manage my blood
sugar by doing fancy tricks with my insulin. I tell
myself it’s OK because diabetes is all about blood
sugar management, right?
No. I’m justifying unhealthy eating behaviour
and using blood sugar as an excuse. Honestly, I’m
intimidated by the idea of learning about food. The
endeavour seems overwhelming, with conflicting
opinions and misinformation throughout the
journey. Where do I start? Who do I trust?
People living with type 2 diabetes successfully are
my heroes here. Their most influential tools are
often food and activity. They may not know how
much I admire them or look to them for inspiration
and leadership. Why?
Because I imagine, at diagnosis, they also had little
interest in learning about food. It may have even
been an emotional trigger evoking the diagnosis
experience all over again.
And now, here they are, the challenge overcome,
using the power of healthy eating to manage their
health. They are setting examples that can often
serve us all well, regardless of what type of diabetes
we have. I have much to learn from my friends in
the community living with type 2 diabetes. Thank
you for being brave, inspirational type 2 diabetes
leaders. I am ever grateful to you.
Visit Scott Johnson’s blog.
DICKY POON (HONG KONG)
Student, diagnosed with type 1 diabetes at 6 years
In 2014 I joined a Youth Diabetes Action bike
tour for 8 hours a day over a period of nine days.
The greatest challenge was managing continuous
and vigorous exercise on insulin. During the
latter part of the journey, my daily insulin usage
actually decreased by 40%! The greatest threat
was hypoglycaemia, and even delayed effects of
low blood glucose at night. Even with all these
challenges, I believe that regular exercise, insulin
therapy and managing food all go hand-in-hand.
One of my challenges related to eating with
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© Dicky Poon
Diabetes Voice Online - November 2015
diabetes is how to calculate the amount of
carbohydrates in food when eating out at a
restaurant or having take-away. In Hong Kong,
there are so many restaurants providing different
cuisines. One type of food, such as noodles, can
be cooked in so many ways with a huge variety
of sauces and seasonings, which usually contain
sugar. As a result, every time I visit a restaurant
where I have never been before, I can only guess
the amount of carbohydrates in those dishes, and
I often underestimate, which results in a higher
blood glucose value.
Overall, the food choices available and affordable
for students like me on a budget here in Hong Kong
are usually not healthy. What I can do is to eat “less
unhealthily” and choose dishes with enough meat,
vegetables with less salty or less sugary sauces
if possible, and avoid cold drinks which usually
contain a large amount of simple sugar.
Maybe this challenge can be overcome by bringing
packed lunch to school or workplace, which can
be prepared at home with the accurate number of
carbohydrate calculation for easy insulin dosing
at mealtime. Yet, having lunch with friends,
classmates or colleagues is a crucial part of my
social life, and everyone enjoys eating out. It’s
a hard decision to sacrifice my social life for a
healthier diet. It’s important to mention that most
people don’t care if I have diabetes or not, as it
is not the most important characteristic of myself.
Generally, I think most of the pressure comes from
ourselves.
© International Diabetes Federation
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